It is the pursuit of ordinary people to feel happy and comfortable at the beach, basking in the warm sunshine, tasting delicious food with their beloved ones. But for the unfortunate esophageal cancer patients, the pain they suffer is more than the difficulty of eating. Esophageal cancer is a malignant tumor that originates from the epithelial tissue of esophageal mucosa, which is the innermost surface of esophagus. It accounts for 2% of malignant tumors, and about 220,000 people worldwide suffer from this disease every year. China is a multi-prevalent area of esophageal cancer, especially in Henan, Hebei, Shanxi and Shaanxi in Taihang Mountains and Luliang Mountains, as well as in Inner Mongolia, Jiangsu and Anhui, where there are more migrant people nearby. In addition, the incidence rate is also higher in Sichuan, Hubei, Guangdong and Fujian. The mortality rate of esophageal cancer is high, and the overall five-year survival rate of esophageal cancer only reaches about 40% after years of efforts and active treatment. The main reason is that early diagnosis is not easy and the disease is already very serious when it is diagnosed. In fact, the treatment effect of early esophageal cancer is very good, and the five-year survival rate can reach 70-80%. From 1964 to now, under the kind care of several generations of leaders such as Premier Zhou Enlai, the national tumor prevention and treatment office was established, and manpower and material resources were organized to carry out large-scale in-depth research nationwide, starting from Yao Village, Lin County, Henan Province, firstly, and great achievements were made, and the diagnosis and treatment level of esophageal cancer reached a new height and the technology was basically mature. When it comes to esophageal diagnosis, especially early diagnosis, the main problems that plague people are: first, the lack of medical knowledge; second, the psychological confusion caused by the social environment. We have seen many patients, not because they do not feel the disease, but because of economic or work-related reasons, they are reluctant to seek medical treatment, forming a situation where minor illnesses are delayed, major illnesses are treated, and serious illnesses are carried to the hospital. Even if they have undergone surgery, they are unwilling to review on time, preferring to be confused and rejecting treatment, and eventually die without treatment. An esophageal cancer specialist in our esophageal cancer high incidence area felt the unpleasantness of eating by himself, did the examination, and put the examination result in his desk due to the psychological problem when the diagnosis was clear that it could be treated, and had to save his life only after several months, delaying the disease by himself. In fact, esophageal cancer is not like what people say: nine out of ten cancers are buried, and the remaining one is not cancer. A lot of clinical data prove that the treatment of early esophageal cancer is easier and the effect is also very ideal. Today, when the Party and the State are trying to improve people’s medical conditions and medicine is highly developed, the concept should be changed. The dilemma of “if you are hospitalized once, you have to work for nothing for a year, and if an ambulance rings, you have to raise a pig for nothing” should also be changed. Medical treatment is not only for oneself, but also for family happiness and social harmony. There are many causes of esophageal cancer, but on the surface, it seems to be related to long-term consumption of food containing nitrosamines; lack of trace elements in food, poor eating habits, causing chronic inflammation or traumatic damage to the esophageal mucosa. For example, long-term use of macerated sauerkraut, heavy consumption of strong alcohol, smoking, preference for coarse foods and irritating foods, eating too fast and too hot. In essence, it is related to genetic inheritance and mutation of genes. Many of our patients have a family history and even multiple relatives with esophageal cancer, especially male relatives. This suggests its genetic link. Scientific experiments have also identified multiple genetic variants in esophageal cancer, suggesting that the occurrence of esophageal cancer is the result of the emergence of multiple genetic variants. Genetics may pass down some variant genes, but these genes are generally not enough to cause cancer. In other words, these people are more prone to get esophageal cancer than others, that is, they are highly susceptible. Once new genetic mutations are caused by acquired stimuli and lack of attention in life. All the mutated genes work together to contribute to the occurrence of cancer, which eventually develops into lesions visible to the naked eye. Two of my patient friends, one is a computer expert in China and the other is a distinguished diplomat in China, both of their paternal elders have many people suffering from esophageal cancer, and the men in their family are especially able to drink alcohol, and I almost drink alcohol as water. These examples also show the role of congenital and acquired in the occurrence of esophageal cancer. Therefore, scientists are currently trying to find these susceptible people and actively guide and intervene to prevent its occurrence, and the main intervention method that has been proven to be effective is taking retinoic acid. Esophageal cancer, commonly known as “choking”, is characterized by progressive and immediate difficulty in eating, followed by eating discomfort, pain, chronic pharyngeal discomfort and gastritis. Doctors have made it into a jingle: “One pharyngeal obstruction, two chest pain, three foreign body sensation, four swallowing stop, five heart soreness, six throat dryness, seven stifling and swelling behind the sternum.” In the course of medical practice, we have noticed that many patients with severe pharyngitis come to the doctor because they feel a foreign body in the throat and swallowing discomfort, which is actually a neurosis, commonly known as “plum nucleus”. It is characterized by a marked improvement in symptoms when attention is not focused. Some patients with cardia also have difficulty eating, but they often have the feeling that they can press food into their stomach after drinking a lot of water. Patients with symptoms should seek prompt medical attention. The common diagnostic tests used in hospitals today are gastroscopy, esophagogram, chest CT, etc. In the past, the exfoliative cytology examination one was gradually replaced by gastroscopy. It is also called esophageal net pulling examination, that is, a small balloon with a net on the surface is used and the patient is allowed to take it, and then the balloon is inflated and pulled out from the esophagus, relying on friction to make the esophageal cancer shed cells fall into the net and be brought out. This method is called economical and simple, but there are many shortcomings such as technical errors, atypical cell morphology, poor visualization and small amount of information, etc., and there are fewer competent cytologists, which also restrict primary hospitals to go for it. Gastroscopy, as a more practical method at present, has a high prevalence rate. However, due to the poor quality of the microscope itself in some hospitals and the inexperience of the examiner, there is often inaccurate description of lesions and under-reporting of early lesions. Early lesions are mainly manifested microscopically as inconsistency with surrounding tissues, which can be specifically classified into occult, cachectic, plaque and papillary types. Esophageal cancer develops with atypical hyperplasia, which can be stained with iodine. Clinical use of iodine staining can make early cancer and precancerous lesions easy to be detected. Especially with esophageal ultrasound endoscopy, it is more accurate for estimating tumor condition and understanding the relationship between tumor and surrounding tissues and organs. At present, due to the improvement of gastroscopic technology, early stage cancer can be cured by gastroscopic resection only instead of open-heart or other major surgery. This method does not require general anesthesia or hospitalization, so it is easy and economical. Esophagogram is diagnosed by the discontinuous and unobstructed image formed by tumor obstruction during the process of contrast down the throat. CT, as a large medical diagnostic equipment, is now more popular and economical. Its value is high for observing whether the tumor invades the surrounding tissues and for estimating the possibility of complete resection before surgery. Since esophageal cancer is somewhat hereditary and geographic, there is often a certain amount of common sense and it is not difficult to take this disease into consideration. The delay of most patients’ disease lies in reasons other than medical ones, especially economic ones, which is the biggest confusion for doctors. The pathology of esophageal cancer, the vast majority of which is squamous cell carcinoma in China, is different from adenocarcinoma, which occurs in the cardia. Adenocarcinoma is also more common abroad and is mainly associated with intestinal epithelial hyperplasia of esophageal mucosa due to reflux esophagitis (Berrett’s esophagus). Clinically, they are classified into cervical segment, upper, middle and lower thoracic esophageal cancer according to the location of the lesion. The difference in location results in differences in the choice of surgical procedure. For esophageal cancer in the upper segment located next to the aortic arch, preoperative detection of enlarged upper mediastinal lymph nodes especially in the right side requires a combined cervical, thoracic and abdominal incision due to the surgical field of view. Other lesions in earlier and intermediate stages can be added/not added to the neck incision on the left side of the chest. The principle of surgery is to maximize the resection of the lesion as well as to preserve the maximum physiological function. The basic surgical procedure is to remove the diseased segment of the esophagus and surrounding lymph nodes, replace the resected esophagus segment with a free stomach or jejunum or colon, and reconstruct the upper gastrointestinal tract. Because of the superiority of the stomach over the jejunum and colon, the stomach is most often used clinically to replace the resected esophagus. Transplantation of another person’s esophagus and artificially created esophagus are under investigation and are not yet mature. Minimally invasive surgery is performed using thoracoscopy and laparoscopy with the same combined cervical, thoracic and abdominal incisions. It reduces the patient’s pain and is more expensive at the same time. Minimally invasive surgery is suitable for patients at earlier stage and upper segment because it is difficult to separate the adhesions and invasion of middle and lower segment cancer foci with descending aorta on the right side, which is poorer and more difficult than the left side open chest view. In addition, the thoracic stomach is located in the esophageal bed, and consolidation radiation therapy cannot be performed after surgery. The early and late stage of esophageal cancer disease is what patients and family members are eager to know, and it is also the basis for doctors to evaluate the difficulty of treatment and treatment effect. Through long-term follow-up of a large amount of clinical data and statistical analysis, it is found that the depth of esophageal cancer infiltration can better reflect the early and late stage of the disease than the length. Tumor that only invades the mucous membrane layer is called early stage cancer (carcinoma in situ); when it invades the outermost fibrous membrane of esophagus or has lymph node metastasis, it is advanced stage; between the two, it is called infiltrating cancer; if there is metastasis from other organs, it means the disease is quite serious. Infiltrating carcinoma can be broadly divided into medullary type (growing in the esophageal wall and resembling brain marrow in profile), myxomatous type, narrowing type and intraluminal type. The most advanced esophageal cancer often has lymph node metastasis, and the most advanced patients sometimes only have multi-site, large volume lymph node metastasis, but no bloodstream metastasis from other organs. Therefore, prevention and removal of metastatic lymph nodes is the focus of treatment and the key to improving survival. Many surgeries are set up to better manage and prevent lymph node metastasis. The most important of these are three-field clearance and radiation therapy for esophageal cancer. On the road of fighting against esophageal cancer, striving for early prevention, early diagnosis and early treatment is the direction we strive for. Strengthen health education and enhance the confidence of patients in middle and late stages to overcome the disease, as long as they face life positively, there will always be miracles. One of my patients, despite multiple metastases, has obtained long-term survival with tumor through various local treatments, including esophageal stenting and radiotherapy. Therefore, we often say that one-third of patients are scared to death by themselves, and we should have confidence in facing tumors.