I. Incidence of esophageal cancer.
Esophageal cancer is one of the common malignant tumors in China, ranking the second place of digestive tract tumors. There are six high incidence areas of esophageal cancer in China.
1.High incidence area in Taihang Mountains in North China, mainly concentrated in the southern section of Taihang Mountains at the junction of Henan, Hebei and Shanxi provinces. For example, the mortality rate of esophageal cancer in more than a dozen cities such as Linxian in Henan, Magxian in Hebei and Yangcheng in Shanxi is above 100 people/100,000 population.
2.High incidence area in the eastern mountainous area of Qinling Mountains bordered by Shaanxi, Henan and Hubei provinces, where the mortality rate of esophageal cancer is 50-100 people/100,000 population.
3.High incidence area of Dabie Mountain in Hubei, Henan, Hubei, Xiaogan and Anhui, more than ten counties and cities. The mortality rate of esophageal cancer is around 50 people/100,000 population.
4.High incidence area in northern Sichuan.
5.Min and Guangdong high incidence area, including Shantou area, Meixian area in Guangdong, Nan’an County in western Fujian, etc. The mortality rate of esophageal cancer is 20-50 people/100,000 population.
6. High incidence area in northern Jiangsu, which is around the river in northern Jiangsu, centering on Yangzhong County with 110 people/100,000 population, including Huai’an, Taixing and Jianhu counties. Esophageal cancer is most common in men, the ratio is about 1.6:1, and it is higher in rural areas than in cities, 3:1. The age of onset is 50-69 years old, accounting for about 60%, the youngest age is 18 years old, and the age below 40 years old accounts for about 10%.
What kind of people are vulnerable to esophageal cancer?
According to decades of epidemiological research and experimental studies, there are several possible factors for the occurrence of esophageal cancer as follows
1.Long-term bad dietary stimulation. Residents in certain areas with high incidence of esophageal cancer are accustomed to consume overly hard and rough food for a long time, and chew and swallow quickly when eating; some people also like to drink overly hot tea or soup, or overly hot porridge. The rough and hard food or overheated food rubs and stimulates the esophageal mucosa when passing through the esophagus, which causes chronic trauma and inflammation of the esophageal mucosa over the years and repeatedly causes the squamous epithelial cells lining the esophagus to be damaged and then proliferate and repair, during which the squamous epithelial cells may become cancerous and produce esophageal cancer.
2. Long-term consumption of water or certain food with high content of carcinogenic compounds such as amine nitrite. The higher the intake of such carcinogenic substances, the greater the possibility of esophageal cancer.
3.Long-term chronic inflammation of esophagus. According to the survey, esophageal diverticulum, scar stenosis, chronic esophagitis and esophageal polyp may become malignant and form esophageal cancer if they exist for a long time.
4. Long-term consumption of fermented and moldy food. Epidemiological survey and animal experimental research confirm that long-term consumption of fermented or moldy food is prone to esophageal cancer due to the presence of many kinds of molds. For example, the content of mold and nitrosamines in food is high, and the two have strong synergistic carcinogenic effects.
5.Long-term smoking and alcohol consumption. Research has found that long-term smokers, especially those who smoke pipe tobacco and chewing tobacco, are not only prone to lung cancer, but also to esophageal cancer, and those who have the habit of drinking alcohol at the same time are at greater risk of esophageal cancer.
6.Hereditary factors. 80-90% of the occurrence of esophageal cancer is due to acquired factors or environmental factors. However, the survey found that there are also certain genetic factors.
7.Other factors. Investigation and research found that the occurrence of esophageal cancer is related to the lack of certain vitamins and trace elements, such as riboflavin, vitamin C, vitamin A and niacin, and the lack of trace elements such as molybdenum, zinc and selenium.
In a word, the occurrence of esophageal cancer is related to the above-mentioned factors, and it is likely to be the result of a combination of factors, but one of them must be the leading factor, and the leading factors leading to esophageal cancer are not the same in different regions and populations.
3. How to detect esophageal cancer early?
The structure of esophagus can be divided into three layers, from inside to outside, which are mucosal layer, submucosal layer and muscular layer in order. Early esophageal cancer, also known as superficial esophageal cancer, refers to cancer confined to the mucosal layer or only invading the submucosal layer, without invading the muscular layer, and without lymph node metastasis and distant metastasis. Since early stage esophageal cancer can be completely removed surgically, the surgery is relatively easy, the surgical effect is good, and the survival rate of 5 years after surgery can be more than 90%, and even long-term survival can be achieved. Therefore, it is very important to detect esophageal cancer early, that is, to make a diagnosis at the early stage of esophageal cancer. Early esophageal cancer has no obstruction to the lumen of the esophagus, but has some effect on the movement of the esophageal wall. Therefore, most of these patients have self-conscious symptoms of different degrees. Moreover, one patient can have one or several symptoms, which often appear intermittently and recurrently, and can be affected by many factors such as diet and emotion. These symptoms can last for several months or even two or three years or longer, and the general health condition is not affected.
The main manifestations of early stage esophageal cancer include the following five kinds.
1. Choking sensation when swallowing food. 50%-60% of patients with early stage esophageal cancer have this symptom. After this symptom appears, it can disappear on its own without treatment, but it can appear again after a period of time and gradually worsen.
2. Foreign body sensation in esophagus. 15-20% of patients feel a foreign body in the esophagus when swallowing. The site of foreign body sensation is mostly consistent with the cancerous site of esophageal wall.
3. Dryness and tightness in the throat. 30% of the patients often complain of dryness and tightness in the throat, or describe it as tightness in the neck and poor swallowing of food.
4. Slow passage of food and a feeling of retention. About 14% of the patients felt slow downward movement or stagnation when swallowing food and passing the food mass through the esophagus.
5.Posterior sternal pain or stuffy discomfort or pain under the glabella and epigastric region. Almost more than half of the patients have such symptoms. It is mainly dull pain or burning pain or pins and needles and pulling pain. The pain is more pronounced when swallowing rough food, hot food or irritating food, and less when eating liquid, semi-liquid or warm soft food and swallowing slowly. Most patients have pain when swallowing the first or second bite of food, and then it decreases and gradually disappears. The pain is usually mild at first, intermittent and short-lived, but progressively worse. If one or more of these recurrences occur, the
Although some patients are due to other factors such as chronic pharyngitis, esophageal diverticulum, reflux esophagitis, etc. However, it must be kept in mind that without thorough examination to exclude esophageal cancer, one should not take it lightly, but should seek medical examination on the basis of suspicion or high suspicion of esophageal cancer, especially for those who are located in the high incidence area of esophageal cancer, aged 40 or above, or have had esophageal cancer patients in their family.
What are the treatment methods for esophageal cancer?
There are roughly 5 methods for esophageal cancer treatment.
1.Surgical treatment: Surgical resection is the preferred treatment method for esophageal cancer patients, which is to remove a section of esophagus with tumor, and then to elevate the stomach in the abdominal cavity to the chest cavity or neck, and then to connect and anastomose the upper section of esophagus and stomach, so that the stomach can play the role of esophagus at the same time.
2.Radiotherapy: There are mainly two types of irradiation: body irradiation and intra-esophageal lumen irradiation. Generally speaking, esophageal cancer in upper and middle esophagus is more sensitive to radiation therapy and has better treatment effect, while cancer in lower esophagus has worse effect; surgery combined with preoperative or postoperative radiation therapy has better effect than surgery or radiation therapy alone.
3.Anti-cancer drug chemotherapy: the effect of anti-cancer drug on esophageal treatment is not very ideal. At present, it is only used as an auxiliary method after surgery, which can consolidate the effect of surgery and prevent recurrence and metastasis. Relying on chemotherapy alone is not effective.
4.Chinese medicine treatment: it is not the main method, but only an auxiliary treatment for esophageal cancer. Chinese medicine emphasizes dialectical treatment, which can regulate qi and blood and enhance patients’ immune function, and has certain effects, especially for patients with weaker constitution and older age, and can reduce the uncomfortable reaction of radiotherapy and chemotherapy, and can also be used as adjuvant treatment after surgery.
5.Immunotherapy: The decrease of immune function of tumor patients has been confirmed, and it is related to the occurrence and development of tumor. Immunotherapy should have a great role, but so far, there is not an effective method. Interleukin-2 and interferon currently used may have some effects on esophageal cancer, but these can only be used as postoperative adjuvant therapy.
V. Indications for esophageal cancer surgery
Whether esophageal cancer patients can be treated surgically or not mainly depends on which stage of esophageal cancer has been developed and the patient’s physical condition. But in principle, if surgery can be done, surgery should be pursued.
1.Patients who are suitable for surgery
(1) Early-stage esophageal carcinoma in situ can be treated surgically.
(2) Early esophageal cancer, i.e. cancer in the middle and lower esophagus within 5CM, and cancer in the upper esophagus within 3CM, are suitable for surgical treatment.
(3) Middle-stage esophageal cancer, i.e. lesions of 5CM or more, without lymph node metastasis in the neck, can be treated surgically, preferably in combination with preoperative radiation therapy.
(4) For those with esophageal recurrence after radiotherapy, the lesion range is small.
2.Surgery is contraindicated
(1) Esophageal cancer is already in advanced stage, the cancer has obviously invaded trachea, aortic arch, lung, etc., or hoarseness and continuous chest and back pain appear. Because surgery is often unable to remove the tumor.
(2) Patients with esophageal cancer have enlarged lymph nodes in the neck and liver metastasis. At this time, resection of esophageal cancer cannot solve the fundamental problem, even if the primary lesion is removed, metastatic cancer will appear in other parts soon.
(3) Patients with serious heart disease or poor lung function, such as emphysema, pulmonary alveoli, etc. Since esophageal cancer surgery is a major surgery, it is difficult for patients with poor heart and lung function to safely pass the surgery.
What about esophageal cancer patients who cannot be removed surgically?
The main reasons why esophageal cancer cannot be treated surgically are that the esophageal cancer is already advanced, the esophageal cancer is large and located in the cervical or upper thoracic section, or the systemic condition is not good enough to tolerate surgery. The following methods are available for the treatment of such patients, and the specific method should be decided by doctors.
1.Radiation therapy
It is suitable for cervical and upper thoracic esophageal cancer that cannot be removed surgically. The 5-year survival rate can reach 15-30%, and some patients can be treated with surgery after radiotherapy.
2.Palliative surgery treatment
The biggest pain of advanced esophageal cancer is that the lesion is narrow and obstructed and cannot be eaten, or even cannot be swallowed by dripping water in serious cases, and cannot be treated by radical surgery and radiotherapy. In order to solve the patient’s feeding, improve nutrition and general condition, palliative surgery can be performed.
The main ones are.
(1) Gastrostomy, where the diet is injected through the gastric tube.
(2) Esophagogastric short-circuit surgery, which is suitable for esophageal cancer that cannot be removed after open-heart surgery, and connects the stomach to the esophagus of the upper part of the cancer. The patient can eat more normally after the operation.
3. Endoscopic treatment of esophageal cancer.
(1) Endoscopic esophageal dilation and built-in esophageal tube. (1) Endoscopic esophageal dilation and endoesophageal intubation, i.e., through esophagoscope, the esophagus of the narrowed section caused by cancer is dilated, however, a hollow tube is placed so that food can pass into the tube, thus solving the patient’s eating difficulties. After the whole body nutritional status is improved, radiation therapy or chemotherapy can be done again.
(2) Endoscopic laser treatment. Laser treatment is applied under esophagoscope to vaporize the cancerous tissues that are obviously protruding from the esophageal lumen, thus, the esophagus is opened and the patient can eat. Although laser treatment can treat early-stage esophageal cancer, it is generally used only for advanced esophageal cancer.
(3) Endoscopic microwave therapy. Under the guidance of esophageal endoscope, microwave heating is used to necrotize and dislodge the cancer protruding from the lumen of esophagus, so that the lumen of esophagus can be opened. This method is only applicable to units without laser treatment.
(4) Endoscopic local injection of anti-cancer drugs. The biggest advantage of this method is the high concentration of drugs in the tumor site, strong effect and small systemic side effects. The effect of advanced esophageal cancer is not good because of obvious tumor spreading, while the efficacy is better for those who are not suitable for surgery in early stage of esophageal cancer.
4.Therapeutic Chinese medicine
This method can only play the role of relieving the disease and cannot achieve the purpose of radical cure, but the combination of Chinese and Western treatment is beneficial to prolong the survival time.
7.How to prevent esophageal cancer?
Esophageal cancer, like tumors in other parts of the body, has the tendency to recur. How to prevent and detect the recurrence of esophageal cancer at an early stage is very important to patients and an important measure to improve long-term survival rate.
Some specific measures are as follows.
1.Avoid some triggering factors of esophageal cancer, please refer to the previous content for details.
2.Change the bad eating habits. Mainly, no smoking, no drinking, no rotten, moldy and spoiled food, and no overly hot food.
3.Improve the nutritional status, diet and living rules, maintain an optimistic mood and attitude, strengthen physical exercise, and improve the body’s ability to resist disease.
4.Complete the chemotherapy and radiotherapy plan on schedule according to the doctor’s instructions.
5.Regularly go to the outpatient clinic for review, if necessary, whether there is enlargement of lymph nodes in the neck, barium esophageal X-ray, and fiberoptic esophagoscopy if necessary.
6.Once there is recurrence of anastomotic esophageal cancer, laser treatment can be used in early stage, and chemotherapy and radiotherapy can also be combined.
7.If there is enlarged lymph nodes in the neck, radiotherapy is generally used, preferably combined with chemotherapy.
8.If there is pain in a part of the body such as bone pain and back pain, chest pain, etc., you should seek medical examination in time to prevent bone metastasis.
To prevent recurrence of esophageal cancer after surgery, one of the important points is to maintain an optimistic attitude towards life and strengthen physical exercise, which is very important to improve the immunity and disease resistance of the body, and is also one of the important factors to achieve good term-free effect.