Supportive Therapy in Esophageal Cancer

Mirjana Milanović ,
Mirjana Milanović
Contact Mirjana Milanović

Department of Anesthesiology and Resuscitation, Clinical Hospital Center Zemun , Belgrade , Serbia

Srđan Milanović ,
Srđan Milanović

Department of Radiotherapy, Institute for Oncology and Radiology of Serbia , Belgrade , Serbia

Slavica Milović
Slavica Milović

Department of Anesthesiology and Resuscitation, Clinical Hospital Center Zemun , Belgrade , Serbia

Published: 12.11.2025.

Volume 39, Issue 2 (2025)

pp. 40-45;

https://doi.org/10.63696/TMJ202502187

Abstract

Introduction: Esophageal cancer is one of the ten most common cancers globally with a high mortality rate. The etiology is multifactorial, non-hereditary risk factors are smoking, alcohol consumption, obesity, and hereditary risk factors are Lynch syndrome, Plummer-Vinson syndrome, Peutz-Jaegers syndrome, and Li-Fraumeni syndrome. The treatment is multidisciplinary, and combined, chemotherapy, radiotherapy, immunotherapy, and surgery are applied. From the moment of diagnosis, supportive therapy is necessary to alleviate and eliminate the symptoms of the disease. Dysphagia is present in almost all patients with esophageal cancer. A loss greater than 5% of total body weight is associated with a worse prognosis. Discomfort and vague chest pain, hoarseness, cough, and sore throat are less common. Locally invasive tumors cause other symptoms such as hematemesis, hemoptysis, melena, dyspnea, cough, and pleural effusion. Horner's syndrome and superior vena cava syndrome may also occur in advanced tumors. The involvement of large blood vessels can lead to fatal bleeding. In the case of metastatic disease, different symptoms may be present depending on the location. Objective: The objective of this literature review is to indicate the importance of supportive therapy in the treatment of patients with esophageal cancer. Supportive therapy in esophageal cancer: The purpose of good supportive therapy is to ensure the best possible quality of life for patients. In esophageal cancer, the reduction of symptoms significantly contributes to the extension of life. Esophageal cancer treatment is actually the treatment of symptoms. Given that the most common symptom of these cancers is dysphagia, treatment of the underlying disease will also lead to an improvement in symptoms. Patients who have a complete or severe obstruction at any level of the esophagus must be provided with adequate nutrition. Oral nutrition contributes to a better quality of life. Before starting pain therapy, it is necessary to assess the cause and characteristics of pain. A step-by-step approach involves the gradual introduction of analgesic therapy. Dosing of opioids and determining the therapeutic dose should be in accordance with the current guidelines of the World Health Organization. Conclusion: supportive therapy contributes to longer survival in esophageal cancer at an advanced stage of the disease, and better tolerance of aggressive treatment regimens, reducing the toxicity, which leads to improved quality of life.

Keywords

References

1.
Organization WH. International Agency for Research on Cancer (IARC) Global Cancer Observatory (GLOBOCAN): Cancer Today. 2020.
2.
Republici Srbiji M. Registar za rak u Republici Srbiji. In: Institut za javno zdravlje Srbije “Dr Milan Jovanović Batut.” 2020.
3.
Siegel RL, Miller KD, Fuchs HE, statistics JAC. *CA Cancer J Clin.* 2022 Jan;72(1):7-33. 2022;
4.
Howlader N, Noone A, Krapcho M. SEER cancer statistics review 1975–2013. 2021.
5.
Karimi P, Islami F, Anandasabapathy S. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. *Cancer Epidemiol Biomarkers Prev*. 2014;23(5):700–13.
6.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Esophageal and Esophagogastric Junction Cancers Version. 2023;1.
7.
Halperin EC, Wazer DE, Perez CA, Brady LW. *Perez and Brady’s Principles and Practice of Radiation Oncology.*. 2019.
8.
National Comprehensive Cancer Network. NCCN Guidelines Palliative Care Version. 2023;1.
9.
Blazeby JM, Williams MH, Brookes ST. Quality of life measurement in patients with oesophageal cancer. *Gut*. 1995;37:505–8.
10.
Pichel RC, Araújo A, Domingues VDS, Santos JN, Freire E, Mendes AS, et al. Best supportive care of the patient with oesophageal cancer. *Cancers. 2022;
11.
Hébuterne X, Lemarié E, Michallet M, Montreuil CB, Schneider S, Goldwasser F. Prevalence of malnutrition and current use of nutrition support in patients with cancer. *J Parenter Enter Nutr*. 2014;38:196–204.
12.
Organization WH. WHO Guidelines Approved by the Guidelines Review Committee. In: *WHO Guidelines for the Pharmacological and Radiotherapeutic Management of Cancer Pain in Adults and Adolescents* World Health Organization. 2018.
13.
Fallon M, Giusti R, Aielli F, Hoskin P, Rolke R, Sharma M, et al. Management of cancer pain in adult patients: ESMO clinical practice guidelines. *Ann Oncol*. 2018;29(Suppl 4).
14.
National Comprehensive Cancer Network. NCCN Guidelines. Adult Cancer Pain. Version. 2022;2.
15.
Guyer DL, Almhanna K, McKee KY. Palliative care for patients with esophageal cancer: a narrative review. *Ann Transl Med*. 2020;Sep;8(17):1103.

Citation

Copyright

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Most read articles

Partners