Managing Esophageal Stricture and Motility Issues After Cancer Treatment

Esophageal sclerosis and impaired peristalsis?

Hello Dr.
Chen: My father is 72 years old and was diagnosed with stage III esophageal cancer two years ago.
He underwent stereotactic body radiation therapy, chemotherapy, and has not had surgery.
Currently, both CT scans and PET scans show no signs of cancer recurrence.
However, he has been experiencing difficulty swallowing for the past three months and has been limited to a liquid diet.

Regarding my father's esophageal stricture and poor motility following radiation and chemotherapy, aside from medications that aid motility and the esophageal stent (which the physician does not recommend), are there any other treatment options you would suggest? Is it possible for him to return to a normal diet like he had three months ago? Are there any specific things he should avoid to prevent worsening the esophageal stricture?

Tina, 40~49 year old female. Ask Date: 2022/07/12

Dr. Chen Sirong reply Oncology

Tina / 42 years old / Female
1.
Besides medications that aid peristalsis and the esophageal stent (which the physician does not recommend for your father), are there any other suggested treatment options?
A:
1.1 It is uncertain whether esophageal balloon dilation would be beneficial for your father; you may want to consult a thoracic surgeon for evaluation.
1.2 You could also consider rehabilitation services for exercise training.
2.
Is it possible for him to return to eating normally like three months ago?
A: The chances are slim, especially as the patient will continue to age and face malnutrition, creating a vicious cycle that makes it increasingly difficult for him to eat normally.
3.
Are there any precautions to take to prevent worsening of esophageal sclerosis?
A:
3.1 You can refer to educational pamphlets from the hospital, or you can find information online.
3.2 Here are some examples to consider based on your father's acceptance and feasibility: lifestyle modifications such as elevating the head of the bed by at least 15 centimeters; dietary changes including increased intake of high-protein, low-fat foods, avoiding citric acid juices (like orange juice), tomato products, and coffee, not overeating, and avoiding food intake before bedtime; and he should quit smoking.
Wishing you peace,
Taoyuan Hospital
Chen Si-Rong

Reply Date: 2022/07/12

More Info

Managing esophageal stricture and motility issues after cancer treatment can be quite challenging, especially for patients who have undergone extensive therapies such as radiation and chemotherapy. Your father's situation, where he is experiencing swallowing difficulties and has been limited to a liquid diet for the past three months, is not uncommon in patients who have received treatment for esophageal cancer.
Esophageal stricture, which is a narrowing of the esophagus, can occur as a result of radiation therapy, leading to fibrosis and scarring in the esophageal tissue. This can significantly impact motility and the ability to swallow solid foods. While it is encouraging that recent scans show no signs of cancer recurrence, the complications from treatment can still pose significant challenges.

Treatment Options
1. Dilation Therapy: One of the most common interventions for esophageal stricture is endoscopic dilation. This procedure involves the use of a balloon or other instruments to widen the narrowed area of the esophagus. It can provide immediate relief and improve swallowing ability. Although your father's physician may have reservations about this option, it is worth discussing again, as many patients benefit from dilation.

2. Medications: While you mentioned that your father is already taking medications to help with motility, it may be beneficial to review these with his healthcare provider. Prokinetic agents, such as metoclopramide, can help enhance esophageal motility. Additionally, medications that reduce acid reflux may also help alleviate some symptoms.

3. Nutritional Support: Since your father is currently on a liquid diet, it is crucial to ensure that he is receiving adequate nutrition. Consulting with a dietitian who specializes in oncology can help create a balanced diet plan that meets his nutritional needs while being easy to swallow. Nutritional supplements may also be recommended to help maintain his weight and strength.

4. Esophageal Stents: Although the physician has advised against stenting, it is another option for managing strictures. Stents can provide a more permanent solution to keep the esophagus open, but they come with risks and potential complications, such as migration or obstruction.

5. Physical Therapy: Swallowing therapy with a speech-language pathologist can be beneficial. They can work with your father on swallowing techniques and exercises that may help improve his ability to swallow solids again.

Lifestyle Modifications
To prevent further deterioration of esophageal function, consider the following:
- Avoid Irritants: Encourage your father to avoid spicy foods, alcohol, and tobacco, which can irritate the esophagus and exacerbate symptoms.

- Eat Smaller, More Frequent Meals: If he can tolerate it, smaller meals may be easier to manage than larger ones.

- Stay Upright After Eating: Remaining upright for at least 30 minutes after meals can help reduce reflux and improve swallowing.

- Hydration: Ensuring adequate hydration is essential, especially if he is on a liquid diet. Encourage him to drink fluids throughout the day.

Prognosis and Expectations
While it is difficult to predict whether your father will return to eating a normal diet, many patients do see improvement with appropriate interventions. The goal of treatment is to enhance quality of life and improve swallowing function. Regular follow-ups with his healthcare team are essential to monitor his condition and adjust treatment as necessary.

In conclusion, it is vital to maintain open communication with your father's healthcare providers regarding his symptoms and treatment options. Each patient's situation is unique, and a tailored approach will yield the best outcomes. If dilation or other interventions are not currently being considered, advocating for a second opinion or further evaluation may be beneficial.

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