I. Incidence of esophageal cancer: Esophageal cancer is one of the common malignant tumors in China, ranking the second among digestive tract tumors. There are six high incidence areas of esophageal cancer in China: (1) High incidence area of Taihang Mountain in North China, mainly concentrated in the southern section of Taihang Mountain at the junction of Henan, Hebei and Shanxi provinces. For example, the mortality rate of esophageal cancer in a dozen cities such as Linxian of Henan, Magixian of Hebei, and Yangcheng of Shanxi is over 100 per 100,000 population. (2) The high incidence area in the eastern mountainous region of the Qinling Mountains bordering Shaanxi, Henan and Hubei provinces, where the mortality rate of esophageal cancer is 50-100 people/100,000 population. (3) The high incidence area of Dabie Mountain in EHU, mainly including more than ten counties and cities such as Xinyang in Henan, Xiaogan area in Hubei and Lu’an area in Anhui. The mortality rate of esophageal cancer is around 50 people/100,000 population. (4) High incidence area in northern Sichuan. (5) High incidence area of Fujian and Guangdong, including Shantou area and Meixian area in Guangdong and Nan’an county in western Fujian, etc. The mortality rate of esophageal cancer is 20-50 people/100,000 population. (6) High incidence area in North Jiangsu, that is, around the Lixia River in North Jiangsu, centered on Yangzhong County (110 people/100,000 population) and including Huai’an, Taixing, Jianhu and other counties. Esophageal cancer is predominant in males, with a ratio of 1.6:1, higher in rural areas than in urban areas, with a ratio of 3:1. The age of onset of the disease is 50-69 years old, accounting for 60% of the cases, while the youngest age is 18 years old, and the age of 40 years old accounts for 10% of the cases. Which kind of people are prone to esophageal cancer? According to decades of epidemiological research and experimental study, there are several possible factors for the occurrence of esophageal cancer: (1) Long-term bad dietary stimulation. Residents of certain areas with high incidence of esophageal cancer are accustomed to consuming hard and rough food for a long time and chewing and swallowing quickly when eating; some people also like to drink too hot tea or soup or too hot porridge. Rough and hard food or overheated food rubs and stimulates the esophageal mucosa when passing through the esophagus, and the adverse stimulation over the years causes chronic trauma and inflammation of the esophageal mucosa, and the squamous epithelial cells lining the esophagus are repeatedly damaged and repaired by hyperplasia, and the cancerous transformation of squamous epithelial cells may occur in the process, resulting in esophageal cancer. (2) Long-term consumption of water or certain foods with high content of amine nitrite carcinogenic compounds. The higher the intake of such carcinogenic substances, the higher the possibility of esophageal cancer. (3) Long-term chronic inflammation of the esophagus. According to the survey, esophageal diverticulum, scar stricture, chronic esophagitis, esophageal polyps, etc., which exist for a long time, may undergo malignant transformation and form esophageal cancer. (4) Long-term consumption of fermented and moldy food. Epidemiological investigations and animal experimental studies have confirmed that long-term consumption of fermented or moldy food, which contains many kinds of molds, is prone to esophageal cancer. If the content of molds and nitrosamines in food is high, both of them have strong synergistic cancer-causing effect. (5) Long-term smoking and drinking. It is found that long-term smoking, especially smoking pipe tobacco and chewing tobacco, is not only easy to suffer from lung cancer, but also easy to suffer from esophageal cancer, such as the habit of drinking alcohol at the same time, the risk of esophageal cancer is greater. (6) Hereditary factors. 80-90% of the occurrence of esophageal cancer is due to acquired factors or environmental factors. However, it is found that there are certain genetic factors. (7) Other factors. It is found that the occurrence of esophageal cancer is related to the lack of certain vitamins and trace elements, such as the lack of riboflavin, vitamin C, vitamin A, niacin, etc., and the lack of molybdenum, zinc, selenium and other trace elements. In a word, the occurrence of esophageal cancer is related to the above mentioned factors, which is probably the result of the joint action of many factors, but one of them must be the dominant factor, which is not the same in different regions and people. How to detect esophageal cancer at an early stage? The structure of esophagus can be divided into three layers, which are mucous membrane layer, submucous membrane layer and muscular layer from inside to outside. Early stage esophageal cancer, i.e. superficial esophageal cancer, means that the cancer is confined to the mucosal layer or only invades the submucosal layer and has not yet invaded the muscularis propria, and there is no lymph node metastasis or distant metastasis. Since early esophageal cancer can be completely removed by surgery, the operation is relatively easy and has good surgical effect, and the 5-year survival rate after operation can reach more than 90%, and even long-term survival. Therefore, early detection of esophageal cancer, i.e. being able to make a diagnosis at the early stage of esophageal cancer, is of great significance. Early esophageal cancer has no obstruction to the lumen of the esophagus, but it has some effect on the movement of the esophageal wall. Therefore, the vast majority of these patients have self-conscious symptoms of different degrees. Moreover, a patient can have one or several symptoms, which often appear intermittently and recur repeatedly, and can be affected by many factors such as diet and emotion. These symptoms can last for several months, even two or three years or more, and the general health condition is not affected. Early stage esophageal cancer has the following five main manifestations: 1. Choking sensation when swallowing food. 50%-60% of early esophageal cancer patients have this symptom. After the appearance of this symptom, it can disappear by itself without treatment, but it may reappear after a period of time and gradually worsen. Foreign body sensation in the esophagus. 15%-20% of patients feel a foreign body sensation in the esophagus when swallowing. The site of foreign body sensation mostly coincides with the cancerous site of esophageal wall. Dryness and tightness in the throat. 30% of patients often complain of dryness and tightness in the throat, or describe it as tightness in the neck and difficulty in swallowing food. 4. Slow passage of food and a sense of retention. About 14% of the patients when swallowing food, food mass through the esophagus, consciously slow downstream or have a sense of stagnation. 5. Pain or discomfort behind the sternum or pain in the subxiphoid and epigastric regions. Almost more than half of the patients have such symptoms. Mainly dull pain or burning pain or pins and needles and pulling pain. The pain is obvious when swallowing rough food, hot food or irritating food, and is less severe when eating liquid, semi-liquid or warm soft food and swallowing slowly. In most patients, the pain occurs when swallowing the first two mouthfuls of food, and then decreases and gradually disappears. The pain is usually mild at first, intermittent and short-lived, but progressively worsening. If one or more of the above recurrences occur, the pain may be due to other factors, such as chronic pharyngolaryngitis, esophageal diverticulum, or reflux esophagitis, although in some cases it may be due to other factors. However, it must be kept in mind that, without thorough examination to exclude esophageal cancer, patients should not take it lightly, but should consult doctors for examination on the basis of suspicion or high suspicion of esophageal cancer, especially those who are located in areas with high incidence of esophageal cancer, over 40 years old, or with patients with esophageal cancer in their families, and they should pay more attention to it. What are the treatments for esophageal cancer? There are five treatments for esophageal cancer: 1. Surgery: Surgical resection is the preferred treatment for esophageal cancer patients, which involves removing a section of esophagus with tumor, then lifting the stomach from the abdominal cavity to the thoracic cavity or neck, and then anastomosing the remaining esophagus in the upper section with the stomach, so as to make the stomach play the role of esophagus. 2.Radiation therapy: Radiation therapy for esophageal cancer has been widely used in recent years. There are mainly two ways: body irradiation and endoluminal irradiation. Generally speaking, upper and middle esophageal cancers are more sensitive to radiation therapy and have better therapeutic effect, while lower esophageal cancers have poorer effect. Surgery combined with preoperative or postoperative radiation therapy is more effective than surgery or radiation therapy alone. 3. Chemotherapy with anticancer drugs: the therapeutic effect of anticancer drugs on esophagus is not very ideal, and currently it is only used as an auxiliary method after surgical treatment, which can consolidate the effect of surgery and prevent recurrence and metastasis. Relying on chemotherapy alone is not effective. 4. Traditional Chinese medicine: It is not the main method and only used as auxiliary treatment for esophageal cancer. Chinese medicine emphasizes dialectic treatment, which can regulate qi and blood, enhance patients’ immune function and have certain effects, especially for patients with weak physique and older age, which can help more, and can reduce the uncomfortable reaction of radiotherapy and chemotherapy, and can also be used as auxiliary treatment after surgery. 5.Immunotherapy: It has been confirmed that the immune function of tumor patients is lowered, and it is related to the occurrence and development of tumor. It is supposed that immunotherapy has a great role, but so far, there is not an effective method. At present, interleukin-2 and interferon may have some effects on esophageal cancer, but they can only be used as auxiliary treatment after surgery. V. Which esophageal cancers are suitable for surgery and which are not? Whether esophageal cancer patients can be operated or not mainly depends on the stage of esophageal cancer and the physical condition of patients. However, in principle, patients who can undergo surgery should strive for surgical treatment. (1) Early esophageal cancer in situ can be treated surgically; (2) Early esophageal cancer, i.e., the cancerous lesions in the middle and lower esophagus are within 5CM, and the cancerous lesions in the upper esophagus are within 3CM, are suitable for surgical treatment; (3) Intermediate esophageal cancer, with the lesion range of more than 5CM and without lymph node metastasis in the neck, can be treated surgically, and it is better to combine with preoperative radiotherapy; (4) Patients with recurrence of esophageal cancer after radiotherapy can be treated with surgery, and it is better to combine with preoperative radiotherapy. Those who have esophageal recurrence after radiotherapy, if the lesion range is less than 3cm. Patients who are not suitable for surgery: (1) Esophageal cancer is in advanced stage, and the cancer has obviously invaded the trachea, aortic arch, lungs, etc., or there is hoarseness, continuous chest and back pain. Because surgery is often unable to remove the tumor. (2) Patients with esophageal cancer have enlarged lymph nodes in the neck and liver metastasis. At this time, resection of esophageal cancer can not solve the fundamental problem, and even if the primary lesion is removed, metastatic cancer will appear in other parts of the body soon. (3) Having serious heart disease or poor lung function, such as emphysema and pulmonary alveolus. Since esophageal cancer surgery is a major surgery, it is difficult for patients with poor heart and lung functions to pass the surgery safely. What about patients with esophageal cancer that cannot be surgically removed? The main reasons for inoperable esophageal cancer are that the esophageal cancer is in advanced stage, the esophageal cancer is large and located in cervical or upper thoracic segment, or the general condition is not good enough to tolerate surgery. The following methods are available for the treatment of this kind of patients, and the specific methods should be decided by doctors. Radiation therapy: it is suitable for cervical and upper thoracic esophageal cancer that cannot be surgically resected. The effect of radiation therapy is good, the 5-year survival rate can reach 15-30%, and some patients can be operated again after radiation therapy. 2.Palliative surgical treatment: The biggest pain of advanced esophageal cancer is that the lesion is narrowed and obstructed, so that the patient can not eat, and in serious cases, the patient even can not swallow water, and it is not possible to operate radical treatment and radiotherapy. In order to solve the problem of feeding, improve nutrition and general condition of patients, palliative surgery can be performed. The main ones are: (1) Gastrostomy, in which food and drink are injected through the gastric tube. (2) Esophagogastric short-circuit surgery, which is suitable for esophageal cancer that cannot be resected after chest opening and connects the stomach to the esophagus in the upper part of the cancer. The patient can eat more normally after the operation. Endoscopic treatment of esophageal cancer: (1) Endoscopic esophageal dilatation and esophageal endotomy. That is to say, through esophagoscopy, the esophagus, which is narrowed by the cancer, is dilated, and a hollow tube is placed so that food can pass through the tube, thus solving the patient’s difficulty in eating. After the general nutritional status is improved, radiation therapy or chemotherapy can be performed. (2) Endoscopic laser therapy. Endoscopic laser therapy is used to vaporize the cancerous tissue protruding into the lumen of the esophagus, thus clearing the esophagus and allowing the patient to eat. Although laser therapy can treat early esophageal cancer, it is generally used only for advanced esophageal cancer. (3) Endoscopic microwave therapy. Under the guidance of esophageal endoscope, microwave heating is used to necrose and detach the cancer protruding from the esophageal lumen, so that the esophageal lumen can be opened. This method is only applicable to units without laser treatment. (4) Endoscopic local injection of anti-cancer drugs. The biggest advantage of this method is that the concentration of drugs in the tumor site is high, the effect is strong and the systemic side effects are small. It is less effective for advanced esophageal cancer due to obvious spreading of tumor, while it is more effective for those who are not suitable for surgery in early stage of esophageal cancer. 4. Traditional Chinese medicine treatment: This method can only play the role of alleviating the condition, but cannot achieve the purpose of eradicating the disease, but the combination of traditional Chinese medicine and western medicine is conducive to prolonging the survival time. How to prevent esophageal cancer? Esophageal cancer, like tumors in other parts of the body, has the tendency to recur easily, so how to prevent and find out the recurrence of esophageal cancer at an early stage is very important for patients, and it is also an important measure to improve the long-term survival rate. Specific measures are as follows: (1) Avoiding some triggering factors of esophageal cancer, please refer to the previous content for details. (2) Change bad dietary habits. (2) Change bad dietary habits, mainly not to smoke, not to drink alcohol, not to eat rotten, moldy and spoiled food, and not to eat too hot food. (3) Improve nutritional status, strengthen physical exercise, and improve the body’s ability to resist disease. (4) Eat, drink and live in a regular manner and maintain an optimistic mood and attitude. (5) Live within your means and do work or activities within your ability, which is good for both physical exercise and emotional well-being. (6) Complete the chemotherapy and radiotherapy program on schedule according to the doctor’s instructions. (7) Go to the outpatient clinic for regular checkups, such as whether there are enlarged lymph nodes in the neck, barium X-ray examination of the esophagus, and fiberoptic esophagoscopy if necessary. (8) Once there is recurrence of anastomotic esophageal cancer, laser treatment can be used in the early stage, or combined with chemotherapy and radiotherapy. (9) If there are enlarged lymph nodes in the neck, radiotherapy is usually used, preferably combined with chemotherapy. (10) If there is any bone pain in a certain part of the body, such as back pain or chest pain, consult the doctor for examination in time to prevent bone metastasis. Once the diagnosis is clear, radiotherapy should be used in time. To prevent recurrence of esophageal cancer after surgery, one of the important points is to keep an optimistic attitude towards life and strengthen physical exercise, which is very important to improve the immunity and disease-resistant ability of the body, and is also one of the important factors to achieve good long-term results.