Oesophagus cancer surgery

Upper Gastro-intestinal system.

What is oesophagus/oesophageal cancer?

The oesophagus is the medical name for the gullet. It is part of the digestive system. The oesophagus is a long tube that carries food from the throat to the stomach. The top part of the oesophagus lies behind the windpipe (trachea). The bottom part runs through the chest between the spine and the heart.

The body is made up of millions of different types of cells. Cancer happens when cells multiply in an abnormal way, causing a growth called a tumor to form. Tumors can be benign (not cancerous) or malignant (cancerous). Tumors can occur in any part of the body where the cells multiply abnormally.

There are two main types of cancer of the oesophagus:

• Squamous cell carcinoma forms in the upper part of the oesophagus when cells on the inside lining of the oesophagus multiply abnormally.
• Adenocarcinoma of the oesophagus forms in the lower part of the oesophagus when cells inside the mucous glands that line the oesophagus multiply abnormally. Mucous glands produce a slimy substance to help food slide down the oesophagus more easily.

What are the causes of oesophagus cancer/oesophageal cancer?

The rate of oesophageal cancer is increasing rapidly in Australia and the rest of the Western world according to Cancer Victoria. The risk factors include:

• Greater risk amongst males than females
• Obesity
• Smoking
• Genetics and family history
• Reflux
• Barretts oesophagus

Barretts oesophagus

This is a relatively common condition that effects the lower part of the oesophgus where the stomach joins the oesophagus. It is related to reflux disease and is often silent. It may be found on a routine endoscopy. More information can be found at barrettsinfo.com.

The lower cells of the oesophagus change from one type to another and can become unstable leading to a pre malignant condition called dysplasia which can turn to cancer.

Not everybody with Barretts will get cancer but the chances are higher than if you don’t. We therefore perform regular endoscopy on people with barretts to make sure the cells have not started to change.

Treatment for oesophageal cancer

Treatment for oesophageal cancer will depend on the type, location and stage of your cancer.

It will also depend on your age, general health and personal preferences.

The first aim of treatment for oesophageal cancer is to completely remove the tumor and any other cancerous cells in your body. If this is not possible then we will focus on preventing the tumor from getting any bigger and causing any further harm to your body.

Unfortunately, in some cases it is not always possible to eliminate the oesophageal cancer, or slow down its progression. In this case, your treatment will aim to relieve your symptoms and keep you as comfortable as possible.

Surgery - Oesophagectomy (Trans-thoracic oesophagectomy)

This surgery is done if your cancer is only present in your oesophagus (and not the surrounding tissues or organs). With this surgery Adam Skidmore will make incisions into your abdomen and chest, he will then remove the section of your oesophagus which contains the tumor. The remaining section of your oesophagus is then reconnected to your stomach. If your stomach can not be pulled up to meet your oesophagus, a small section of your intestine may be used. In short, the cancerous section of your oesophagus will be removed, as with the upper part of your stomach and surrounding lymph nodes. (Lymph nodes are small collections of lymphatic tissue which help keep the body’s immune system working).

After the oesophageal cancer operation

After your operation most people will be nursed in the intensive care or high dependency unit for a day or two. This is normal practice and does not mean that there are any complications or that your operation has gone badly.

A drip will continue to give you, your fluids as you will remain nil orally. A feeding tube will also be inserted directly into your small bowel during your surgery. This tube will feed you whilst you are unable to eat or drink, ensuring that you do not become malnourished. This tube is removed approximately 4 – 6 weeks after your surgery.

Chest drains are also inserted during your surgery, these drains will drain any fluid away that may have collected around your lungs. The fluid will drain into sealed bottles. These drains can be uncomfortable but are necessary. They will be removed as soon as clinically possible.

You will also have an epidural inserted during your oesophageal cancer operation for pain relief. The epidural isinserted into the epidural space around your spinal cord to provide you with pain relief – the medication is administered through this fine tube and provides you with a nerve block. The anesthetist and nursing team keep a close eye on you whilst the epidural is running. If you have pain you must still let the nurse or doctor know.

You will also have a urinary indwelling catheter after your oesophageal cancer surgery. This catheter will drain the urine from your bladder into a sealed bag. This catheter too will be removed as soon as clinically possible.

Nursing and medical staff will encourage you to start moving around as soon as possible. This is an essential part of your recovery. Even if you stay in bed, it is very important to do regular leg/limb movements (even if you a wearing anti embolism stockings) and deep breathing and coughing exercises to help keep your lungs and chest clear.

Diet Modifications after a Gastrectomy

The process of digestion begins in the mouth and is continued into the stomach; due to the removal of part or all of your stomach this process has been altered.

This diet is suggested as it will meet your present nutritional needs and to help you cope with any of the dietary problems that may arise as a result of your operation. Your stomach or pouch should stretch over the next few months, and eventually you may not need to restrict the volume you take at one time. Immediately after your surgery however, you will need to alter your eating pattern in the following ways to avoid weight loss.

Small frequent meals
Take six – nine small meals per day, rather than three large ones. As your capacity increases, you will be able to eat three larger meals and three in between meal snacks. If during your meal you feel a sensation of fullness, do not force yourself to continue, as this may cause vomiting.

Eat at regular times
Do not go for long periods of time without food. You will need to eat or drink at least every two hours initially to maintain an adequate intake. You will feel full very quickly, but you cannot rely on your appetite to tell you when you need to eat.

DO NOT drink with your meals
This applies to all fluids. Fluids should be taken thirty minutes before meals or thirty – sixty minutes after eating. Drinking with meals restricts the volume of food you can take at one time, and also increases the rate at which food is emptied from the stomach. This increases the likelihood of suffering from dumping syndrome too.

Eat slowly and chew foods well
Chew all food thoroughly before swallowing. Avoid the following foods, as they are difficult to chew adequately for digestion:

• Nuts
• Tough meat
• Fruit pips
• White bread
• Asparagus stalks
• Stringy celery
• Dried and glace fruit

Soft diet
While in hospital, your diet will progress from fluids to soft. Soft diet should be taken for at least two weeks. Progress onto mushy food then slowly re introduces solid foods. Don’t forget to chew food well.

Balanced diet
A balanced diet including the food groups along with adequate protein and energy intake is necessary for your recovery.

More information on Oesophageal cancer

All of the information you need to know, pre and post-operatively, will be made available to you in separate information packs given to you before and after your surgery. Our practice nurse, Kylie, will also be able to assist you with any questions that you might have at any time on Oesophagus cancer.

Consent form

You are required to fill out a consent form prior to Oesophageal surgery. You can obtain a form from our clinic or download the consent form and print it out yourself.