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Saturday, May 10, 2008

Relieving difficulty in swallowing when you have oesophageal cancer

If you find swallowing difficult there is much that can be done to help make it easier. Your doctor may suggest one or more of the following treatments:

Stretching (dilatation)

This involves the doctor stretching the oesophagus, using a tube to enlarge the space for food and fluid to pass through. Stretching is also often done after radiotherapy or surgery and you may need to have the procedure repeated. It is a simple and quick procedure, which may be carried out under general or local anaesthesia.

Intubation or stenting

A plastic or wire mesh tube (a stent) can be put into the oesophagus using an endoscope. The procedure is similar to oesophagoscopy. The tube helps to keep the oesophagus open and should enable you to eat more comfortably. It is important to take care with your diet to ensure the tube does not become blocked. Drinking fizzy drinks after eating will help to keep the tube clean and clear. Information on diet is available from the Oesophageal Patients Association.

Laser treatment

Laser treatment can sometimes be used to remove enough of the tumour to allow food to pass down the oesophagus. This treatment can sometimes be given with a local anaesthetic, in which case you go home the same day. The procedure may be done under sedation and occasionally a general anaesthetic. It is carried out using an endoscope so is similar to having the oesophagoscopy. The procedure takes about 15 minutes.

It may take two or three sessions of laser treatment to clear your oesophagus enough for you to be able to swallow normally. Further treatments may be needed after 4–6 weeks. You are unlikely to feel any pain after the procedure; although there may be some temporary swelling in your oesophagus, which may make swallowing more difficult at first. You may also have some discomfort in your abdomen. If you have any pain, tell your doctor or nurse.

Alcohol injection

Alcohol injection aims to shrink enough of the tumour to allow food to pass down the oesophagus. Using an endoscope the tumour is injected with small amounts of ethanol alcohol. This usually makes it easier for people to swallow, though it can take a few days to work.

Photodynamic therapy

Photodynamic therapy (PDT) uses low-powered lasers combined with a light-sensitive drug to destroy cancer cells. In the UK it is only carried out in a few specialist hospitals.

Photodynamic therapy is given in two stages. First you will be given a drug that makes the cells of the cancer more sensitive to light (a photosensitiser). This is usually given as an injection into a vein in your arm (intravenously). For the second part of the treatment a laser is shone onto the cancer, using an endoscope. The laser activates the photosensitiser to destroy the cancer cells.

The treatment will make you sensitive to light and you will need to take precautions to avoid exposure to sunlight for a few days. PDT may also make the area in the oesophagus become temporarily inflamed and swell up. At first, this can make swallowing more difficult.

Although PDT is an established treatment to relieve the difficulty in swallowing caused by oesophageal cancer it is not widely used as a ‘first line’ treatment. However, in December 2006, The National Institute for Health and Clinical Excellence (NICE) produced guidance for doctors on PDT as a treatment for early (stage one) oesophageal cancer. It was thought that PDT might be a possible alternative to surgery for some people.

The guidance says that more evidence is needed before we can really know how effective PDT is for early oesophageal cancer. We don’t yet know enough about how well it works and how it compares in the long-term with surgery. In the meantime, doctors may offer PDT for stage one cancer as long as they discuss the possible risks and benefits with people. NICE suggests that doctors use PDT within research trials if possible and also make sure that patients are followed up to check their progress.

Via: http://www.cancerbackup.org.uk

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