Esophageal cancer refers to malignant lesions formed by abnormal proliferation of esophageal squamous or glandular epithelium. Its development generally passes through the stages of epithelial atypical hyperplasia, carcinoma in situ and invasive carcinoma. Esophageal squamous epithelial atypical hyperplasia is an important precancerous lesion of esophageal cancer, and it usually takes several years or even a dozen years from atypical hyperplasia to cancer. Because of this, some esophageal cancers can be detected early and can be completely cured. Patients with dysphagia or foreign body sensation should undergo gastroscopy as soon as possible to detect early esophageal cancer or precancerous lesions. Causes Esophageal cancer, like other malignant tumors, has a background of genetic changes and involves a complex process of multi-factor, multi-stage, multi-gene variation accumulation and interaction, involving many proto-oncogenes, oncogenes and protein changes at the molecular level. However, long-term poor living or eating habits may be the culprit for the occurrence of esophageal cancer. At present, it is believed that the main risk factors for esophageal cancer are: eating foods containing more nitrosamines (e.g. pickles) or moldy foods, long-term preference for hot food (e.g. the high incidence of esophageal cancer in Chaoshan people may be related to long-term drinking of kung fu tea), bad habits (e.g. smoking and drinking alcohol), etc. China is a region with high incidence of esophageal cancer, ranking fourth in tumor death. Clinical manifestations Esophageal cancer is insidious in origin and may be asymptomatic in early stage. Some patients have foreign body sensation in esophagus, or slow or obstructive choking feeling when passing food. It may also manifest as burning, pinching or pulling pain behind the sternum when swallowing. Progressive esophageal cancer is often diagnosed with dysphagia, which is progressive in development and even completely unable to eat. It is often accompanied by vomiting, epigastric pain, weight loss and other symptoms. Late stage of the disease may be accompanied by obvious malnutrition, emaciation and cachexia due to long-term lack of food intake, and complications such as cancer metastasis and compression may occur. Such as hoarseness caused by cancer compression of laryngeal nerve, pain caused by bone metastasis, jaundice caused by liver metastasis, and other symptoms. When the tumor invades the neighboring organs and is complicated by perforation, it may also cause mediastinal abscess and pneumonia. Some patients may occasionally feel a hard abdominal mass in the upper abdomen or touch enlarged lymph nodes on the clavicle. It is worth noting that other diseases of esophagus such as gastroesophageal reflux, esophageal cardia failure, esophagitis, benign esophageal stricture, etc. may also show the above symptoms, so it does not mean that with the above symptoms, one has esophageal cancer, but if these symptoms appear, one must go to hospital for examination to exclude whether one has esophageal cancer. Diagnosis and differentiation Early diagnosis of esophageal cancer is important. Esophageal cancer refers to malignant tumor occurring from esophagus, which often has a long process of occurrence, that is to say, it cannot appear suddenly like a cold and fever. Generally speaking, it is believed that the occurrence of esophagus should go through the stages of epithelial atypical hyperplasia, carcinoma in situ, invasive carcinoma, metastatic carcinoma and so on. Atypical hyperplasia and carcinoma in situ can be completely cured. Esophageal squamous epithelial atypical hyperplasia is an important precancerous lesion of esophageal cancer, and it usually takes several years or even a dozen years from atypical hyperplasia to cancer. Esophageal invasive cancer, also known as progressive cancer, can be cured in about half of patients, but when it comes to metastatic cancer, it is less likely to be cured and generally can only control the disease, therefore, esophageal cancer emphasizes early diagnosis. Gastroscopy is preferred, even essential! Since the key to cure esophageal cancer is early detection and early treatment. Therefore, anyone who is over 50 years old and has stagnant feeling after eating or difficulty in swallowing should have gastroscopy in time. Generally speaking, gastroscopy rarely misses the diagnosis of esophageal cancer, and if the gastroscopy photos are clear, even if the gastroscopy is done in a small hospital, and the report says that there is no lesion in the esophagus, it will be fine, and there is no need to go to a big hospital for repeated gastroscopy. However, if gastroscopy in a small hospital reveals lesions in the esophagus and cannot prove whether it is esophageal cancer or precancerous lesions, it is necessary to seek consultation with experienced doctors. Gastroscopy can directly observe the tiny lesions, and at the same time, it can easily clamp the lesion tissue for pathological examination, so it is the main examination means for esophageal cancer diagnosis at present. When an endoscopist finds esophageal cancer, it is generally not easy to judge whether it is early stage cancer or late stage cancer because the early and late stage of cancer does not depend on the size of tumor, which is not commonly understood as large tumor is late stage, but on the depth of tumor infiltration in the esophageal wall. If the tumor infiltrates more than half of the esophageal wall, it is the progressive stage. If ultrasound endoscopy should be done, the depth of tumor infiltration can be observed, therefore, in order to determine the treatment plan, the doctor will often suggest the patient to have another ultrasound endoscopy. It is worth noting that gastroscopy finding lumps or ulcers in esophagus does not indicate malignant tumor, because some benign lesions, such as esophageal tuberculosis, Crohn’s disease, etc., can also show similar manifestations, therefore, gastroscopy finding esophageal lesions after clamping tissue for pathological examination is necessary. If no clear pathology report is available, surgeons generally will not do surgical treatment and internists will not dare to rashly administer chemotherapy. Since endoscopic biopsy for pathological examination has too little tissue to be clamped, clinically it is sometimes not clearly reported as esophageal cancer, leading to repeated gastroscopy, and experienced doctors can reduce the occurrence of the variant. Some other imaging methods such as barium esophagogram are most commonly used, mainly for those patients who are not suitable for gastroscopy, but these methods can only detect progressive or larger lesions of esophageal cancer, and have limited effect on detection of early stage cancer or precancerous lesions, therefore, they are not recommended as routine examinations. CT examination has similar limitations and is not a substitute for gastroscopy. However, after the diagnosis of esophageal cancer is confirmed, doctors often recommend patients to have CT examination again, the purpose of which is mainly to observe whether there is metastasis or spread of esophageal cancer outside the esophagus. If it is clear that there are tumors in other organs, it means that esophageal cancer is in advanced stage and the treatment plan is different, and surgery is not done as the main method. If the experience condition is better, patients with esophageal cancer can be recommended to do positron emission tomography (i.e. PET-CT examination), which is a simpler and more convenient method to find out whether there is systemic metastasis of esophageal cancer, and its principle is to take advantage of the fact that tumor cells are high metabolism cells, which eat more than normal cells and are not full. If there are cancer cells in the body, they will eat a lot of sugar when they see it, while normal cells will stop eating after eating a little. As a result, if there is a large amount of marked sugar accumulated in the body during CT scan, where it may be a tumor, these discoveries where there is a tumor and where the tumor has metastasized to will be clear at a glance. Disease treatment Esophageal cancer, like other malignant tumors, emphasizes early diagnosis and early treatment. Pre-cancerous lesions or early cancer confirmed during gastroscopy can be removed by endoscopic peeling or local surgery. If cancer cells are confirmed to be not deeply infiltrated in the esophageal wall, chemotherapy is not needed; however, when cancer cells are deeply infiltrated in the esophageal wall, doctors will recommend patients to have surgery and recommend to combine with radiotherapy or chemotherapy. Upper esophageal cancer is close to the pharynx, so it is more difficult to have surgery, so radiotherapy is the main treatment, and the effect is similar to surgery. For middle and lower esophageal cancer, surgical resection is preferred, together with chemotherapy, radiotherapy and other symptomatic supportive treatment. If the tumor is too advanced to be resected, but in order to relieve the symptoms such as solving the eating problem, tumor reduction, diversion or fistula can be performed. Early stage cancer resection can achieve radical effect, while those with distant metastases are generally not suitable for surgery and can only be treated with palliative care or chemotherapy. Thoracoscopic esophageal cancer resection has little damage to chest wall, light impact on cardiopulmonary function, late recovery and few complications. Clinical data show that this surgery can achieve radical resection for early and middle stage cancer. The key of the operation is lymph node dissection, which has a lot to do with the experience of the operator. Patients with advanced esophageal cancer who cannot eat, or patients with esophageal stricture or with esophageal fistula can adopt endoscopic stent implantation to relieve esophageal obstruction. After diagnosis, patients with esophageal cancer often need to undergo surgery, radiotherapy and other treatments. During the treatment process, it will bring different degrees of pain and trouble to patients. The mental state and nutritional status of patients are closely related to the outcome and prognosis of treatment. Therefore, both patients and family members should communicate more with doctors, establish correct anti-disease concept, overcome fear of disease and cooperate with treatment with optimistic attitude. The diet of esophageal cancer patients should focus on lightness, but some patients like to taste heavy, but too light affects patients’ appetite, so the diet should pay attention to patients’ personal appetizing food, as long as there is nutrition, they can eat whatever they like. Conditions can be more stewed broth, eggs, fish, shrimp, a variety of meat, pig liver and other foods with high protein content are very good nutrition, but also appropriate supplement some milk powder, milk, soy milk, etc.. Vegetables help to replenish vitamins. Disease care After esophageal cancer surgery, because a section of esophagus has been removed, the esophagus becomes shorter, plus there is often anastomitis secondary to surgery, and there are different degrees of narrowing in the gastroesophageal connection, so when eating, food cannot enter the stomach as quickly as normal people, but is easily retained in the esophageal cavity and refluxed to the pharynx and trachea cavity, which can easily cause symptoms such as difficulty in eating and coughing. This situation is like pouring wine into a small wine glass, too fast or too large an amount will easily spill out. The most common complication of postoperative reflux esophagitis is acidic fluid or food reflux in the pharynx or mouth, often accompanied by burning or painful sensation behind the sternum and difficulty in swallowing. Therefore, post-operative patients with esophageal cancer should pay attention to diet, chew slowly and have small and multiple meals. After meals, it is better to stand up and take a walk, and when sleeping, put the pillow up so that the head and shoulders are in a state of “high pillow”, which can help prevent gastroesophageal reflux. If there are obvious respiratory infections, such as persistent cough, purulent sputum, chest tightness and difficulty in breathing, patients should go to hospital for active treatment in order to improve the quality of life after surgery. Patients are prone to nausea, vomiting, loss of appetite, etc. during radiotherapy for esophageal cancer. Generally, they can recover by themselves after treatment, and those with heavy reactions can be treated with drugs.