What Are the Terminal Symptoms of Esophageal Cancer Before Death?

There are numerous treatment methods for esophageal cancer. However, in the advanced stages, the disease is often difficult to control. The primary goal is to improve the patient's quality of life and extend survival time, ultimately leading to the inevitable outcome of death. Family members of patients with advanced esophageal cancer often express concern about the symptoms that may occur prior to death, as it allows them to prepare accordingly. So, what are the symptoms of advanced esophageal cancer before death?

1. The typical symptoms of advanced esophageal cancer include persistent chest pain or continuous back pain, indicating that cancer cells have invaded tissues outside the esophagus. Subsequently, there may be temporary remission of inflammatory edema or partial shedding of cancerous tissue, resulting in temporary relief of obstruction, which can sometimes be mistaken for an improvement in the condition.

2. Other symptoms commonly observed before death in advanced esophageal cancer include difficulty swallowing, pain, hoarseness, hiccups, vomiting, respiratory symptoms, and significant weight loss. The difficulty in swallowing can vary depending on the location of the cancer, such as when the proximal esophageal mucosa is congested, edematous, and inflamed, leading to increased difficulty in swallowing.

It is important to note that judging the proximity of death solely based on the symptoms experienced by patients is not scientific. Instead, we can rely on pharmacological treatments to help alleviate their suffering.

1. Progressive difficulty in swallowing is a common presenting symptom in the majority of patients with advanced esophageal cancer. However, it is a relatively late manifestation of the disease. The esophagus possesses elasticity and the ability to expand, and difficulty in swallowing typically arises only when approximately two-thirds of the esophageal circumference is infiltrated by the cancer. Therefore, following the emergence of early symptoms, the condition gradually worsens over several months, progressing from the inability to swallow solid food to even liquids.

If the cancer is accompanied by esophageal wall inflammation, edema, or spasms, it can further exacerbate the difficulty in swallowing. The location of the sensation of obstruction often corresponds to the site of the cancerous tumor.

2. Food regurgitation often occurs when the difficulty in swallowing intensifies. The regurgitated material is usually small in volume and may contain food particles, mucus, and occasionally blood or pus.

3. Other symptoms may include hoarseness due to compression of the recurrent laryngeal nerve by the tumor, hiccups or paralysis of the phrenic nerve due to its invasion, shortness of breath and dry cough due to compression of the trachea or bronchi, and fatal hemorrhage in case of erosion of the aorta. Additionally, when the cancer is located in the upper esophagus or complicated by tracheoesophageal or bronchoesophageal fistulas, swallowing liquids may elicit signs of cervical sympathetic nerve paralysis.