First, the cause of the disease
The esophagus is a muscle food passage between the pharynx and the stomach. The upper end of the esophagus continued in the lower edge of the sixth cervical vertebra, descending along the front of the spine, and connected to the gastric cardia on the left side of the eleventh thoracic vertebra. Esophageal cancer is a malignant tumor with a strong regional distribution. The incidence rates vary widely among countries and regions around the world. China’s high incidence, ranked fourth in malignant tumors, more than 150,000 new cases, accounting for more than half of the total number of cases in the world. The incidence of Western countries such as the United States and Europe is significantly lower than in Asia and Africa. Moreover, even in China, the incidence of esophageal cancer in high-incidence areas and low-incidence areas varies by a few dozen to several hundred times.
In short, the epidemiological characteristics of esophageal cancer are mainly There are:
1, there are obvious geographical and population distribution, China is mainly distributed in Taihang Mountain, Henan, Hebei and Shanxi Provinces, the border of Hubei and Jiangxi in the Dabie Mountains, Sichuan Basin and Northwest Sichuan, Jiangsu Province The northern region, the border area between Fujian and Guangdong and the Kazakh settlement in Xinjiang.
2. The central region of the high-incidence area of esophageal cancer has the highest incidence rate and decreases to the surrounding gradient.
3. Poverty-stricken areas are higher than those in wealthy areas.
4. People of color are higher than whites.
5. Asian and African countries are higher than European and American countries.
6. Men are higher than women, and family history is higher than those without family history.
7. Epithelial cells with severe hyperplasia in the normal population of high-incidence areas are common.
8. The incidence of esophageal cancer increases with age (mostly 60-70 years).
The exact cause of esophageal cancer is still not fully understood.
The majority believe that the occurrence of esophageal mucosal epithelial tumors is the result of a combination of multiple factors and long-term chronic stimulation.
1 The common dietary characteristics of high-risk groups of esophageal squamous cell carcinoma are:
Eating too fast, food is overheated, high-starch foods, little or no vegetables and fruits.
2 Other possible factors include:
Lack of certain trace elements in soil and water, nitrite accumulation, unreasonable food structure leading to vitamin and essential fatty acid deficiency and Causes long-term chronic damage of esophageal mucosa, poor oral hygiene, long-term alcohol abuse, large amount of smoking, long-term consumption of food contaminated with mold (aflatoxin), and genetic factors (in the history of esophageal patients in Henan County, family history) 24%-61%).
3 The most closely related to esophageal adenocarcinoma is Barrett’s esophagus.
The so-called Barrett’s esophagus is the esophageal mucosal injury caused by gastric reflux in the esophageal squamous epithelium of the esophagus and stomach. The healing occurs repeatedly, resulting in the phenomenon of columnar epithelial metaplasia. This columnar epithelium is not a columnar mucosa that was innately preserved, but was later acquired and has a process of repeated repairs. It is generally believed that the Barrett’s esophagus with severe dysplasia is a precancerous lesion that is closely related to invasive adenocarcinoma and requires surgical resection.
Esophageal cancer occurs mostly in the middle of the esophagus.
The incidence of esophageal cancer in the upper, middle, and lower segments was 15%, 50%, and 35%, respectively. The pathological type is mainly squamous cell carcinoma, accounting for about 95%.
In recent years, epidemiology has shown that squamous cell carcinoma is still the main cause in China, and the incidence rate has a certain downward trend. However, the incidence of tube cancer in Europe is on the rise, mainly in esophageal adenocarcinoma. At present, the proportion of European-style tube adenocarcinoma and squamous cell carcinoma is half. The reason for this is unclear. Some people think that the increase in esophageal adenocarcinoma may be related to Barrett’s esophagus and obesity.
1, early symptoms
The early symptoms of esophageal cancer are atypical, non-specific, good, bad, and recurrent. Common discomforts include:
1 large mouthful of solid food stalks.
This is one of the most common early symptoms. It usually appears when eating in the first place, disappears afterwards, and appears once every few days to several months, which is easily overlooked. There are also persistent occurrences, but many mistakes are pharyngitis or esophagitis. It can be relieved after taking anti-inflammatory drugs. In fact, no drugs can be used, and the symptoms can be alleviated because the symptoms are not caused by mechanical obstruction of the disease, but lesions. Inflammation of the site, nerve reflexes, esophageal spasm and other factors. As the disease progresses, the interval between symptoms gradually decreases and the symptoms become more pronounced. Clinically easily misdiagnosed.
2 Foreign body sensation in the esophagus.
Approximately 15-21% of patients have a foreign body sensation in the esophagus when swallowing. Some patients felt that foreign bodies adhered to the esophageal wall when eating, and they could not spit out or feel discomfort. The location of foreign body sensation is consistent with the site of esophageal lesions.
3 Post-sternal pain, discomfort or stagnation.
A mild sternal pain after eating or not eating, sometimes absent, more likely to occur when eating hot food. Sometimes when you swallow food, you may be stagnant or mildly stalked at a certain location.
4 lower esophageal cancer can also appear under the xiphoid or upper abdominal discomfort, hiccups, belching.
2, middle and late symptoms
How many patients with esophageal cancer are in the advanced stage when they go to the hospital. The clinical symptoms of advanced esophageal cancer mainly include:
90% of patients are hospitalized after this symptom, and the symptoms of dysphagia are lost with time. Sexual increase. When you start eating large chunks of food, you gradually need to wash water or porridge when you eat rice-sized food. Then you can only eat a semi-liquid or liquid diet. In severe cases, the last drop of water will not enter. This process usually takes only 3-6 months.
Severe cases of complete obstruction when eating, and often accompanied by persistent oral foamy mucus. This is due to the infiltration of esophageal cancer and the reflexivity of inflammation, which is caused by increased secretion of esophageal glands and salivary glands. The accumulation of mucus in the esophagus can cause reflux, vomiting and even coughing, and severe aspiration pneumonia.
mostly swallowing pain when eating, and persistent sternal or back pain in the late stage, the nature of which is dull or dull, and also has burning pain or tingling. And accompanied by a heavy feeling. The location of the pain can be inconsistent with the location of the lesion. Pain often indicates that the tumor has been invaded, causing inflammation around the esophagus and mediastinal inflammation, but it can also be caused by a deep ulcer of the esophagus caused by the tumor. Severe pain can not fall asleep or accompanied by fever, not only the possibility of surgical resection is small, but also should pay attention to the possibility of tumor perforation.
A small number of patients with esophageal cancer will come to the hospital for hematemesis or melena. Tumors can infiltrate large blood vessels, especially the thoracic aorta, causing fatal bleeding. For patients with penetrating ulcers, especially if CT scan shows that the tumor invades the thoracic aorta, attention should be paid to bleeding.
is often caused by direct tumor invasion or compression of the recurrent laryngeal nerve after tracheal esophageal lymph node metastasis.
3, other systemic symptoms, metastatic symptoms and complications
1 weight loss and fever.
There is less food intake due to obstruction, and the nutritional status is getting lower and lower, and weight loss and dehydration often appear one after another. Weight loss, fever, etc. may also occur when the tumor spreads. Most of the tumor fever occurs in the afternoon, about 38 degrees, and the body temperature is often normal in the morning and morning.
2 Tumor infiltration through the esophagus invades the mediastinum, trachea, bronchi, hilar, pericardium, large blood vessels, etc., causing mediastinal inflammation, abscess, pneumonia, lung abscess, tracheobronchial fistula, fatal bleeding.
3 The corresponding symptoms caused by extensive systemic metastasis.
If there is a lung metastasis, cough, chest tightness, difficulty breathing, etc.; abdominal lymph node metastasis, abdominal pain, loss of appetite, etc., liver metastases, right upper quadrant pain, loss of appetite, jaundice, ascites, major bleeding, Coma and so on.
4 dyscrasia, dehydration, and exhaustion. It is characterized by extreme weight loss and exhaustion, often accompanied by hydroelectric medium disorder.
1, superficial lymphadenopathy
Supracondylar lymphadenopathy is a common sign in patients with esophageal cancer. Both cervical and thoracic esophageal cancers have the potential for supraclavicular lymph node metastasis. Most swollen lymph nodes are very hard, such as stony, fixed. Cervical lymph node metastasis is relatively small, mainly from the cervical and upper thoracic esophageal cancer. Occasionally there is axillary lymph node metastasis. In addition, the probability of superficial lymph node metastasis in other areas is very low.
2, vocal cord activity is limited or fixed
If the patient has hoarseness, an indirect or direct laryngoscopy is required to see if there is limited vocal activity Or fixed. Most of the causes of hoarseness are caused by swelling of the tracheal esophageal sulcus lymph nodes or invasion of the recurrent laryngeal nerve. Sometimes it is possible for the tumor to directly invade the recurrent laryngeal nerve.
3, related signs of metastatic sites
The tumor may metastasize to other sites and corresponding signs may appear. If there is bone pain, find out if there is local tenderness in the pain area.
4, general conditions
It should be noted that the patient’s systemic nutritional status, with or without fever, anemia and cachexia.
1. X-ray barium meal examination, also called esophagus. The advantages are simplicity, high accuracy, and less pain for the patient. It can not only observe the location of the esophageal lesion, the length, the degree of obstruction, the size and depth of the ulcer, the presence or absence of perforation and fistula formation, but also the changes of esophageal mucosa and esophageal dynamics.
2, CT tomography/magnetic resonance (MRI). It can not only see the location and length of the lesion, but also the thickness of the esophageal wall, tumor invasion, the relationship with adjacent organs, the metastasis of the neck or mediastinal lymph nodes, and lung metastasis.
3, Esophageal ultrasound (EUS). It has a high accuracy of T-stage of lesions, about 70%-80%; at the same time, the diagnosis rate of paraesophageal lymph node metastasis is higher than CT scan, up to 70%.
4. Esophagoscopy and biopsy Esophagoscopy is a reliable method for diagnosing esophageal cancer. It can observe the size, shape and location of the tumor under direct vision, and can also be biopsied or brushed in the lesion.
5. Positron emission computed tomography (PET): It can detect primary and regional lymph node metastasis, especially for distant lymph nodes and distant organ metastasis. This inspection has been considered routine in European and American countries.
6. Abdominal CT/B-ultrasound: Find or exclude abdominal metastases.
7, ECT: If there is doubt about bone metastasis, ECT should be performed.
8. Esophageal pull net: Esophageal pull net is another method for obtaining cytological diagnosis if pathology cannot be obtained by esophagoscopy.
9, blood routine, liver and kidney function, electrocardiogram, etc. These tests are designed to assess the general condition of the patient and to improve the reference for treatment options.
Author: Happy Zhao Fudan University Cancer Hospital
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