The incidence rate of esophageal cancer in China is the first in the world, and two out of every three people in the world get esophageal cancer in China, which seriously threatens the health and life of Chinese people. According to Chinese literature, this disease was described more than 2,000 years ago and was called “choking and hiccup disease”. There are obvious regional differences in the incidence of esophageal cancer, with northern China as the high incidence area, and Guangdong’s eastern Guangdong, especially Chaoshan, as the high incidence area, while the incidence in the rest of the country is relatively low. (1) Dietary factors: ①Nitrosamines: Nitrosamines are recognized as a carcinogenic substance, and large amount of food containing nitrites, such as sauerkraut, kimchi, pickles, salted meat, salted fish, sausages, etc. ②Eating moldy food. Moldy food contains a lot of aflatoxin, especially moldy peanuts, cottonseed, corn in high content. ③ overeating. ④Eating rough and hard food often, eating too fast and eating coarse and hard food may cause damage to the esophageal mucosa, and repeated damage can cause mucosal hyperplasia and interstitial degeneration and finally lead to cancer. ⑤ Like to eat too hot food, drink strong tea, and take in more chili, garlic, vinegar and other stimulating foods. (2) Stimulation of smoking and alcohol: long-term smoking and alcohol consumption are related to the development of esophageal cancer. The relative risk of esophageal cancer for smokers is 1.3 to 11.1 times greater than that for non-smokers. Scientists also found that people who have the habit of chewing tobacco and sniffing snuff have a higher incidence of esophageal cancer; the incidence of esophageal cancer among those who drink 6 bottles of beer daily is 2.3 times higher than those who do not drink alcohol. (3) Nutrient deficiency: Nutrient deficiency is related to the incidence of esophageal cancer. The lack of vitamins and other components in the diet can make the esophageal mucosa proliferate and interstitially change, which can further cause cancer. Especially the deficiency of vitamins and trace elements of aluminum, magnesium, zinc, iron and copper. (4) Genetic factors: The susceptibility of the population is related to genetic and environmental conditions. About 10% of esophageal cancer is familial. (5) Local damage of esophagus: Long-term preference for hot diet may also be one of the cancer-causing factors. Long-term damage to the esophagus caused by various original solids may be the pre-cancerous lesion of esophagus. (6) Gender factor: more men than women, the incidence rate of men and women is 1.3-2.7:1. (7) Age of incidence: less affected by this disease under 30 years old, the incidence rate increases with age above 30 years old, and the peak incidence rate is 50-69 years old. Clinical manifestations: Esophageal cancer is often asymptomatic in the early stage, and occasionally manifests as retrosternal pain and discomfort. With the increase of tumor, patients will experience progressive discomfort of eating and swallowing or foreign body sensation. It is often manifested as slowing down the speed of eating and often needing soup and water to deliver meals. After a few months, the patient can only eat liquid food because the tumor further enlarges and obstructs the lumen of the esophagus, and when the tumor completely obstructs the lumen of the tube, the patient will have “difficulty in passing water”. It takes about one year from the appearance of symptoms to complete obstruction. Therefore, patients with suspicious symptoms should go to hospital for examination as soon as possible. Symptoms in the middle and late stages: dysphagia, obstruction, pain, bleeding, hoarseness, weight loss and anorexia, etc. Terminal symptoms and complications: cachexia, dehydration, failure, mediastinitis, pneumonia, lethal hemorrhage, respiratory distress to coma, etc. Examination methods 1.Barium swallow X-ray examination This is the most basic routine examination. This method is simple and painless. 2.Esophageal endoscopy The endoscope is placed directly into the lumen of the esophagus, which can be positioned to clearly observe the condition of the esophagus and can take pictures of the lesion and biopsy it, which is the most authoritative examination to confirm the diagnosis of the esophagus. The Department of Thoracic Surgery of Cancer Hospital of Fudan University uses gastroscopic mucosal resection (EMR) to improve the detection rate of early esophageal cancer. For patients who are too old for surgery, the use of “Cook knife” to perform “skin removal” under gastroscopy has become a standard procedure at home and abroad. 3.CT scan of esophagus This method can further understand the external invasion of esophageal cancer, which is very helpful for treatment decision and has great value for the evaluation of the effect of radiotherapy and chemotherapy of esophageal cancer. Treatment methods: Since esophageal cancer in the United States is mainly adenocarcinoma of the esophagus, while squamous carcinoma is mainly in China, the treatment methods of western countries cannot be copied. In terms of surgery, a comprehensive assessment of the patient’s tumor and systemic condition is needed to adopt different surgical approaches. For advanced esophageal cancer that cannot eat, the Department of Thoracic Surgery of Cancer Hospital of Fudan University has carried out gastroscopic gastrostomy (PEG surgery), and the success of PEG surgery has greatly benefited the patients. We can also place a jejunostomy tube under laparoscopy to improve the nutritional status of patients and their tolerance to chemoradiotherapy. Prevention No inevitable factors have been found to induce tumor development, therefore, 1/3 of cancers can be prevented by adopting healthy eating habits and lifestyle. 1/3 of cancers may be cured if diagnosed early. Reasonable and effective palliative care can improve the quality of survival of the remaining 1/3 cancer patients.