Harmony in the Valley of the Heart No. 4: A Guide to Recovering from Esophageal Cancer Discharge (The Subway to Spring)

  Harmonioussoulravine (HSR) is a spiritual space where people with the same or similar characteristics can purify their minds, calm their hearts, become peaceful and quiet, and enter into an eternal harmony of essence, energy and spirit! In today’s society, which is in a special historical stage of structural adjustment, the doctor-patient relationship is also going through a period of profound change in development. The author has always believed that the harmony of the mind between individuals is both the original intention and the destination. When the body of the special line of transport materials traffic incident, let each other in this quiet Silicon Valley dedicated to maintain the “subway to spring”!  The incidence of esophagealcarcinoma is the ninth highest of all malignant tumors in the world, and the incidence is particularly high in developing countries. China is also a country with high incidence of esophageal cancer, and the survey in the 1990s showed that the mortality rate of esophageal cancer is the fourth of all malignant tumors, and the incidence rate of men is significantly higher than that of women, mostly seen between 40 and 70 years old (the high incidence age group is 60 to 64 years old). Squamous carcinoma is the most common in high incidence areas of esophageal cancer, while adenocarcinoma is common in non-high incidence areas. Squamous carcinoma is mostly seen in men and is related to smoking and alcohol consumption; adenocarcinoma is often associated with Barrett’s esophagus, gastroesophageal reflux and esophageal hiatal hernia. The most typical symptom is progressive dysphagia. Once esophageal cancer is diagnosed, without distant lymph nodes and organ metastasis, and if physical condition allows, surgical resection should be pursued. However, the effect of single surgical treatment for esophageal cancer is not very satisfactory. The main reason is that this malignant tumor is easy to recur and metastasize, so comprehensive treatment such as preoperative and/or postoperative radiotherapy and chemotherapy is adopted.  Diet: After esophageal cancer surgery or radiotherapy, patients should mainly take liquid or semi-liquid food and gradually transition to soft food; chew slowly and use high protein and high vitamin food that is easy to digest and swallow, such as meat jelly, fruit, cake, yogurt, milk, etc.; avoid any stimulating diet, such as chili, garlic, fried food, etc. Medicinal diet can be chosen from yam, lotus and coix congee, i.e. yam 20g, lotus 20g and coix 60g, boil congee and take it often.  Activity: Patients with esophageal cancer should avoid fatigue and take sufficient rest after treatment, and generally should not do strenuous activities of upper body, nor should they bend their heads excessively and turn back. One to two months after surgery, if there is numbness or heavy pressure on the upper limb of the operated side, massage of the affected upper limb and muscles around the wound should be performed, but avoid knocking and massaging the chest wall. Strengthen the exercise of the upper limb on the operated side to prevent upper limb dysfunction, frozen shoulder and muscle atrophy, specific medical exercises can be referred to and selected from the “postoperative sports therapy for general thoracic surgery”.  Review indications: Patients with esophageal cancer should be reviewed regularly to understand the changes of the disease after treatment, to prevent recurrence and metastasis, and to seek treatment again.  1) Patients after esophageal cancer treatment (including surgery, radiotherapy and chemotherapy) should be reviewed once every three months in the first year, and once every six months in the second year, and once every year until the end of life.  2) The time of review depends on the condition of the patient. If the following conditions occur: abnormal discomfort after eating, nausea, vomiting, or even vomiting blood or black stool; choking, fever, cough, chest and back pain, shortness of breath, hoarseness, weakness, progressive wasting, and severe swallowing difficulties, the patient should immediately seek medical attention for examination to exclude the possibility of recurrence and metastasis.  3) During the review, the patient’s medical history, treatment, life and activities, comprehensive physical examination, chest fluoroscopy or radiograph (CXR), barium swallow X-ray (GI) every six months, and special examinations such as esophagoscopy (gastroscopy), CT, MRI, ECT, etc. are feasible if necessary.  IV. Precautions: 1) Quit smoking and alcohol; psychological and mental regulation, maintain a good state of mind; face the disease and treatment positively and optimistically.  2) Adapt to changes in dietary habits and food structure: take fresh vegetables and fruits for many times, take vitamin B, C and A frequently; because the gastroesophageal anastomosis is inelastic after surgery, it cannot be fully expanded when swallowing food, so when eating too fast or swallowing larger or harder food after surgery, you will feel poor swallowing, and in serious cases, the anastomosis may be blocked by large pieces of food causing obstruction, so you must chew slowly when eating, eat small amounts of more meals, and after eating It is best to move a little and then rest in bed to reduce reflux.  3) Since some tiny nerve endings were cut off during the surgery, the sensation around the wound is abnormal, and it takes about 3 months to 6 months for the nerve to regenerate, so the symptoms will gradually improve after 6 months. During this period, you should not give up the functional exercise of upper limbs because of pain, and you can take oral pain medication if necessary. If there is retrosternal discomfort and difficulty in swallowing, but the GI, gastroscopy (esophagoscopy) and histological examination are negative, and the symptoms still persist, close observation should be made and the examination should be repeated every one to three months.  4) The presence of esophageal perforation and esophagotracheal fistula should be noted during radiotherapy, and radiotherapy should be terminated and examined in detail if there is sudden onset of severe retrosternal pain, recurrent cough, cough, limited pneumonia, fever, etc.; 5) Chemotherapy patients generally have a treatment cycle of more than 3 weeks and a course of 6 to 7 weeks with an interval of 5 weeks, which must be adhered to; 6) Where there is complete obstruction of swallowing, esophageal bleeding, perforation, severe nausea 7) Generally, patients with serious local invasion of tumor or combined lymph node metastasis need to combine post-operative radiotherapy and chemotherapy; they should not believe in the advertising propaganda in the market, which may lead to serious consequences, and anti-tumor drugs must be taken under the guidance of doctors, not used at will.