I. Overview of esophageal cancer
Esophageal cancer, also called esophageal cancer (shiguanai), is a malignant tumor that occurs in the epithelial tissue of esophagus, accounting for 2% of all malignant tumors. There are about 220,000 people die from esophageal cancer worldwide every year, and China is a high incidence area of esophageal cancer, which is the second most common cause of death after stomach cancer. The occurrence of esophageal cancer is related to the chronic stimulation of nitrosamines, inflammation and trauma, genetic factors and the content of trace elements in drinking water, food and vegetables.
Factors related to the development of esophageal cancer
The development of esophageal cancer is mainly related to the following 5 points.
1.Nitrosamines: Nitrosamines are a strong carcinogenic substance. Studies have shown that residents who consume sauerkraut in Lin County, an area with high incidence of esophageal cancer, have methylbenzyl nitrosamines, nitrosopyrrolidine and nitrosoguanidine in their gastric juice and urine, which induce esophageal cancer. And it was found that the amount of sauerkraut consumption and the incidence of esophageal cancer were directly proportional.
2. Damage to esophageal mucosa: Long-term preference for hot food, coarse food, drinking strong tea, eating pepper and other irritating foods can cause damage to esophageal mucosa and interstitial changes in esophageal mucosa proliferation, which may also be one of the carcinogenic factors. Smoking and drinking strong alcohol have a certain relationship with the development of esophageal cancer. Various kinds of long-term untreated esophagitis may be precancerous lesions of esophageal cancer.
3, mold carcinogenic factors: moldy food can induce precancerous lesions or squamous epithelial carcinoma in the esophagus and stomach of mice. This kind of mold has synergistic effect with nitrosamine cancer promotion.
4, micronutrients and malnutrition: serum molybdenum, hair molybdenum, urine molybdenum and molybdenum in esophageal cancer tissues are lower than normal in the population of high incidence area of esophageal cancer. The lack of molybdenum in the soil and water in the high incidence area of esophageal cancer in Linxian, and the cancer suppressing effect of molybdenum is confirmed by most scholars. Insufficient intake of animal protein and lack of vitamin AB2C are common features of the diet of residents in high esophageal cancer areas, but most of the areas with high incidence of malnutrition do not have high incidence of esophageal cancer, so this is not likely to be a dominant factor.
5.Hereditary factor: Esophageal cancer has a significant phenomenon of family gathering, and it is not uncommon to see three or more consecutive generations of affected families in high incidence areas.
Clinical manifestations of esophageal cancer
Early symptoms of esophageal cancer
1.Choking sensation in the throat is the most common, which can disappear or recur spontaneously and does not affect eating. It often occurs when the patient’s mood fluctuates, so it is easily mistaken for functional symptoms.
2.Posterior sternal and subxiphoid pain is more common. When swallowing food, there is pain behind the sternum or subsynovial pain, the nature of which can be burning-like, pinprick-like or pulling-like, with the swallowing of rough, burning or irritating food as the focus. Initially, it is intermittent, but when the cancer invades the nearby tissues or penetrates, there can be severe and continuous pain. The site of pain often does not exactly correspond to the site of lesion in the esophagus. The pain can be temporarily relieved by antispasmodics.
3, food retention infection and foreign body sensation when swallowing food or water, there is a feeling of slow downward movement of food and stagnation, as well as a feeling of tightness behind the sternum or food adhering to the esophageal wall, etc., which disappears after eating.
4, throat dryness and tightness feeling swallowing dry and rough food is particularly obvious.
5.Other symptoms: a few patients may have post-sternal stuffiness and discomfort, anterior pain and koron (19)
Middle-term symptoms of esophageal cancer
1.Choking sensation in the throat is the most common, which can disappear and recur spontaneously and does not affect eating.
2.Post-sternal and subxiphoid pain is more common.
When swallowing food or drinking water, there is a feeling of slow downward movement of food and stagnation, as well as a feeling of tightness behind the sternum or food adhering to the esophageal wall, which disappears after eating. The site of the symptoms is mostly the same as the site of the lesion in the esophagus.
4. Dryness and tightness in the throat is especially obvious when swallowing dry and rough food, and the occurrence of this symptom is often related to the patient’s mood swings.
5.Other symptoms: a few patients may have retrosternal stuffiness and discomfort, anterior pain and koron (19)
Typical symptoms of mid-stage esophageal cancer: progressive dysphagia. There may be pain behind the sternum when swallowing and spitting mucus-like sputum.
[3] Late stage symptoms of esophageal cancer
1.Progressive dysphagia is the main symptom of most patients at the time of consultation, but it is the late manifestation of the disease.
2.Food reaction often appears when dysphagia is aggravated, and the reflux volume is not large, containing food and mucus, but also blood and pus.
3.Other symptoms: when the cancer presses the recurrent laryngeal nerve, it may cause hoarseness; when it invades the phrenic nerve, it may cause eruption or phrenic nerve paralysis; when it presses the trachea or bronchus, it may cause shortness of breath and dry cough; when it erodes the aorta, it may produce fatal bleeding. If the cancer is located in the upper part of esophagus or esophageal-tracheal or bronchial fistula, cervical sympathetic nerve palsy can be produced when swallowing liquid.
Treatment of esophageal cancer
Early treatment of esophageal cancer should be a comprehensive treatment combining surgery, radiotherapy and Chinese medicine.
1.Surgical treatment
Surgery: Surgery is the first choice of treatment for early esophageal cancer. Once diagnosed, patients with esophageal cancer should be treated by surgery once their physical conditions allow. According to the condition, there are two kinds of surgery: palliative surgery and radical surgery. Palliative surgery is mainly used for patients who cannot be cured at advanced stage or after radiotherapy, such as esophageal gastric diversion, gastrostomy and esophageal intubation to solve feeding difficulties. Radical surgery depends on the location of the lesion and the specific situation of the patient. In principle, most of the esophagus should be removed, and the esophageal resection area should be at least 5 cm from the tumor. The surgical resection rate of lower segment cancer is 90%, that of middle segment cancer is 50%, and that of upper segment cancer is 56.3%-92.9% on average.
The contraindications of surgery are ① clinical x-ray examination confirms that the esophageal lesion is extensive and involves adjacent organs, such as trachea, lung, mediastinum, aorta, etc. (2) Those with severe cardiopulmonary or hepatic and renal insufficiency or cachexia who cannot tolerate surgery.
2.Radiotherapy and chemotherapy