Esophageal cancer, also called esophageal cancer, is a malignant tumor that occurs in the epithelial tissue of the esophagus, accounting for 2% of all malignant tumors. There is a possibility of cure for esophageal cancer in early and middle stages; treatment methods include surgery including palliative surgery and radical surgery, radiation therapy, chemotherapy, targeted therapy, Chinese medicine and herbal medicine. The occurrence of esophageal cancer is related to chronic stimulation by nitrosamines, inflammation and trauma, genetic factors, and the content of micronutrients in drinking water, grain and vegetables. China is a high incidence area of esophageal cancer, with more men than women, and most of them are over 40 years old. Let us see the “appearance” of esophageal cancer (different performance in different stages) 1. Early symptoms of esophageal cancer 1. Choking sensation is the most common, which can disappear and recur on its own and does not affect eating. It can disappear and recur on its own and does not affect eating. It often occurs when the patient’s mood fluctuates, so it is easy to be mistaken as a functional symptom. 2.Post sternal and subxiphoid pain is more common. When swallowing food, there is pain behind the sternum or under the raphe, the nature of which can be burning, pins and needles, or pulling, to swallow rough, burning or irritating food. It is intermittent at the beginning, and when the cancer invades nearby tissues or has penetration, there can be severe and continuous pain. The site of pain often does not exactly coincide with the site of the lesion in the esophagus. The pain can mostly be relieved temporarily by antispasmodics. 3, food retention infection and foreign body sensation when swallowing food or drinking water, there is a slow downward movement of food and the feeling of retention, as well as tightness behind the sternum or food adherence to the esophageal wall and other sensations, disappeared after eating. The location of the symptoms is mostly consistent with the location of the lesion in the esophagus. 4. Dryness and tightness of the throat, especially when dry and rough food is swallowed, are often associated with emotional fluctuations of the patient. 5.Other symptoms, a few patients may have the discomfort and anterior pain of the sternum. 1, the most common pharyngeal choking sensation, can be self-selected disappearance and recurrence, does not affect the food. It often occurs when the patient’s mood fluctuation, so it is easy to be mistaken for functional symptoms. 2.Post sternal and subxiphoid pain is more common. When swallowing food, there is retrosternal or subxiphoid pain, the nature of which may be burning, pins and needles, or pulling, to swallow rough, burning or irritating food. It is intermittent at the beginning, and when the cancer invades nearby tissues or has penetration, there can be severe and continuous pain. The site of pain often does not exactly coincide with the site of the lesion in the esophagus. The pain can mostly be relieved temporarily by antispasmodics. 3, food retention infection and foreign body sensation when swallowing food or water, there is a slow downward movement of food and retention of the feeling, as well as the sense of tightness behind the sternum or food adherence to the esophageal wall and other sensations, disappear after eating. Symptoms occur in parts of the esophagus consistent with the location of the lesion. 4.Dryness and tightness in the throat are especially obvious when dry and rough food is swallowed, and the occurrence of this symptom is often related to the patient’s emotional fluctuations. 5. Other symptoms: A few patients may have the discomfort of tightness and swelling behind the sternum, anterior pain and kojon (19) typical symptoms of mid-stage esophageal cancer: progressive dysphagia. There may be pain behind the sternum when swallowing and spitting mucus-like sputum. Late stage esophageal cancer symptoms 1. Difficulty in swallowing: Difficulty in swallowing is the main symptom of the vast majority of patients, but it is the late stage of the disease. Because the esophageal wall is rich in elasticity and expansion ability, dysphagia only occurs when about 2/3 of the circumference of esophagus is infiltrated by cancer. Therefore, after the appearance of the above early symptoms, the disease gradually worsens in a few months, from inability to swallow solid food to inability to swallow liquid food. Difficulty in swallowing may be aggravated if the cancer is accompanied by inflammation, edema and spasm of the esophageal wall. The location of obstruction often conforms to the site of the cancer. Food reaction often occurs when the difficulty in swallowing is aggravated, and the regurgitant flow is not large, containing food and mucus, or blood and pus. Other symptoms: when the cancer compresses the recurrent laryngeal nerve, it may cause hoarseness; when it violates the phrenic nerve, it may cause eructation or phrenic nerve paralysis; when it compresses the trachea or bronchus, it may cause shortness of breath and dry cough; when it erodes the aorta, it may cause fatal hemorrhage. When esophageal-tracheal or esophageal-bronchial fistula occurs or the cancer is located in the upper esophagus, cervical sympathetic nerve paralysis can be produced when swallowing liquid. Signs of esophageal cancer: There are no signs in early stage. In the late stage, patients may suffer from malnutrition due to difficulty in eating, which may lead to signs of emaciation, anemia, water loss or cachexia, etc. When the cancer metastasizes, it may be palpable. When the cancer metastasizes, enlarged and hard superficial lymph nodes or enlarged and nodular liver can be touched. Jaundice and ascites may also be present. Other rare signs include nodules at the skin and abdominal white line, and enlarged lymph nodes in the groin. Figuring out his “strength” (applying scientific means to understand the condition) Several conventional diagnostic methods of esophageal cancer: 1. Fiberoptic endoscopy: Since the 1970s, fiberoptic endoscopy has gradually replaced metal rigid tube mirror, due to its bendability, good illumination, wide vision, safety and accuracy, it has become the most important method to check the diseases (esophageal cancer, gastric cancer, gastric cancer, etc.) in the upper GI tract, and it can also be used in the examination of the upper GI tract and gastric cancer. Since fiberoptic microscopy replaced metal rigid tube in the 1970s, it has become a reliable method for routine clinical diagnosis, postoperative follow-up and observation of therapeutic effect of upper gastrointestinal tract diseases (esophageal cancer, gastric cancer, etc.). In early esophageal cancer, the detection rate of fiberoptic endoscope can reach more than 85%. Esophageal endoscopic ultrasonography: In recent years, esophageal ultrasonography has been gradually applied in clinical practice. Its advantages are that it can accurately determine the depth of infiltration of lesions in the esophageal wall; it can measure the abnormal enlarged lymph nodes outside the wall; and it can easily distinguish the lesions in the esophageal wall. Esophageal exfoliative cytology: this method is simple, less painful and with low false-positive rate, which has been proved to be practicable in the large-scale census in the high incidence area of esophageal cancer, and the total positive rate can reach more than 90%, and is the preferred method for early diagnosis of esophageal cancer. X-ray barium meal contrast of esophageal cancer diagnosis: except for very early esophageal cancer which is not easy to be shown, experienced radiologists can adjust the barium adequately, make the patient swallow in small bites in several times, and then observe carefully in multi-direction and gas-barium double contrast, which can mostly find the thickening of esophageal mucous membrane, tortuous or dotted interruption, or esophageal hairy edges, small filling defects, small niches, or confined stiffness of the wall of the tube or barium stagnation. The signs of earlier cancer such as barium retention. Chest CT scan of esophageal cancer diagnosis: the role in diagnosing esophageal cancer varies, but it is helpful for the staging of esophageal cancer, the judgment of resection possibility and the estimation of prognosis. V. Scientific victory over esophageal cancer (knowledge to be grasped by family members and nurses) I. Preoperative nursing 1. Psychological nursing The patient has progressive dysphagia, is getting thinner and thinner, has poor tolerance to surgery, lacks confidence in treatment, and has a certain degree of fear of surgery. Therefore, we should explain, comfort and encourage the patient’s psychological state, establish a fully trustful nurse-patient relationship, make the patient realize that surgery is a complete treatment method, and make him/her willing to accept surgery. 2.Strengthen the nutrition Those who can still eat should be given fluid or semi-fluid diet with high calorie, high protein and high vitamin. Those who can not eat should be given intravenous supplementation of water, electrolytes and calories. For patients with hypoproteinemia, blood or plasma protein transfusion should be given to correct it. 3, gastrointestinal preparation ①, pay attention to oral hygiene ②, preoperative placement of gastric tube and duodenal drip tube ③, preoperative fasting, food retention, preoperative night with isotonic saline esophageal flushing, is conducive to reducing tissue edema, reduce postoperative infection and anastomotic fistula incidence. ④, for those who intend to have colon instead of esophagus, preoperative care should be prepared according to colon surgery, see preoperative preparation for colorectal cancer. Preoperative exercises should be taught to the patients, such as deep breathing, effective coughing, sputum evacuation and defecation in bed. In addition to observing the vital signs and other routine nursing care, patients should also: 1. Keep the gastrointestinal decompression tube open. A small amount of blood should be regarded as normal when it drains out 24-48h after operation, and report to the doctor for treatment immediately if a large amount of blood is drained out. The gastrointestinal decompression tube should be kept for 3 to 5 days to reduce the anastomotic tension and facilitate healing. Pay attention to the accurate connection of gastric tube, fix it firmly to prevent dislodgement and smooth drainage. Closely observe the amount and nature of thoracic drainage fluid If abnormal bleeding, turbid fluid, food residue or coeliac discharge is found in the thoracic drainage fluid, it suggests that there is active bleeding in the thoracic cavity, esophageal anastomotic fistula or coeliac chest, and corresponding measures should be taken to make a clear diagnosis and deal with it. If there is no abnormality, the drainage tube should be removed 1~3 days after operation. 3, strict diet control The esophagus lacks plasma membrane layer, so the anastomosis healing is slower, and the postoperative period should be strictly fasting and water fasting. During the period of fasting, intravenous rehydration should be performed daily. For those who put duodenal drip tube, after the recovery of intestinal peristalsis on the 2nd day after surgery, nutrient solution can be dripped through the catheter to reduce the amount of fluid infusion. On the 5th day after surgery, if there is no special change in the condition, milk can be fed orally, 60 ml each time, every 2hl times, the interval can be given the same amount of boiled water, if there is no adverse reaction, the amount can be increased day by day. The 10th to 12th postoperative day to change the slag-free semi-liquid diet, but should pay attention to prevent eating too fast and too much. 4, observe the symptoms of anastomotic fistula The clinical manifestations of esophageal anastomotic fistula are high fever, rapid pulse, dyspnea, severe chest pain, intolerable; low respiratory tone on the affected side, turbid tone on percussion, elevated leukocytes and even shock. Treatment principles: ① pleural cavity drainage, promote lung expansion; ② choose effective antibiotics to fight infection; ③ replenish sufficient nutrition and calories. At present, complete gastrointestinal nutrition (TEN) is mostly used to treat by gastrostomy instillation, and the effect is exact and satisfactory. Characteristic treatment. Dietary care Emphasize on dietary care, during the treatment period, light, nutritious and easy-to-digest food should be given, and should pay attention to the color, aroma, taste and shape of the food in order to improve appetite and ensure nutrition; during the intervals between treatment, it is advisable to give more food with the effect of blood tonic, blood nourishment and qi tonic to improve the body’s resistance to disease. Fourth, psychological care Strengthen emotional care, comfort patients, eliminate tension, fear, depression, depression and other psychological, patient treatment explanation. If there is hair loss, hair sets can be configured, and if the condition permits, patients can be organized to take a walk and recreational activities, so as to make patients in the process of chemotherapy in the best physical and mental state.