Symptoms associated with oesophageal cancer are described as insidious and progressive. This may explain the late presentation of symptoms and difficulties with diagnosis and management of the disease for general practitioners.
The predominant symptom, reported by 85%-95% of people with oesophageal cancer, is dysphagia (difficulty in swallowing). Dysphagia has physical, emotional and social ramifications that can impact on a person's quality of life.12 At diagnosis, 30% of people with oesophageal cancer report pain.13
Diagnosis with oesophageal cancer is often unexpected and devastating to the person and their family. Specific issues can include:14
- existential concerns, particularly when the diagnosis is late
- a sense of guilt and responsibility for the diagnosis.
Nearly 50% of people with oesophagogastric cancer present with locally advanced or metastatic disease.4, 15, 16 Newly diagnosed individuals are often faced with the challenge of an advanced stage, incurable cancer with a poor survival outcome.4, 9,16, Supportive care screening and a comprehensive assessment of supportive care needs is required to ensure that the impacts of the disease, across all domains of health, are identified and taken into account when planning care. The SCN can reduce the difficulties experienced by people facing such decisions by providing information, education, and supportive care.
Following diagnosis, confirmed by biopsy, staging of oesophageal cancer generally involves physical examination, blood tests (including liver and renal function), endoscopy, and a CT scan.17 Endoscopic ultrasound provides evidence of depth of tumour invasion, presence of abnormal or enlarged lymph nodes and occasionally evidence of lesions in surrounding organs.4 When available, PET scans may help to locate otherwise undetected distant metastases. Laparoscopy may also be used to rule out peritoneal metastases.17 The HER2 (Human Epidermal growth factor Receptor 2) status of the tumour can also be confirmed. The prognostic significance of HER2-neu expression is not clear. Overexpression seems to be associated with poorer survival, especially in individuals with SCC.4
Staging methods have improved to the extent that patients who have incurable disease can now be identified earlier.11 Initial workup enables individuals to be classified into two groups with: 4
- Locoregional cancer (stages I-III)
- Metastatic cancer (stage IV).
Access the NCCN Guideline – Esophageal and Esophagogastric Junction Cancers. Version 1.20144 (a free resource, but you must register and then click 'Remember me' to bypass the login page in future) and:
- Review the TNM staging system for oesophageal cancer
- Discuss reasons that oesophageal cancer is often diagnosed at a late stage.
Compare the physical symptoms and psychological needs that may be common among people newly diagnosed with:
- early stage oesophageal cancer
- advanced oesophageal cancer.
Case Study: Meet Burt
Burt is a 68-year-old male recently diagnosed with oesophageal cancer.
Read Burt's health history, watch his first video, and then work through the learning activities. Use your notebook at the top of the screen to answer the learning activity questions and record your thoughts.
Burt’s story 1: meet Burt
M ☑ F ☐
Presented to A&E ten days ago after a fall at the hostel in which he lives. A fellow resident rang an ambulance after Burt was having trouble getting up and appeared disorientated. Burt presented with >10kg weight loss in three months, malnourishment, dysphagia and pain associated with swallowing. Investigations have identified Stage III squamous cell carcinoma of the oesophagus. Staging has found loco-regional disease and no evidence of metastases. Co-morbidities include heavy alcohol and tobacco use, altered liver enzymes, and right-sided deafness.
Burt appears to have limited social supports other than mates at the hostel. He is a retired labourer, currently on the pension.
Burt presents with tobacco and alcohol dependence.
- Explain strategies a health care facility may implement to manage this dependence and ensure safety for Burt, other individuals and staff.
- Discuss how other health team members may contribute to the multidisciplinary management of Burt.
Review a supportive care screening tool used in your practice setting.
- Evaluate how well this tool would assess Burt's needs.
- Identify specific assessment data that may be needed to enable a more detailed assessment of Burt's social context.
Examine factors that might impact on Burt's ability to effectively participate in education about his disease and its management.
Discuss what Burt's immediate psychological needs may be.