Palliative treatment helps improve quality of life by alleviating symptoms of cancer without trying to cure the disease. It is particularly important for people with advanced cancer. Often treatment is concerned with pain relief and stopping the spread of cancer, but it can also involve the management of other physical and emotional symptoms.

Radiotherapy, chemotherapy and other medication may also be used. For example, radiotherapy can help to relieve pain and make swallowing easier if an oesophageal cancer cannot be removed.

Oesophageal stent

An oesophageal stent is a hollow tube which is placed into the oesophagus if it becomes obstructed by a narrowing such as an oesophageal cancer. A stent enables food to travel through the oesophagus and into the stomach although it does not restore normal oesophageal function. Some modifications to your diet are therefore required.

WHEN IS IT USED?

1. To provide improvement in swallowing in patients who have oesophageal cancer that will not be treated by other means (palliative treatment). This type of stent would be metal one.
2. In patients who are having chemotherapy and or radiotherapy prior to surgery for their oesophageal cancer, a stent may be inserted to enable the patient to eat and drink in the weeks prior to surgery. This type of stent would be a plastic one.

Oesophageal stents are inserted with the use of a gastroscope. The procedure is performed under a general anaesthetic. All patients will experience some chest pain and discomfort following their stent insertion. Pain killers will be provided post operatively and in most cases patients will be admitted to the ward overnight following stent insertion.

For the first 24 hours following stent insertion you will be limited to sips of water and ice to suck. For a further 24 hours you should limit your intake to clear fluids and jelly. Following this your dietary intake may increase to what you are able to tolerate.

POSSIBLE SIDE EFFECTS

All stents are at a risk of migration (moving out of position). If you are experiencing deterioration in your swallowing, a chest x ray should be performed to check the position of the stent. Most stents will be positioned across the valve at the bottom of the oesophagus. This will result in reflux and you should take anti reflux medication to prevent heart burn and regurgitation.

WHAT CAN I EAT?

Once the stent has been placed you will start with fluids and then build up gradually to a soft diet. You will need to have plenty of sauces and gravy with your food. Also, avoid chunky or lumpy foods which may cause your stent to block.
With your stent in place you should be able to eat soft foods and manage a more varied diet without feeling that food is getting stuck.

HERE ARE SOME TIPS:

• Meals should be small and frequent
• Sit upright at mealtimes and for half an hour afterwards
• Relax and eat your meals slowly
• Cut your food up into small pieces and chew each mouthful thoroughly. It is important that you do not swallow any hard lumps of food that may block the stent
• Don’t be afraid to spit out lumps that can not be chewed
• Have plenty of sauces, gravy, custard or cream with your meals.
• It will make your food moist and easy to swallow
• Take drinks during and after each meal, they help keep your stent clear. Warm and carbonated drinks may help the most but all fluids are beneficial.
• If you wear dentures make sure they fit correctly

Remember it is important to include a wide variety of foods of suitable texture to give you all the nourishment you need.

SUGGESTED MEAL PLAN

ADDITIONAL COMMENTS

Foods such as bread, toast, egg, fish with bones, pithy fruit (orange, grapefruit, pineapple, stringy vegetables (green beans, celery), salad items, raw vegetables and chips may cause your stent to block. This is why they have not been included in the suggested meal plan. However, you should be able to eat some foods that are not listed and is best to ask your dietician about these foods.

WHAT CAN I DO IF I DON’T FEEL HUNGRY?

If you have a poor appetite or have lost some weight try the following:

• Eat little and often, including small snacks
• Choose full cream milk and full fat foods instead of low fat products
• Add sugar to cereals, puddings and drinks
• Grated cheese, cream or butter can be added to mashed potatoes, soups, sauces and desserts
• Fortify milk by adding 2-4 tablespoons of dried milk powder to 500mls of milk. Use this for drinks, soups, puddings and sauces.
• Try a nourishing drinks such as Sustagen, Ensure Powder or make your own fruit smoothie or milkshakes
• There are nutritional products which can be recommended by your doctor, Cancer Nurse Coordinator (CNC) or dietician if
• you continue to lose weight. Your CNC and dietician can offer more information and advice

WHAT IF MY STENT GETS BLOCKED?

If you feel that your stent is blocked follow these basic guidelines:

• Try not to panic
• Stop eating
• Stand up and take a few sips of your drink
• Walk around
• Carbonated drinks in particular “Coke”

If it has not cleared after 1-2 hours contact your CNC or doctor.