Currently, the internationally accepted data is that the chance of distant metastasis at the first diagnosis of esophageal cancer patients is about 50%. Once distant metastases have occurred, it means that the disease is too advanced to be cured by surgery or radiotherapy, and the 5-year survival rate is less than 5%.
Where does esophageal cancer tend to metastasize? What is the incidence of each?
In terms of a single organ, the most likely site of metastasis for esophageal cancer is the liver, followed by the lung, bone, and brain.
The chances of esophageal cancer metastasizing to each site are:
- Liver metastasis 23%~47%
- Lung metastasis 22%~52%
- Abdominal lymph node metastasis 21% to 47%
- Supraclavicular cervical lymph node metastasis 6%~37%
- Renal metastases 8% to 13%
- Adrenal metastases 6% to 20%
- Retroperitoneal lymph node metastasis 6%~12%
- Bone metastases 4%~15.7%
- Central nervous system metastases 1%~5%
- peritoneal metastases 0~17%
- Gastric metastases 0~15%
- Pericardial metastases 0~12%
- Pancreatic metastases 0~11%
- Heart metastases 0~9%
- Spleen metastases 0~8%
- Thyroid metastases 0~6%
- Skin metastasis 0~2%.
How do I find signs of metastasis? And how can doctors look for metastases?
Metastases from esophageal cancer are detected through symptomatic observation, physical examination, blood tests, and imaging.
When metastases are large, they can produce local pressure symptoms that affect organ function, and you may also feel the onset of some uncomfortable symptoms.
However, when distant metastases occur, your symptoms may also be very atypical. If the metastases are small, you may not have any symptoms.
So, if you are unfortunate enough to have esophageal cancer, it is important to have regular checkups after treatment is completed. Once new symptoms appear, you should see a doctor promptly and let a professional judge.
The doctor will carefully ask about your symptoms, examine your body for positive signs, and reasonably arrange for blood tests, imaging, and pathological biopsy if necessary to find and confirm the metastases.
According to the clinical routine, the screening tools for distant metastases include head, chest, abdominal, pelvic CT and bone scan. If a suspicious metastasis is found, enhanced CT can be performed to help show the blood supply to the lesion and indicate benignity or malignancy. Hematological tests can reflect the function and damage of some organs, and the magnitude of the elevation of tumor markers can help determine the tumor load, all of which can assist the physician’s judgment to some extent.
In the vast majority of cases, the gold standard for confirming metastases is a pathologic biopsy. In lesions where the diagnosis is doubtful, pathologic biopsy may be considered when conditions allow.
What are the symptoms of metastases at different sites? What can the examination reveal?
- Metastases occurring in the liver may have symptoms such as swelling and pain in the liver area (which may be aggravated by acute abdominal pain if the metastases rupture) and obstructive jaundice; physical examination may reveal palpable liver enlargement; blood tests may reveal abnormal liver function and abnormal blood picture; and liver B-ultrasound, CT, and MRI may reveal intrahepatic occupancy.
- If the metastasis is in the lung, symptoms such as irritating dry cough, coughing sputum (blood in the sputum, hemoptysis, etc. may occur when the metastasis invades the blood vessels), chest pain (chest pain is obvious when the metastasis invades the pleura), and dyspnea may occur; physical examination may show hypopnea or abnormal breath sounds at the site of the lesion; chest X-ray or CT may reveal an intrapulmonary occupancy.
- The metastases are located in the peritoneum and may cause abdominal distention, poor appetite, obstruction of bowel movement, and in severe cases, intestinal obstruction; rupture of the metastases may cause abdominal bleeding; abdominal B ultrasound, CT, or MRI may reveal abdominal occupancy and ascites.
- Metastases in the brain may cause high cranial pressure symptoms, such as headache, nausea, vomiting, mental and mental abnormalities, and impaired movement of the limbs, and may also trigger neurological diseases such as epilepsy and cerebral hemorrhage; CT or MRI of the brain may help detect intracerebral occupations.
- Metastases in bone may present with pain at the metastatic site and pathological fractures; osteolytic lesions may induce hypercalcemia, which may lead to a range of symptoms such as nausea, vomiting, dehydration, and weight loss; X-rays or CT may reveal bone occupations and bone destruction, and bone scans may also help screen for systemic bone metastases.