Oesophageal Cancer

Introduction

This information booklet has been prepared to inform you about the operation your surgeon has recommended. The booklet will also give you some useful information about when you return home after your surgery. Your surgeon has recommended surgery to remove part or most of the oesophagus (gullet). This surgery is called an oesophagectomy (or oesophagogastrectomy). This surgery is almost always performed to remove a cancerous growth in the oesophagus but may also be recommended due to a condition called Barrett’s oesophagus which has shown early cancerous change. Other reasons for performing an oesophagectomy include a rupture (perforation) in the oesophagus or longstanding difficulties with swallowing.

 

What is an oesophagectomy?

An oesophagectomy is a surgical procedure which removes part or most commonly the entire oesophagus and the top part of the stomach. The oesophagus is located toward the back of the chest and is difficult to reach. There are a number of different ways to reach the oesophagus, therefore there are a number of different surgical procedures.

The operation may involve surgery in the neck, chest and abdomen and may be performed by open or keyhole (laparoscopic) techniques. The choices between the different approaches are influenced by the cause and location of the problem. For example, in the case of a cancer the size and/or position of the cancer would be the influencing factors which would affect the choice of surgical techniques. Another influencing factor may be previous operations to the abdomen.

A number of incisions (cuts) will need to be made in order to reach the exact location in the

oesophagus. There may be an incision in the abdomen, on the left or right side of the chest or on the left side of the neck depending on the type of surgical procedure performed. Your surgeon will discuss the exact details of your operation with you prior to the procedure.

Some people may be left with a very small stomach after the operation if part of it has been

removed. The remaining stomach is pulled up into your chest cavity to join the remaining part of the oesophagus.

Occasionally, during an oesophagectomy, the surgeon may determine that the disease is no

longer treatable with surgery. Example of this would be the finding of many lymph nodes (draining glands) which have become affected or the tumour has spread further than what can be removed with the operation. While every effort is made to reduce the chances of this happening, should this happen, other types of treatment will be discussed with you by your surgeon.

 

The benefits of an oesophagectomy

The benefits of an oesophagectomy are quite dependent on your diagnosis. In the case of an oesophageal cancer, surgery provides the best possibility of a cure. However, this is also dependent on the extent (stage) of the disease. If the surgery is due to other oesophageal conditions such as long-standing difficulties with swallowing, surgery is most likely to lead to an improvement in your quality of life.

 

What are the alternative treatments?

Alternative treatments for oesophageal cancer may include chemotherapy and/or radiotherapy

and possibly the insertion of an expanding metal mesh tube (stent) into the oesophagus.

 

Risks and complications

This is a large operation and carries a significant mortality rate (risk of death). An oesophagectomy is considered to be a bigger procedure than open heart surgery. The mortality rate ranges in South Australia compares favourably with international statistics. The mortality rate is up to 5% which means that out of 100 patients having an oesophagectomy, up to 5 patients might die. These figures will vary depending on the individual person due to other medical conditions. For example, the risk is lower in younger people, and higher in people with chronic heart or lung diseases.

Other possible complications from this surgery are those which may occur during other operations such as an infection of a wound, bleeding (haemorrhage), heart attack (myocardial infarction), chest infection (pneumonia), a clot in the leg (deep vein thrombosis) or lung (pulmonary emboli), and urinary tract infection. These potential risks are relatively small. However, complications which delay discharge from hospital occur in 30% to 40% of patients. Leakage from the join in between the oesophagus and the stomach can also take place and has been found to occur in approximately 5% of patients. Your surgeon will discuss the risks and complications in further detail with you when you are asked to sign consent for the operation.

 

What can I do to prepare before coming into hospital?

If you smoke, giving up as early as possible before the operation will reduce the risk of breathing problems. If you are not able to stop completely, then the chances of being offered curative treatment are diminished. If you require assistance giving up smoking, you can be referred to services to assist you or contact the Quitline on 137848 (13-QUIT) for their free package and telephone assistance which is available 24 hours a day, 7 days a week. Regular exercise to improve your general fitness will also be of benefit.

If you are having difficulties with swallowing and are not able to manage a liquid diet you MUST contact the hospital as soon as possible to prevent you from becoming unwell and malnourished. When you are being admitted to the hospital, bring a list of all your medications with you. This includes tablets and inhalers you currently use.

As the first few weeks you are at home will be difficult both physically and emotionally, it will be extremely useful to give some thought as to how you will manage at home once you are discharged from the hospital. You should make arrangements before your surgery if possible. If you are not able to have someone available to help you, please let the surgeon or your Upper GI Cancer Clinical Practice Consultant know in the clinic or ward staff know as soon as you can when you are admitted to hospital.

 

When you arrive at the hospital

You may be admitted to hospital the day before but most people are admitted on the day of the operation itself. You can expect to stay in hospital for approximately 10 to 14 days. You may be asked to come in earlier if specific preoperative tests or treatments are necessary. If you are admitted on the same day as your operation, you will be assessed in a pre-admission clinic approximately a week before your surgery.

You will meet a number of people before your operation including members of the nursing staff who will help you settle in. The nurse will weigh you and take your temperature, blood pressure, pulse and breathing rate. You will also be asked questions about your general health, your family and home support network. A doctor from the surgical team who works with

your surgeon may also visit you when you are admitted to the hospital. The doctor will discuss what the operation will most likely involve, and the risks and benefits of the surgery and will ask you to sign a consent form if you have not already signed one. This indicates that you agree to the operation, therefore it is very important that you have discussed it fully with the doctor and understand what is involved. You can withdraw your consent at any time prior to the operation.

As your surgery will be performed under a general anaesthetic you will meet an anaesthetist if you have not already done so in the clinic. The anaesthetist will also examine you and ask questions about your health, medications you are currently taking and allergies. They will also discuss pain management options with you. Other staff members of the team you may meet

include dieticians, physiotherapists, social workers and occupational therapists depending on your operation and circumstances.

 

On the day of your operation

As with most operations, you will need to fast for a specific period of time. The staff will give

you clear instructions about when you must stop eating and drinking before your operation. It is very important to follow these instructions as it could delay your surgery. Your medications will be given as usual unless a member of the surgical team or the anaesthetist has requested they not be given. If you take drugs to stop you getting clots or drugs for diabetes, you will be given specific instructions.

You will need to take a shower at home to reduce the chance of a wound infection and remove any make-up, nail polish and contact lenses. Long hair should be tied back but do not use metal clips. You can wear your glasses, hearing aid, denture or wig to the operating theatre but all jewellery apart from a wedding ring must be removed and given to the nurses to have locked away. It is necessary to shave areas on your body where there is going to be an incision or a drip, for example, the chest and forearm. It is not necessary to shave yourself before coming to hospital as this will be performed in hospital.

Often you will need to wear special support stockings to help prevent a blood clot forming in your legs. These stockings will remain on for the duration of your stay. Your surgeon may also want you to have a small daily injection to try and prevent the complication of blood clots forming in your legs.

A clean hospital gown that ties at the back will be given to you as well. If you wish to wear underwear or pants they must be cotton. Bras need to be removed before an operation involving the chest.

The doctors may arrange a pre-medication (premed) before you go to the operating theatre. This is the name for drugs that are sometimes given before an anaesthetic, although today they are infrequently used. This may make you drowsy so you will need to stay in bed after it has been given.

 

When you go to the operating theatre

A nurse will accompany you to the anaesthetic room where staff will introduce themselves and check your identification bracelet, your name, hospital number and the consent form. You will be attached to monitors to measure your blood pressure, heart rate and oxygen levels continuously. The anaesthetist will place a small plastic tube (through which drugs will be given) in the back of your hand or arm if one is not already inserted. If, as discussed with you, the anaesthetist is placing an epidural, it may be put in at this stage or when you are asleep.

Before you go to sleep, you will be given oxygen to breath through a face mask. As the epidural affects the nerves that supply the bladder, it may be difficult to pass urine and a tube will usually be inserted into the bladder to drain it continuously. This will be removed in a few days after surgery when the effect of the epidural wears off.

An additional drip may be placed into a vein in your arm or neck. This is called a central venous catheter (CVC), and it allows you to have any additional medications or fluids. The drip is usually in place for several days following surgery or until you are able to eat or drink.

 

How long will the operation take?

The operation will take between 4 and 8 hours. You will then be transferred directly to the Intensive Critical Care Unit (ICCU)

 

What happens after the operation?

You will be cared for in the Intensive Critical Care Unit (ICCU) for the first 24-48 hours after your operation. However, you may need to stay for a few days longer until you are ready to move to another ward. Sometimes, you will need help with your breathing after such a major operation. If this is the case a breathing machine (ventilator) will be used to help you. If not, you will have an oxygen mask over your nose and mouth. Although this can be noisy, it is very important that this stays in place until the doctors feel that you no longer require it.

Initially, a drip will be used to give you fluids until you are able to eat and drink again and you no longer require the epidural or medications that need to be given through the drip. You may find that you have a fine plastic tube in the side of your neck and possibly one in your wrist to deliver the drugs and also to measure your blood pressure.

You will also have a tube that passes down your nose into your stomach which allows any fluids to be removed from your stomach so that you do not feel sick. You may have a small feeding tube on the left side of your abdomen. This allows you to be given liquid nourishment in the short term. After 24 - 28 hours you will be transferred to the High Dependency Unit (5F).

 

Wounds

Your wound may be sutured (stitched) or clipped (using special staples) together. Certain types of sutures can be absorbed by your body. Clips and other types of sutures need to be removed several days after your operation. Your wound dressings will be checked regularly. Once your wounds are clean and dry they will be removed entirely.

 

Pain

Being comfortable will help you to recover more quickly. Please tell your nurse if you experience any pain. Your pain should be treated early rather than allowing it to become worse. Pain relief will be offered regularly by nursing staff. The doctor will order analgesics (painkillers) for as long as necessary. The type of medication will depend on the extent of your surgery and the amount of discomfort you experience.

During the first few days after your operation, you will require stronger painkillers. These may be given through the epidural, injection, tablet, liquid, suppository or as patient controlled analgesia (PCA). Patient controlled analgesia allows you to press a button on a handset to infuse a set dose of painkiller into a vein. The nurse will explain how to use it. Occasionally some side effects occur with stronger painkillers. Some people may feel sick but this can be helped with regular anti-sickness medications.

Other side effects may include drowsiness, itching and constipation. Usually these are not

too troublesome but if they are let the nurse and doctor know as it may be possible to change to an alternate medication. Eventually you will move onto moderate painkillers as the discomfort begins to settle.

 

Chest drains

Following your operation, you will have one or two tubes near the site of your operation. These plastic tubes (chest drains) are inserted into your chest to allow excess air, blood or fluid that may have collected around the lungs to drain away into a bottle beside your bed. The chest drains help your lungs to re-expand. Your drains will be in for several days and will be removed once your lung has fully expanded. Once removed, a stitch will be tied at each drain site. The stitch will be taken out after about five days.

If you have been discharged with these stitches still in place, the nursing staff will arrange an appointment in the clinic or a district nurse to do this. You will be able to shower once your chest drains have been removed. You will have a chest x-ray on the morning after your operation and then at different intervals during your hospital stay as a routine part of your care. Your blood will be taken and tested regularly to keep an eye on your progress and to help prevent problems from occurring. The physiotherapists will encourage you to deep breathe, cough and move around as well as exercise your arms and shoulders (with particular attention to your operation side). In the following days, they will encourage you to sit in a chair by the bed and later walk around the room.

 

Moving around

Although your mobility will be restricted at first because of your chest drains, monitors and other tubes, it is extremely important that you follow the instructions from the nursing staff and physiotherapists. By sitting in a chair or walking around the ward this can help prevent a chest infection or clots forming in the leg.

 

Passing water

If a tube (catherter) was placed into your bladder to drain urine, this will usually be removed once the effect of the epidural wears off. If you do not have a catheter, the nurses will advise you on how to meet your toileting needs and will provide assistance as necessary.

 

When you can eat and drink

During your surgery, your stomach has been joined to the remainder of your oesophagus. To give this the best chance of healing, it is important that nothing passes through this area until it has begun to heal. For a number of days after your operation you will be given nothing to drink. You will, however, receive fluids intravenously (drip). After a few days you may be allowed small amounts of water or ice chips to keep your mouth moist. After 5 to 7 days, you will have a special x-ray to check that the join between the stomach and the oesophagus has sealed and that there is no leakage. If this x-ray is alright and shows no leak, you will be allowed to start to drink first then eat. If there is leakage, you will not be able to begin eating or drinking until the leak has closed. This can take between a few days to potentially a few weeks.

When you are allowed to eat, you will start on soft foods such as soup, jelly, ice cream and custard and then move on to semi-solid foods. Although you are unlikely to have a bowel motion for the first few days after the operation, once you start eating you may have diarrhoea and rumbling or gurgling in your stomach which is normal.

The dietician will see you and give you advice and information about what types of food you

can expect to eat when you are getting used to your smaller stomach and when first go home.

 

Going home

Following your discharge, it is important that you have someone with you to help with the cooking and shopping. If you live alone, it is suggested that you arrange for a friend or relative to stay with you or help you on a regular basis for seven to ten days. Other support services can be arranged if required and the staff can arrange this prior to discharge from hospital.

The amount of discomfort experienced following surgery varies from person to person, but you can expect to feel some discomfort for up to three months after the operation. You will require a supply of pain relieving medication when you leave the hospital and you will need to see your GP for further supplies. Continue taking your pain relieving medication on a regular basis; especially in the first week after discharge. When you feel you are ready, reduce them gradually over several days.

Your wound will be healing well by the time you leave hospital. You may still have some bruising, swelling and numbness, but this is quite normal and may take weeks to improve. Should your wound become red, hot to touch or ooze any type of fluid then seek advice from your Upper GI Cancer Clinical Practice Consultant, surgeon, GP, or Flinders Medical Centre Emergency Department.

If you are going to be in the sun, ensure that your wound is not exposed in the first three months. You may take a bath or shower as normal. At first do not bathe if you are alone in the house, as you may need help getting in and out of the bathtub. Avoid rubbing soap directly over the wound or soaking the wound for long periods as it is needs to be kept relatively dry until it has completely healed.

If you smoked before your operation, use this as an opportunity to become a non-smoker as you will not have smoked for a while.

If you need a medical certificate, ask your doctor before you go home.

 

The speed of recovery

The recovery period from such a major operation is prolonged. However, some people recover more quickly than others. It may take some time before you are at your peak and you will have ‘off’ days along the way. The convalescent period after surgery can last for up to 3 months and your quality of life may not return to what it was before surgery for up to 12 months.

 

When you can drive again

You should be able to return to driving after at least 6 weeks following your surgery.

 

When you can go on holidays again

You can go on a planned holiday as soon as you feel ready and able to travel. If you are planning to travel by aircraft, you should wait at least six weeks after the operation and it is best to seek advice from your surgeon first.

 

When you can have sex again

It is not uncommon for any major surgery to cause a temporary reduction in your libido. You should be able to resume sexual activity as soon as you feel physically able to.

 

General comments

It is not uncommon to feel low or down in the dumps after a major operation. This can be

related to a number of factors such as being tired or the frustration at the impact the operation

can temporarily have on a wide range of things including your employment, hobbies and personal relationships. It is important to remember that it can take a few months for you to feel you have regained the strength and energy that you are used to. It may be helpful to set some small goals to achieve in the first few weeks after your surgery - rather than expecting to resume your normal daily activities (which you find you may not be able to do, which in turn may can lead to more disappointment and frustration).

 

When can you resume activity?

You will need to build a rest into the middle of the day (perhaps for two hours) as well as progressive activity. It is important to continue the exercises given to you by the physiotherapist once you are at home. Check your posture in the mirror and make sure that your shoulders are level, nicely relaxed and your back is straight.

For the first few weeks, you should try to walk around the house. Take this slowly at first and then build up over time. Climbing stairs might be a struggle at first, so rest half way or as often as you need to.

After four to six weeks, you should start to increase your activity at home by taking on some light tasks such as cooking or washing up. You can start taking short walks outside each day, increasing your distance as time goes on and as you feel able. When you start exercising after this sort of surgery, it is very likely that you will feel a little short of breath. This is quite normal and it will become easier.

After three months, you should be ready to take on more activities and be able to walk longer distances. If you previously played sport, you can start to do so again. However, this should be a gradual process. Swimming is an excellent form of exercise but you should consult your surgeon before undertaking competitive or contact sports.

 

Eating and meals

In the weeks and sometimes months following surgery, you will most likely lose some weight but things will slowly improve. Most people need tempting during the early stages of recovery so concentrate on things you like. Your appetite and confidence will improve in time. Although initially you may not feel like eating, it is important that you try. In the early days when your appetite is poor, your doctor may be able to offer you food supplements in the form of drinks to help ensure you are well nourished.

You should eat when you like but most patients tend to find that they feel full quite quickly. This is mostly due to the fact that the storage capacity of the stomach is reduced. You will probably need several snacks between meals. You should eat 6 to 8 smaller meals rather than 3 large meals. It may help to not drink too much with your meal, but equally it is important to drink something with meals to aid the passage of food through your new oesophagus. It is not necessary to stay on a liquid diet. Eating soft but solid foods will minimise the chances of food sticking, but you should avoid hard or sharp foods during the first six weeks at home.

Make sure that you always sit to eat. Don’t rush eating or drinking and rest for twenty minutes or so after a meal. There is nothing you cannot eat but you may find that your tastes have changed. Your diet should be returning to normal after six weeks and social events that include eating are an important part of returning to a normal life.

Certain foods may upset you in the early days, perhaps making you feel sick or causing nausea. If you find, for example, that dairy products upset you, leave them for a while before trying again. A food diary may help you to identify foods that suit you and other foods you should avoid.

 

What to do when you experience food sticking

When the affected part of the oesophagus is removed, the stomach or small intestine is joined to the remaining part of the oesophagus. Scarring of the join may result in slight restriction of flow of food which may result in food sticking. It is important to persist with eating if this does happen as things can often improve as you begin to eat normally. If your swallowing does not improve, stretching the scar tissue by means of an endoscopy at the hospital may be necessary. Stretching is required for some patients. Sometimes, this might be done more than once. If this occurs, contact your surgeon or the oesophageal cancer nurse.

 

Reflux

Reflux of stomach juices and/or bile into the back of the throat occurs in up to 50% of people after oesophagectomy because the valve preventing reflux at the bottom of the gullet is removed as part of the operation. This happens most often if they have been lying flat, eat too much before going to sleep or bend over for short periods of time. It is important to try to avoid this as it can result in acid entering the lungs which can cause serious damage. Instead of bending over to do things, try to squat or kneel.

In the evening, try not to eat after 6 or 7pm. To prevent night time reflux, you will need to have your bed head raised approximately 10 to 15 centimetres. This can be achieved by elevating the head of the bed on blocks or purchasing an electric adjustable bed, however this can be quite expensive. A wedge shaped pillow under the mattress can also be an option. It is also suggested that a footer be fitted to the bed. Medications are available which assist in reducing reflux by reducing the amount of acid the stomach produces. You will need to consult with your doctor about these medications.

 

Dumping syndrome

One of the problems that can occur after surgery is a condition called dumping syndrome – whatever is eaten is ‘dumped’ quickly into the digestive system resulting in numerous problems. This can result from either rapid entry of food and fluids directly into the small intestine which results in a decrease in blood pressure and increased flow of blood to the intestines (early dumping) or low blood sugar caused by excess insulin produced in response to the sudden dumping of foods and fluids into the intestine (late dumping). This gives a feeling of sickness or faintness after meals. Sometimes people also experience diarrhoea and bloating.

 

Delayed gastric emptying

You may experience gastric retention which is the opposite of dumping syndrome. Food can sometimes remain in the stomach for a longer period of time. It is a common situation and medication is available which can improve the motility (movement) of the digestive system. However, this only provides improvement in approximately 50% of patients. The problem tends to resolve in time, however can persist for 1 to 2 years. During your operation, major nerves are cut which result in this problem.

 

Returning to work

When you feel ready to return to work, think about the type of work you do. Returning to work may not be suitable for the first few months as you may find you will tire quickly or your work goes against advice given to you by your surgeon. This is most important if your work involves bending or lifting or operating heavy machinery. Even in jobs which are less physical and may involve working at a desk can quickly become tiring. You will need to discuss returning to work with your employer and gradually start with a few hours in the first few weeks.

 

Other issues

Other problems often noted include intolerance to milk and belching/bloating. There are substitutes available to replace milk such as soy or rice milk. Belching/bloating may be a long term problem but can be controlled. Remember that although the majority of the recovery occurs in the first few weeks after surgery, the rest may be frustratingly slow, particularly

recovery from tiredness and shortness of breath on exertion. A lot of rest is needed initially.

 

Outpatient appointments

You will normally be seen in the clinic at approximately 4 weeks after you leave the hospital

to see how you are doing. After this first follow up appointment, you will be seen every three

months for the first two years, 6 monthly for the subsequent two years then one year later. If you are concerned about any aspect of your recovery you can make an appointment to see Dr. Bessell or the Upper GI Cancer Clinical Practice Consultant.

 

Eating after Oesophagectomy

An oesophagectomy is the removal of part, or the entire oesophagus. Part of the stomach may also be removed. This can make it difficult to eat normally after surgery, which is why nutrition is such an important component of this surgery.

 

Before surgery

Prior to your surgery, it is recommended that you have a supplement, called Impact Advanced Recovery. It improves your outcomes after surgery by reducing the risk of infections, enhancing your recovery and promotes a shorter stay in hospital. Each serve comes in a tetra pack.

You will need to have 3 servings of Impact Advanced Recovery every day, for 5 days before your surgery. It can be purchased at Atlas Health Care Edwardstown but you MUST ORDER FIRST over the phone (Ph: 08 8177 1600; Web; www.atlashc.com.au). Then, you can either choose to pick it up from their store, or have it delivered to your house for an additional fee of $5.50. We also recommend you take Nutricia PreOp. It is a clear, lemon flavoured carbohydrate drink; designed to prevent you feeling hungry and thirsty just before your surgery. Take 2 of the 200 ml drinks the evening before surgery. And take another 2 of the 200 ml drinks two hours before admission on the day of surgery. You can buy Nutricia Preop from our office; SA Group of Specialists, Wakefield Clinic, 270 Wakefield Street, Adelaide 8359 2411.

 

In Hospital - Nutrition following surgery

During surgery you will have a feeding tube called a jejunostomy inserted into your abdomen to provide nutrition to the bowel while you are not eating normally. This allows time for your body to recover. The fluids provided will contain all the nutrients your body needs.

After 3 to 5 days you will have a special x-ray to check that the oesophagus has healed and that there is no leakage. Then you will be able to start drinking and progress to soft food a few days later. By the time you go home you will be eating relatively normally.

When you start eating you may still need some additional nutrition via the jejunostomy tube. This will depend on how much you can eat orally. Once you can eat and drink enough yourself, the jejunostomy feeding can be stopped. The tube may stay in position for up to 6 weeks in case it is needed again, or it may be removed before you leave hospital. If you go home with the tube, you will need to care for it yourself. It is important NOT to have a dressing over the tube as this will make the area moist and smelly. All that is required is that you coil the tube up like a Catherine wheel and use a criss cross of pink elastoplast to simply hold it in place. When you have a shower you can pull the elastoplast off and let the tube dangle so it gets a wash. Then just recoil and restick again after.

You will be given instructions in hospital on the following stages as you start to eat and drink orally:

1. Clear fluids
2. Free fluids
3. Soft/minced foods
4. Normal diet

A multivitamin supplement is advised after surgery. We recommend you take 2 BN multivitamins every day for the first 6 months after surgery (available from our office). After 6 months Blackmores Conceive Well Gold may be a suitable option (dont worry its a pregnancy vitamin!). These are available at most chemist shops.

 

After Discharge - Long-term diet

After the soft/minced diet you should be able to introduce more solid foods. Some foods such as tougher meats and fresh, doughy bread may be difficult to eat. Some people will need to eat soft foods (those that can be cut with the side of a fork) long term. To obtain an adequate diet long term you will need to:

 

Eat small frequent meals

• Instead of the 3 large meals per day eat 6 to 9 smaller meals per day.
• Graze throughout the day.
• If you feel full during a meal don’t force yourself to eat more as this may cause vomiting.
• Eventually aim for 3 larger meals and 3 mid meal snacks per day.

 

Eat at regular meal times

• Eat or drink every 2 to 3 hours.
• Avoid long periods without food.
• Carry nutritious snacks with you when you are on the go.

 

Avoid gas-forming foods

• Certain vegetables such as cabbage, onion and Brussels sprouts.
• Legumes such as beans, chickpeas and lentils.
• Carbonated (fizzy) drinks.

 

Take small bites and chew well

• Taking small bites and chewing your food well will aid swallowing and digestion.
• Eating in a rush is more likely to cause swallowing of air.
• Eating slowly also allows you to more comfortably tell when you have had enough.

 

Don’t eat and drink at the same time

• Drinking fluids with foods limits the amount of food that can be eaten and increases the chance of dumping syndrome, an unpleasant side effect.
• Drink fluids 30 minutes before, or 30-60 minutes after meals.
• Fizzy drinks should be avoided.

 

Drink nourishing fluids

• Aim to include at least 1500ml of fluid per day.
• Wherever possible drink nourishing fluids such as milk and fruit juices.
• Include cordial and soft drink to increase your energy intake.

See separate information of a Nourishing Diet.

 

Potential problems following surgery

The following may occur in some people who have had an oesophagectomy.

 

Weight Loss

Maintaining your weight following surgery can be difficult. Include small frequent meals and eat at regular meal times. See information on A Nourishing Diet.

 

Reflux

To reduce the risk of reflux, try to avoid large meals prior to bed. Remain in an upright position for 30 – 60 minutes after meals and at least 2 hours before going to bed. You can also elevate the head of your bed with bricks or blocks, or use extra pillows or a bed wedge to elevate your upper body to a minimum angle of 30 degrees, enabling gravity to help limit the possibility of reflux.

 

Dumping Syndrome

Although it has a catchy name Dumping syndrome only occurs only very rarely. It occurs when undigested food, particularly very sugary food, passes too quickly out of the stomach and into the small bowel. This can cause sweating, nausea, dizziness and diarrhoea shortly after eating.

The following can help reduce symptoms:

• Do not drink with meals – drink 30 minutes before and 30-60 minutes after eating
• Eat foods containing protein at each meal and snack such as meat, chicken, fish, eggs, cheese and milk
• Eat slowly and chew food well
• Avoid very hot or very cold foods • Avoid any food you know causes symptoms
• Rest whenever symptoms occur
• Eat small meals often
• Limit sugary food and fluid eg. soft drink, cordial, lollies, chocolate, desserts.

 

Diarrhoea

Diarrhoea may be a problem in the first few months after surgery. Some types of fibre may worsen diarrhoea. Avoid or limit dried fruits, legumes, nuts and seeds, as well as remove skins, pips and seeds from fresh fruits and vegetables. Discuss with your dietitian.

 

Deficiencies

If you also have part of your stomach removed you may be at risk of some nutritional deficiencies. These include Iron, Folate and Vitamin B12. It is recommended that you get a regular blood test to check your levels every 6 months. If you become deficient you will need supplementation. Speak to your doctor or dietitian if this occurs.

 

References:

• DAA Manual 2009. • Kight CE. Nutrition Consideration in Esophagectomy Patients, Nutrition in Clinical Practice 2008; 23(5): 521-528.

 

Contact details:

 

Jeff Bull

Upper GI Cancer Clinical Practice Consultant

Mobile: 0459 837 722

Ph: (08) 8204 6063       Pager: 38975

 

Dr Justin Bessell

SA Group of Specialists

Level 1, Wakefield Clinic

270 Wakefield Street

Adelaide SA 5000

Ph: (08) 8359 2411

 

The Cancer Council South Australia

202 Greenhill Road

Eastwood SA

P.O. Box 929

Unley SA

Ph: (08) 8291 4122

Web: www.cancersa.org.au

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Cancer Help Line

Ph: 13 11 20

 

South Australian Oesophageal Cancer Support Group

Mrs Jane Osborne

Ph: (08) 8294 9562

 

 

Other addresses, internet websites and email addresses

National Cancer Institute

Web: www.cancer.gov

 

“What you need to know about Cancer of the Esophagus”

Web: www.cancer.gov/cancertopics/wyntk/esophagus

 

Humberside Oesophageal Support Group

Web: www.hosg.org.uk

 

Oesophageal Patients Association

Web: www.opa.org.uk

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Cathy’s EC Café

Web: http://www.ec-cafe.org/

 

Oesophageal Cancer Awareness Group Inc.

Web: www.ocagi.org

Facebook: https://www.facebook.com/MarkGrundyOesophagealCancerAwarenessGroupInc?ref=bookmarks