Grand Rounds

Symptom Management for Patients With Esophageal Cancer After Esophagectomy

Laura A. Pachella, RN, AGPCNP-BC, MSN, AOCNP®, and Susan Knippel, RN, MSN, FNP-C

From the Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Correspondence to: Laura A. Pachella, RN, AGPCNP-BC, MSN, AOCNP®, 1400 Pressler Street, Unit 1489, Houston, TX 77030. E-mail: lpachella@mdanderson.org

ABSTRACT

Case Study

KD is a 67-year-old man with a medical history of hypertension, asthma, and a 20-pack/year smoking history who developed progressive dysphagia 8 months ago. Upon consultation with his primary care provider, he underwent an esophagogastroduodenoscopy (EGD) for evaluation. A friable mass was visualized at the gastroesophageal junction, and biopsies confirmed adenocarcinoma of the esophagus. KD completed a staging evaluation with positron-emission tomography/computed tomography (PET/CT), which did not reveal distant metastatic disease. He also had an endoscopic ultrasound (EUS), which showed the tumor invading the muscularis propria and did not identify any enlarged regional lymph nodes (stage T3N0 disease).

KD was referred to a medical oncologist and a radiation oncologist; he underwent concurrent chemoradiation therapy with docetaxel and fluorouracil and radiation therapy (50.4 Gy). KD was referred to thoracic surgery following restaging with PET/CT and EGD; there was no evidence of distant metastatic disease, and pathology findings revealed residual adenocarcinoma in one of the four esophageal biopsies.

KD underwent Ivor Lewis esophagectomy and had a jejunostomy tube placed for nutritional requirements for 10 weeks as he adjusted to oral nutrition. Surgical pathology findings revealed residual adenocarcinoma with treatment effect; no malignancy was detected in the sampled regional lymph nodes.

Four months later, KD presents with complaints of frequent postprandial diarrhea and reflux. He says he has been trying to lie down after meals due to palpitations and flushing. He is anxious about these symptoms and fearful about his long-term prognosis adjusting to the side effects of esophagectomy and would like to discuss lifestyle modifications.

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