When esophageal cancer has progressed to its end stage, the focus of care is on symptom relief and quality of life. Though each person’s journey is unique, there are some common threads that most people experience when cancer treatment is no longer viable.
The signs of dying from esophageal cancer include greater difficulty swallowing (dysphagia), as well as symptoms common to other types of cancers, such as:
- onset of pain
- breathing troubles
- swings in mood and awareness
You should never hesitate to ask questions or share information about your physical and emotional needs at this time.
In this article, we’ll review the signs and symptoms of end stage esophageal cancer, along with symptom relief options and palliative care.
Early on, esophageal cancer usually has no obvious signs and symptoms. When they do appear, the most common symptom is dysphagia.
Eating regular, bite-sized portions may make you feel like you’re choking or that something is stuck in your throat. Trying smaller bites and softer food, as well as consuming plenty of liquids, can help for a while.
Other early signs and symptoms can include:
- unexplained weight loss
- chest pain, burning, or pressure
- heartburn or indigestion
Esophageal symptoms tend to worsen as the disease progresses and the cancer metastasizes. Dysphagia, for example, may reach a point when a liquid-only diet is necessary.
Other end stage signs and symptoms of esophageal cancer can include:
- worsening cough and sore throat
- labored breathing
- greater hoarseness and difficulty speaking above a whisper
- nausea and vomiting
- bone and joint pain
- bleeding in the esophagus, which can lead to blood in the digestive tract and stool
- fatigue, which could be brought on by anemia, triggered by blood loss; certain medications and cancer treatments; and poor sleep due to pain or medication side effects
Treatments to ease the pain and discomfort of end stage symptoms include medications and surgical procedures.
It’s important to discuss the pros and cons of each option, as some treatments may interfere with a person’s quality of life or end-of-life desires.
If swallowing is becoming too difficult, esophageal dilation may be an option. In this procedure, a doctor extends a small, balloon-like cylinder down into the esophagus to gently stretch the tissue and widen the opening for food and liquids to pass.
Another similar procedure involves the placement of a stent in the esophagus to keep it open.
Doctors may also use a laser beam aimed at the cancerous tissue that is narrowing the esophagus. The beam destroys the tissue, improving swallowing and digestion.
If procedures to widen the esophagus aren’t reasonable or welcome options, a doctor may be able to insert a feeding tube.
A feeding tube supplies nutrients either directly into a blood vessel or into the stomach or small intestine. This is done to prevent malnutrition and extend life expectancy.
Though they’re more common in a hospital or hospice setting, some feeding tubes can be used at home. A palliative care nurse can provide instructions for use.
To ease other symptoms, such as pain, doctors have a variety of medications and ways to deliver those medications if swallowing pills, for example, is too difficult.
Pain medications fall into two general categories:
Opioids, such as fentanyl and oxycodone, have deservedly received considerable attention in recent years for their addictive nature and the tragic stories of people who have misused these medications.
However, when used appropriately and under a doctor’s strict care, opioids can be effective treatments for the pain of end stage cancer and other conditions. They’re usually prescribed when non-opioid pain relievers, such as ibuprofen (Advil) and acetaminophen (Tylenol), aren’t effective.
If a person is given medications to control physical pain and is provided fluids and nutrients through a tube to bypass swallowing problems, then the end of life with esophageal cancer doesn’t have to be a painful or scary experience.
But because the medications used to treat pain are often quite strong, an individual may be sleepy much of the time or experience confusion.
These responses are exacerbated by the slowing down of the body’s functions. For example, the heart rate slows, meaning less oxygenated blood reaches the brain. A person may slip in and out of consciousness and have trouble remembering or focusing.
Changes in bodily functions also lead to shallower breathing and a loss of bladder and bowel control.
Watching a loved one go through these changes can be emotionally painful for others, but for the individual with cancer, many of these physical changes will occur without notice.
There are some steps family members and healthcare providers can take to ease discomfort during end-of-life stages:
- Ice chips. Because swallowing is difficult, giving a person a small piece of ice or a sip of fluid will keep their mouth moist.
- Lip balm. Lip balm will help keep lips from becoming sore and cracked.
- Warm blankets. Reduced circulation can make limbs feel cold, so having warm blankets available can make the person more comfortable.
Be patient and accepting of a person’s emotional needs
Everyone greets their final moments in their own way. Some people have moments of sadness or fear, while many people are often at peace, accepting of what’s ahead.
If you’re with someone dying of esophageal cancer, make sure they’re physically comfortable, but also offer words of comfort. They may want to complete unfinished business, such as resolving relationship conflicts, financial concerns, or the distribution of special belongings.
Be prepared to patiently listen and accept whatever comes from an individual in this situation and offer whatever support you can at the end.
The signs of dying from esophageal cancer are much like those experienced by people with other types of cancer. There’s usually pain that can be reduced with powerful medications, as well as general weakening of the body and a slowing down of all bodily functions.
Symptoms specific to esophageal cancer, such as difficulty swallowing, worsen toward the end, so a feeding tube may be necessary.
Though physical pain can often be controlled, the emotional and spiritual challenges experienced by an individual with cancer and their friends and family members are sometimes more difficult to manage.
Focus on offering support and taking steps to ensure their physical comfort. And don’t hesitate to talk with a palliative care provider for their advice and recommendations.