During the progression of esophageal cancer, it may invade surrounding tissues or metastasize to other organs, which in turn may induce a series of complications.
Progressive dysphagia
As the tumor increases in size, dysphagia becomes more severe.
In the early stages, dysphagia is less obvious and you may only feel discomfort when swallowing coarse, hard foods. As you swallow, you may experience a choking sensation, or even a slow passage of food, a stagnant or foreign body sensation, or a feeling of “food hanging on your sternum. After drinking water, this feeling of difficulty in swallowing can be relieved or disappeared. In addition, you may also feel a burning sensation in your chest, or a painful sensation like being pricked, pulled or rubbed. The symptoms are sometimes mild and sometimes severe, but in general they are slowly getting worse.
In the middle and late stages, swallowing difficulties become more severe, first with difficulty swallowing drier foods (such as rice), then with difficulty swallowing semifluid foods (such as rice porridge, noodles, etc.), and finally with the inability to swallow even water and saliva. Clinically, some patients experience esophageal obstruction when eating large, coarse and hard foods, for example, chicken pieces, meat pieces, etc. stuck in the lower esophagus. Special attention should be paid to eating at this stage, with liquid, highly nutritious foods (such as chicken soup, milk, egg drop soup, etc.).
Bleeding or vomiting of blood
Usually occurs in advanced stages, when vomiting blood or even hemorrhage is caused by cancerous ulcers that occur when the tumor invades the esophageal wall or erodes into the lungs or large blood vessels in the chest. The bleeding can also lead to severe anemia, triggering symptoms such as weakness and fatigue.
If bleeding or vomiting of blood occurs, it is recommended that you tell your family and call emergency services as soon as possible to get you to a hospital. You should remain in a flat position and not eat hot food or hot drinks until the emergency ambulance arrives.
Esophageal perforation
Advanced esophageal cancer, especially ulcerated esophageal cancer, can cause perforation due to local erosion and severe ulceration of the tumor. Differences in perforation site and adjacent organs can lead to different symptoms.
- Perforation of the trachea, where food may enter the trachea after the esophagus is connected to the trachea, causing choking and coughing, which is more obvious when eating a liquid diet;
- Piercing into the mediastinum, causing infection and symptoms such as chest tightness, chest pain, cough, fever, rapid heart rate, and elevated white blood cells;
- Penetrating the lung, causing lung abscess, with symptoms such as high fever, cough, and pus-producing sputum;
- Penetrating the aorta, vomiting blood and even fatal hemorrhage can occur.
Esophageal perforation is a more serious complication. If any of these manifestations occur at home, especially if there is sudden chest pain or coughing, we recommend that you go to the hospital as soon as possible rather than trying to figure out what to do at home. If the bleeding or vomiting of blood is more serious, it is recommended that you seek help from a family member or call an emergency number on your own. Your doctor will provide you with a combination of measures such as fistula repair, infection control, acid suppression therapy, and adequate nutritional support. Surgery can be performed to repair the fistula, or palliative care such as overlying stent placement, gastrostomy, or nasal nutrition.
Water and electrolyte disturbances
People secrete about 1 to 2 liters of saliva per day, which contains inorganic substances such as sodium, potassium, calcium, and chloride. The concentration of potassium in saliva is typically 20 mmol/mL, which is higher than that of other gastrointestinal secretions. Patients with esophageal cancer may show signs of hypokalemia, such as numbness of the extremities and general weakness, because they have difficulty swallowing and sometimes cannot even swallow saliva. At this time, it is recommended that you seek medical attention promptly. The doctor will administer an electrolyte-balancing infusion based on the blood test results.
Symptoms caused by tumor metastasis
- Vocal cord paralysis and hoarseness due to cancer invasion of the recurrent laryngeal nerve;
- Tumor compression and invasion of the trachea and bronchi, causing shortness of breath and irritating dry cough;
- Invasion of the phrenic nerve, causing diaphragmatic paralysis;
- invasion of the vagus nerve, causing accelerated heart rate;
- Infringement of the brachial plexus nerve, causing arm soreness, pain, and abnormal sensation;
- Compression of the superior vena cava, causing superior vena cava compression syndrome, resulting in coughing and vomiting;
- Oesophageal obstruction can cause aspiration, leading to aspiration pneumonia, which can be associated with fever and systemic toxic symptoms (nausea, vomiting, general weakness, etc.);
- Metastasis to vital organs such as liver, lung and brain occurs, which can cause complications such as jaundice, ascites, liver failure, respiratory distress and coma.
If the above metastatic symptoms occur, they are often at an advanced stage. At this point, it is recommended that you seek medical help as soon as possible to clarify whether the tumor has metastasized and where it has metastasized, and to follow the principles of treatment for metastatic cancer.
Malignant fluid
At the advanced stage of esophageal cancer, the increasing difficulty in swallowing leads to insufficient protein intake, varying degrees of dehydration, inadequate nutritional intake, and weight loss, eventually leading to a state of high emaciation, weakness, loose and dry skin, and general exhaustion. This is the medical term “cachexia (or cachexia)”.
At this time, it is recommended that you do not eat large or irritating foods and try to avoid violent vomiting. The daily diet is based on a highly nutritious liquid or soft food. If you experience any significant discomfort that interferes with your daily life, you should seek prompt medical attention from a specialist. If available, you can seek help from a hospice (or palliative care) center, where a team of oncologists, psychotherapists, and professional nurses can help you live comfortably.