The main factors of high incidence of esophageal cancer
1.The role of alcohol and tobacco
Alcohol is a very important factor among many pathogenic factors of esophageal tumor. The risk of esophageal tumor is directly proportional to the daily consumption of alcohol and tobacco, and the risk of smoking and alcohol addiction is tens of times higher than that of tobacco or alcohol addiction alone.
2, nitrosamines and fungal toxins
Nearly 30 kinds of nitrosamines are known to induce tumors in animals. Pickled and moldy foods contain nitrosamines and mycotoxins. The content of nitrate, nitrite and secondary amine in food and drinking water in the high prevalence area is significantly higher and is positively correlated with the prevalence of local esophageal tumor and esophageal epithelial hyperplasia, which are easily synthesized into tumorigenic substances nitrosamines in the stomach.
3.Malnutrition and micronutrient deficiency
Insufficient intake of animal protein and lack of vitamin A, B2, E and C, lack of trace elements such as molybdenum, zinc, magnesium, manganese, cobalt and iron, as well as lack of fresh fruits and vegetables are prone to esophageal cancer.
4.Esophageal injury, esophageal diseases and stimulation of food
Residents in areas with high incidence of esophageal cancer have the habit of eating very hot diet, drinking strong alcohol, eating large amount of pepper, chewing betel nut or tobacco, which can cause local epithelial cell proliferation due to chronic physical and chemical stimulation of esophageal mucosa.
5.Hereditary factors
The onset of esophageal often shows the phenomenon of familial aggregation. In China, the survey in Shanxi, Shandong and Henan provinces found that about 1/4-1/2 of the patients have positive family history, among which the paternal line is the highest and the maternal line is the second highest.
It is found that certain diseases are pre-tumor states for the occurrence of esophageal cancer.
1, short esophageal mucosa.
2, chronic esophagitis.
3, corrosive lesions of the esophagus.
4, megaesophagus.
5, history of ear, nose and throat tumors.
6, cancerous esophageal diverticulum tumor.
7.PlummerVision syndrome, caused by iron deficiency anemia.
Early symptoms of esophageal and cardia cancer
In the early stage of pancreatic cancer, patients basically have no discomfort. With the development of the disease and the expansion of the tumor, the patient may gradually develop abnormal sensation. At the beginning, it is not easy for patients to pay attention to this feeling because it does not affect their life and living. The esophagus is the channel for eating, so when the tumor increases, the first thing is to hinder eating. Once the patient feels difficulty in swallowing, most of them are already in the middle and late stage of cancer.
According to the census data, the following may be the early symptoms of cardia cancer.
1.Distension or slight pain behind the sternum. This symptom does not occur continuously, but intermittently or worsens after exertion and when eating quickly. This is because the esophagus itself is peristaltic at any time, and the symptoms will appear only when the peristaltic movement reaches the lesion site.
2. Foreign body sensation when swallowing food. During swallowing, food (especially dry and hard food) passing through the lesion area (the lesion is small) may produce a foreign body sensation, and it is often fixed in one part, and some patients describe the feeling of having something that can never be swallowed. It is easy to be neglected by patients because the symptoms are mild and occur intermittently.
3. Stagnation or stuttering sensation when swallowing. The patient seems to have a feeling of stagnation and frustration when swallowing food at a certain place for a while, which is not continuous and becomes obvious only after the lesion develops.
4. A feeling of chest distension or constriction, often accompanied by a feeling of dryness in the throat. Patients complain of a kind of stuffy phenomenon in the front of the chest all the time, as if there is an object blockage, so that the chest is a tight feeling, especially obvious when swallowing food, but does not affect normal life and work.
5.Fullness and light pain in the heart fossa, subxiphoid or epigastric region. It is more obvious when eating dry food, but it does not occur every time and is intermittent. This is often an early symptom of esophageal and cardia cancer.
The above early symptoms usually last for more than 3 months, and when they occur frequently and persistently and worsen, they are no longer early.
Common middle and late stage symptoms of esophageal cancer and cardia cancer
Early stage of esophageal cancer can be asymptomatic due to superficial lesions, or occasional nerve irritation symptoms, which are often transient. As the lesion progresses, the frequency of symptoms increases, and they are choking sensation, painful swallowing, stuffy discomfort behind the sternum, foreign body sensation in the esophagus, pain in the upper abdomen, tightness in the throat, and the initial symptoms are mild and easy to be ignored.
As the lesion progresses, the lumen of the esophagus becomes narrowed and the symptoms worsen, mainly manifesting as follows
1.Progressive aggravation of dysphagia: It occurs occasionally at the beginning when eating hard food, then gradually and frequently, with small slow swallowing or water delivery, and in the late stage, only semi-liquid or liquid can be entered, and it is serious and dripping.
2.Pain: vague, burning pain behind the sternum when swallowing, severe pain is rare, mostly occurring after swallowing, and the more obvious pain behind the sternum at the beginning of the disease accounts for 1/5.
3, vomiting: with the progress of the disease esophagus will appear different degrees of obstruction, the upper food retention, esophagus is obviously dilated, thus causing vomiting, vomit is mainly mucus and foam, can be mixed with a small amount of food.
4.Weight loss: Due to the moderate reduction can cause weight loss, and severe cases can be malodorous.
5, vomiting blood, blood in stool: this is the first symptom is rare.
6.Symptoms of perforation: With the progress of lesion, the tumor can cause perforation of esophagus, and the performance varies according to the size of perforation site.
7. Other: such as enlarged supraclavicular lymph nodes, hoarseness, hepatomegaly.
Routine examination of esophageal tumor is.
①Barium meal examination of upper gastrointestinal tract.
② Esophageal fiberoptic endoscopy.
Generally, the correct diagnosis can be obtained by these two examinations. After the diagnosis, when choosing the treatment method, it is still necessary to make the corresponding perfect examination. If necessary, esophagoscopy should be performed for upper middle esophageal cancer before surgery. CT examination of chest and ultrasound examination of abdomen should be performed before surgery to understand whether the tumor has invasion, relationship with surrounding tissues and organs, and whether there is metastasis, etc. Ultrasonic scan examination in the lumen of esophagus can provide information on lesion site, size, invasion depth, relationship with surrounding tissues and lymph node enlargement; PET+CT examination can locate and stage lymph nodes; mediastinoscopy can understand lymph node metastasis.
Since the early stage of esophageal tumor is directly related to the curative effect, patients should go to a specialized oncology hospital as soon as possible when early symptoms appear in order to obtain early diagnosis and treatment and improve the survival and cure rate.
Treatment of esophageal cancer – Comprehensive treatment based on surgery
Currently, surgery-based comprehensive treatment is the best treatment for esophageal cancer and the most effective way to improve the survival rate and quality of life of patients with esophageal cancer. As long as the patient’s physical condition allows and the tumor has the possibility of resection, surgery should be performed, and even palliative resection should be pursued as much as possible.
Radiation therapy for esophageal cancer
Surgery is the main treatment method for esophageal cancer, but for those patients who are too old, weak, combined with other serious diseases and cannot bear surgery, or those with large lesions and difficult to resect, radical radiotherapy or preoperative treatment is feasible.
Preoperative radiotherapy can improve the resection rate of surgery and remove lesions that cannot be resected before radiotherapy, while not significantly increasing the incidence of postoperative complications. Radiotherapy can also be used as an adjuvant treatment after surgery to kill the residual tumor tissue and metastatic lymph nodes in the mediastinum to reduce the recurrence and metastasis after surgery. Radiotherapy is one of the effective local treatment measures.
Endoscopic treatment for esophageal cancer
For early esophageal tumor, the main treatment is endoscopic esophageal mucosal resection, including endoscopic high-frequency electrocoil resection, endoscopic double-loop resection, endoscopic peel biopsy resection, microwave coagulation therapy with cap, endoscopic laser photocoagulation therapy and endoscopic laser photodynamic therapy. Its main indications are.
(1) Tumors in situ and intramucosal tumors.
(2) The maximum diameter of the lesion should be less than 3 cm.
(3) The best site is the posterior lateral wall of the middle and lower segments.
The main advantages are: simple operation, safety, little suffering and low medical cost.
For middle and advanced esophageal tumors, the main methods of endoscopic treatment include endoscopic microwave therapy, endoscopic laser therapy, laser photodynamic therapy, electrochemical therapy, transendoscopic injection of chemotherapeutic agents, endoluminal radiotherapy, esophageal dilatation, endoluminal stenting, and so on. The indications are those who cannot undergo surgical resection of mid- to late-stage esophageal tumors, or whose physical condition cannot tolerate surgery, radiotherapy, chemotherapy or recurrence afterwards. Endoscopic treatment can relieve or relieve obstruction, relieve patients’ pain, improve life quality and prolong life appropriately, which is a better palliative treatment.
Special treatment of esophageal cancer – self-expanding esophageal stent placement
Self-expanding esophageal stent is a mesh support tube woven from nickel-titanium alloy (Ni-Ti alloy) wire, also known as nickel-titanium memory alloy stent. This stent has a high utility in the treatment of esophageal stricture diseases and perforation or fistula formation diseases due to certain causes.
This procedure is suitable for: esophageal strictures due to malignant diseases that are not suitable for surgery; esophage-tracheal (or bronchial) fistulas due to various causes and recalcitrant benign esophageal strictures. This method can significantly improve the survival time and quality of life of patients. The success rate of fistula closure with overlapping stents for esophagotracheal (or bronchial) fistula is over 95%.
Postoperative dietary considerations for patients with cardia and esophageal cancer
1.Patients can continue to have semi-liquid diet such as lotus root powder, steamed egg, cereal porridge, rice porridge, rotten noodles, etc. after discharge from the hospital after surgery.
2.After that, the diet can be gradually changed from thin to thick, and can transition to normal diet about one month after surgery. From one month to three months after surgery, it is appropriate to eat more dry and hard food to prevent esophageal stricture.
3, pay attention to less food and more meals, according to the need for 5-8 meals per day, chew slowly when eating.
4.Don’t avoid eating, all kinds of food can be eaten as long as they are light, fresh, nutritious and easy to digest, no spicy and stimulating food, no smoking and alcohol.
Simple treatment for postoperative discomfort of esophageal cancer and cardia cancer
Patients with pancreatic cancer and esophageal cancer will have discomfort such as acid reflux, easy fullness, choking and coughing after surgery, then patients should not be nervous because the cardia is removed and the gastrointestinal emptying function is weakened, so the food and gastric juice in the stomach and intestines will sometimes reflux into the esophagus and cause discomfort. After the above-mentioned dietary and postural adjustment measures, it can generally be relieved, and if it still cannot be relieved, it can be controlled by taking some drugs such as omeprazole and morbutrin.
If you have diarrhea, it is often related to gastrointestinal dysfunction after surgery. In addition to paying attention to clean food, you should avoid eating greasy food to avoid aggravating diarrhea symptoms.
If you feel pinprick pain and numbness in the surgical wound, it is related to the nerves of chest wall cut off during the surgery, and the discomfort will slowly subside after several months.
Dietary guidance for esophageal and cardia cancer
Many people’s cancer is eaten out, for example, moldy peanuts and rice contain aflatoxin, which can induce liver cancer when eaten. So many gastric cancers in Guangdong are found to be related to the consumption of salted fish meat through investigation and can induce gastric cancer. We should pay attention to dietary health and food therapy to reduce the incidence of cancer. Patients with esophageal and cardia cancer then need to pay attention to the following dietary principles.
1. Do not eat too hard and too rough food, select coarse grains, make coarse grains and staple foods should be soft but not hard.
2. Do not eat too fast, do not eat too hot food, chew slowly, do not swallow, do not overeat, do not overeat, do not eat food that irritate and damage the mucosa of cardia, such as spicy food.
3, to develop three meals a day, regular and quantitative eating habits, to avoid hunger and satiety.
4, strictly forbidden to eat foods with high nitrosamines content, such as sauerkraut, kimchi, pickled foods; high income class should also eat less bacon, roast meat, bacon and other smoked or fried and overcooked food.
5, it is strictly prohibited to eat moldy, rotten food, try not to eat overnight meals, those who have the conditions should use the refrigerator to store food, do not eat moldy peanuts, rice, sorghum rice, etc..
6, pay attention to the cleanliness of the diet, do not use contaminated water to wash rice and vegetables, do not eat contaminated food, do not eat unwashed fruits and vegetables, do not use toxic plastic bags and printed paper wrapped food.
7. Prohibit the consumption of toxic foods such as “poisoned rice”, “lean meat essence” pork and “pesticide” vegetables that enter the market.
Example of one day recipe after esophageal cancer surgery in January
Breakfast: sweet milk 300g (milk 300g, sugar 10g, cocoa powder 10g), egg custard (egg 50g)
Additional meal: fresh juice (orange juice 200g)
Lunch: rice porridge (100g of rice), minced meat and carrot (100g of tofu, 100g of lean minced meat, 50g of carrot puree), tomato soup (50g of tomato, 50g of cucumber, 50g of egg)
Additional meal: soy milk (250g of soy milk)
Dinner: thin noodles (noodles 100g), fried minced pork with cucumber (lean minced pork 50g, diced cucumber 100g, tomato juice 100g)
Additional meal: milk (fresh milk 250g full day cooking oil 40g)