Cancer caused by eating! These 4 symptoms in the throat may be a warning sign of esophageal cancer...

According to the global cancer burden data released by the International Agency for Research on Cancer, esophageal cancer is one of the top ten cancers in the world. In 2020, there were more than 600,000 new cases of esophageal cancer worldwide. Among them, 53.7% of new esophageal cancer cases and 55.3% of esophageal cancer deaths occurred in China.

In other words, more than half of the new cases of esophageal cancer in the world each year are in China, and two-thirds of the cases occur in the Taihang Mountain area spanning Henan, Shanxi and Hebei.

The "Comprehensive Talk on Esophageal Cancer", a sub-volume of the "Popular Science China·Tumor Prevention and Control Popular Science Series", interprets the current status of esophageal cancer from multiple perspectives, and explains the knowledge on the prevention and treatment of esophageal cancer from multiple perspectives in easy-to-understand language.

Common sites of esophageal cancer

The esophagus of a healthy adult is about 25 cm long. It is a muscular tube with its upper end located at the lower edge of the sixth cervical vertebra or the lower edge of the cricoid cartilage. It starts at the pharynx and its lower end is located on the left side of the 11th thoracic vertebra, following the cardia of the stomach.

The structure of the human digestive system. Image source: "Science Popularization China·Tumor Prevention and Control Science Series: Comprehensive Discussion on Esophageal Cancer"

The esophagus is mainly divided into three sections: cervical, thoracic, and abdominal. Each node may become the growth site of esophageal tumors, especially the three physiological narrow areas of the esophagus.

Compared with other parts, food stays longer in the narrow part. Therefore, certain carcinogens in food have more chances to contact and stay longer in the three narrow parts of the esophagus than in other parts. At the same time, because the narrow part of the esophagus has a smaller diameter, it is more likely to rub against harder food, causing a certain degree of mechanical damage, which can easily lead to chronic inflammation or damage in the long run, which is also one of the important reasons for esophageal cancer.

There are three physiological strictures of the esophagus:

The first stenosis is located at the beginning of the esophagus, that is, the junction of the pharynx and the esophagus, which is equivalent to the lower edge of the cricoid cartilage and the sixth cervical vertebra, and is surrounded by the cricopharyngeus muscle and cricoid cartilage;

The second stenosis is 7 cm below the entrance of the esophagus, where the left bronchus crosses the esophagus, which is equivalent to the level of the sternal angle or between the fourth and fifth thoracic vertebrae. It is formed by the aortic arch passing through its left side and the left bronchus crossing the front of the esophagus. This part is where foreign bodies are easily retained in the esophagus.

The third stenosis is the hole where the esophagus passes through the diaphragm, which is tilted upward from right to left. During esophageal barium meal radiography, these three pressure marks of the esophagus can be seen.

These groups of people are very likely to get esophageal cancer

The etiology of esophageal cancer is relatively complex. It is generally believed that the occurrence of esophageal mucosal epithelial tumors is the result of the combined action of multiple factors and long-term chronic stimulation.

According to the definition of the Expert Consensus on Screening for Early Esophageal Cancer and Precancerous Lesions in China, people aged 40 and above who meet one of the following six criteria are considered to be at high risk for esophageal cancer:

Esophageal cancer stages. Image source: "Science Popularization China: Cancer Prevention and Control Science Series: Comprehensive Esophageal Cancer"

1

People who live in areas with a high incidence of esophageal squamous cell carcinoma for a long time

In my country, the most concentrated area for esophageal cancer is located on the south side of Taihang Mountain at the junction of Hebei, Henan and Shanxi provinces, especially in Ci County, where the age-standardized incidence rate exceeds 100/10,000; there are also relatively concentrated high-incidence areas in Qinling Mountains, Dabie Mountains, northern Sichuan, Fujian and Guangdong, northern Jiangsu, Xinjiang and other places.

2

Bad eating habits

Such as eating fast, liking hot food, high-salt diet, and liking to eat pickled vegetables.

"Eat while it's hot" has been a traditional Chinese dietary habit for many years. Many foods are indeed more delicious when they are hot, but the "heat" must be controlled well. Studies have shown that long-term consumption of hot drinks or food above 65°C increases the risk of esophageal cancer. Overly hot food can cause physical damage to the esophageal mucosa. Long-term repeated damage is prone to atypical hyperplasia, which increases the risk of esophageal cancer.

3

Bad habits such as smoking and drinking

4

A first-degree relative with esophageal cancer

Esophageal cancer has a familial clustering phenomenon, which may be related to the same genetic background of family members or the common exposure of family members to specific environmental factors. A large population-based case-control study showed that there is a close association between family history of esophageal cancer and the risk of esophageal squamous cell carcinoma. The risk of esophageal squamous cell carcinoma increases with the number of affected first-degree relatives. In addition, individuals whose parents both have esophageal cancer have a significantly increased risk of esophageal squamous cell carcinoma.

5

Poor oral hygiene

Tooth loss, low frequency of toothbrushing, and poor periodontal health are also potential risk factors for esophageal squamous cell carcinoma. Severe tooth loss increases the risk of esophageal squamous cell carcinoma by 1.5 times. In China, people with decreased esophageal microbial abundance and reduced saliva microbial diversity may be more likely to develop atypical hyperplasia of esophageal squamous epithelial cells (precancerous lesions of esophageal squamous cell carcinoma). In addition, a team led by Chinese scholar Gao Shegan found that an important periodontitis pathogen, Porphyromonas gingivalis, has been considered one of the high-risk pathogenic factors for esophageal cancer in recent years. Porphyromonas gingivalis colonizes in human esophageal epithelial cells, causing chemotherapy resistance in esophageal cancer, and is significantly associated with a poor prognosis of esophageal cancer.

6

Have upper gastrointestinal symptoms

Such as people who suffer from nausea, vomiting, acid reflux, abdominal distension, chest pain, etc.

Esophageal adenocarcinoma is closely associated with gastroesophageal reflux, especially when gastroesophageal reflux is long-lasting and the symptoms are severe. Gastroesophageal reflux with obesity further increases the risk of esophageal adenocarcinoma.

Image source: "Popular Science China·Tumor Prevention and Control Science Series: Comprehensive Discussion on Esophageal Cancer"

7

Previous esophageal cancer precancerous lesions or diseases

Such as people with esophageal squamous epithelial dysplasia, esophageal intraepithelial neoplasia, etc.

8

I have a history of head and neck cancer.

These changes in the body

It may be a warning sign for esophageal cancer

1

Slow esophageal transit with a feeling of stagnation or choking

Patients with esophageal cancer often experience a smaller esophageal opening, difficulty swallowing food, and a feeling of retention. These symptoms only occur when swallowing food and disappear immediately after eating. They have nothing to do with the nature of the food, and the same feeling can even occur when drinking water.

2

Foreign body sensation in the esophagus

Patients with esophageal cancer may feel as if there is a foreign body in their esophagus, or feel that food is stuck to the esophagus, or that a foreign body was swallowed by mistake and remains in the esophagus. There are grains of rice or vegetable fragments stuck to the esophagus, which they cannot swallow. There is no pain and it has nothing to do with eating. Even if they do not swallow, they still feel the presence of a foreign body. The location of the foreign body sensation often coincides with the location of the lesion of esophageal cancer.

3

Progressive dysphagia

The most obvious symptom of esophageal cancer is the feeling of choking when swallowing. As the disease progresses, the symptoms will become more and more obvious. It is often manifested as local small-scale congestion, swelling, erosion, superficial ulcers and small plaque lesions of the esophageal mucosa. When food passes through, there will be a feeling of swallowing discomfort or difficulty in swallowing. If the disease progresses further, a choking feeling will occur, mostly when swallowing foods such as pancakes, dry steamed buns or other foods that are not easy to chew thoroughly. The natural course of the disease progresses from the inability to swallow solid food to the inability to swallow liquid food.

4

Pain behind the sternum

This symptom is more common in patients with early esophageal cancer. When swallowing food, there is often a slight pain behind the sternum, and the location of the pain can be felt. The nature of the pain can be burning pain, needle-like pain, pulling and friction pain. The severity of the pain is related to the nature of the food. When swallowing rough, hot or irritating food, the pain is more severe; when swallowing liquid, warm food, the pain is relatively mild. The pain when swallowing food is relieved or even disappears after eating. Most of these symptoms can be treated with drugs and temporarily relieved. However, after a few days or months, the disease will relapse, and it will recur and exist for a long time.

Image source: "Popular Science China·Tumor Prevention and Control Science Series: Comprehensive Discussion on Esophageal Cancer"

5

Hoarseness

The recurrent laryngeal nerve, which originates from the vagus nerve, is distributed in the muscles of the larynx and is involved in controlling normal voice production. Damage to the recurrent laryngeal nerve caused by any reason can cause hoarseness. Once you find hoarseness, you must go to the hospital to find out the cause of the hoarseness. The esophageal cancer lesions themselves and metastasis to the lymph nodes can directly invade or compress the recurrent laryngeal nerve, causing hoarseness. Therefore, if hoarseness occurs, the possibility of esophageal cancer should be considered, and relevant examinations should be completed to detect possible lesions.

6

Gastrointestinal symptoms

People with digestive system symptoms are more likely to develop esophageal cancer, such as gastroesophageal reflux, black stools, and hematemesis. This is because long-term irritation of the esophagus by adverse symptoms can cause esophageal cells to be affected by carcinogens during proliferation and become cancerous. Therefore, people with digestive tract symptoms have a higher risk of developing the disease than the average person.

Esophageal cancer patients

Things to note during recovery

1

Proper diet and adequate exercise

Eat more protein-rich foods, more vegetables and fruits, and limit the intake of refined sugar. In a nutshell, follow a diet pattern of "high quality protein, moderate proportion of fat and low sugar, high dietary fiber".

Image source: "Popular Science China·Tumor Prevention and Control Science Series: Comprehensive Discussion on Esophageal Cancer"

Do not eat spoiled or moldy food, or food that is difficult to digest or too sticky, such as rice dumplings, rice cakes, glutinous rice balls, and vegetables with crude fiber, to avoid obstruction. For patients after esophageal cancer surgery, proper exercise can reduce the risk of thrombosis (lying still for a long time after surgery can easily cause thrombosis); it can promote gastrointestinal function and improve appetite; active functional exercise can minimize the damage caused by surgery; moderate exercise can improve sleep and restore physical strength, etc. When exercising, you need to choose appropriate sports, exercise intensity and exercise time, and try to focus on gentle exercise.

2

Quit smoking and drinking, and maintain a balanced mentality

On the one hand, most people will experience strong psychological fluctuations after learning that they have cancer, and in severe cases, they may even experience "stress shock". Afterwards, the patient will be in a confused psychological state. Over time, the body's immune function, nervous system, and endocrine system will be affected, and the internal environment will be difficult to stabilize. These, in turn, increase the possibility of metastasis and recurrence. Therefore, it is very important to try to help patients eliminate their fear of cancer.

On the other hand, although there is still controversy about whether personality can cause cancer or whether cancer patients have clear personality tendencies, personality differences do have a certain relationship with cancer metastasis and recurrence. Patients can be encouraged to actively participate in relevant community activities and gradually change or optimize their personalities through continuous interactions with cancer patients. As a first step, patients should be kindly told about their personalities and their weaknesses, and be helped to analyze and optimize their personalities.

Image source: "Popular Science China·Tumor Prevention and Control Science Series: Comprehensive Discussion on Esophageal Cancer"

3

Pay attention to the combination of work and rest and develop good work and rest habits

4

Regular physical examinations and timely follow-up

Regular follow-up is a compulsory course for every patient discharged from the hospital for esophageal cancer. Taking postoperative patients as an example, patients are generally evaluated in the outpatient clinic 1 month, 3 months and 6 months after surgery. After that, a follow-up is performed every 6 months for 5 years. If no disease progression is found within 5 years, a follow-up is performed once a year thereafter.

Generally speaking, after cancer patients receive treatment, the high incidence of recurrence and metastasis is 2 to 3 years. If there is no recurrence or metastasis within 4 to 5 years, or the biological indicators related to the tumor are relatively stable, the probability of subsequent recurrence and metastasis will be greatly reduced, which also indicates that the control of cancer has been largely successful. However, many patients will slack off because of this. In fact, the period after 5 years is not a period of complete health and peace of mind. Recurrence can occur decades later.

To a certain extent, the follow-up and reexamination of cancer patients should be lifelong. This can help to detect signs of tumor recurrence, metastasis or the possibility of other tumors in a timely manner, and timely treatment will achieve better results.

Source: Book "Popular Science China·Tumor Prevention and Control Science Series: Comprehensive Discussion on Esophageal Cancer"