“This year I am 62 years old, from the age of 16 or 7 to work in the city, mason, small coal kiln have done, and later in the coal mine turned positive, down the shaft as a coal digger. The company’s main business is to provide a wide range of products and services to the public.
In the beginning, there was no major problem, but it was a little hard to swallow when eating, and then I felt a little choked, and my chest was a little uncomfortable, so I thought I was smoking too much, so I quit again, and I stopped drinking. The company’s main business is to provide a wide range of products and services to its customers.
Then my child took me to the hospital, had a film taken and a gastroscopy done, and the final diagnosis was esophageal cancer, which is closer to the throat and cannot be operated on.”
Once detected, it is advanced, which is the epitome of millions of esophageal cancer patients.
In China, roughly 50% of patients with esophageal cancer have progressed to an advanced stage by the time they are first diagnosed, losing the opportunity for surgical cure. Compared to other common tumors of the digestive tract, the survival time for advanced esophageal squamous carcinoma is relatively short. Without treatment, patients typically have only 6 to 8 months to survive, with a 5-year survival rate of less than 15%.
The most painful thing for patients with advanced esophageal cancer is the difficulty in swallowing, they can only eat liquid or semi-liquid food, and in severe cases, they can only drink water.
The further spread of cancer cells may also compress the trachea, causing coughing or breathing difficulties; if the tumor penetrates the esophagus and forms a fistula between the trachea and the esophagus, food residue may enter the lungs and induce pneumonia or lung abscess. Of course, advanced esophageal cancer may also invade nerves and blood vessels and metastasize to other parts of the body such as liver, brain and bone ……
The danger of esophageal cancer is like planting a time bomb in the middle of one’s chest that has already started counting down, as if one can hear the ticking sound of the ticking clock. The root cause of all the suffering of advanced patients lies in this bomb that cannot be defused.
The road to treatment for advanced esophageal cancer
Inoperable means, to a large extent, a lost chance of a cure. Therefore, “how to live better, how to live longer” is our primary concern. Modern medicine has many options, such as radiotherapy, chemotherapy, targeted therapy, and immunotherapy, which can control the progression of cancer to some extent, improve the quality of life by improving uncomfortable symptoms such as difficulty swallowing and pain.
Radiotherapy
95% of all esophageal cancers in China are squamous, a type that is more sensitive to radiation. Radiotherapy targeting the lesions of advanced esophageal cancer can locally shrink the mass, reduce the symptoms of dysphagia, improve the eating status, improve the quality of life, and prolong life to some extent.
Some advanced patients develop bone metastases and brain metastases, causing bone pain or headaches in the metastatic area, and systemic treatment modalities such as chemotherapy are difficult to reduce these symptoms. At this point, radiation therapy becomes an important modality to improve cancer pain.
Extended reading: Why do doctors recommend radiotherapy when esophageal cancer is not curable?
Chemotherapy
For patients with squamous esophageal cancer, chemotherapy is not as sensitive as radiation, but it is still a powerful treatment. Many people say that chemotherapy is “worse than death” or “faster than death”.
Chemotherapy has side effects, and they are not small, which is a disadvantage, but it is not advisable to “demonize” chemotherapy. The main thing is to listen to your doctor’s professional opinion on the pros and cons of chemotherapy.
Targeted therapy
First of all, it should be noted that there is no targeted drug that can treat esophageal cancer that has been approved for clinical use, both domestically and internationally. Although there are many potential therapeutic targets for esophageal cancer and the prospect of treatment with targeted drugs is promising, the targets are more dispersed, making it difficult for scientists to focus their firepower on attacking them.
At present, most potential targeted drugs for esophageal cancer are still in clinical trials or preclinical studies. There is still a long way to go before they can actually be used in the clinic.
Also, anti-angiogenic therapy, which is a treatment using vascular-targeted drugs, has the potential to be used for esophageal cancer in the future. The main purpose of vascular-targeted drugs is to improve the microenvironment around the tumor and block the production of blood vessels that feed the tumor. If the tumor is compared to an invading army, the microenvironment around the tumor is the “food”. Chemotherapy is a direct attack on the tumor itself, while anti-angiogenic drugs can cut off the supply of “food and grass”. The combination of the two may have a greater effect.
Immunotherapy
In recent years, what really put immunotherapy on the stage of oncology treatment was the successful use of immune checkpoint inhibitors.
● Checkpoints are a series of molecules expressed on immune cells that regulate the degree of immune activation and play an important role in preventing autoimmunity (abnormal immune function that attacks normal cells) from occurring. The tumor cells have learned to use this mechanism to “exploit” the immune cells, so that these “human police” are not working, and they can escape surveillance and survive.
At this time, immune checkpoint inhibitors are not approved for the treatment of esophageal cancer. If you want to be treated with an immune checkpoint inhibitor, you need to participate in a clinical trial.
Supplementation, too, is a weapon in the fight against cancer
Once the fate of the disease takes hold, patients with advanced esophageal cancer often find it difficult to eat, and with insufficient nutritional intake and energy consumption by the tumor, the body becomes severely malnourished.
Different stages require different nutritional regimens. The nutrition here is not as simple as having some fish soup or rib soup, but requires the guidance of a professional nutritionist.
● For patients with a long life expectancy, dietary guidance, oral nutritional supplementation, enteral nutrition tube feeding or parenteral nutrition support are needed;
● for patients with a life expectancy of only a few weeks or less than 2 months, oral nutritional supplementation or moderate rehydration therapy based primarily on the person’s desire to eat on their own, rather than invasive intravenous nutritional support and massive rehydration therapy is recommended;
● In terminally ill patients, nutritional support is primarily for the relief of hunger and thirst.
Advanced esophageal cancer has to face a torment of disease that is often unimaginable to normal people. Although modern medicine cannot completely eliminate every cancer cell in advanced patients, it can still control the tumor and allow patients to live and survive better.
The 5-year survival rate for patients with early-stage esophageal squamous carcinoma is 85% to 90% after surgical resection, while most patients with advanced disease are inoperable and have a 5-year survival rate of less than 15%. This huge difference in survival tells us that to fight the disease, early detection, early diagnosis and early treatment is the only way to actively choke the throat of fate.