Do What You Can to Ease Side Effects of Treatment for Esophageal Cancer

It's likely that you will have physical concerns since your cancer may cause symptoms and your treatment may cause side effects. In this section, you'll learn more about how to respond to some of the most common symptoms and side effects from treating esophageal cancer.

Here are some common side effects from treatment for esophageal cancer and how to ease them. You may not have all of these. We've listed them in alphabetical order so that you can find help when you need it.

Anemia (low red blood cell counts)

Throughout your treatment, your doctor will test your blood. One thing he or she is checking is your red blood cell count. Red blood cells carry oxygen throughout the body. If your body does not have this oxygen, you may feel tired. Decreased red blood cell counts can be caused by small amounts of blood loss, by chemotherapy or radiation, or by the cancer itself.

If your doctor tells you that you have anemia, take these actions to feel better:

• Take short rests when you're tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine.

• Balance activity with rest. Save your energy for important tasks.

• Drink plenty of water. Dehydration adds to fatigue.

• Talk with your doctor about medications or treatments that may help manage your anemia.

Anxiety and depression

Many people may feel blue, anxious, or distressed after being told they have cancer. These feelings may continue or come back throughout treatment.

Taking these actions may ease your mental stress:

• Talk with your family or friends.

• Consider joining a cancer support group or finding a cancer "buddy" who can help you cope.

• Ask your doctor about medications for depression and anxiety.

Constipation

This may be a side effect of chemotherapy or some pain medicines. Constipation, which includes difficult or infrequent bowel movements, can range from mildly uncomfortable to painful. Taking pain medications can lead to constipation, so it's wise to take these preventive actions. These same steps will give you relief if you are already constipated:

• Drink plenty of fluids, especially water and prune juice.

• Eat foods high in fiber, such as cereals, whole grains, fruits, and vegetables.

• Exercise.

• Take stool softeners or a laxative only as prescribed by your doctor.

Diarrhea

Many drugs can cause bowel changes. This may be a side effect of chemotherapy. Diarrhea, which includes loose or frequent bowel movements, or both, may lead to dehydration if you don't take these precautions:

• Avoid milk and milk products.

• Avoid gas-producing vegetables, dried fruit, fiber cereals, seeds, popcorn, nuts, corn, and dried beans.

• Eat low-residue, low-fiber foods such as those included in the BRAT diet (bananas, rice, applesauce, and toast).

• Drink more fluids, such as water and broth, to prevent dehydration.

• Ask your doctor about medications that may help.

Difficulty eating

Many factors may make eating, drinking, and swallowing difficult. The cancer and related tightening of the esophagus, surgery, radiation therapy, and photodynamic therapy can all cause this side effect.

Take these actions to feel better:

• Ask about using an IV or a feeding tube when swallowing is most difficult, especially after surgery.

• Eat several small meals and snacks throughout the day instead of three large meals.

• Sit up for a while after eating.

• Try not to eat just before going to bed.

• Use an extra pillow or two when lying down.

• Ask to see a dietitian for diet counseling after surgery.

Dry or irritated skin

This may be a side effect of radiation therapy.

• Protect your skin from sun exposure by wearing sunscreen of at least 30 SPF.

• Ask your doctor or nurse what kind of lotion you can use to moisturize and soothe your skin. Don't use any lotion, soap, deodorant, sunblock, cologne, cosmetics, or powder on your skin within two hours after radiation treatment because they may cause irritation.

• Wear loose, soft clothing over the treated area. Cotton underwear can help prevent further irritation.

• Don't scratch, rub, or scrub treated skin. After washing, gently blot dry.

• Don't bandage skin with tape. If you must bandage it, use paper tape, and ask your nurse to help you place the dressings so that you can avoid irritation.

• Don't apply heat or cold to the treated area. Bathe only with lukewarm water.

• If you must shave the treated area, use only an electric shaver. Don't use lotion before shaving. And don't use hair-removal products.

• Keep your nails well trimmed and clean.

Hair loss

Losing your hair is called alopecia. It can be upsetting because baldness is a visible reminder that you are being treated for cancer. Chemotherapy and radiation can cause hair loss. Keep in mind that your hair will probably grow back after treatment.

Try these coping tips:

• Consider cutting your hair before treatment starts.

• Think about getting a wig, hat, or scarf before your hair loss starts. That way, you can get a wig that matches your hair and you'll be ready with head coverings, if you choose to use them.

• Because your scalp may be more sensitive to temperature and sun, protect it with sunscreen and hats or scarves.

Mouth sores (mucositis)

Some types of chemotherapy and radiation therapy may cause mouth sores. These may hurt and make eating an unpleasant experience.

To prevent sores in your mouth, take these actions:

• Brush your teeth after meals and before bedtime; floss every day.

• Keep your mouth and lips clean and moist.

• Use sugar-free candies or gums to increase moisture in your mouth.

To ease the pain if you get sores in your mouth, take these actions:

• Avoid alcohol and mouthwashes containing alcohol because they may irritate the sores.

• Avoid hot, rough, or spicy foods because they may irritate the sores.

• Avoid tobacco because it may irritate the sores. Smoking can also make you more susceptible to sores.

• Ask your doctor or nurse about topical mouth medications.

• Ask your doctor or nurse what you can take for pain.

• Call your doctor or nurse if your temperature reaches 100 degrees or higher.

Nausea or vomiting

Nausea or vomiting as a result of surgery, chemotherapy, or radiation treatment for cancer may range from barely noticeable to severe. It may help you to understand the different types of nausea:

• Acute-onset nausea and vomiting. This occurs within a few minutes to several hours after chemotherapy. The worst episodes tend to be five to six hours after treatment, and the symptoms end within the first 24 hours.

• Delayed-onset vomiting. This develops more than 24 hours after treatment.

• Anticipatory nausea and vomiting. These are learned from previous experiences with vomiting. As you prepare for the next dose of chemotherapy, you may anticipate that nausea and vomiting will occur as it did previously, which triggers the actual reflex.

• Breakthrough vomiting. This occurs despite treatment to prevent it. It requires additional treatment.

• Refractory vomiting. This occurs after one or more chemotherapy treatments--essentially, you're no longer responding to antinausea treatments.

To prevent nausea, take these actions. Most nausea can be prevented:

• Ask your doctor about getting a prescription medicine to control nausea and vomiting. Then make sure you take it as directed. If you are vomiting and cannot take the medicine, call your doctor or nurse.

• If you have bothersome nausea and vomiting even though you are taking your medicine, call your doctor or nurse. Your medicine can be changed, or other medicines can be added.

• Your doctor may want you to use an IV or feeding tube for receiving fluids, nutrients, and medications, especially if you had surgery.

To help ease nausea or vomiting if you have it, try these tips:

• Try eating foods and drinking beverages that were easy to take or made you feel better when you've had the flu or were nauseated from stress. These may be bland foods, sour candy, pickles, dry crackers, ginger ale, flat soda, or others.

• Do not eat fatty or fried foods, very spicy foods, or very sweet foods.

• Eat room-temperature or cold foods. The smells from hot foods may make your nausea worse.

• Ask your doctor or nurse if he or she can help you learn a relaxation exercise. This may make you feel less anxious and more in control, and decrease your nausea.

• Ask your doctor or nurse about using acupressure bands on your wrists, which may help decrease your nausea.

Neutropenia (low white blood cell levels)

Throughout your treatment, your doctor will test your blood. One thing he or she is checking is your white blood cell count. Many types of chemotherapy can cause low white blood cell counts, as can the cancer itself. Without enough white blood cells, your body may not be able to fight infection. If your doctor tells you that your white blood cell count is low, take these actions to stay healthy:

• Avoid crowds or people with colds.

• Wash your hands often or use hand sanitizer throughout the day to kill germs.

• Call your doctor right away if you have any of these signs of infection: a temperature of 100.5 degrees or higher, severe chills, a cough, pain, a burning sensation during urination, or any sores or redness.

Numbness, tingling, or muscle weakness in your hands or feet (peripheral neuropathy)

If you have numbness, tingling, or weakness in your hands and feet, you may have nerve damage called peripheral neuropathy. This can be a side effect of chemotherapy. Other signs of this problem are ringing in your ears or trouble feeling hot or cold. If you have symptoms such as these, take the precautions to protect yourself:

• Take extra care walking and moving so that you don't fall.

• Use warm, not hot, water for bathing to prevent burns. Consider using a shower chair or railing.

• If your daily activities become too difficult, ask your doctor for a referral to an occupational therapist or a physical therapist. They can help teach you new ways of doing things so that you can stay as active as possible.

• Take extra care when driving (you may have trouble feeling the gas and brake pedals). Ask friends and family to drive you places.

Thinking and remembering problems

You may have mild problems with concentration and memory during and after chemotherapy. Being tired can make this worse.

Taking these actions may help:

• Make lists and write down important information.

• Use other tools to help organize your life, such as calendars, pill dispensers, or alarm clocks.

Tiredness

Tiredness is a very common symptom and side effect from surgery, chemotherapy, and radiation treatments. You may feel only slightly tired, or you may suffer from extreme fatigue. Taking these actions may help increase your energy level. Fatigue can last four to six weeks after treatment ends:

• Take short rests when you feel tired. Avoid long naps during the day so that you can sleep well at night.

• Add mild exercise, such as walking, to your daily routine. It may help you sleep better.

• Save your energy for important tasks.

• Drink plenty of fluids. Dehydration leads to increased fatigue.

• Take action to treat a poor appetite, because eating improperly can make you tired.

• If your fatigue is severe or chronic, ask for help with routine tasks that can drain your energy, such as grocery shopping or housework. Some people reduce their hours at work.