Esophageal cancer is a common cancer in the elderly. The incidence rate increases significantly with age after people pass the age of 40, with a peak at the age of 60-65. However, do not think that prevention of esophageal cancer is a matter for the elderly, because the latent period of cancer is up to 10-20 years. Therefore, it is important to pay attention at any age.
1.Protect the esophagus The esophagus is the organ through which all food passes, and food is formed into a mass in the esophagus and enters the stomach in an orderly way for digestion. It is important to chew and swallow slowly. Saliva is secreted by three kinds of glands, which, when fully mixed with food, can promote digestion, hydrolyze starch or maltose, etc.; dilute and dissolve food and enhance the sense of taste; mucin can lubricate food and facilitate swallowing; neutralize toxic substances and sterilize. Swallowing can damage the esophagus. Do not eat food that is too hot, too hard and irritating. Otherwise the oral, esophageal and gastric mucosa will be damaged. Stimulating foods also include strong tea, strong coffee, strong alcohol, etc. Pay attention to oral hygiene. Any lesions in the oral cavity are detrimental to digestion, and if there is an infection, it can easily spread to the esophagus.
2.Reject carcinogenic food Nitrosamines are closely related to esophageal cancer, and mold can enhance the carcinogenic effect of nitrosamines. Overnight vegetables, rotten fruits, moldy food, salted fish and pickles, and fried, fried and baked food should be prohibited. Drinking water should pay attention to the water source, and tap water should also be prevented from being contaminated, otherwise it can also cause cancer. Do not smoke. Smoking can cause a wide range of cancers, and the formation of cancer can cause cancers of the digestive, respiratory and urinary tracts. No alcohol abuse. It is inevitable to drink a lot of alcohol for a long time without consuming carcinogens. Some wine contains carcinogens such as nitrosamines and aflatoxins, and indirect carcinogens such as aldehydes and alcohols.
3.Rational nutrition Epidemiological survey confirms that malnutrition is related to esophageal cancer. Lack of protein will lead to mucosal hyperplasia of esophagus, which will easily become malignant; lack of fat will hinder the absorption of essential fatty acids and fat-soluble vitamins, which will affect health and lower immune function. We should eat more fresh vegetables and fruits, the former cannot replace the latter, because cooking often destroys a lot of vitamins and trace elements. To promote the drinking of tea. Green tea can prevent cancer and is beneficial to cardiovascular disease and so on. But do not advocate booze, it is best to “taste”, to a small number of effective drink in the body. When pregnancy, breastfeeding, fever, bleeding and gastrointestinal disease, then do not or cautiously drink.
Patients suffering from esophageal cancer often lack trace elements such as iron, molybdenum, zinc, manganese, selenium and vitamins A, B2 and C. Aspirin can prevent this disease, so high-risk groups can supplement relevant trace elements, vitamins and drugs to prevent it under the guidance of physicians.
5.Actively treat esophageal diseases such as esophagitis, leukoplakia, polyps, diverticula and cardia incontinentia, which are prone to deteriorate and form cancer due to histological changes, functional variation and local stimulation. Must be closely observed, active treatment and take effective measures to prevent.
6.Wide health promotion and education work to popularize cancer prevention knowledge.
7.Conduct census to detect early cases in time to improve the cure rate.
8.Keep a good mood and do not be sulking.
9.Strengthen physical exercise (such as practicing qigong, playing tai chi, etc.).
Other tips.
1, change bad eating habits, do not eat moldy food, eat less or no sauerkraut.
2, improve water quality, reduce the nitrite content in drinking water.
3, the promotion of trace element fertilizers, correct the soil lack of molybdenum and other trace elements condition.
4.Apply Chinese and Western drugs and vitamin B2 to treat esophageal epithelial hyperplasia to block the cancer process. Actively treat esophagitis, esophageal leukoplakia, cardia laxa, esophageal diverticulum and other diseases related to the occurrence of esophageal cancer.
5.Surveillance for susceptible people, popularize cancer prevention knowledge and raise cancer prevention awareness.
6.Don’t eat too hot food, don’t eat too fast, and don’t drink too much strong alcohol to reduce the stimulation to esophageal mucosa.
7.Don’t eat moldy food and eat less sauerkraut. Because moldy grain can produce toxins. Change the habit of eating sauerkraut, sauerkraut contains a large number of nitrosamines, these substances have a strong carcinogenic effect.
8.Treat drinking water with bleach to reduce the nitrite content in water, and often take vitamin C, which can reduce the formation of nitrosamines in the stomach.
9.If you live in a region with high incidence of esophageal cancer, a male above 40 years old, usually have the habit of eating pickles, drinking alcohol, etc., and recently have difficulty in swallowing, pain or discomfort behind the sternum, you should undergo esophageal exfoliation cytology examination, barium meal X-ray examination, esophagoscopy and biopsy as soon as possible for early detection and early treatment.
10. Prohibit smoking and refrain from drinking alcohol as much as possible.
11, pay attention to hygiene, especially brush your teeth and wash your mouth every day, pay attention to oral hygiene. Change the bad habits such as coarse, hard, hot, fast and squat food in diet.
Laboratory examination of esophageal tumor
A. Barium X-ray examination of esophagus can show that the barium is stagnant at the tumor swelling point, the barium flow is thin and narrow in the lesion; the esophageal wall is stiff, the peristalsis is weakened, the mucosal pattern is coarse and disorderly, the edge is rough; the lumen of esophagus is narrow and irregular, the upper part of obstruction is mildly dilated, and there can be ulcerative niches and abandonment defects and other changes. The superficial and small tumor swelling is often not easily detected by routine barium X-ray examination. The application of sodiummethylcellulose and barium for double contrast imaging can show the esophageal mucosa more clearly and improve the detection rate of esophageal tumor.
Fiber optic esophageal gastroscopy can directly observe the morphology of tumor swelling, and biopsy can be performed under direct vision to confirm the diagnosis.
3.Esophageal mucosa exfoliation cytology examination applies wire mesh balloon double-lumen tube cell collector swallowed into the esophagus, inflate the balloon after passing through the lesion section, and then slowly pull out the balloon. The positive rate can reach more than 90%, which is often used to find some early disease, and is an important method for mass screening of esophageal tumors.
CT scan examination of esophagus can clearly show the relationship between esophagus and neighboring mediastinal organs. If the thickness of esophagus wall increases and the boundary between esophagus and surrounding organs is blurred, it means the existence of esophageal lesions.
V. Other examination methods: The application of toluidine blue or iodine in vivo staining endoscopy method has certain value for the early diagnosis of esophageal tumor. This method has the advantages of being simple and easy to perform, and accurate in locating and determining the scope of tumor swelling.
Diagnostic differentiation of esophageal tumor
Anyone who has the above clinical symptoms must consider the possibility of esophageal tumor. Through detailed medical history, symptom analysis and laboratory examination, it is generally not difficult to confirm the diagnosis.
The diagnosis of esophageal tumor can be confirmed without difficulty through detailed history, symptom analysis and laboratory examination.
This disease should be differentiated from the following diseases.
Patients with esophageal achalasia are mostly young women with a long course of disease and symptoms that are sometimes mild and severe. A barium esophageal examination reveals a smooth funnel-shaped stricture at the lower end of the esophagus, which can be dilated with the application of antispasmodics.
Benign esophageal stricture 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.
Barium X-ray examination can show round, oval or lobulated filling defects in the esophagus with neat edges and normal surrounding mucosal pattern.
Fourth, hysterical ball syndrome is mostly seen in young women, sometimes with a ball-like foreign body sensation in the pharynx, which disappears when eating, often triggered by mental factors. There is no organic esophageal lesion in this disease, and it is not difficult to distinguish it from esophageal tumor.
In addition to dysphagia, there may also be microcytic hypochromic anemia, lingual inflammation, lack of gastric acid and regurgitation.
Organ lesions around the esophagus, such as mediastinal tumors, aortic aneurysms, enlarged thyroid gland and enlarged heart. In addition to mediastinal tumors invading the esophagus, barium X-ray examination can show smooth indentation of the esophagus with normal mucosal lines
1.Surgical treatment.
Modern medical research on surgical treatment of esophageal cancer has a history of more than 100 years, and modern treatment principles of transthoracic resection of esophageal cancer and one-stage reconstruction of digestive tract have been established. At present, the 5-year survival rate of stage I esophageal cancer surgical treatment reaches 90%. With the further deepening of basic research on esophageal cancer, improvement of early diagnosis technology, innovation of surgical methods and improvement of surgery-based comprehensive treatment, the therapeutic effect of esophageal cancer will be increasingly improved.
The main surgical methods are.
(1) Surgical exploration to clarify the site, scope, degree of external invasion and metastasis of tumor.
(2) Definition of resection scope.
(3) reconstruction of esophagus, etc.
Surgical complications.
(1) pulmonary complications, with pneumonia, atelectasis and pulmonary insufficiency being the most common.
(2) anastomotic fistula.
(3) Suppurative thorax.
(4) Celiac disease, anastomotic stenosis, gastric torsion, diaphragmatic hernia, and laryngeal nerve injury are less common.
2.Radiotherapy.
Radiation therapy is less damaging, less restricted by important organs and tissues around the esophagus, and has a wider application than surgery, so it is one of the important means to treat esophageal cancer. It mainly includes radical and palliative types, and the irradiation methods include external radiation, preoperative radiation and postoperative radiation. Early stage esophageal cancer is usually curable. There is no significant difference in the overall survival rate between radiation therapy and surgery for esophageal cancer, but surgery for cervical and upper thoracic esophageal cancer is highly traumatic and has high complication rate, while radiotherapy is less invasive and has better efficacy than surgery, so radiotherapy should be preferred. Once there is lymph node metastasis in lower esophageal cancer, radiation therapy is often difficult to cure it, so surgery should be the first choice. For constricted esophageal cancer, complete obstruction of esophagus, bleeding tendency and obvious regional lymph node metastasis, surgery should be the first choice.
Radical radiation therapy can be performed for patients with moderate general condition, able to eat semi-liquid or smoothly eating liquid food, no supraclavicular lymph node metastasis and distant metastasis of thoracic esophageal cancer, no tracheal invasion, no signs of esophageal perforation and bleeding, lesion length <7-8 cm and no contraindication of internal medicine. Radiation therapy is contraindicated in cases of malignant fluid, esophageal perforation, esophagotracheal fistula, mediastinitis or abscess, and those with relatively large amounts of esophageal bleeding. Other patients may undergo palliative radiation therapy aimed at relieving esophageal obstruction, improving feeding difficulties, relieving pain, improving the quality of survival and prolonging survival. Before radiation therapy, attention should be paid to improving the patient's nutritional status, controlling local inflammation of the esophagus, and treating medical entrapment. During treatment, we should ensure patients' nutrition, prevent food obstruction, and drink more water after eating to prevent food retention at the lesion leading to infection and affecting radiotherapy sensitivity.
The main radiation modalities are.
(1) external radiation.
(2) intra-esophageal luminal proximity post-loading radiation. Radiation reactions and complications: The most common reactions and complications are radiation esophagitis, tracheitis, esophageal perforation, esophageal-tracheal fistula and hemorrhage.
(3) Chemotherapy: Chemotherapy is not only used for the treatment of advanced esophageal cancer, but also for the combination with surgery and radiotherapy.
Chemotherapy is generally used in three situations.
(1) For palliative treatment of progressive esophageal cancer with limited benefit.
(2) Preoperative treatment, alone or in combination with radiotherapy to shrink the primary tumor and improve resection rates.
(3) Combination with radiotherapy as primary therapy for esophageal cancer, combined with surgical or non-surgical treatment.
Main modalities.
(1) single drug chemotherapy, the main drug used after the 1980s is cis-chloroplatinum (DDP).
② Combination chemotherapy, most of the drugs used are bleomycin (BLM) and cisplatin (DDP). Combination chemotherapy is not only used for the treatment of advanced esophageal cancer, but also for the combined treatment with surgery or radiotherapy.
4. Combination therapy.
The purpose of combination therapy is to combine the advantages of surgery and radiation in order to improve the surgical resection rate, reduce local and intraoperative implantation and dissemination, and thus improve the survival rate.
5.Pre-operative radiotherapy.
It is mainly applied to esophageal cancer whose tumor has already invaded externally and is difficult to be resected by surgery alone in clinical judgment, but can be expected to be resected after partial regression of the tumor.
6.Post-operative radiotherapy.
For those who have residual tumor after palliative resection, postoperative pathological report of esophageal segmental cancer infiltration, overly narrow surgical margins, basic resection of tumor but clinical estimation of possible residual subclinical lesions, postoperative radiotherapy should be carried out.
7.Integrated treatment of radiation and chemotherapy.
Certain chemotherapeutic drugs can enhance the sensitivity of radiation and be used as a sensitizer, which can improve the efficacy of treatment, but further research is needed.
Nowadays, the most advanced and minimally invasive treatment is thoracoscopic radical esophageal cancer surgery, which is the most advanced and minimally invasive treatment for esophageal cancer using the highest thoracoscopic technology with outstanding effect. The thoracoscopic technology center led by Shanghai Yuanda Cardiothoracic Hospital has reached the latest technology in China for the treatment of esophageal cancer, and Shanghai Yuanda Cardiothoracic Hospital is the training base of thoracoscopic technology of Chinese Physicians Association.
Dr. Cristina Bosetti and colleagues from IstitutodiRicercheFarmacologicheMarioNegri in Milan, Italy, after analyzing data from a case-control study on the relationship between various fiber consumption and oral, pharyngeal and esophageal cancers in Italy, published a study in the International Journal of Cancer concluding that a high fiber diet can prevent oral, pharyngeal and esophageal cancers. pharyngeal and esophageal cancers. The cases included 271 patients with oral cancer, 327 patients with pharyngeal cancer, and 304 patients with esophageal cancer. The control group consisted of 1,950 patients with acute non-cancerous conditions.
The researchers administered a food questionnaire to these patients during their hospitalization. Age, sex and other confounders (including alcohol consumption, smoking and energy intake) corrected ratio ratios (OR) were also calculated.
The ratio ratios for the highest and lowest quintiles of fiber intake in patients with oral, pharyngeal, and esophageal cancer were 0.40 for total fiber, 0.37 for soluble fiber, 0.52 for cellulose, 0.48 for insoluble noncellulosic polysaccharides, 0.33 for total insoluble fiber, and 0.38 for lignin, respectively.
The same inverse relationship was found for vegetable fiber, fruit fiber and cereal fiber, with ratios of 0.51, 0.60 and 0.56, respectively, but the inverse relationship was stronger in oral and pharyngeal cancers than in esophageal cancers, while the ratios were similar in men and women.
The present findings further confirm the findings of studies conducted in North America and Europe on upper gastrointestinal tract tumors associated with whole cereal grains.