What to look out for: Symptoms of oesophageal cancer

Persistent heartburn or acid indigestion, frequent bouts of hiccups and difficulty swallowing are potential symptoms of oesophageal cancer that many people could dismiss as annoying minor health complaints.

"Seventy per cent of people with oesophageal cancer have symptoms for three months before checking them out with their GP," explains Cathy White, senior dietician in surgery at Beaumont Hospital, Dublin

White says that as well as these digestive symptoms, someone with oesophageal cancer can experience weight loss - particularly muscle loss. “The difficulty with losing muscle is that if people are overweight or obese, they might not look like they have lost weight yet they have,” says White.

About 430 people are diagnosed with oesophageal cancer in Ireland every year, 255 of whom are men, 175 of whom are women. Most people are diagnosed between the ages of 50 and 75, many of whom have already had the cancer for some time before diagnosis. About half of these will have chemotherapy and radiotherapy with one in five needing surgery following these earlier treatments.

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While survival rates are increasing, only 30 per cent of patients live for one year after the diagnosis.

Patients are advised to alter their eating habits from three large meals a day to five to six smaller meals

Dietary advice from a specialist dietician is crucial to the treatment of oesophageal cancer. “Weight loss is a big issue because the cancer itself causes changes in the metabolism but its location also causes difficulty with swallowing and reflux,” explains White.

Patients are advised to alter their eating habits from three large meals a day to five to six smaller meals. “We need to maximize nutrition ahead of treatment with extra energy and protein foods. Then, during treatment, patients may need protein-dense nutritional drinks and medications to treat nausea and reflux,” says White.

Nurses and dieticians at Beaumont Hospital continue to support patients after they have been discharged from hospital. “Following surgery, the gut takes time to adapt and a feeding tube may be required for a while both in hospital and at home. Then, softer, small portions are given to allow the digestive system time to adjust. Some people will have no appetite for several months after treatment yet it’s vital they get enough nutrition for healing,” says White. Regular gentle exercise and good sleeping habits can also help improve appetite.

Oesophageal cancer is different to other cancers in that the eating-related side effects don’t necessarily subside after treatment ends. In the long term, those who have had oesophageal cancer will need to continue with smaller portions, eating slowly and chewing their food well. Enzymes may be prescribed by dieticians to help with food absorption.

A new website was set up by the Oesophageal Cancer Fund in 2019 to give patients and their families accurate information

Dermot (57) says that he suffered from reflux for years, taking indigestion tablets to deal with it. However, about 18 months ago, he suddenly found that he couldn’t swallow and was diagnosed with oesophageal cancer. “I was sent straight for surgery and didn’t need chemotherapy or radiotherapy. I was back playing football six weeks later but I have ongoing problems with my stomach and digestion,” he explains.

He follows the advice to eat often and in small portions but he sometimes still wakes up in the middle of the night with reflux. More recently, his dietician has recommended enzyme therapy to help his digestion. “One year after surgery, I had a CT scan and got the all clear but I’ll be called back every year for the next five years,” he explains.

A new website, ocf.ie was set up by the Oesophageal Cancer Fund in 2019 to give patients and their families accurate information about the diagnosis, treatment and recovery from this cancer. The website includes an e-book with recipes for those who experience difficulty swallowing.