Esophageal cancer is a malignant tumor that occurs in the epithelial cells of the esophageal mucosa, and about 300,000 people die from esophageal cancer worldwide every year. China is one of the regions with high incidence of esophageal cancer in the world, with an average of 150,000 deaths per year. There are more men than women, and the age of onset is mostly above 40 years old. As a coastal area, our city is one of the areas with high incidence of esophageal cancer, and our thoracic surgery department treats more than 100 cases of esophageal cancer patients every year, but clinically there are fewer cases of early stage esophageal cancer, and most of the patients come to the hospital in the middle or late stage. Therefore, it is very necessary to vigorously carry out cancer prevention publicity and education and popularize anti-cancer knowledge.
A Causes of esophageal cancer: The population distribution of esophageal cancer is related to age, gender, occupation, race, geography, living environment, diet and living habits, genetic susceptibility and so on. Regarding the factors of esophageal cancer, there are many in-depth investigations and laboratory observations in recent years, but there is no accepted conclusion yet. It is generally believed that esophageal cancer may be a disease caused by many factors, and the following factors are the main ones.
①Chemical etiology: nitrosamines, a lot of research has been done on these compounds at home and abroad, and it has been confirmed that nitrosamines have strong carcinogenic effect.
Biological etiology: fungus. From the data of some high incidence esophageal cancer areas in China, it is proved that residents in high incidence areas use more fermented and moldy food than residents in low incidence areas.
③Lack of certain trace elements: molybdenum, iron, zinc, fluorine, selenium, etc. According to the survey, molybdenum, copper, iron, zinc and nickel are low in the external environment of human body in areas with high incidence of esophageal cancer in China.
Dietary habits, physical stimulation of food such as hot, coarse and hard, smoking, drinking alcohol, eating pickles, chewing betel nut, etc. are related to the occurrence of esophageal cancer.
⑤ Genetic susceptibility, according to the epidemiological survey of esophageal cancer, 60% of patients have family history of esophageal cancer, but whether it is genetic relationship or the same dietary habits in the same family is still to be proved by future research.
(6) Carcinogenesis of inherent esophageal diseases and certain diseases in the esophagus itself finally become esophageal cancer, such as Barrett’s esophagus, esophageal scar stenosis, cardia failure, esophageal diverticulum, etc.
B. Symptoms of esophageal cancer: The symptoms of early stage of esophageal cancer are often not obvious, among which there are four main symptoms: slight choking sensation when swallowing hard food; pain in the esophagus when swallowing; dull and painful discomfort behind the sternum when swallowing; foreign body sensation in the esophagus after swallowing. These symptoms are very mild and intermittent, each time for a short period of time, and can easily be ignored. Some of them last for several years without significant changes, while some of them are progressively aggravated, but most of them progress slowly.
If the cancer continues to develop and cause lumen narrowing, it will produce typical symptoms of esophageal cancer, which have the following manifestations.
1. Difficulty in swallowing. After the development of esophageal cancer to the middle stage, most patients have progressive symptoms of difficulty in swallowing. The degree of dysphagia depends on the extent of invasion of esophageal circumference, and is also related to the pathological type, with symptoms of narrowing type and medullary type being more severe.
2.Vomiting, eating and vomiting is also a common symptom of esophageal cancer, which mostly occurs in patients with more serious obstruction. Due to the dilatation of the upper part of esophagus, food and oral mucus are retained; on the other hand, reflex secretion of esophageal glands and salivary glands is increased due to esophageal obstruction. Vomiting is often caused after eating, and a large amount of mucus and food is vomited. A few patients also vomit blood, which is caused by ulceration on the surface of cancer tissue or cancer penetrating the adjacent tissue.
3.Pain in chest and back, some patients have heavy, dull pain and blockage feeling behind the sternum when swallowing food. Few of them have stabbing pain and burning sensation. If there is persistent chest and back pain, it is mostly caused by the invasion of primary cancer or metastatic cancer pressing intercostal nerve or mediastinal nerve.
When cancer develops to advanced stage, compression of trachea may cause cough and dyspnea; when cancer tissue penetrates trachea and tracheoesophageal fistula occurs, there are choking cough from eating, pneumonia, lung abscess, fever and pus-smelling sputum; when cancer tissue invades laryngeal nerve, hoarseness occurs; when invasion of phrenic nerve causes diaphragm paralysis, dyspnea and paradoxical movement of diaphragm occurs; in advanced stage, patients appear cachexia, which is manifested as extreme wasting and C
C. Auxiliary examination: In suspected patients, a dilute barium swallow X-ray should be performed. For those who have clinical symptoms or suspicion but fail to make a clear diagnosis, fiberoptic esophagoscopy should be performed as soon as possible. Under direct vision, multiple biopsies should be taken for pathological tissue examination. In particular, people aged 40 years or older should be given high priority and be examined regularly. For diagnosed cases, CT and color ultrasound should be performed, which can clarify the extent of the lesion and the degree of extravasation, so as to further evaluate the disease and clinical staging.
D Prevention: To establish prevention and treatment research sites in high prevalence areas, to conduct census by means of education and application of diagnostic methods such as esophageal cells, in order to detect early, treat early and improve the cure rate. Specific measures include.
①Etiology prevention: improve drinking water, prevent mold and detoxification, change bad living habits, apply chemical drugs, etc.
②Pathogenetic prevention: applying preventive drugs (retinoids, vitamin B2, B6, C, E, K, etc.), actively treating esophageal epithelial hyperplasia, dealing with precancerous lesions such as esophagitis, polyps, diverticula, etc.
③ Vigorously carry out cancer prevention publicity and education, popularize anti-cancer knowledge, and make census and screening among people in high incidence areas.
E Treatment: Treatment methods of esophageal cancer include surgical treatment, radiotherapy, chemotherapy, Chinese medicine treatment and comprehensive treatment. The simultaneous or sequential application of two or more therapies is called comprehensive treatment. Statistics show that the effect of comprehensive treatment is better. Surgery is the first choice for esophageal cancer treatment. If the general condition is good, the heart and lung function is still good and there is no obvious sign of distant metastasis, surgery will be considered.
Esophageal cancer resection is a treatment method to remove part of esophagus and then the stomach is lifted up to connect with the rest of esophagus. The surgeon connects the healthy part of the esophagus to the stomach so that the patient can still swallow food. Depending on the condition, the colon or small intestine may sometimes be used in place of the removed esophagus. The lymph nodes surrounding the esophagus are also removed and looked at under a microscope to see if they are infiltrated by cancer.
Radiotherapy is the use of high-energy X-rays or other radiation to kill tumor cells. There are two types of radiation therapy; external and internal. External irradiation is a method of irradiating a tumor focus from outside the body with radiation emitted from a radiation therapy machine; internal irradiation is a method of irradiating a tumor by enclosing a radioactive substance in a needle, seed, thread, or catheter and placing it directly into or next to the tumor. Radiotherapy is selected according to the type of cancer and the stage of the tumor at the time of treatment.
Chemotherapy is a treatment method that applies drugs to inhibit tumor growth by killing tumor cells or inhibiting the way they divide. When chemotherapy drugs are administered orally, intravenously, or intramuscularly, they can enter the bloodstream to reach tumor cells throughout the body (systemic chemotherapy); when chemotherapy drugs are injected directly into the spinal cavity, organs, or body cavity such as the abdominal cavity, the drugs mainly act on cancer cells in these areas (local chemotherapy). The choice of chemotherapy method depends on the type and stage of the tumor at the time of treatment.
F Precautions for esophageal cancer patients after surgery
After esophageal cancer surgery, part of the esophagus is removed and replaced by the stomach to regain the function of the digestive tract. The role of the patient’s cardia is completely lost, the volume of the stomach is reduced compared with before, and the position is elevated from the abdominal cavity to the thoracic cavity, and changed from transverse to the vertical position, all of which can cause changes in the function of the digestive tract. Therefore, early postoperative patients need to eat high-calorie, easily digestible fluid or soft meals, eat less and more meals, 4-6 meals a day is appropriate, do not lie down immediately after the meal, so as not to return food into the trachea choking. This kind of diet should be adhered to for six months to one year, after which the patient can resume three meals a day like normal people, and the total amount of food reaches the pre-operative level.
Postoperative patients often experience a sense of pause after eating, easy satiety, gas string-like sensation in the stomach, and need to burp as much as possible before eating. This is because the volume of the stomach is reduced after surgery, so the swallowed air has nowhere to stay, and the food mass can enter after it is expelled. Because the vagus nerve was cut during surgery, some patients may have diarrhea and increased saliva, which can be treated symptomatically. Some patients have postoperative acid reflux, burning pain behind the sternum, vomiting or even vomiting blood. This is due to too large anastomosis and reflux of gastric contents into the esophagus. Fiberoptic endoscopy and esophageal pressure and PH measurement should be performed to determine the presence of reflux esophagitis and anastomotic ulcers. Conservative treatment is effective for reflux esophagitis, and severe cases can be managed surgically.
Some patients have postoperative dysphagia, the cause of which varies depending on the time of occurrence. When dysphagia occurs about 2 months after surgery, it is mostly due to a small anastomosis and scar contraction, resulting in anastomotic stricture. For stenosis due to scar, dilatation therapy is feasible in mild cases, and surgical resection of the stenosed portion and reanastomosis is required in severe cases. After a considerable period of postoperative obstruction symptoms, especially when there is positive stump, tumor recurrence should be suspected, which needs to be confirmed by upper gastrointestinal imaging as well as fiberoptic endoscopy and pathological biopsy. After tumor recurrence, those who are physically able to tolerate surgery can be considered to operate again, while those who are not in a position to operate can be treated with radiotherapy or jejunostomy to maintain nutrition.
If uncomfortable symptoms appear after esophageal cancer surgery, immediate medical consultation should be made. Even if there are no obvious discomfort symptoms, regular follow-up should be done in the early postoperative period, once every 1-3 months is appropriate; if there is no obvious abnormality after several follow-ups, the follow-up time can be extended appropriately. In addition to physical examination, routine blood tests, chest X-ray, abdominal “B” ultrasound, upper gastrointestinal tract imaging and fiberoptic endoscopy should also be done during the follow-up. If abnormalities are found, appropriate treatment measures should be actively taken.