Since last year, Mr. Qiao, a 54-year-old citizen of Nanjing, has been feeling uncomfortable in his throat when he eats, especially when he eats some especially hot and spicy food, his sternum hurts like pins and needles, but it disappears after a while. Unfortunately, the result of gastroscopy showed that he had esophageal cancer. Esophageal cancer is one of the common malignant tumors of digestive tract, and China is the country with the highest incidence and mortality rate of esophageal cancer in the world, and 60% of esophageal cancer occurs in China. Northern Jiangsu Province is also one of the high incidence areas of esophageal cancer. The occurrence of esophageal cancer has a lot to do with some poor living and eating habits of people, and the standardized treatment of esophageal cancer can significantly improve the 5-year survival rate of esophageal cancer patients after surgery.
Esophageal cancer is a “lifestyle cancer”
In 2010, Nanjing CDC announced the causes of death of the city’s deceased residents, and among the top 10 single causes of death, the mortality rate of esophageal cancer exceeded that of liver cancer for the first time, reaching 21.72/100,000, ranking eighth among the single causes of death and becoming the third most lethal “cancer of death” after stomach cancer and lung cancer. The following are some important factors known to influence the occurrence of esophageal cancer, from which we can see that bad eating habits are closely related to the development of esophageal cancer.
I. Smoking and alcohol consumption.
Smoking has been recognized as a risk factor for esophageal cancer, and it increases with the increase of smoking volume and the growth of smoking age. Cigarette smoke and tar contain many carcinogens, such as benzo(a)pyrene, polycyclic aromatic hydrocarbons, nitroso compounds, epoxide, etc. These substances can act directly on cell proteins, nucleic acids and other components, causing cell damage and triggering carcinogenesis. There is a certain relationship between alcohol and esophageal cancer, and some studies have proved that alcohol itself is not carcinogenic, but it can be used as a solvent for carcinogens, which can easily promote carcinogens into the esophageal mucosa.
Second, excessive intake of pickled products.
Studies have found that other factors affecting the high incidence of esophageal cancer include too much intake of pickled products, too much hot food and too little intake of fresh fruits and vegetables. The survey found that residents of Linzhou City, Henan Province, a region with high incidence of esophageal cancer, especially like to eat local pickled vegetables, and there are a lot of carcinogenic substances that induce esophageal cancer in the gastric juice and urine of local residents.
Third, bad eating habits.
Bad habits such as preferring hot food, rough food, high salt diet, hot food and fast food. These bad dietary habits can aggravate the physical stimulation and damage to esophageal mucosa, resulting in inflammation and even atypical hyperplasia.
The epidemiological survey of esophageal cancer shows that people who like to eat hot food are prone to esophageal cancer. Eating too fast, coarse and hard food can easily cause mechanical damage to the mucosa of the upper gastrointestinal tract; eating too fast can also easily cause hot food to go down, which can burn and necrosis the mucosa of the esophagus due to the high temperature of food. According to the survey, residents of Linzhou in Henan, Nara in Japan and northern Siberia in Russia have the habit of eating hot food and drinking hot tea, and these areas are precisely the high incidence areas of esophageal cancer.
Fourthly, the dietary protein intake is low.
In addition, insufficient intake of trace elements is also related to the occurrence of esophageal cancer.
V. Food is contaminated by fungus.
The incidence of esophageal cancer in high incidence areas of China is related to fungal esophagitis and fungal contamination of food. The contamination of Streptomyces vaginalis, Fusarium cepacia and Aspergillus fumigatus in the food of high incidence areas is more common. These fungi can not only reduce nitrate to nitrite, but also decompose protein, increase the amine content of food and promote the synthesis of nitrosamines related.
Nitrosamines are a very strong carcinogen. Nitrate, nitrite and secondary amine levels are significantly higher in food and drinking water in high prevalence areas, and are positively correlated with the prevalence of local esophageal tumors and severe atypical hyperplasia of the esophageal epithelium.
Sixth, genetic factors.
In the high incidence area of esophageal cancer, it is found that there is a family gathering phenomenon, and it is mostly concentrated among the family members with pedigree relationship, which suggests that genetic factors play a role in the occurrence of esophageal cancer.
Seven, viral infection.
Studies have shown that human papillomavirus (HPV) types 6, 16 and 18 are more closely related to esophageal cancer.
How to reduce the incidence of esophageal cancer
I. Reduce and avoid the intake of nitrosamine chemicals.
Try to eat fresh food and less food that has been stored for too long or pickled food. Prevent food from becoming moldy in storage, and try to wash the food well before cooking to remove the existing fungus. Edible oils (such as peanut oil) are sometimes susceptible to contamination by Aspergillus flavus and should be consumed within a certain storage period. Tomatoes, cucumbers and other poorly stored easy to grow white fungus, contaminated vegetables are not edible.
Second, long-term excessive smoking and alcohol make the risk of disease significantly higher.
Third, eat more fresh vegetables and fruits, supplemented with vitamin C, B2, etc., and trace elements such as iron, copper, zinc and selenium.
Medical research shows that both vitamin C and vitamin B2 have a protective effect on esophageal cells. The best way to consume vitamins is from natural foods. Recent studies show that eating 500 grams of vegetables and fruits daily can reduce the risk of esophageal cancer by a quarter. Vitamin B2 can be found in milk.
Avoid hot food and hot food, chew and swallow slowly.
5. Seek medical attention early when choking sensation occurs.
Due to the lack of specific symptoms in the early stage, patients with esophageal cancer are mostly in the middle and late stage when they visit the doctor. When there is difficulty in swallowing, they should go to the hospital immediately, and endoscopy is the best. Therefore, if the following symptoms appear, it should be alerted.
1. Choking sensation. It is usually caused by swallowing rice, steamed buns, pancakes, sweet potatoes and other foods in large gulps, causing a choking or suffocating sensation. This symptom can disappear on its own without treatment, but it can reappear after a few days or weeks, and then the number of times increases and the degree of choking gradually increases.
2.Post-sternal or subxiphoid pain. When eating, there is pain behind the sternum and in the fossa of the heart, and its nature can be burning-like, pinprick-like or friction-like pain. When swallowing rough, overheated, irritating (such as chili pepper, strong wine, etc.) food, the pain increases. At first it is mild and occurs less frequently, but later it can recur and the pain increases. According to statistics, about 50% of early esophageal cancer patients have this symptom.
3. Foreign body sensation in esophagus. There is the feeling of food staying in the esophagus when eating, without pain. Some patients feel that there are vegetable leaf fragments or rice-like objects attached to the esophagus wall even when they are not eating, so they cannot swallow it.
4. Food retention sensation. After swallowing food, the mouth of the esophagus becomes narrow and constricted, and the food moves down slowly and even stays in the esophagus.
Very few patients may be asymptomatic, and most have one or several symptoms at the same time. These states may come and go, and sometimes disappear after taking medication. In this way, patients are sometimes paralyzed and do not seek medical treatment in time, and doctors are not vigilant, so they may easily mistake it as esophagitis, pharyngitis or plum pneumonia, etc., and lose the opportunity of early diagnosis.
Reasons for high mortality rate of esophageal cancer
It is noteworthy that esophageal cancer ranks third in mortality rate despite its current incidence rate ranks sixth in the country. Its deep-seated reasons are worth exploring, which are mainly the following.
First, not paying attention to symptoms after they appear, or refusing to seek medical treatment because they do not believe they will get sick.
Generally speaking, there are almost no obvious symptoms in the early stage of esophageal cancer. Only in the middle stage of cancer, when the tumor becomes bigger and blocks the esophagus, it will cause the symptom of difficulty in swallowing. Clinically, 95% of esophageal cancer patients have dysphagia as the first symptom.
Second, there is lymphatic metastasis in early stage.
Another important reason is that there is a possibility of lymphatic metastasis of esophageal cancer cells from the early stage. Since the lymphatic network under the mucosa of esophageal cancer is crisscrossed, once the tumor infiltrates into the submucosa and muscle layer, the chance of distant lymph node (neck, upper mediastinum, upper abdomen) metastasis will increase significantly. In other words, some patients with esophageal cancer already have lymph node metastasis when they develop clinical symptoms. After conventional esophagectomy (left dissection), 70% of patients die of recurrent metastases within 5 years because of insufficient lymphatic clearance, among which lymph node metastases account for most of them.
Due to the special structure of narrow and long esophagus, lymphatic metastasis of esophageal cancer can often exist far away from the primary focus, and lymphatic metastasis in the neck and abdomen can occur in the upper, middle and lower esophageal cancer. Therefore, the standardized removal of lymph nodes in esophageal drainage area is crucial in the surgical treatment of esophageal cancer, and the effect depends on the thoroughness of the removal.
Third, no standardized treatment is performed.
Surgery is the first choice for treatment of early and mid-stage esophageal cancer. Once diagnosed, patients with esophageal cancer should take surgery as the basis of comprehensive treatment once their physical condition allows. At present, the most effective treatment for esophageal cancer is still standardized radical resection and comprehensive treatment. Some patients are misled by traditional concepts or believe that the cure rate of esophageal cancer surgery is low, so they choose conservative treatment or take traditional Chinese medicine, which misses the timing of cure. On the other hand, on the overall level of esophageal cancer surgical treatment in China, most of the hospitals in small and medium-sized cities in China cannot meet the requirements of standardized treatment in terms of treatment concept, technology and objective conditions, and the current restrictions on medical insurance for outbound medical treatment make it an empty word to improve the overall treatment effect of esophageal cancer in China.
Fourth, misdiagnosis.
Some patients, especially those from non-high-incidence areas and younger patients, will first go to ENT or head and neck departments of hospitals when they have throat discomfort or even hoarseness, while some doctors do not suggest patients to do gastroscopy because they do not know enough about the characteristics of esophageal cancer, thus missing some patients and delaying their condition.
Standardized treatment of esophageal cancer surgery
Theoretically, if the affected lymph nodes in the esophageal drainage area can be completely removed while removing the esophageal cancer lesions, the chance of cure will be greatly increased. The radical cure of esophageal cancer still relies on complete surgical resection and standardized lymph node dissection.
Due to the advanced concept and technology of treatment of esophageal cancer in Japan, extensive and meticulous lymph node dissection has been increasingly emphasized in China. The traditional left dissecting thoracic all-opening surgery is not able to perform satisfactory lymph node dissection due to the anatomical characteristics of human body, and the surgery is more traumatic and has poor therapeutic effect, so it has the tendency to be eliminated. Systematic two-field lymph node dissection of the thoracic and abdominal cavities in right dissection and three-field lymph node dissection of the double neck, right chest and abdomen in recent years can significantly improve the surgical efficacy of esophageal cancer without increasing the surgical risk. The purpose of second- and third-field lymph node dissection for esophageal cancer is to remove lymph nodes in the lymphatic drainage area of the esophagus, which are prone to metastasis, through an extended dissection, thus improving the treatment outcome.
In Japan, it usually takes surgeons 6-8 hours to perform surgery for esophageal cancer. Through cervicothoracic and abdominal three-field sweeps, more lymph node groups are removed, which not only improves the detection rate of metastatic lymph nodes in the neck, but also more thoroughly removes mediastinal and abdominal lymph nodes.
At present, few large hospitals in China perform two-field lymph node dissection, but only very few units have performed three-field lymph node dissection for esophageal cancer. The 5-year survival rate of patients with indications for three-field lymph node dissection can be significantly improved. Jiangsu Cancer Hospital is the first hospital in the province to routinely carry out standard three-field lymph node dissection and neoadjuvant chemotherapy.
Comprehensive treatment: preoperative chemotherapy (radiotherapy) has better effect
Chemotherapy is one of the main means to treat middle and late stage esophageal cancer. Nowadays, some people still have fear of chemotherapy. Of course, chemotherapy may cause side effects such as vomiting, hair loss, low white blood cells, etc. However, there are many new drugs and the side effects have been greatly reduced compared with the previous ones, so most patients can complete chemotherapy successfully. Preoperative chemotherapy can reduce clinical stage, facilitate tumor resection, kill or reduce micro-metastases, improve pathological remission rate, understand the sensitivity of tumor to chemotherapy drugs and protocols, prevent and reduce distant metastases, and improve the overall treatment effect. Some patients whose eating was affected by esophageal cancer obstruction had shrunken lesions after chemotherapy, resulting in smooth eating and significantly improved nutritional status, creating better conditions for subsequent surgery.
In developed countries, multicenter randomized controlled clinical trials have demonstrated that preoperative treatment can significantly improve long-term survival. In Japan, preoperative chemotherapy has become the standard of care. Preoperative radiotherapy has also entered clinical studies. In China, clinical studies of comprehensive perioperative treatment have also started.