Overview of esophageal cancer
Esophageal cancer is a malignant tumor occurring in the epithelial tissue of esophagus, accounting for 2% of all malignant tumors. There are about 310,400 new cases of esophageal cancer worldwide every year, and about 200,000 people die from esophageal cancer, while China accounts for 167,200. China is a high incidence area of esophageal cancer, and the second highest death rate after gastric cancer, and the incidence age is mostly above 40 years old, with more men than women. However, in recent years, there is a growing trend of people under 40 years old. The occurrence of esophageal cancer is related to the chronic stimulation of nitrosamines, inflammation and trauma, genetic factors, and the content of trace elements in drinking water, food and vegetables. However, the exact cause is not well understood and needs to be further investigated.
Esophageal cancer etiology and risk factors
There are several main factors as follows.
(1) Smoking and alcohol: long-term smoking and alcohol consumption are related to the development of esophageal cancer.
(2) Local damage of esophagus: Long-term preference for hot diet may also be a factor of carcinogenesis. Long-standing esophagitis caused by various kinds of original solids may be the pre-cancerous lesion of esophagus, especially those with interstitial cell formation have greater risk of cancer. Esophagitis also occurs in the mid-thoracic esophagus.
(3) Nitrosamines: Nitrosamines are a very strong carcinogen. The amount of pickles consumed is directly proportional to the incidence of esophageal cancer. Some foods are often contaminated with mold in the pickling process. Mold can contribute to the increase in nitrite and secondary amine content in food.
(4) the role of mold: cross-streptomycosis, Aspergillus and other molds present in food are highly carcinogenic substances.
(5) nutrition and trace elements: lack of vitamins, protein and essential fatty acids in the diet and other components of the lack of vitamins, protein and essential fatty acids can make the esophageal mucosa proliferation, interstitial changes, and further can cause cancer.
(6) Genetic factors: The susceptibility of the population is related to genetic and environmental conditions.
(7) Other factors: Eating too fast and eating hard and coarse food may cause damage to esophageal mucosa, and repeated damage may cause mucosal hyperplasia and interstitial degeneration, which may eventually lead to cancer.
Early signs of esophageal cancer
Esophageal cancer is one of the common tumors and one of the diseases that seriously threaten people’s health and life. About 209,000 people die from esophageal cancer in China every year. The treatment result of esophageal cancer varies greatly depending on the early and late stage of the disease. Take surgery as an example, the 5-year survival rate of early stage cancer is about 90%, while the 5-year survival rate of middle and late stage cancer is reduced to 20%-30%. Esophageal cancer is formed by normal epithelial cells of esophageal mucosa gradually becoming cancer by stimulation of various factors inside and outside the body. It is still unclear how long it takes to develop from normal epithelium to cancer, generally speaking, it takes several years to develop from esophageal epithelial hyperplasia to cancer, and about one year to develop from early cancer to middle and late cancer.
In the past, it is wrong to think that early esophageal cancer has no symptoms and signals. Because these signals and symptoms are mild, appearing and disappearing automatically without treatment, they are ignored by patients and doctors and fail to be further examined and diagnosed, and then the best treatment time is lost. In fact, most patients with early stage esophageal cancer have experienced different types and degrees of self-perceived symptoms, and should be alerted if they find the following symptoms
1. Choking sensation when swallowing food is the most common symptom. Some patients can even clearly recall when it first occurred. These symptoms may disappear spontaneously without treatment and reappear after a few days or months, with the frequency of occurrence and the degree of choking gradually increasing later.
2. Pain behind the sternum and pain in the esophagus when swallowing This symptom is also more common. The pain behind the sternum or esophagus during eating is burning, pins and needles, pulling or rubbing sensation. The pain increases when swallowing coarse or hot food in large bites, and is less severe when swallowing thin or warm and cold food in small bites. The site of pain is usually higher than the actual site of cancer growth. In lower esophageal cancer, the pain can occur in the upper abdomen. The pain can be relieved after a few days or after taking medication. The pain will come back when you do not eat properly or when you have mood swings. This situation will be repeated.
Patients feel that the food they have eaten at one time is coarse and hard and cut through the esophagus, and there is food adhering to the esophageal wall and cannot be swallowed.
4, food down slowly and have a sense of retention when the food through the esophagus patients feel less smooth than before, food down slowly, or even in a place to stay. This feeling is not related to the nature of the food, sometimes drinking water will also appear this feeling.
5.There is dryness and tightness in the throat that can be accompanied by slight pain, sometimes related to the patient’s emotional wave dynamics.
6.There is a feeling of stuffiness behind the sternum. Patients often cannot describe this feeling specifically, but only say that the chest is uncomfortable.
Differential diagnosis of esophageal cancer
This disease should be differentiated from the following diseases.
1.Esophageal cardia achalasia: Patients are mostly young women with long duration of disease and symptoms are sometimes light and heavy. Barium examination of esophagus shows a smooth funnel-shaped stenosis at the lower end of the esophagus, which can be dilated when applying antispasmodics.
2. Benign esophageal stricture: It can be caused by scarring caused by accidental swallowing of corrosive agents, esophageal burns, foreign body injuries, chronic ulcers, etc. The duration of the disease is long, and the dysphagia develops to a certain degree without aggravation. It can be identified by detailed medical history and barium X-ray examination.
3, benign esophageal tumor: mainly rare smooth muscle tumor, the course of the disease is longer, the dysphagia is mostly intermittent. barium X-ray examination can show that the esophagus has a round, oval or lobulated filling defect, with neat edges and normal surrounding mucosal pattern.
4, hysterical ball syndrome: mostly seen in young women, sometimes there is a ball-like foreign body sensation in the pharynx, disappears when eating, often triggered by mental factors. This disease actually does not have organic esophageal lesions, and it is not difficult to differentiate it from esophageal cancer.
5.Iron deficiency pseudomembranous esophagitis: Mostly female, in addition to dysphagia, there may also be small cell hypochromic anemia, tongue inflammation, lack of gastric acid and regurgitation, etc.
6.Organ lesions around the esophagus: such as mediastinal tumor, aortic aneurysm, enlarged thyroid gland, enlarged heart, etc. Except for mediastinal tumor invading into esophagus, barium X-ray examination can show smooth indentation of esophagus with normal mucosal pattern.
Dietary attention for esophageal cancer patients
The prominent symptom of esophageal cancer patients is difficulty in swallowing, which is also a serious problem in the diet of esophageal cancer patients. Most esophageal cancer patients’ dysphagia occurs gradually and worsens progressively. At the beginning, patients only have choking sensation when eating dry food, but it gradually worsens to the extent that they have difficulty in eating soft food and semi-liquid food, and finally they have complete difficulty in drinking water and eating good food, which makes patients’ nutritional status worse and worse and finally leads to cachexia. Thus, it can be seen that difficulty in eating is a very serious problem for patients with esophageal cancer.
Early and middle stage esophageal cancer patients who have been diagnosed should seize the opportunity to increase nutrition, give them soft food or semi-liquid food with high protein and high vitamin, and make use of the absorption function of their gastrointestinal tract to supplement nutrition as much as possible, so that they can have a better physical condition to receive surgery or chemotherapy or radiotherapy.
In the diet of esophageal cancer patients, the main points to avoid are
1. When patients have choking sensation, do not swallow forcibly, otherwise it will stimulate local cancer tissue bleeding, spreading, metastasis and pain. When choking is serious, patient should have liquid food or semi-liquid food.
2.Avoid cold liquid food and cold noodles, milk, egg soup, etc. which are placed for a longer period of time should not be drunk. Because the narrow part of the esophagus to cold food stimulation is very obvious, easy to cause esophageal spasm, nausea and vomiting, pain and swelling and numbness and other feelings. Therefore, it is better to eat warm food.
3, can not eat spicy, spicy, smelly, awake stimulating food, because these foods can also cause esophageal spasm, so that the patient produces discomfort. For patients with esophageal cancer who cannot eat at all, they should be given intravenous high nutrition to maintain the needs of the patient’s organism.
How to “eat well” after esophageal and cardia cancer patients is very important, which can be divided into four stages.
Nasal feeding stage 1~5 days after surgery, the patient is just in the traumatic period of surgery, the anastomosis has not yet healed, the gastrointestinal function has not yet recovered well, and the digestive function is poor. During this period, only nasal feeding can be used. It is a very thin and specially designed nutrition tube placed through the nose directly to the jejunum to deliver nutrition. During the nasal feeding stage, the patient can be fed with mixed milk, vegetable juice, fruit juice, rice soup, etc. The amount of infusion can be divided into 2 to 3 drips from 500 ml on the first day, and then increased to 1500 to 2000 ml per day according to the patient’s tolerance. The temperature at the time of dripping is appropriate to approximate the body temperature. It is required that the nasal nutrition solution should contain protein, fat, carbohydrate, vitamin, salt and water in appropriate proportions as far as possible.
The fluid phase refers to 5 to 10 days after surgery. During this period, the patient has basically passed the surgical trauma period, and the gastrointestinal function starts to recover gradually, which is manifested as having appetite and anal exhaust (commonly known as farting). A small amount of plain water (3 to 5 tablespoons) can be given at first, gradually increasing to 30 to 50 ml. If there is no obvious discomfort, rice soup, egg soup, fresh milk, fish soup and various types of poultry simmered soup can be given, 100 to 200 ml each time, 5 to 7 times a day.
The semi-fluid diet phase begins in the second postoperative week. During this period, all kinds of drains left in patients after surgery have been removed, and intravenous fluid infusion is gradually stopped. Except for some elderly or super-elderly patients who cannot get out of bed, most of them can walk and move around, and the amount of food is gradually increased. However, during this period, only small and frequent meals can be eaten, with easily digestible non-slag food (such as thin rice, noodles, egg custard, tofu, etc.), especially some patients with large preoperative food intake should not eat a lot to avoid causing gastrointestinal complications or anastomotic fistula.
Normal diet phase This phase usually starts from the fourth week after surgery. During this time, most patients have been discharged from the hospital to rest at home and are being cared for by their own loved ones. At this time, the diet can be expanded as much as possible (except for fried and sweet foods), except for those foods that the physician specifically emphasized not to eat at the time of discharge, and the patient can be instructed to do some appropriate physical activities to facilitate digestion and absorption. During this period, a few patients may have symptoms such as epigastric fullness, diarrhea, acid vomiting, etc. They can take morpholine 20 mg (2 tablets) 3 times a day and compound phenelpodine 2 tablets 3 times a day. If the symptoms are not relieved after medication, the patient can go to hospital for consultation and treatment.
What tests should be done if esophageal cancer is suspected
1.Esophageal exfoliative cytology examination This method is simple, less painful and with low false positive rate. It has been proved through practice that it is feasible to conduct large area census in high incidence area of esophageal cancer, and the total positive rate can reach over 90%, which is the first choice for early diagnosis of esophageal cancer.
2.Barium X-ray meal imaging Except for very early esophageal cancer which is not easy to show, experienced radiologists can fully adjust the barium and make the patient swallow it in small bites, and then carefully observe in multiple directions and double air-barium imaging, which can mostly detect the signs of early cancer such as thickened esophageal mucosa, tortuous or dashed interruption; or hairy esophageal edge; or small filling defect; or small niche shadow; or limited wall stiffness; or barium retention.
3.Fiber endoscopy Since the fiber optic mirror gradually replaced the metal rigid tube mirror in 1970s, it has become a reliable method for routine clinical diagnosis, postoperative follow-up and efficacy observation of upper gastrointestinal tract diseases (esophageal cancer, gastric cancer, etc.) due to its bendability, good illumination, wide visualization, safety and accuracy. In early esophageal cancer, the detection rate of fiberoptic endoscopy can reach more than 85%.
Chest CT scan The role in diagnosing esophageal cancer varies, but it is helpful for staging, determination of resection possibility, and estimation of prognosis of esophageal cancer.
Endoscopic ultrasound examination of esophagus In recent years, endoscopic ultrasound examination of esophagus has been gradually applied in clinical practice. Its advantages are that the depth of lesion infiltration in the esophageal wall can be measured more precisely; the abnormal enlarged lymph nodes outside the wall can be measured; and the lesion in the wall part of the esophagus can be distinguished more easily.