Do you feel a foreign body when swallowing? These signs are worth noting

Esophageal cancer (EC) is a malignant tumor that originates from the squamous and columnar epithelium of the esophagus, with squamous cell carcinoma accounting for about 90% and adenocarcinoma accounting for about 10%. There are obvious regional differences in esophageal cancer patients, with the highest incidence in East Asia and relatively low incidence in developed countries such as Europe and the United States. my country is a major country for esophageal cancer, accounting for about 55% of new cases and deaths worldwide, ranking first in the world, and has a poor prognosis, with a 5-year survival rate of less than 30%, making it the sixth most common tumor in my country. Among Western esophageal cancer patients, 80% are esophageal adenocarcinomas, while the main subtype of esophageal cancer in my country is esophageal squamous cell carcinoma, which often occurs in the middle thoracic esophagus.

These people should pay attention! They are the high-risk screening group for esophageal cancer!

(1) Age: 40-69 years old;

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

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

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

(5) Born or lived for a long time in areas with a high incidence of esophageal cancer; combined with other high-risk factors for esophageal cancer: hot and sour food, habit of eating pickled food, etc.

What factors are related to the incidence of esophageal cancer?

The cause of the disease is closely related to nitrosamines, mold, lack of certain vitamins and trace elements, heredity, bad eating habits such as hot drinks and hot food. It is more common in men than in women, and the age of onset is generally over 40 years old, and it is more common in the elderly aged 55 to 74. In traditional Chinese medicine, it is classified as "choking", "nausea", "restriction", "symptom accumulation" and so on.

(1) Nitrosamine compounds and molds: Many studies at home and abroad have confirmed that nitrosamine compounds and molds have strong carcinogenic effects. Asymmetric nitrosamines can cause esophageal cancer and pharyngeal cancer, and have strong organ selectivity. In areas with a high incidence of esophageal cancer, high levels of nitrates and nitrites can be detected in food, sauerkraut, drinking water, and gastric juice of residents. The levels are related to the occurrence of esophageal epithelial carcinogenesis in high-incidence areas. Therefore, nitrosamine compounds play an important role in the occurrence and development of esophageal cancer. In recent years, in order to inhibit the carcinogenic effect of nitrosamines, experiments at home and abroad have shown that cod liver oil, dry yeast, riboflavin, vitamin C, vitamin A, and cystine can block the nitrosylation of amines to inhibit carcinogenic effects. Molds, such as Fusarium moniliforme and Aspergillus niger, and the toxins they produce have a synergistic carcinogenic effect with nitrosamines. Most studies have confirmed that the contamination rate of these fungi in high-incidence areas is significantly higher than that in low-incidence areas.

(2) Nutrients and trace elements: Domestic and foreign studies have shown that the lack of molybdenum, zinc, iron, fluorine, selenium, etc. in water and food has a certain impact on human growth, development and tissue wound repair. It may also cause nitrates in plants to aggregate and provide precursors for the synthesis of nitrosamines. Supplementing with multiple nutrients can reduce the risk of esophageal, cardia, gastric and other cancers to a certain extent. In addition, selenium supplementation can promote the reversal of mild atypical hyperplasia and block its progression.

(3) Diet and lifestyle habits: Physical stimulation from food, such as heat, hardness, smoking, drinking, eating pickled vegetables, chewing betel nuts, etc., are related to the occurrence of esophageal cancer. Among them, new cases of esophageal cancer caused by smoking account for 45% of new cases in men worldwide. Therefore, quitting smoking is not only to stay away from lung cancer, but also to help people stay away from esophageal cancer.

(4) Genetic susceptibility and molecular biological markers: According to epidemiological data in my country, 24% to 61% of esophageal cancer patients have a positive family history, with a clear family clustering phenomenon. Some studies have shown that fragile sites found on chromosomes of family members of positive patients and slow repair may be related to genetic susceptibility to esophageal cancer.

(5) Chronic esophageal inflammation: Complications such as esophageal scar stenosis, hiatal hernia, reflux esophagitis, esophageal diverticulum, and achalasia increase the chance of developing esophageal cancer.

(6) Geographical environmental factors: Climate conditions and soil properties affect the occurrence of esophageal cancer. For example, the incidence rate is higher in low mountain and hilly areas than in high mountainous areas and plains. Esophageal cancer is more common in temperate and subtropical areas with drought and low rainfall. The incidence rate is higher in brown, yellow, brown and alkaline soils.

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

symptom:

There are generally no obvious symptoms in the early stage, but there may be intermittent discomfort behind the sternum, friction, slight pain or foreign body sensation when eating, and dryness and tightness in the throat; in the middle and late stages, there is progressive dysphagia (first dry food is difficult to swallow, then semi-liquid food, and finally water and saliva cannot be swallowed), and there may gradually be manifestations of invasion of adjacent organs or cancer metastasis, such as hoarseness, shortness of breath, vomiting blood or black stools, hepatomegaly, jaundice, ascites, etc.; end-stage anemia, dehydration, and cachexia are very common.

Diagnostic methods:

The diagnosis can be confirmed based on epidemiological characteristics and clinical symptoms, combined with esophageal barium meal, endoscopy, exfoliated cells and pathological examination. Common imaging examination methods for esophageal cancer include endoscopic ultrasound, computed tomography, 18F-fluorodeoxyglucose PET-CT and MRI.

What are the treatments for esophageal cancer at different stages?

In the early stage of Western medicine treatment, surgery is the main method, combined with radiotherapy and chemotherapy. For those who cannot undergo surgery, endoscopic interventional treatment is feasible. For those with esophageal cancer stenosis, stent implantation is feasible. Since esophagectomy is relatively traumatic, it may affect the patient's quality of life. Therefore, minimally invasive treatment has been a hot topic in clinical research in recent years.

Endoscopic resection (ER), endoscopic submucosal resection (ESD), endoscopic mucosal resection (EMR), and photodynamic therapy (PDT) are often used for early esophageal cancer. The indication for ER is determined by the risk of lymph node metastasis. Lymph node metastasis rarely occurs in carcinoma in situ or tumors confined to the mucosal lamina propria. ESD is suitable for tumors with lesions <20 mm. Tumors with lesions <20 mm cannot guarantee the accuracy of resection because the lesions are too large and need to be resected in segments. PDT is a relatively good choice for local recurrence after comprehensive treatment of esophageal cancer. Unlike ESD, EMR can provide complete resection regardless of the size of the lesion or the degree of submucosal fibrosis, and has a low local recurrence rate and a low probability of postoperative bleeding. However, EMR has higher requirements for the operator, the operation takes longer, and the risk of perforation is high. The probability of postoperative stenosis is higher, and lesions greater than 3/4 of the circumference are all important risk factors.

Neoadjuvant therapy, radical concurrent chemoradiotherapy or radical surgery (DCRT) are often used for locally advanced esophageal cancer. DCRT is a combination of radiotherapy and chemotherapy, which is suitable for patients with locally advanced unresectable cT4b, extensive lymph node metastasis or 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 a low efficacy rate and targeted therapy has made slow progress. Compared with the first two, immunotherapy has been a hot research direction in recent years, such as pembrolizumab and nivolumab.

How can we prevent esophageal cancer from every aspect of life?

1. Change bad eating habits such as fast food, hot food, sauerkraut and preserved food. Avoid eating hard, crispy and fried food.

2. Postoperative diet should mainly consist of liquid or semi-liquid food, and any irritating food intake should be avoided to prevent infection and damage to the anastomosis.

3. During radiotherapy, you should choose nutritious and easy-to-swallow foods, such as milk, cake, yam powder, fresh vegetable or fruit juice, coriander, bitter gourd, rapeseed, fungus, seaweed, etc.

4. Make sure to keep a happy mood.

5. During radiotherapy, keep the skin in the irradiated area dry and do not scratch it.

6. Generally, a follow-up examination should be conducted every 3 months. If the condition is good, a follow-up examination can be conducted once every 6 months.

References:

[1] Luo Jie. New Encyclopedia of Family Doctors[M]. Hubei Science and Technology Press, 2014: 174.

[2] Gan Xiao. A new treatment for esophageal cancer is expected[N]. China Science Daily, 2021-04-14 (001).

[3] He Haibo, Song Xianren. The essence of Chinese medicine special effects diet for oncology[M]. Huazhong University of Science and Technology Press, 2015: 1-3.

[4] Chinese Society of Integrated Traditional Chinese and Western Medicine. Expert consensus on the treatment of esophageal cancer with integrated traditional Chinese and Western medicine (2021 edition) [J]. Journal of China-Japan Friendship Hospital, 2021, 35(1): 3-7.

[5] Jia Ruinuo, Sheng Manxi, Kong Jinyu, et al. New progress in esophageal cancer research in my country[J]. Chinese Research Hospital, 2021, 8(1): 2-12.

[6] Cao Qidi. Early diagnosis and treatment of esophageal cancer[J]. Journal of Clinical Digestive Diseases, 2021, 33(2): 141-143.