According to the global burden of cancer 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 world’s new esophageal cancer patients each year are in China, and two-thirds of these cases occur in the Taihang Mountains region spanning Henan, Shanxi and Hebei. Let’s learn about the prevention and treatment of esophageal cancer.
Predisposed sites for esophageal cancer
The total length of the healthy adult esophagus is about 25 cm. 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. Its height starts from the pharynx, and its lower end is located on the left side of the 11th thoracic vertebra and follows the cardia of the stomach.
The esophagus is mainly divided into three segments: neck, chest, and abdomen. Each node may become the growth site of esophageal tumors, especially the three physiological strictures of the esophagus.
Because food stays in stenoses for a longer time than in other parts. Therefore, the contact opportunities and residence time of certain carcinogens in food with the three strictures of the esophagus are much greater than in other parts. At the same time, because of its smaller diameter, the esophageal stenosis is more likely to rub against harder food, causing a certain degree of mechanical damage. In the long run, it can easily lead to chronic inflammation or damage, which is also one of the important reasons for esophageal cancer.
Three physiological strictures of the esophagus:
The first stenosis is located at the beginning of the esophagus, that is, at the junction of the pharynx and the esophagus, which is equivalent to the cricoid cartilage and the lower edge of the sixth cervical vertebra, and is surrounded by the cricopharyngeal muscle and cricoid cartilage;
The second stenosis is 7 cm below the entrance of the esophagus. It is located at the point where the left bronchus crosses the esophagus, which is equivalent to the sternal angle or the level between the fourth and fifth thoracic vertebrae. It is crossed by the aortic arch from its left side and the left bronchus. The tract is formed by crossing the front of the esophagus. This part is where foreign bodies in the esophagus are likely to remain;
The third stenosis is the hiatus where the esophagus passes through the diaphragm, which is inclined upward from right to left. During barium esophagography, these three impressions of the esophagus can be seen.
These groups of people are highly susceptible to esophageal cancer
The cause of esophageal cancer is 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 Opinion on Screening for Early Esophageal Cancer and Precancerous Lesions in China”, people aged 40 and above who meet one of the following six points are high-risk groups for esophageal cancer:
1 People who have lived in areas with high incidence of esophageal squamous cell carcinoma for a long time
In China, the densest area of esophageal cancer is located on the south side of the Taihang Mountains at the junction of Hebei, Henan, and Shanxi provinces, especially in Cixian County, where the age-standardized incidence rate exceeds 100/10,000; in Qinling Mountains, Dabie Mountains, northern Sichuan, Fujian, Guangdong, and northern Jiangsu There are also relatively concentrated high-incidence areas in China, Xinjiang and other places.
2. Bad eating habits
Such as eating quickly, liking hot foods, eating high-salt foods, and liking pickled vegetables.
“Eating while it’s hot” has been a traditional eating habit of Chinese people for many years. Many foods do taste better when they’re hot, but this “heat” must be grasped. Research shows that long-term consumption of hot drinks or food above 65°C will increase the risk of esophageal cancer. Food that is too hot 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 lifestyle habits such as smoking and drinking
4 First-degree relatives have a history of esophageal cancer
Esophageal cancer has a familial aggregation phenomenon, which may be related to members of the same family having the same genetic background, or because members of the same family are jointly exposed to specific environmental factors.
A large population-based case-control study showed a strong association between a 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.
5Poor oral hygiene
Tooth loss, infrequent brushing, 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 reduced esophageal microbial abundance and reduced salivary microbial diversity may be more likely to develop esophageal squamous epithelial cell dysplasia (the precancerous stage of esophageal squamous cell carcinoma). In addition, research by the team of Chinese scholar Gao Shegan found that Porphyromonas gingivalis, an important pathogenic bacteria of periodontitis, has been considered as one of the high-risk pathogenic factors of esophageal cancer in recent years. Porphyromonas gingivalis colonizes human esophageal epithelial cells, causes esophageal cancer chemotherapy resistance, and is significantly associated with poor prognosis of esophageal cancer.
6. Have upper gastrointestinal symptoms
Such as nausea, vomiting, acid reflux, abdominal distension, chest pain, etc.
Esophageal adenocarcinoma is closely related to gastroesophageal reflux, especially when gastroesophageal reflux lasts for a long time and symptoms are severe. Gastroesophageal reflux and obesity further increase the risk of esophageal adenocarcinoma.
7. Have had esophageal cancer precancerous lesions or diseases in the past
Such as esophageal squamous epithelial dysplasia, esophageal intraepithelial neoplasia, etc.
8. I have a history of head and neck cancer
These changes occur in the body
May be a warning of esophageal cancer
1 Slow passage of the esophagus with a feeling of retention or choking
Patients with esophageal cancer often have a smaller esophageal orifice, difficulty swallowing food, and a feeling of being stuck. These symptoms only appear when swallowing food and disappear after eating. They have nothing to do with the nature of the food. The same feeling can even be felt when drinking water.
2 Feeling of foreign body in the esophagus
Patients with esophageal cancer may feel as if there is a foreign body in the esophagus, and feel that food is stuck to the esophagus, or they may mistakenly swallow the foreign body and remain in the esophagus, such as rice grains or vegetable fragments attached to the esophagus, making them unable to swallow. The absence of pain has nothing to do with eating. Even without swallowing, there is still a feeling of the presence of a foreign body. The location of foreign body sensation is mostly consistent with the location of esophageal cancer lesions.
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 often manifests as local small-scale esophageal mucosal congestion, swelling, erosion, superficial ulcers and small plaque lesions. When food passes, swallowing discomfort or difficulty in swallowing will occur. If the disease progresses further, a choking sensation will occur, most likely when swallowing pancakes, steamed buns or other foods that are difficult to chew thoroughly. The natural course of the disease progresses from being unable to swallow solid food to being unable to swallow liquid food.
This manifestation is more common in patients with early-stage esophageal cancer. Often when swallowing food, there is slight pain behind the breastbone and the painful area can be felt. The nature of the pain can be burning pain, pinprick pain, or pulling and friction pain.
The severity of the pain is related to the nature of the food. The pain is more severe when swallowing rough, hot or irritating food; the pain is less severe when swallowing liquid or warm food. Pain when swallowing food, which is relieved or even disappears after eating. Most of these symptoms can be treated with medication to provide temporary relief. But a few days or months later, the condition will relapse, and it will appear repeatedly and last for a long time.
5 hoarse voice
The recurrent laryngeal nerve derived from the vagus nerve distributes to the muscles of the larynx and participates in controlling normal voice production. Damage to the recurrent laryngeal nerve from any cause can cause hoarseness. Once you find hoarseness, you must go to the hospital to find out the cause of the hoarseness.
Esophageal cancer itself and metastasis to 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 discover possible lesions.
6 Gastrointestinal symptoms
People with digestive system symptoms, such as gastroesophageal reflux, melena, and hematemesis, are more likely to develop esophageal cancer. This is because long-term irritation of the esophagus by adverse symptoms can cause esophageal cells to be affected by carcinogens during their proliferation and become cancerous. Therefore, people with gastrointestinal symptoms have a higher risk than the average person.
Precautions for patients with esophageal cancer during recovery period
1. Eat a reasonable diet and exercise appropriately.
Appropriately consume more protein-rich foods, eat more vegetables and fruits, and limit the intake of refined sugar. In one sentence, we should follow a dietary pattern of “high quality protein, moderate proportion of fat, low sugar, and high dietary fiber”.
Do not eat spoiled or moldy food, or food that is difficult to digest or is too sticky, such as rice dumplings, rice cakes, glutinous rice balls, vegetables with crude fiber, etc., to avoid causing obstruction.
For patients after esophageal cancer surgery, appropriate exercise can reduce the risk of thrombosis (lying down for a long time after surgery is prone to thrombosis); it can promote gastrointestinal function and improve appetite; active functional exercise can reduce the damage caused by surgery to a minimum. Minimum; moderate exercise can improve sleep, restore physical strength, etc.
When exercising, you need to choose appropriate exercise items, exercise intensity and exercise time, and try to focus on gentle exercise.
2 Quit smoking and drinking, and balance your mind
On the one hand, most people will have strong psychological fluctuations after learning that they have cancer. In severe cases, they may even suffer from “stress shock.” Afterwards, the patient will be in a chaotic psychological state. In the long run, the body’s immune function, nervous and endocrine systems will be affected, and the internal environment will also be difficult to stabilize. These, in turn, increase the likelihood of metastatic recurrence. Therefore, it is very important to work hard to help patients eliminate their fear of cancer.
On the other hand, although it is still controversial whether personality can cause cancer, or whether cancer patients have clear personality tendencies, personality differences do have a certain relationship with the metastasis and recurrence of cancer. Patients can be encouraged to actively participate in relevant community activities and gradually change or optimize their personality through continuous interactions with cancer friends. As the first step, patients need to be kindly informed of the strengths and weaknesses of their personalities and help them analyze and optimize their personalities.
3 Pay attention to the balance between work and rest, and develop good work and rest habits
4. Regular physical examination and timely review
Regular review is a required course for every discharged patient with esophageal cancer. Taking postoperative patients as an example, patients generally need to be evaluated in the outpatient clinic 1 month, 3 months and 6 months after surgery. Thereafter, reexamination will be conducted every 6 months for 5 years. If no disease progression is found within 5 years, reexamination will be performed annually thereafter.
Generally speaking, after cancer patients receive treatment, 2 to 3 years is the period of high incidence of recurrence and metastasis. There is no recurrence of metastasis within 4 to 5 years, or the biological indications related to the tumor have been relatively stable, and the probability of subsequent metastasis and recurrence is high. It will drop significantly, which also indicates that the control of cancer has been successfully achieved. But many patients also slack off because of this. In fact, five years is not a completely healthy period of peace of mind. Relapse may occur after decades at the longest.
To a certain extent, follow-up review of cancer patients should be lifelong. In this way, signs of tumor recurrence, metastasis or the possibility of other tumors can be discovered in a timely manner. Timely treatment will achieve better results.