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May 16, 2010

Esophageal Cancer

As part of the capstone course for physical therapy school, we were treated to a continuing education class (16 hours of intensive coursework over two day) on oncology. Following this class we were all assigned a type of cancer which we may encounter as physical therapists. I was assigned esophageal adenocarcinoma.

Luckily, esophageal cancers are rare and esophageal adenocarcinoma is the rarer of the two types that occur in this body structure. It usually arises as a result of chronic irritation such as GERD or due to alcoholism, especially if it is accompanied by smoking. Malnutrition plays a role, as well, with deficiencies in Vitamin A and zinc making the mucosal lining of the esophagus more vulnerable to neoplastic changes. A genetic predisposition, known as Barrett's esophagus, also increases an individual's risk for developing esophageal cancer.

So what can physical therapists do for people who have this type of cancer? If a patient comes to us for physical therapy, say, for a sprained ankle, we take a medical history, screening patients body systems. If patients exhibit signs and symptoms consistent cancer: unremitting pain, unexplained weight gain or loss, night sweats, unusual bleeding or any other red flags associated with the CAUTION mnemonic, then we need to refer the patient to their primary physician. In the case of esophageal cancer, patient will have pain or difficulty swallowing, heartburn behind the breast bone that radiates around to their back, and maybe even hoarseness and recurrent pneumonia. We would then examine their upper quadrant looking for swelling in lymph nodes.

Physical therapists are part of the multidisciplinary health team that gets folks back on their feet following surgery. For someone who has a an esophageal resection or esophagectomy, physical therapy can help maintain post-surgical mobility and function through range of motion exercises and gentle stretching, and abdominal strengthening and lumbar stabilization. Physical therapy can also assist with postural education, diaphragmatic breathing education to prevent pneumonia, and prevent or reduce lymphedema.

One of the most debilitating side effects of chemotherapy is fatigue, in part, due to a reduced number of oxygen-carrying red blood cells. A home-based walking program 90 minutes a day, 3 days a week is recommended to reduce fatigue. Radiation therapy has been found to cause immunosuppression, putting patients at risk for infection. Minimal levels of aerobic exercise enhance immune function, and stamina for exercise increases even during radiation treatment. Other improvements attributed to exercise for cancer patients include improved lymphatic circulation, reduced chemotherapy-related nausea, and increased well-being and quality of life. Patients who exercise improve their ability to better monitor patterns of fatigue. This allows physical therapists to makes suggestions for energy conservation techniques that will optimize patient performance during peak energy levels.

Posted by linda at May 16, 2010 9:02 AM

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