Esophageal cancer, also called esophageal cancer, is a malignant tumor occurring in the epithelial tissue of esophagus, accounting for 2% of all malignant tumors. About 220,000 people die of esophageal cancer worldwide every year, and China is a high incidence area for esophageal cancer, which is the second most common cause of death after gastric cancer, with the age of onset mostly above 40 years old and more men than women, but there is a growing trend of onset below 40 years old in recent years. The occurrence of esophageal cancer is related to the chronic stimulation of nitrosamines, inflammation and trauma, genetic factors and the content of trace elements in drinking water, food and vegetables.
Early symptoms of esophageal cancer.
1.Choking sensation in the throat is the most common, which can disappear and recur spontaneously and does not affect eating. It often occurs when the patient’s mood fluctuates, so it is easily mistaken for functional symptoms.
2.Posterior sternal and subxiphoid pain is more common. When swallowing food, there is pain behind the sternum or subsynovial pain, the nature of which can be burning-like, pinprick-like or pulling-like, with the swallowing of rough, burning or irritating food as the focus. Initially, it is intermittent, but when the cancer invades the nearby tissues or penetrates, there can be severe and continuous pain. The site of pain often does not exactly correspond to the site of lesion in the esophagus. The pain can be temporarily relieved by antispasmodics.
When swallowing food or water, there is a sensation of slow movement and retention of food, as well as a feeling of tightness behind the sternum or food adhering to the esophageal wall. The site of the symptoms is mostly the same as the site of the lesion in the esophagus.
4. Dryness and constriction in the throat is especially obvious when swallowing dry and rough food, and the occurrence of this symptom is often related to the patient’s mood swings.
5.Other symptoms: a few patients may have posterior sternal stuffiness and discomfort, anterior pain
Middle-term symptoms of esophageal cancer.
1.Choking sensation in the throat is the most common, which can disappear and recur spontaneously and does not affect eating. It often occurs when the patient’s mood fluctuates, so it is easily mistaken for functional symptoms.
2.Posterior sternal and subxiphoid pain is more common. When swallowing food, there is pain behind the sternum or subsynovial pain, the nature of which can be burning-like, pinprick-like or pulling-like, with the swallowing of rough, burning or irritating food as the focus. The pain may be intermittent at first, but when the cancer invades the nearby tissues or penetrates, there may be severe and continuous pain. The site of pain often does not exactly correspond to the site of lesion in the esophagus. The pain can be temporarily relieved by antispasmodics.
3, food retention infection and foreign body sensation when swallowing food or water, there is a feeling of slow downward movement of food and stagnation, as well as a feeling of tightness behind the sternum or food adhering to the esophageal wall, etc., which disappears after eating. The site of the symptoms is mostly the same as the site of the lesion in the esophagus.
4. Dryness and tightness in the throat is especially obvious when swallowing dry and rough food, and the occurrence of this symptom is often related to the patient’s mood swings.
5.Other symptoms: a few patients may have posterior sternal stuffiness and discomfort, anterior pain.
Typical symptoms of mid-stage esophageal cancer: progressive dysphagia. There may be pain behind the sternum when swallowing and spitting mucus-like sputum.
Advanced symptoms of esophageal cancer.
Progressive dysphagia is the main symptom of most patients at the time of consultation, but it is the late manifestation of the disease. Because the wall of esophagus is elastic and expandable, dysphagia only appears when about 2/3 of the circumference of esophagus is infiltrated by cancer. Therefore, after the appearance of early symptoms mentioned above, the disease gradually worsens within a few months, from inability to swallow solid food to inability to swallow liquid food as well. If the cancer is accompanied by inflammation, edema and spasm of the esophageal wall, the difficulty in swallowing may be aggravated. The location of the obstruction often conforms to the site of the cancer.
2.Food reaction often appears when the difficulty in swallowing is aggravated, and the reflux volume is not large, containing food and mucus, but also blood and pus.
3.Other symptoms may cause hoarseness when the cancer presses the recurrent laryngeal nerve; invasion of phrenic nerve may cause erratic reflux or phrenic nerve paralysis; compression of trachea or bronchus may cause shortness of breath and dry cough; erosion of aorta may produce fatal bleeding. If the cancer is located in the upper esophagus or esophagobronchial fistula, cervical sympathetic nerve palsy may occur when swallowing liquid.
Signs.
Early signs are to be absent. In the late stage, eructation and dysphagia may occur. And due to the difficulty in eating, the patient may suffer from malnutrition and show signs such as wasting, anemia, water loss or cachexia. When the cancer metastasizes, enlarged and hard superficial lymph nodes or enlarged and nodular liver can be palpated. Jaundice and ascites may also be present. Other rare signs include nodules at the skin and abdominal white line, and enlarged inguinal lymph nodes.
The development of esophageal cancer may be related to the following factors.
1. Dietary habits.
Long-term smoking and strong alcohol, long-term hot food, hard food without fine chewing, etc. have certain relationship with the occurrence of esophageal cancer.
2.Carcinogenic substances.
(1) Nitrosamines: Nitrosamines are a group of very strong carcinogenic substances. Residents in Henan Lin County, a high incidence area of esophageal cancer, like to eat sauerkraut, which contains ammonium nitrite. It is proved that the amount of sauerkraut consumed is directly proportional to the incidence of esophageal cancer.
(2) Mold: Some people in China use moldy food to feed rats for a long time and induce esophageal cancer.
3.Genetic factors.
The susceptibility of human population is related to genetic and environmental conditions. Esophageal cancer has a remarkable phenomenon of family gathering, and it is not uncommon to see families with three or more consecutive generations of esophageal cancer patients in high incidence areas.
Precancerous lesions and other disease factors: such as chronic esophageal inflammation, esophageal epithelial hyperplasia, esophageal mucosal injury, Plummer-Vinton syndrome, esophageal diverticulum, esophageal ulcer, esophageal leukoplakia, esophageal scar stenosis, hiatal hernia, pancreatic dyscrasia, etc. are considered precancerous lesions or precancerous diseases of esophageal cancer.
5.Lack of vitamins, proteins and essential fatty acids in the diet can make the esophageal mucosa proliferate and interstitially change, which can further cause cancerous changes. The lack of trace elements such as iron, molybdenum and zinc is also related to the occurrence of esophageal cancer.