Symptoms of advanced oesophageal cancer

Advanced oesophageal cancer means that cancer that began in the food pipe (gullet or oesophagus) has spread to another part of the body. Some people have advanced cancer when they are first diagnosed. Other people have cancer that has come back and spread after treatment.

The symptoms of advanced oesophageal cancer depend on what part of the body the cancer has spread to. The most common place for oesophageal cancer to spread is to the liver. It can also spread to the lungs and the lymph nodes.

General symptoms

You may get a number of general symptoms with oesophageal cancer. Some of these happen in the later stages of disease. The most common symptoms include:

• difficulty swallowing
• unexplained weight loss
• increased acid reflux
• pain in your throat or behind your breastbone
• feeling tired
• feeling generally unwell

Where cancer can spread

The most common places for oesophageal cancer to spread to are the: 

• liver
• lungs 
• lymph nodes
• bone

Symptoms if cancer has spread to the liver

You might have any of the following symptoms if your cancer has spread to the liver:

• discomfort or pain on the right side of your tummy (abdomen)
• feeling sick
• poor appetite and weight loss
• a swollen tummy (called ascites)
• yellowing of the skin and whites of the eyes (jaundice)
• itchy skin

Symptoms if cancer has spread to the lung

You may have any of these symptoms if your cancer has spread into the lung:

• a cough that doesn’t go away
• breathlessness
• ongoing chest infections
• coughing up blood
• a build up of fluid between the chest wall and the lung lining (a pleural effusion) 

Symptoms if cancer has spread to the lymph nodes

Lymph nodes are part of a system of tubes and glands in the body that filters body fluid and fights infection.

The most common symptom if cancer has spread to the lymph nodes is that they feel hard or swollen. Swollen lymph nodes in the neck area can make it hard to swallow.

Symptoms if cancer has spread to the bone

You might have any of the following symptoms if your cancer has spread to the bones:

• pain from breakdown of the bone – the pain is continuous and people often describe it as gnawing
• backache, which gets worse despite resting
• weaker bones – they can break more easily
• raised blood calcium (hypercalcaemia), which can cause dehydration, confusion, sickness, tummy (abdominal) pain and constipation
• low levels of blood cells – blood cells are made in the bone marrow and can be crowded out by the cancer cells, causing anaemia, increased risk of infection, bruising and bleeding

Cancer in the spinal bones can cause pressure on the spinal cord. If it isn't treated, it can lead to weakness in your legs, numbness, paralysis and loss of bladder and bowel control (incontinence). This is called spinal cord compression. It is an emergency, so if you have these symptoms contact your 24 hour advice line or healthcare team straight away. If you can't get through, contact your GP or go to your nearest accident and emergency department (A&E). 

Controlling symptoms

Symptoms can usually be well controlled. Your doctor or nurse can tell you about medicines that will help you. They can also tell you about things that you or your friends and family can do.

Swallowing problems

Swallowing can be difficult and painful if the cancer has fully or partly blocked the oesophagus. This might make it hard to get enough nutrition, and can cause weight loss.

There are many treatments to help shrink the cancer or open the oesophagus. This can help you swallow more easily. These include:

• chemotherapy
• radiotherapy
• an oesophageal stent
• laser therapy
• heat treatment
• dilatation

Swollen tummy (ascites)

Having a swollen tummy isn't a common symptom of advanced oesophageal cancer. 

You might have a swollen tummy (abdomen) if your cancer has spread to the liver. The swelling is due to a build up of fluid called ascites. It can make your clothes feel tighter. Your tummy might feel bloated. You might also find it difficult to sit comfortably or to move around. Ascites can make you feel breathless, especially when lying flat.

Your doctor can drain off the fluid by putting a small, flexible tube into the abdomen. This helps you to feel more comfortable.

Help with controlling symptoms

Your doctor or specialist nurse can help you to control symptoms. They can:

• give you medicines
• get equipment that you need
• suggest other ways of controlling your symptoms
• refer you to a symptom control team (a palliative care team)

Symptom control team

There are symptom control teams in most cancer units. They can help you to stay as well as possible for as long as possible. They are also in hospices and many general hospitals.

Most symptom control teams have home care services so they can visit you at home.