Introduction
When you are diagnosed with esophageal cancer, it is normal to feel worried and have many questions. This guide is designed to help you understand what this disease is, how it is treated, and what changes you can expect after treatment.
The esophagus is the tube that connects the throat to the stomach and allows food to pass through. When a tumor appears in this area, treatment usually combines different strategies depending on the stage of the disease.
Types of esophageal cancer
Squamous cell carcinoma
- Originates in the cells that line the inside of the esophagus
- More common in the upper and middle third of the esophagus
- Related to tobacco and alcohol
Adenocarcinoma
- Originates in glandular cells
- More common in the lower third of the esophagus
- Related to chronic gastroesophageal reflux and Barrett's esophagus
Symptoms of esophageal cancer
The most common symptoms include:
- Dysphagia: Difficulty swallowing, first solids then liquids
- Involuntary weight loss
- Pain or discomfort when swallowing
- Chest or back pain
- Persistent hoarseness
- Chronic cough
- Food regurgitation
Important: These symptoms can be due to other causes, but it is essential to consult a specialist for proper diagnosis.
Treatment of esophageal cancer
Treatment depends on the stage of the disease and each patient's characteristics. The main options are:
Neoadjuvant treatment
In many cases, before surgery the following is administered:
- Chemotherapy: To reduce tumor size
- Chemoradiation: Combination of chemotherapy and radiotherapy
This pre-treatment improves the chances of surgical success.
Surgery: Esophagectomy
This is the main intervention when the tumor is resectable. It involves:
- Removing the part of the esophagus affected by the tumor
- Removing nearby lymph nodes
- Reconstructing the digestive tract, usually by pulling up the stomach
Types of esophagectomy
There are different surgical techniques depending on tumor location:
- Transhiatal esophagectomy: Through the abdomen and neck, without opening the chest
- Transthoracic esophagectomy: With incisions in chest and abdomen (Ivor-Lewis or McKeown)
- Minimally invasive esophagectomy: Using laparoscopy and thoracoscopy
The surgical team will choose the most appropriate technique for each case.
Preparation for surgery
Good preparation is essential for recovery:
- Nutrition: Optimize nutritional status, sometimes with supplements or enteral feeding
- Stop smoking: At least 4 weeks before surgery
- Respiratory physiotherapy: Exercises to strengthen lung function
- Physical activity: Maintain mobility as much as possible
- Psychological preparation: Understand the process and express concerns
Surgery and immediate postoperative period
During surgery
- Duration: approximately 4-6 hours
- General anesthesia
- May require ICU stay for the first hours or days
Immediate postoperative period
- Nasogastric tube to protect the suture
- Chest and/or abdominal drains
- Feeding tube (jejunostomy) for initial nutrition
- Pain control with analgesia
- Early mobilization to prevent complications
Possible complications
Like any major surgery, esophagectomy has risks that are important to know:
Pulmonary complications
These are the most common and include:
- Pneumonia
- Atelectasis (partial lung collapse)
- Pleural effusion
Respiratory physiotherapy and early mobilization help prevent them.
Anastomotic leak
Leak at the junction between the remaining esophagus and stomach. It is detected through tests and may require:
- Fasting and tube feeding
- Drains
- In severe cases, new intervention
Vocal cord paralysis
Can cause temporary or permanent hoarseness. In most cases, it improves over time.
Changes in eating
After esophagectomy, the way you eat will change significantly:
Basic principles
- Small, frequent meals: 6-8 times a day instead of 3 large meals
- Eat slowly: Chew well and take your time
- Upright posture: Stay seated during and after eating
- Don't lie down immediately: Wait at least 2-3 hours
- Elevate the head of the bed: For sleeping, prevents reflux
Dumping syndrome
Can occur when the stomach empties its contents too quickly into the intestine:
- Nausea, sweating, dizziness after eating
- Diarrhea
- Feeling of excessive fullness
Prevention: Avoid simple sugars, eat slowly, separate liquids from solids.
Recovery and quality of life
Recovery is a gradual process:
- First weeks: Adaptation to new way of eating, frequent fatigue
- First months: Progressive recovery of weight and energy
- Long term: Most patients recover a good quality of life
It is normal to lose weight after surgery. Over time and with dietary adaptation, most patients stabilize their weight.
Long-term follow-up
Follow-up includes:
- Regular check-ups with the medical team
- Nutritional and weight monitoring
- Imaging tests according to protocol
- Vitamin supplementation if needed (B12, iron)
- Quality of life assessment
A message of hope
Treatment of esophageal cancer has advanced significantly. Although adaptation requires time and effort, many patients manage to recover a good quality of life. The medical team will accompany you throughout the process, from diagnosis to complete recovery.
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