Esophageal cancer (EC) is a malignant tumor originating from the squamous and columnar epithelium of the esophagus, with squamous carcinoma accounting for about 90% and adenocarcinoma accounting for about 10%. There are obvious geographical differences among patients with esophageal cancer, which is most common in East Asia and relatively less in developed countries such as Europe and the United States, while China is a large country with the incidence of esophageal cancer, accounting for about 55% of new patients and deaths globally, which is the first in the world, and the prognosis is poor, with a 5-year survival rate of less than 30%, and it is the sixth most common tumor in China. Among western esophageal cancer patients, 80% are esophageal adenocarcinoma, while the main subtype of esophageal cancer in China is esophageal squamous carcinoma, which mostly occurs in the mid-thoracic esophagus.

These people should pay attention! It’s a high-risk screening group for esophageal cancer!

(1) Age: 40~69 years old;

(2) Lifestyle: Previous or current smoking and drinking habits (especially liquor);

(3) Heredity: first-degree or second-degree relatives with a history of esophageal cancer;

(4) Tongue characteristics: people with long-term stasis, cracked tongue or red tongue characteristics;

(5) Being born or living in areas with high incidence of esophageal cancer; combining with other high risk factors of esophageal cancer: hot and scalded diet, habit of consuming pickled products, etc.

What factors are associated with the development of esophageal cancer

The causes of the disease are closely related to nitrosamines, molds, deficiency of certain vitamins and trace elements, heredity, hot drinks and hot food and other bad dietary habits. There are more males than females, and the age of onset is usually above 40 years old, mostly seen in the elderly aged 55~74. In Chinese medicine, it belongs to the category of “choking, diaphragm”, “regurgitation”, “guan ge”, “zheng jie” and so on.

(1) Nitrosamines and molds: Many studies at home and abroad have confirmed that nitrosamines and molds have strong carcinogenic effects. Asymmetric nitrosamines can cause esophageal cancer and pharyngeal cancer with strong organ selectivity. Higher levels of nitrates and nitrites can be detected in grains, sauerkraut, drinking water, and gastric juices of residents in areas of high incidence of esophageal cancer, which are associated with cancerous changes of esophageal epithelium in areas of high incidence. Therefore, nitrosamines play an important role in the development of esophageal cancer. In recent years, in order to inhibit the carcinogenic effect of nitrosamines, experiments at home and abroad have proved that cod liver oil, dry yeast, riboflavin vitamin C, vitamin A and cystine can block the nitrosation of amines in order to inhibit the carcinogenic effect. Molds, such as Fusarium tandem, Aspergillus niger, and the toxins they produce and nitrosamines have carcinogenic synergistic effects. Most studies have confirmed that these fungi have significantly higher contamination rates in high prevalence areas than in low prevalence areas.

(2) Nutrients as well as trace elements: Studies at home and abroad have shown that a lack of molybdenum, zinc, iron, fluorine and selenium in water and food has an impact on human growth, development and tissue trauma repair. It may also cause nitrates in plants to aggregate, providing precursors for the synthesis of amyl nitrite. Supplementation with multiple nutrients may reduce the risk of cancers of the esophagus, cardia, and stomach to some extent. In addition, selenium supplementation may promote the reversal of mild atypical hyperplasia and block its progression.

(3) Dietary and living habits: physical stimulation of food, such as heat, hardness, smoking, drinking, eating sauerkraut, chewing betel nut and so on, have a certain relationship with the occurrence of esophageal cancer. Among them, new cases of esophageal cancer caused by smoking account for 45% of new cases in men all over the world. So quitting smoking is not only to keep away from lung cancer, but also can help people to keep away from esophageal cancer.

(4) Genetic susceptibility and molecular biomarkers: According to the epidemiological data in China, 24%~61% of esophageal cancer patients have positive family history, with obvious family aggregation phenomenon. Some studies have indicated that brittle sites and slow repair are found on chromosomes of family members of positive patients, which may be related to genetic susceptibility of esophageal cancer.

(5) Chronic inflammation of esophagus: esophageal scar stenosis, esophageal hiatal hernia, reflux esophagitis, esophageal diverticulum, pancreatic achalasia and so on have increased chances of complication of esophageal cancer.

(6) Geographic environment factors: climatic conditions and nature of soil affect the occurrence of esophageal cancer. For example, the incidence rate of esophageal cancer is higher in low mountainous and hilly areas than in high mountainous areas and plains; esophageal cancer is more frequent in temperate zones and subtropical zones with drought and low rainfall; and the incidence rate of brown, yellow, brown and alkaline soil is higher.

What are the signs of esophageal cancer? What are the clinical diagnostic methods?

Symptoms:

Early stage usually has no obvious symptoms, but there may be intermittent post-sternal discomfort, friction, slight pain or foreign body sensation when eating, dryness and constriction in the throat; middle and late stage manifests progressive dysphagia behavioral dysphagia (firstly, it is difficult to swallow dry food, then semi-fluid food, and finally, water and saliva can’t be swallowed), and there may be gradual appearance of invasion of adjacent organs or metastasis of the cancer, such as hoarseness, shortness of breath, vomiting blood or black stool, liver enlargement, jaundice, ascites, etc.; end stage anemia, dehydration and malaise are very common. , hepatomegaly, jaundice, ascites, etc.; end-stage anemia, dehydration and malaise are very common.

Diagnostic methods:

According to epidemiological features, clinical symptoms, combined with barium esophageal meal, endoscopy, exfoliated cells and pathological examination, the diagnosis can be clearly defined. Commonly used imaging methods for esophageal cancer include endoscopic ultrasound, computed tomography, 18F-fluorodeoxyglucose PET-CT and MRI.

What are the treatments for esophageal cancer at different times?

Western medical treatment is mainly based on surgery in the early stage, together with radiotherapy and chemotherapy; for those who cannot undergo surgery, endoscopic intervention is feasible; for those with cancerous stenosis of esophagus, stent implantation is feasible. As esophagectomy is more traumatic, it may affect patients’ quality of life. Therefore, minimally invasive treatment has been a hot spot of clinical research in recent years.

Endoscopic resection (ER), transendoscopic submucosal dissection (ESD), endoscopic mucosal resection (EMR), and photodynamic therapy (PDT) are often used for early stage esophageal cancer.The indications for ER are based on the risk of lymph node metastasis. Lymph node metastasis rarely occurs in carcinoma in situ or tumors confined to the lamina propria of the mucosa.ESD is indicated for tumors with lesions <20 mm, and for tumors with lesions <20 mm, which need to be resected in segments because of oversized lesions, the accuracy of resection is not guaranteed.PDT is a relatively good choice for local recurrence after comprehensive treatment of esophageal cancer. Unlike ESD, EMR provides complete resection regardless of the size of the lesion or the degree of submucosal fibrosis, with a low rate of local recurrence and a low probability of postoperative bleeding. However, EMR is more demanding on the operator, takes longer to perform, and has a higher risk of perforation, a higher probability of postoperative stenosis, and a lesion larger than 3/4 of the circumference, all of which are important risk factors.

Locally advanced esophageal cancer is often treated with neoadjuvant therapy, radical simultaneous radiotherapy or radical surgery (DCRT). Among them, DCRT, which uses simultaneous radiotherapy and chemotherapy, is indicated for patients with locally advanced unresectable cT4b, extensive lymph node metastasis or those who are not suitable for surgery.

For advanced or recurrent esophageal cancer, systemic treatment options include chemotherapy, small molecule targeted drug therapy, immunotherapy and traditional Chinese medicine. Chemotherapy has low effective rate and targeted therapy has slow progress. Compared with the first two, immunotherapy is a hot research direction in recent years, such as pabolizumab and nabulizumab.

How to prevent esophageal cancer from every bit of life?

1. Change bad eating habits such as fast food, hot food, pickles and preserved products. Avoid eating hard, crunchy and fried foods.
2. After operation, the diet should be mainly fluids or semi-fluids, avoiding any stimulating diet to prevent anastomotic infection and damage.
3. Nutritious and easy-to-swallow foods should be used in radiotherapy, such as milk, cake, yam powder, fresh vegetable or fruit juice, cilantro, bitter gourd, oilseed rape, fungus, nori and so on.
4. Pay attention to keep a relaxed mood.
5. Keep the skin in the radiation area dry and do not scratch during radiation therapy.
6. generally should be rechecked once every three months, and those in good condition can be rechecked once every six months.