The cardia is the part of the stomach that connects to the esophagus and is the entrance to the upper part of the stomach, where food from the esophagus enters the stomach through the cardia. The muscle structure around the cardia prevents food and acid from entering the stomach from flowing back into the esophagus. Cardia cancer is an adenocarcinoma that occurs within about 2cm below the esophagogastric junction line. It is a special type of gastric cancer with its own anatomical and histological characteristics and clinical manifestations, and most cardia cancers are found in the middle and late stages, and the effect of surgical treatment is relatively poor. Nowadays, it is more standardly named as combined esophagogastric cancer, including type 1, type 2 and type 3. Type 1 is adenocarcinoma of the lower esophagus, type 2 is true cardia cancer, and type 3 is subcardia type.
In China, the mortality and incidence rate of pancreatic cancer ranks the highest among all types of malignant tumors. Some information shows that the mortality rate of pancreatic cancer accounts for about 12% of the total mortality rate, and the death caused by it in high incidence areas reaches 20% of the total causes of death of residents. Therefore, early detection, early diagnosis and early treatment are the basic principles to improve the survival rate of pancreatic cancer.
Diagnostic methods for early pancreatic cancer include fiberoptic gastroscopy and upper gastrointestinal X-ray barium meal angiography. Early barium radiography of pancreatic cancer shows subtle mucosal changes, small ulcerative niches and less obvious but constant filling defects, due to the small, shallow and limited lesions, the features of early pancreatic cancer radiography are not obvious, so the diagnosis often relies on fiberoptic esophagoscopy and gastroscopy combined with brush cytology and biopsy pathology.
In the middle and late stage cases, the foci seen on X-ray are clear, including soft tissue shadow, mucosal destruction, ulcer, niche shadow, filling defect, distorted and narrowed cardia channel, invasion of the lower esophagus, and infiltration of the gastric wall in both the large and small curved gastric body of the gastric fundus and reduction of gastric volume.
Clinically, the progressive stage of pancreatic cancer is generally classified into 4 types.
①Elevated type: The tumor is a lump with clear edges that bulges into the lumen, in the shape of cauliflower, nodular mass or polyp, and may have shallow ulcers;
(2) Restricted ulcer type: the tumor is deeply ulcerated, and the marginal tissues are raised like a dike, and the boundary between the cut surface and normal tissues is clear;
③Infiltrative ulcer type: the edge of the ulcer is not clear, and the cut surface is not clearly demarcated from the surrounding tissues;
Infiltrative type: the tumor infiltrates and grows in the wall of cardia, and the involved area is uniformly thickened without boundaries with the surrounding tissues, and the surrounding mucosa is often contracted radially.
The general staging of cardia cancer is related to the histological type. The two types, augmented type and limited ulcerated type, are more frequently associated with highly differentiated adenocarcinoma and mucinous adenocarcinoma. The infiltrative ulcerative type has an increased proportion of low-differentiated adenocarcinoma and mucinous adenocarcinoma. Most of the infiltrative types are low-differentiated diffuse adenocarcinoma or mucinous adenocarcinoma. The prognosis of surgical treatment is best for the augmented type, second for the limited ulcerated type, worse for the infiltrated ulcerated type, and worst for the infiltrated type.
There are two main histological types of adenocarcinoma of the cardia: adenocarcinoma and mucinous adenocarcinoma with significant mucus secretion. These two types are divided into three subtypes: highly differentiated, poorly differentiated and diffuse according to the degree of differentiation. The degree of differentiation is closely related to the prognosis of surgery. In addition to adenocarcinoma and mucinous adenocarcinoma, there are some rare histological types of cardia cancer, such as adenosquamous carcinoma, undifferentiated carcinoma, carcinoid tumor and carcinosarcoma.
There are three main treatment methods for cardia cancer: surgery, chemotherapy and radiotherapy. The preferred method of treatment at this stage is surgery. Surgery includes lower thoracic esophagectomy, proximal gastric or total gastrectomy and lymph node dissection. Because cardia cancer is not sensitive to radiation, chemotherapy is mainly used as preoperative or postoperative adjuvant treatment for intermediate and advanced cardia cancer.
The following symptoms may be the early clinical manifestations of pancreatic cancer.
1. Intermittent posterior sternal distension or pain. It is especially obvious when eating rapidly.
2. Foreign body sensation when swallowing food. When people eat food passing through the lesion, it will produce foreign body sensation, which feels like something can’t be swallowed all the time, especially when swallowing dry and hard food. Since these symptoms are mild and occur intermittently, they are easily overlooked.
3. Food stagnation or stuttering sensation. The patient seems to have a feeling of stagnation and frustration when swallowing food at a certain place, which is intermittent and usually becomes obvious only after the development of the lesion.
4. Chest distension and dryness of the throat. That is, there is always a stuffy phenomenon in the front of the chest, as if there is an object blockage, so that the chest is a tight feeling, especially obvious when swallowing food, in general, does not affect normal life and work.
5.Sense of fullness under the glabella or in the upper abdomen. It also occurs intermittently and is most pronounced when eating dry and hard food.
Gradually worsening difficulty in swallowing is a typical manifestation of esophageal cancer and cardia cancer in the middle and late stages.
Indications for surgery of cardia cancer
So far, surgery is recognized as the treatment of choice for cardia cancer.
①Diagnosis confirmed by X-ray, cytology and endoscopy;
②Excluding lymph nodes, liver, adrenal gland, omentum, peritoneum and pelvic metastasis by ultrasonography, abdominal CT scan or laparoscopy, without ascites;
③General condition is moderate or above, without major cardiopulmonary or other organ comorbidities.
What are the causes of pancreatic cancer?
The etiology of pancreatic cancer is complex, and like other tumors, the cause is unknown. It may be related to dietary factors, environmental factors, genetic factors and H. pylori infection, and may be related to gastroesophageal reflux and esophageal hiatal hernia. Atypical hyperplasia is a precancerous lesion of pancreatic cancer. The average age of onset of pancreatic cancer patients with positive family history is significantly younger than that of patients with negative family history, suggesting that genetic factors play a role in the development of pancreatic cancer.
There are many factors that induce pancreatic cancer. To effectively prevent pancreatic cancer, the following points must be noted in daily life.
1.Do not smoke. According to statistics, smoking is one of the main factors that induce pancreatic cancer, and long-term smoking can directly induce pancreatic cancer. According to relevant data, the incidence of cardia cancer in smokers is 10 times higher than that in non-smokers.
2.No alcohol abuse. Alcohol is very stimulating to the mucous membrane of the cardia and can easily cause degeneration and necrosis of the mucous membrane on the surface of the cardia. Alcohol also contains many carcinogenic substances such as nitrosamines and flavonoid. According to statistics, the incidence of pancreatic cancer is 10 times higher in alcohol drinkers than in non-drinkers. The incidence of cardia cancer is 30 times higher in smokers and drinkers than in non-smokers and non-drinkers. Alcohol consumption can significantly increase the risk of tumors in the upper gastrointestinal tract. It has been shown that the flushing reaction can be a biological marker for the risk of pancreatic cancer in alcohol drinkers, and the risk of pancreatic cancer is also present in those who drink less alcohol but have a flushing reaction. It can be said that as long as alcohol is consumed, the risk of pancreatic cancer is increased for heavy drinkers or those who tend to have a flushing reaction to drinking.
3.Reject barbecue food. Barbecue is prone to produce carcinogenic substances. The process of barbecue produces a carcinogenic substance called benzo(a)pyrene, especially the lightly charred parts. Frequent consumption of barbecue food contaminated with benzopyrene will result in the accumulation of carcinogenic substances in the body, which will induce the risk of intestinal cancer, stomach cancer and other cancers. There is also a carcinogenic substance in barbecue food – nitrite, nitrite is mainly produced in the meat skewers before the barbecue marinade session, the longer the marinade session, the more likely to produce nitrosamines. To sum up, barbecue or not to eat, eat less for the better.
4, do not eat too hot and coarse hard food. Experts in pancreatic cancer high incidence areas in Henan Lin County, Jiangsu Yangzhong County and other areas show that the occurrence of pancreatic cancer is related to the diet is too hot, hard, coarse and fast. Too hot tea and porridge can cause repeated damage to the mucosal epithelium of the cardia, and gradually atypical hyperplasia and carcinoma will appear.
5.Do not eat moldy and pickled food. Moldy peanuts, moldy dried vegetables, cured meat, bacon and other foods are often contaminated by fungi such as Aspergillus flavus and Bacillus albus, which can easily produce carcinogenic substances such as nitrosamines and nitrites, and are prone to cardia cancer after consumption.
6 Increase the absorption of nutrition and various trace elements. In clinical practice, most pancreatic cancer patients are “people who eat badly.” The so-called bad food is meat, animal protein, fat and fresh fruit eaten very little, so the intake of vitamin A, C and riboflavin is low, prone to cardia cancer. The lack of vitamins, protein and essential fatty acids in the diet leads to gastric mucosal hyperplasia and even cardia cancer. The lack of molybdenum, selenium, zinc and magnesium in the soil and water in areas with high incidence of cardia cancer leads to lower content; especially the lack of zinc can cause esophageal epithelial keratinization and increase the carcinogenic effect of amyl nitrite.
7, establish a healthy diet and fitness habits, it is often said that a hundred steps after a meal, live to 99. It was found that shorter dinner-sleep time can significantly increase the risk of pancreatic cancer, while walking after dinner can significantly reduce the risk of pancreatic cancer and significantly weaken the risk of pancreatic cancer caused by shorter dinner-sleep time. The chance of esophageal gastric reflux is increased by satiety and lying down position.
8, maintain good spirit and psychological state: stress is one of the main causative factors of cancer, especially at this stage, life is getting faster and faster, more and more pressure, resulting in some people, the spirit is on the verge of collapse, we suggest that in daily life, we should pay attention to the combination of work and rest, maintain good spirit and psychological state, relieve pressure and adjust bad emotions.
In conclusion, as long as we pay attention to the above points in life, we should be able to reduce the possibility of cardia cancer. If cardia cancer is diagnosed through gastroscopy or upper gastrointestinal tract imaging, we should consult the thoracic surgery department as early as possible.