Stage 4 Esophageal Cancer End of Life - Melodia Care Hospice (2023)

Advanced Stage IV Esophageal cancer is a disease in epidemiologic transition. Patients with stage IV esophageal cancer have metastatic cancer. In Stage IV, esophageal cancer has spread to distant parts of the patient’s body. These patients have many complex symptoms, including:

  • Pain
  • Dysphagia
  • Malnutrition
  • Psychological symptoms due to the location of the tumor and the treatment required

The advanced prognosis of esophageal cancer forces caregivers and relatives to discuss concerns with the medical team and seek professional help. Palliative care is a medical care subspecialty focused on providing comprehensive care for patients with any advanced or severe disease so that they can live as comfortably as possible while facing this disease. Patients with advanced esophageal cancer who are expected to live less than six months may be eligible to receive hospice care in hospitals or other health care institutions or individual homes. Hospice care only provides pain management and palliative care and does not treat esophageal cancer itself.

Early Symptoms & Signs Of Esophageal Cancer

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In the early stage, esophageal cancer usually has no apparent signs and symptoms. When they do appear, the most common symptom is difficulty swallowing. Regularly eating bite-sized foods may make you feel like you’re choking or something is stuck in your throat.

Other early signs and symptoms may include:

  • Weight loss
  • Chest pain
  • Heartburn or indigestion
  • Hoarse voice
  • Cough

Signs & Symptoms Of End-Stage (Stage IV) Esophageal Cancer

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As the disease progresses and cancer metastasizes, esophageal symptoms tend to worsen. For example, dysphagia may reach the point where a pure liquid diet is required.

Other advanced signs and symptoms of esophageal cancer may include:

  • Increased cough and sore throat
  • Difficulty breathing
  • Hoarseness
  • Hiccup
  • Nausea and vomiting
  • Bone and joint pain
  • Infection in the digestive tract because of bleeding in the esophagus
  • Fatigue, which may be caused by anemia caused by blood loss; certain medications and cancer treatments; poor sleep due to pain or medication side effects

Palliative Care For Patients With Stage IV Esophageal Cancer

It is recommended that all cancer patients undergo palliative care at the same time as cancer-oriented treatment-regardless of whether the cancer treatment is to cure or to control the spread of the disease and prolonging life. There are two levels of palliative care for cancer patients.

  • Primary Palliative Care
  • Specialist Palliative Care

Primary palliative care is symptom management and nursing dialogue provided by the patient’s primary oncology team. It is the first layer and applies to all cancer patients. For patients with complex needs, referral to palliative care specialists is recommended.

Specialist palliative care is best provided by an interdisciplinary team of professionally trained physicians, nurses, social workers, pastors and pharmacists who work with the patient’s typical healthcare provider to provide comprehensive symptom management, psychosocial and spiritual support and advance care planning. Given the shortage of professional palliative care providers, this two-tier approach is essential.

Importance Of Hospice Care For Patients With Stage 4 Esophageal Cancer

When a health care team determines that cancer can no longer be controlled, they usually stop medical testing and cancer treatment. But patient care continues, focusing on improving the quality of life of the patient and their loved ones and making them feel comfortable in the next few weeks or months. The medications and treatments people receive when they are dying can control pain and other symptoms, such as constipation, nausea and shortness of breath. Some people stay at home while receiving these treatments, while others go to hospitals or to other institutions. Either way, these services can help patients and their families solve medical, psychological, social and spiritual problems related to death. The hospice is the most comprehensive and coordinated provider of these services. Everyone’s end of life period is different. People’s signs and symptoms may vary and each individual has unique requirements when it comes to information and support. Family members should discuss issues & concerns related to death with each other and with the medical team when they arise. In the last few months of a person’s life, communication about hospice care and decision-making is very important. For cancer patients, it is important to make these decisions before they are too sick to make these decisions. However, if a person does become very ill before completing the advance instructions, it is helpful for home caregivers to know what type of care their loved ones would want to receive.

When You Should Seek Professional Help?

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In any of the following situations, caregivers can contact the patient’s doctor or nurse for help:

  • The patient’s pain cannot be relieved by prescribed doses of pain medication.
  • The patient develops new symptoms such as nausea, vomiting, confusion, anxiety or irritability.
  • The patient shows discomfort, such as making faces or moaning.
  • The patient has difficulty breathing and looks very disturbed.
  • The patient is unable to urinate or defecate.
  • The patient is very depressed or talks about suicide.
  • It is difficult for caregivers to provide medication to patients.
  • The caregiver is overwhelmed by caring for the patient and is too sad or afraid to be with the patient.
  • The caregiver does not know how to deal with a situation

What Are Some Ways To Provide Emotional Support For Cancer Patients?

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Everyone patient has different needs, but most dying patients have some concerns. Two of these concerns are fear of being abandoned and fear of becoming a burden. Dying people also worry about losing their dignity and control.

Here are some ways that caregivers can provide comfort to people with such concerns:

  • Keep in touch with this person. Talk to them, watch a movie with them, read a book with them or be with them.
  • Allow patients to express their fears and worries about death, such as leaving family and friends. Get ready to listen to them.
  • Willing to recall this person’s life.
  • Avoid hiding important information. Most patients prefer to participate in discussions about issues related to them.
  • Assure patients that you will follow advance instructions, such as a living will.
  • Ask if there is anything you can do.
  • Respect the needs of individuals for privacy.
  • Support people’s spirituality. Let them talk about what makes sense to them. If they want, you can pray with them and arrange visits for spiritual leaders and church members where appropriate. Keep items that are meaningful to them at hand.

Treatment Methods To Relieve The End-Stage Symptoms Of Esophageal Cancer

Treatment methods to relieve the pain and discomfort of terminal symptoms include medication and surgery.

It is essential to discuss the pros and cons of each option because specific treatments may interfere with a person’s quality of life or dying wishes.

Esophageal Dilatation

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If swallowing becomes too difficult, dilatation of the esophagus may be an option. During this process, the doctor stretches a small balloon-shaped cylinder down into the esophagus, which gently stretches the tissue and expands the opening to allow food and liquid to pass through. Another similar procedure involves placing a stent in the esophagus to keep it open.

Laser Ablation

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The doctor may also use a laser beam to target the cancerous tissue that narrows the esophagus. The light beam destroys tissues and improves swallowing and digestion.

Feeding Tube

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If the procedure to enlarge the esophagus is unreasonable or unpopular among patient or their family, the doctor may insert a feeding tube. The feeding tube provides nutrition directly to the blood vessels or stomach or small intestine. This is done to prevent malnutrition and extend life expectancy. Although they are more common in hospitals or hospice settings, some feeding tubes can be used at home. Palliative care nurses can provide instructions on how to handle the feeding tube.


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To relieve pain and other symptoms, for example, if swallowing pill is too difficult, doctors will provide various drugs and methods to deliver these drugs.

Analgesics are divided into two main categories:

• Opioids

• Non-opioids

In recent years, opioids such as fentanyl and oxycodone have received considerable attention due to their addictive properties and the tragic stories of people who abuse these drugs. However, if used properly and under strict supervision, opioids can effectively treat the pain of advanced cancer and other diseases. When non-opioid pain relievers such as ibuprofen (Advil) and acetaminophen (Tylenol) are ineffective, they are usually prescribed.


The signs of death from esophageal cancer are similar to those experienced by patients with other types of cancer. It is usually possible to relieve pain and general weakness of the body while slowing down all bodily functions with powerful drugs. Symptoms of esophageal cancer, such as difficulty swallowing, will gradually worsen so that a feeding tube may be required. Although physical pain is usually manageable, the emotional and spiritual challenges experienced by cancer patients, their friends and family members are sometimes more challenging to control. Focus on providing support and taking steps to ensure their physical comfort. And don’t hesitate to talk to palliative care providers to get their opinions and suggestions.

You can reach Melodia Care at any time of day or night by contacting us through our 24/7 online customer support chat or by calling 1-888 635-6347 (MELODI-7).


What happens at the end of life with esophageal cancer? ›

The signs of dying from esophageal cancer include greater difficulty swallowing (dysphagia), as well as symptoms common to other types of cancers, such as: fatigue. onset of pain. breathing troubles.

How long does end stage esophageal cancer last? ›

At this stage, people often complain of throat pain and difficulty swallowing. Twenty to 30 percent of patients in stage III who receive both chemotherapy and radiation are likely to survive between three and five years.

What is the palliative treatment of esophageal cancer? ›

When used to help treat advanced esophageal cancer, chemotherapy and targeted therapy can both be considered a type of palliative or supportive therapy because they are intended to help slow the growth of the cancer and relieve symptoms from the cancer, as opposed to trying to cure it.

What are the signs of last days of life? ›

End-of-Life Signs: The Final Days and Hours
  • Breathing difficulties. Patients may go long periods without breathing, followed by quick breaths. ...
  • Drop in body temperature and blood pressure. ...
  • Less desire for food or drink. ...
  • Changes in sleeping patterns. ...
  • Confusion or withdraw.

How do you know when a cancer patient is close to death? ›

The following are signs and symptoms that suggest a person with cancer may be entering the final weeks of life: Worsening weakness and exhaustion. A need to sleep much of the time, often spending most of the day in bed or resting. Weight loss and muscle thinning or loss.

How long does the final stage of end of life last? ›

The end-of-life period—when body systems shut down and death is imminent—typically lasts from a matter of days to a couple of weeks. Some patients die gently and tranquilly, while others seem to fight the inevitable. Reassuring your loved one it is okay to die can help both of you through this process.

How long do you have with Stage 4b esophageal cancer? ›

Currently available combination chemotherapy treatment for stage IV cancer results in complete remission in up to 20% of patients, with average survival of 8-12 months.

What causes death with esophageal cancer? ›

However, these patients also face considerable risk of death from other cancers, ischemic heart disease, cerebrovascular disease, and respiratory diseases. These common causes of death should be taken into consideration in esophageal cancer management.

What happens as esophageal cancer progresses? ›

The symptoms of esophageal cancer generally progress rapidly. Symptoms of advanced esophageal carcinoma become apparent with tumor growth. An initial inability to swallow solids is followed by difficulty in swallowing ground food and finally liquids.

How long can you live with inoperable esophageal cancer? ›

more than 45 out of every 100 (more than 45%) will survive their cancer for 1 year or more after they are diagnosed. more than 15 out of every 100 (more than 15%) will survive their cancer for 5 years or more. more than 10 out of 100 (more than 10%) will survive their cancer for 10 years or more.

What is the best treatment for stage 4 esophageal cancer? ›

The most common chemotherapy drugs used to treat stage 4 esophageal cancer are: capecitabine (Xeloda) cisplatin and capecitabine. cisplatin and etoposide (Vepesid)

How painful is esophageal cancer? ›

It may feel like food is stuck in the throat or the chest, or you may even choke on the food. This symptom is often mild in its early stages but gradually worsens as the disease progresses. Someone with esophageal cancer may experience pain in the middle of the chest that feels like pressure or burning.

What happens in the last week of life? ›

The dying person will feel weak and sleep a lot. When death is very near, you might notice some physical changes such as changes in breathing, loss of bladder and bowel control and unconsciousness. It can be emotionally very difficult to watch someone go through these physical changes.

What does it mean when hospice says someone is transitioning? ›

Transitioning is the first stage of dying. It describes a patient's decline as they get closer to actively dying. Generally, when one is transitioning, they likely have days — or even weeks — to live. I have seen some patients completely skip the transitioning phase and some stay in it for weeks.

What is the surge before death? ›

This difficult time may be complicated by a phenomenon known as the surge before death, or terminal lucidity, which can happen days, hours, or even minutes before a person's passing. Often occurring abruptly, this period of increased energy and alertness may give families false hope that their loved ones will recover.

When is it time for hospice with cancer? ›

When should hospice care start? Hospice care is used when a disease, such as advanced cancer, gets to the point when treatment can no longer cure or control it. In general, hospice care should be used when a person is expected to live about 6 months or less if the illness runs its usual course.

What are signs of transitioning to death? ›

You may notice their:
  • Eyes tear or glaze over.
  • Pulse and heartbeat are irregular or hard to feel or hear.
  • Body temperature drops.
  • Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours)
  • Breathing is interrupted by gasping and slows until it stops entirely.
3 Aug 2022

How long can a hospice patient live without food or water? ›

As a result of discontinuing eating, patients can die in as early as a few days. For most people, this period without food usually lasts about 10 days, but in rare instances, it can last several weeks.

Is Stage 4 cancer considered end stage? ›

Stage 4 cancer is not always terminal. It is usually advanced and requires more aggressive treatment. Terminal cancer refers to cancer that is not curable and eventually results in death. Some may refer to it as end stage cancer.

What is the life span of someone with Stage 4 cancer? ›

Patients diagnosed in stage 4 who decide against treatment live an average of six months. In contrast, those diagnosed with stage 1A disease who elect no treatment live an average of two years. Mesothelioma survival without treatment depends on cancer stage, overall health and tumor growth rates.

What does Stage 4 esophageal cancer mean? ›

Stage 4 oesophageal cancer means your cancer is advanced. Your cancer might have spread into other organs or body structures next to the oesophagus. Or it might have spread to 7 or more lymph nodes. Some stage 4 cancers have spread to other parts of your body, such as the lungs or liver.

How quickly does esophageal cancer progress? ›

Esophageal cancer grows slowly and may grow for many years before the symptoms are felt. However, once the symptoms develop, esophageal cancer progresses rapidly. As the tumor grows, it can seep into the deep tissues and organs near the esophagus.

What stage is advanced esophageal cancer? ›

The earliest stage esophageal cancers are called stage 0 (high grade dysplasia). It then ranges from stage I (1) through IV (4). As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means cancer has spread more.

Where is the first place esophageal cancer spreads? ›

The most common place for oesophageal cancer to spread to is the liver. It can also spread to the lungs or lymph nodes.

What happens in last stage of cancer? ›

Patients may have trouble swallowing food and fluids at the end of life. Patients with cancer may have trouble swallowing in the last days of life. Both fluids and food may be hard to swallow, causing a loss of appetite, weight loss and muscle wasting, and weakness.

What is a typical later symptom of esophageal cancer? ›

Difficulty swallowing (dysphagia) Weight loss without trying. Chest pain, pressure or burning. Worsening indigestion or heartburn.

Does esophageal cancer spread to the brain? ›

Metastasis of esophageal carcinoma to the brain is rare and associated with overall poor prognosis. Because of a combination of improved treatment modalities for the primary tumor and improved imaging modalities, the frequency of brain metastasis diagnosis is increasing.

Is Stage 4 esophageal cancer terminal? ›

Stage IV esophageal cancer has spread to distant lymph nodes or to other distant organs. In general, these cancers are very hard to get rid of completely, so surgery to try to cure the cancer is usually not a good option.

Why does esophageal cancer have a poor prognosis? ›

The tumor is large, the central area of the tumor is hypoxic. In this case, the cells in the center of the tumor are less sensitive to radiotherapy and therefore have a poor prognosis.

Does esophageal cancer run in families? ›

In some cases, esophageal cancer runs in families. Researchers have discovered mutations, or changes, in several genes that are associated with inherited forms of the disease.

How do you help someone with esophageal cancer? ›

Caring for a loved one with cancer
  1. Providing support and encouragement.
  2. Talking with the health care team.
  3. Giving medications.
  4. Helping manage symptoms and side effects.
  5. Coordinating medical appointments.
  6. Providing a ride to and from appointments.
  7. Assisting with meals.
  8. Helping with household chores.

What is the number one cause of esophageal cancer? ›

The use of tobacco products, including cigarettes, cigars, pipes, and chewing tobacco, is a major risk factor for esophageal cancer. The more a person uses tobacco and the longer it is used, the higher the cancer risk.

Does esophageal cancer come on suddenly? ›

Usually, esophageal cancer does not produce noticeable symptoms until the tumor has grown large enough to interfere with eating, swallowing or digesting food. In many cases, the first warning sign is difficulty swallowing (dysphagia), which can create a sensation that food is lodged in the throat.

What foods cause esophageal cancer? ›

Coffee, tea, and maté may cause esophageal cancer (EC) by causing thermal injury to the esophageal mucosa.

Do you feel ill with esophageal cancer? ›

The most common symptom of esophageal cancer is a problem swallowing (called dysphagia). It can feel like the food is stuck in the throat or chest, and can even cause someone to choke on their food.

What happens in the weeks leading up to death? ›

What happens in the weeks before death? Most people who are dying feel tired. They may want to sleep more often, or for longer periods. They may want to talk less, although some may want to talk more.

What happens in the last few weeks of life? ›

Nearing the end of life

Everyone's experiences are different, but there are changes that sometimes happen shortly before a person dies. These include loss of consciousness, changes to skin colour, and changes to breathing.

How can doctors tell how long you have to live? ›

There are numerous measures – such as medical tests, physical exams and the patient's history – that can also be used to produce a statistical likelihood of surviving a specific length of time.

How long does transitioning last before death? ›

The active phase of dying usually occurs two to three days prior to death. During this time, patients experience symptoms such as: Inability to consume or swallow food or drink. Abnormal breathing patterns.

How long is the transitioning phase of death? ›

The active stage of dying generally only lasts for about 3 days. The active stage is preceded by an approximately 3-week period of the pre-active dying stage. Though the active stage can be different for everyone, common symptoms include unresponsiveness and a significant drop in blood pressure.

What are the 3 stages of hospice care? ›

The early stage, the middle stage, and the final stage are the three stages of death. Various alterations in responsiveness and functionality characterize them. It's crucial to remember, though, that the timing of each stage, as well as the symptoms encountered, might differ from person to person.

What is the last rally before death? ›

What Is an End-of-Life Rally? When a person facing the end of life “rallies,” they become more stable and may want to talk or even begin eating and drinking again. Some people describe this phenomenon as a sudden burst of energy before death.

What are the signs of the last few hours of life? ›

  • Loss of consciousness. Many people lose consciousness near the end of life. ...
  • Changes to skin. Their skin might look slightly blue or become mottled (have different coloured blotches or patches). ...
  • Noisy breathing. ...
  • Shallow or irregular breathing. ...
  • Film: What to expect at the end of life.
11 May 2022

What is the last breath before death called? ›

Gasping is a brainstem reflex; it is the last respiratory pattern prior to terminal apnoea. Gasping is also referred to as agonal respiration and the name is appropriate because the gasping respirations appear uncomfortable, causing concern that the patient is dyspnoeic and in agony.

What are the final stages of transitioning to death? ›

Periods of rapid breathing, and no breathing for brief periods of time, coughing or noisy breaths, or increasingly shallow respirations, especially in final hours or days of life.

What is the prognosis for stage 4 esophageal cancer? ›

Currently available combination chemotherapy treatment for stage IV cancer results in complete remission in up to 20% of patients, with average survival of 8-12 months.

When is surgery not an option for esophageal cancer? ›

Stage IV esophageal cancer has spread to distant lymph nodes or to other distant organs. In general, these cancers are very hard to get rid of completely, so surgery to try to cure the cancer is usually not a good option.

Is Stage 4 cancer a terminal? ›

Is stage 4 cancer always terminal? Stage 4 cancer is not always terminal. It is usually advanced and requires more aggressive treatment. Terminal cancer refers to cancer that is not curable and eventually results in death.

What happens week before death? ›

What happens in the weeks before death? Most people who are dying feel tired. They may want to sleep more often, or for longer periods. They may want to talk less, although some may want to talk more.

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