November 27, 2022

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Esophageal cancer: Causes Symptoms Examination and Prevention

Esophageal cancer: Causes Symptoms Examination and Prevention

 

 

Esophageal cancer: Causes Symptoms Examination and Prevention.  The incidence in Western countries such as the United States and Europe is significantly lower than that in Asia and Africa. Moreover, the incidence of esophageal cancer in the high-incidence area and the low-incidence area is also tens to hundreds of times different.

 

 

 


1. The cause of disease 


The esophagus is a muscular food passage between the pharynx and the stomach. The upper end of the esophagus continues to the pharynx at the lower edge of the sixth cervical vertebra, descends along the front of the spine, and connects to the gastric cardia on the left side of the 11th thoracic vertebra.

 

Esophageal cancer is a kind of malignant tumor with strong regional distribution. The incidence rate varies greatly among countries and regions in the world. 

 

Esophageal cancer: Causes Symptoms Examination and Prevention

 

In short, the epidemiological characteristics of esophageal cancer mainly include:

1. Obvious geographical and population distribution. 

2. The incidence rate is highest in the central area of ​​the high-incidence area of ​​esophageal cancer, which gradually decreases to the surrounding area.

3. The poverty areas are higher than the rich areas, and the rural areas are higher than the cities.

4. People in Africa and Asia are higher than Caucasian.

5. Asian and African countries are higher than European and American countries.

6. Men are higher than women, and those with family history are higher than those without family history.

7. Severe proliferation of epithelial cells is common in normal populations in high-risk areas.

8. The incidence of esophageal cancer increases with age (mostly 60-70 years old).

 

The exact cause of esophageal cancer is still not fully understood.

 

Most believe that the occurrence of esophageal mucosal epithelial tumors is the result of a combination of multiple factors and long-term chronic stimulation.

 

①The dietary characteristics shared by high-risk groups of esophageal squamous cell carcinoma are:

Eating too fast, food too hot, high starch foods, little or no vegetables and fruits.

 

②Other possible factors include:

Lack of certain trace elements in water, soil and food, accumulation of nitrites, unreasonable food structure, lack of vitamins and essential fatty acids, and various reasons lead to long-term chronic damage to the esophageal mucosa, poor oral hygiene, long-term alcoholism, heavy smoking, long-term consumption Food contaminated by mold (aflatoxin) and genetic factors (24%-61% of patients with esophageal cancer in Lin County, Henan Province have family history).

 

③Barrett’s esophagus is most closely related to the occurrence of esophageal adenocarcinoma.

 

The so-called Barrett’s esophagus refers to the esophageal mucosal damage caused by gastric reflux in the esophageal squamous epithelium at the esophagus-gastric junction-healing occurs repeatedly, resulting in columnar epithelial metaplasia.

This columnar epithelium is not a columnar mucosa that is preserved congenitally, but is obtained later, and has a repeated repair process.

It is generally believed that Barrett’s esophagus with severe dysplasia is a precancerous lesion, which is closely related to invasive adenocarcinoma and requires surgical resection.

 

Esophageal cancer mostly occurs in the middle of the esophagus.

 

The incidence of upper, middle, and lower esophageal cancer was 15%, 50%, and 35%, respectively. The main pathological type is squamous cell carcinoma, accounting for about 95%.

 

In recent years, epidemiology has shown that squamous cell carcinoma is still dominated in our country, and the incidence has a certain downward trend.

However, the incidence of gastrointestinal cancer in Europe is on the rise, and it is mainly esophageal adenocarcinoma. At present, the proportion of European gastronomic duct adenocarcinoma and squamous cell carcinoma is half. The reason is not clear. Some people think that the increase in esophageal adenocarcinoma may be related to Barrett’s esophagus and obesity.

 

 

 


2. Symptoms

 

1) Early symptoms

 

The early symptoms of esophageal cancer are often atypical, non-specific, good and bad, and recurring. Common discomforts include:

 

① A choking sensation due to a big mouthful of solid food.

This is one of the most common early symptoms. It usually appears when the first mouthful of food is taken, and then disappears. It appears once in a few days to a few months, which is easy to be ignored. There are also persistent occurrences, but most of them are mistaken for pharyngitis or esophagitis, which can be relieved after self-administration of anti-inflammatory drugs. In fact, the symptoms can be relieved without taking any drugs, because the occurrence of the symptoms is not caused by mechanical obstruction of the disease, but by lesions. Inflammation of the site, nerve reflex, esophageal spasm and other factors are related. As the disease progresses, the interval between symptoms gradually shortens and symptoms become more pronounced. It is easy to be misdiagnosed clinically.

 

② Foreign body sensation in the esophagus.

About 15-21% of patients feel a foreign body sensation in the esophagus when swallowing. Some patients feel that foreign bodies stick to the wall of the esophagus when eating, and they cannot vomit or swallow. The location of foreign body sensation is mostly the same as the location of esophageal disease.

 

③ Pain, discomfort or choking sensation behind the sternum.

After eating or not eating, there will be mild retrosternal pain, sometimes absent, and it is more likely to occur when eating hot food. Sometimes stagnation or a mild choking sensation in a certain area when swallowing food.

 

④Lower esophageal cancer can also cause discomfort under the xiphoid process or upper abdomen, hiccups, and belching.

 

2) Middle and late symptoms

The vast majority of patients with esophageal cancer are already in the advanced stage when they come to the hospital. The clinical symptoms of advanced esophageal cancer mainly include:

 

①Difficulty swallowing

About 90% of patients have this symptom and then seek medical treatment in the hospital, and the symptoms of dysphagia are progressively aggravated over time. It appears when you start to eat large pieces of food, and gradually develops into the need for boiling water or porridge when eating rice-sized food, and then develops to only eat a semi-liquid or liquid diet, and in severe cases, it will not drip in the end. This process generally only takes 3-6 months.

 

② obstruction

In severe cases, it is completely obstructed when eating, and it is often accompanied by continuous oral vomiting of foamy mucus. This is due to the increased secretion of esophageal and salivary glands caused by the infiltration and inflammation of esophageal cancer. The accumulation of mucus in the esophagus can lead to reflux, vomiting and even coughing. In severe cases, aspiration pneumonia may occur.

 

③Pain

It is mostly painful swallowing while eating. In the late stage, there is persistent retrosternal or back pain. Its nature is dull or dull pain, and there is also burning or tingling, accompanied by a feeling of heaviness. The location of pain may not be consistent with the location of the lesion. Pain often indicates that the tumor has invaded, causing periesophageal inflammation and mediastinitis, but it can also be caused by deep esophageal ulcers caused by the tumor. Those who have severe pain and cannot fall asleep or are accompanied by fever, not only have a small possibility of surgical resection, but also should pay attention to the possibility of tumor perforation.

 

④Bleeding

A small number of esophageal cancer patients also come to the hospital for hematemesis or melena. Tumors can infiltrate large blood vessels, especially the thoracic aorta and cause fatal bleeding. For cases with penetrating ulcers, especially those with CT examination showing that the tumor has invaded the thoracic aorta, attention should be paid to the possibility of bleeding.

 

⑤ Hoarse voice

It is often caused by direct tumor invasion or compression of the recurrent laryngeal nerve after metastasis of the tracheoesophageal groove lymph nodes.

 

 

 


3. Other systemic symptoms, metastatic symptoms and complications

 

① Weight loss and fever.

Reduced food intake due to obstruction, lower nutritional status, weight loss and dehydration often occur one after another. When the tumor spreads, weight loss and fever may also occur. Tumor fever mostly occurs in the afternoon, around 38 degrees, and the body temperature is usually normal in the morning and morning.

 

②Tumor infiltration penetrates the esophagus and invades the mediastinum, trachea, bronchus, hilar, pericardium, large blood vessels, etc., causing mediastinitis, abscess, pneumonia, lung abscess, tracheobronchial fistula, and fatal hemorrhage.

 

③ Corresponding symptoms caused by extensive systemic metastasis.

Such as lung metastasis, cough, chest tightness, dyspnea, etc.; abdominal lymph node metastasis, abdominal pain, decreased appetite, etc.; liver metastasis, right upper abdominal pain, decreased appetite, jaundice, ascites, massive bleeding, coma, etc.

 

④ cachexia, dehydration, exhaustion.

It is characterized by extreme weight loss and exhaustion, often accompanied by disorders of hydroelectric media.

 

 

 


3. signs

 

1) Swollen superficial lymph nodes

Supraclavicular lymph node enlargement is a common sign in patients with esophageal cancer. Both cervical and thoracic esophageal cancer may have supraclavicular lymph node metastasis. Most enlarged lymph nodes are very hard, stony, and fixed. There are relatively few cervical lymph node metastases, mainly from cervical and upper thoracic esophageal cancer. Occasionally, there is also lymph node metastasis under the armpit. In addition, the probability of superficial lymph node metastasis in other parts is very low.

 

2) Vocal cord activity is limited or fixed

If the patient has hoarseness, indirect or direct laryngoscopy is required to see if there is limited or fixed vocal cords. Most of the causes of hoarseness are caused by swollen lymph nodes in the trachea and esophagus sulcus or invading the recurrent laryngeal nerve. Sometimes it is possible that the tumor directly invades the recurrent laryngeal nerve.

 

3) Relevant signs of metastasis

Corresponding signs may appear when the tumor has metastasized to other parts. If there is bone pain, find out whether there is local tenderness in the painful area.

 

4) General condition

Attention should be paid to the patient’s general nutritional status, with or without fever, anemia, and cachexia.

 

 

 


4.  Inspection method

 

1) X-ray barium meal examination, also called esophageal film.

The advantages are simplicity, high accuracy, and less patient pain. Not only can the esophageal lesion location, length, degree of obstruction, ulcer size and depth, perforation and fistula formation be observed, but also the changes in esophageal mucosa and esophageal dynamics can be observed.

 

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, relationship with adjacent organs, neck or mediastinal lymph node metastasis, and lung metastasis.

 

3) Esophageal ultrasound (EUS).

The accuracy of T staging of lesions is high, about 70%-80%; at the same time, the diagnosis rate of paraesophageal lymph node metastasis is also higher than that of CT scan, which is as high as 70%.

 

4) Esophagoscopy and biopsy

Esophageal endoscopy is a more reliable method for diagnosing esophageal cancer. It can observe the size, shape and location of the tumor under direct vision, and at the same time biopsy or brush the diseased area.

 

5)  Positron emission computed tomography (PET):

It can detect metastasis of primary tumors and regional lymph nodes, especially for distant lymph nodes and distant organs with higher sensitivity. This inspection has been regarded as a routine in European and American countries.

 

6)  Abdominal CT/B ultrasound:

Find or rule out abdominal metastases.

 

7)  ECT:

If bone metastasis is suspected, ECT should be performed.

 

8) Esophageal netting:

If the pathology cannot be obtained by the esophagus, the esophageal mesh is another way to obtain a cytological diagnosis.

 

9) Blood routine, liver and kidney function, electrocardiogram, etc.

These examinations are to assess the general condition of the patient and to improve reference for treatment selection.

 

 

 


5. Prevention

 

1) Change eating habits

 

The esophageal mucosa is delicate and not sensitive to heat. Eating and drinking above 65°C will burn the mucosa.

Too hot, rough food passing through the esophagus and touching the mucosal epithelium will scald the esophageal mucosal epithelium, causing damage, ulceration, bleeding and other lesions to the mucosal epithelium.

 

Don’t eat too fast, don’t gobble it up, don’t eat food too fast.

 

It is necessary to fast overnight vegetables, rotten fruits, moldy grains, commercially available salted fish and bacon and pickles, as well as fried, fried, and grilled foods.

Pay attention to the source of drinking water, and prevent the tap water from being polluted, otherwise it will cause cancer.

 

2) No smoking and alcohol restriction


Smoking has a wide range of carcinogens, and the formation of cancer can cause cancers of the digestive, respiratory, and urinary tracts. Long-term heavy drinking will inevitably not eat carcinogens. Some wine contains carcinogens such as nitrosamines and aflatoxin, as well as indirect carcinogens such as aldol.

 

3) Improve malnutrition


Protein deficiency can cause esophageal mucosal hyperplasia, which is prone to malignant transformation; fat deficiency hinders the absorption of essential fatty acids and fat-soluble vitamins, affects health and reduces immune function. Eat more fresh vegetables and fruits, the former cannot replace the latter, because a lot of vitamins and trace elements are often destroyed in cooking.

 

4) Supplement trace elements


Patients suffering from esophageal cancer often lack iron, molybdenum, zinc, manganese, selenium and other trace elements and vitamins A, B2, and C; aspirin can prevent this disease, so high-risk groups can supplement related trace elements and vitamins under the guidance of a physician And drugs to prevent.

 

5) Actively diagnose and treat general esophageal diseases

Suffering from esophagitis, leukoplakia, polyps, diverticula, achalasia, etc., due to histological changes, functional variations, and local irritation, it is easy to worsen and form cancer. Must observe closely, actively treat and take effective measures to prevent. Gastroscopy once a year is a vital means to detect early esophageal cancer.

 

(source:internet, reference only)


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