Definition Esophageal cancer is a malignant lesion formed by abnormal proliferation of esophageal squamous or glandular epithelium. Its development generally passes through the stages of epithelial atypical hyperplasia, carcinoma in situ, and invasive carcinoma. Esophageal squamous epithelial atypical hyperplasia is an important precancerous lesion of esophageal cancer, and it usually takes several years or even more than ten years from atypical hyperplasia to cancer. Because of this, some esophageal cancers can be detected early and completely cured. For patients who have difficulty in swallowing or have foreign body sensation, gastroscopy should be performed as early as possible to detect early esophageal cancer or precancerous lesions. Like other malignant tumors, esophageal cancer has the background of genetic changes, which involves a complex process of multi-factors, multi-stage, multi-gene mutation accumulation and interaction, and involves many proto-oncogenes, oncogenes and protein changes at the molecular level. However, long-term poor living or dietary habits may be the culprits leading to the occurrence of esophageal cancer. Currently, the risk factors of esophageal cancer include: eating foods containing more nitrosamines (e.g., pickled sauerkraut) or moldy foods, eating hot food (e.g., the high incidence of esophageal cancer among the Chaoshan people may be related to drinking Kung Fu tea for a long period of time), and bad hobbies (e.g., smoking and drinking alcohol). China is a region with high incidence of esophageal cancer, which ranks the fourth place of tumor death. Clinical manifestations Esophageal cancer starts insidiously and may be asymptomatic in early stage. Some patients have foreign body sensation in the esophagus, or slow or obstructive choking sensation since the passage of food. It may also manifest as burning, pins and needles or pulling pain behind the sternum when swallowing. Progressive esophageal cancer often consults the doctor because of dysphagia, which develops progressively, or even can not eat at all. It is often accompanied by vomiting, epigastric pain, weight loss and other symptoms. In the advanced stage of the disease, long-term insufficient food intake may be accompanied by obvious malnutrition, emaciation, malignant disease and complications such as cancer metastasis and compression. For example, hoarseness caused by compression of recurrent laryngeal nerve, pain caused by bone metastasis; jaundice caused by liver metastasis. When the tumor invades neighboring organs and causes perforation, it can also cause mediastinal abscess and pneumonia. Some patients may occasionally feel hard abdominal mass in the upper abdomen, or touch the enlarged lymph nodes on the clavicle. It is worth noting that other diseases of esophagus, such as gastroesophageal reflux, esophageal cardia, esophagitis, benign esophageal stenosis, benign esophageal tumors, etc., can also show the above symptoms, so it is not possible to say that esophageal cancer is the result of the symptoms mentioned above, but it is necessary to go to the hospital for checkup to rule out the possibility of esophageal cancer if these symptoms appear. Diagnosis Gastroscopy is preferred and even essential! Since the key to cure esophageal cancer is early detection and early treatment. Therefore, anyone who is over 50 years old and has a feeling of stagnation after eating or difficulty in swallowing should have a timely gastroscopy. Generally speaking, esophageal cancer is seldom diagnosed by gastroscopy, if the gastroscopy photo is clear, even if the gastroscopy is done in a small hospital, the examination report says that the esophagus is not diseased, so it is usually fine, and it is not necessary to go to a big hospital to do gastroscopy repeatedly. However, if gastroscopy in a small hospital reveals lesions in the esophagus and cannot prove whether it is esophageal cancer or pre-cancerous lesions, it is necessary to seek consultation with an experienced doctor. Gastroscopy can directly observe the tiny lesions and at the same time, it can conveniently clamp the lesion tissues for pathological examination, which is the main examination means for diagnosis of esophageal cancer at present. Although endoscopy can confirm the diagnosis of esophageal cancer, it cannot determine whether it is in early or late stage. While ultrasonic endoscopy can observe the infiltration depth of the tumor and facilitate preoperative staging. It is worth noting that the finding of esophageal mass or ulceration by gastroscopy does not indicate that it is a malignant tumor, because some benign lesions, such as esophageal tuberculosis, Crohn’s disease and so on, can also show similar manifestations, therefore, the esophageal lesions found by gastroscopy must be clamped and the tissues must be taken to do the pathology examination. Other imaging methods such as barium meal imaging of esophagus are most commonly used, mainly for those patients who are not suitable for gastroscopy, but this method can only detect esophageal cancer with larger lesions, and has limited effect on the detection of early-stage cancer or pre-cancerous lesions.CT examination has similar limitations, and its purpose is mainly to observe whether there is any metastasis or proliferation of the lesion. In addition, positron emission tomography (PET-CT) is relatively simple and convenient for detecting whether esophageal cancer has systemic metastasis, but its disadvantage is that it is expensive. Treatment Like other malignant tumors, esophageal cancer emphasizes early diagnosis and early treatment. For precancerous lesions or early stage cancer, surgical resection or endoscopic stripping resection can be used, and no chemotherapy is needed after surgery; for non-early stage tumors, surgical treatment is preferred and recommended to be combined with radiotherapy or chemotherapy. For the upper esophagus near the pharynx, surgery is difficult and radiotherapy can be chosen. As for middle and lower esophagus cancer, surgery is preferred and can be combined with chemotherapy or radiotherapy if the tumor is late. If the tumor lesion is in advanced stage, it is difficult to remove the lesion, but in order to solve the problem of eating, palliative treatment such as tumor reduction, fistula, or stent implantation is feasible. There are various surgical methods for esophageal cancer, and generally different surgical methods are adopted according to different parts of the body. Including: Sweet esophagogastrectomy (left open chest), Ivor Lewis esophagogastrectomy (open abdomen + right open chest); Mckeown esophagogastrectomy (right open chest + open abdomen + neck anastomosis); trans-diaphragmatic hiatus esophagogastrectomy (open abdomen + neck anastomosis); minimally invasive Ivor-Lewis esophagogastrectomy (laparoscopy + small right chest incision); minimally invasive Mckeown esophagogastrectomy (right thoracoscopic + laparoscopic + cervical anastomosis); optional esophageal replacement organs included stomach (preferred), colon, and jejunum. Lymph node dissection modalities included standard lymph node dissection, and extended lymph node dissection (En-Bloc resection). Thoracoscopic esophagectomy for esophageal cancer has little damage to the chest wall, light impact on cardiopulmonary function, fast recovery of patients after surgery, few complications, and is now developing extremely fast. At present, Municipal Hospital has completed more than 20 cases of total thoracoscopic and laparoscopic combined radical esophagectomy for esophageal cancer with good results. Dietary attention After diagnosis, patients with esophageal cancer often need to undergo surgery, radiotherapy and other treatments. In the process of treatment, it will bring different degrees of pain and trouble to patients. The mental state and nutritional status of patients are closely related to the outcome and prognosis of treatment. Therefore, both patients and their family members should communicate with doctors, set up correct concepts to fight against diseases, overcome the fear of diseases and cooperate with treatment with optimistic attitude. Diet of esophageal cancer patients should focus on light, but some patients like heavy taste, but too light to affect patients’ appetite, so dietary attention should be paid to patients’ personal appetizing food, as long as it is nutritious, and they can eat whatever they like. Conditions can be stewed more broth, eggs, fish, shrimp, a variety of meats, pig liver and other foods with high protein content are very good nutrients, can also be appropriate to supplement some powdered milk, milk, soybean milk and so on. Vegetables help to supplement vitamins. Disease Care After esophageal cancer surgery, a section of esophagus is removed and the esophagus becomes shorter, plus the esophageal reflux is often complicated after surgery, and the anastomosis has different degrees of narrowing. Therefore, when eating, the food can’t enter into the stomach as fast as normal people do, but it is easy to be retained in esophageal lumen and refluxed to the pharyngeal cavity and tracheal cavity, which can easily cause difficulty in eating, coughing and other symptoms. This situation is like pouring wine into a small glass; if you pour too much wine too quickly or in too large an amount, it will easily overflow. Postoperative reflux esophagitis is the most common complication for patients, which is manifested as acidic liquid or food reflux in the pharynx or mouth, often accompanied by burning or painful sensation behind the sternum, difficulty in swallowing and other symptoms. Therefore, postoperative patients of esophageal cancer should pay attention to diet, chew slowly and have small amount of meals. After meals, it is better to stand up and take a walk, and when sleeping, put the pillow up to make the head and shoulders in a “high pillow” state, which can help to prevent gastroesophageal reflux. If there are obvious respiratory infections, such as persistent cough, purulent sputum, chest tightness and dyspnea, etc., patients should go to the hospital for consultation. Patients are prone to nausea, vomiting and loss of appetite during radiotherapy for esophageal cancer. Generally, they can recover on their own after treatment, and if the reaction is severe, they can be treated with medication.