"Drink and drink", "Smoke and race immortals", "eat while hot"... I think we often hear these words in our daily lives. As everyone knows, some seemingly insignificant habits may be regretted for life after accumulating over time.
Real cases
Mr. Li (pseudonym), 63 years old, retired from a state-owned enterprise for three years and enjoyed the joys of life at home. Since his youth, Mr. Li's preference has been to drink some liquor, about five or two a day, which has lasted for more than thirty years.
Since May this year, Mr. Li has felt unwell, his throat is stuck when eating solid food, and his chest is even faintly stuffy, so he can only eat thin noodles or porridge instead. This symptom of dysphagia lasts for half a year and gradually worsens.
Mr. Li felt bad and went to the hospital for examination in November. Gastroscopy was done, indicating "lesions 35 cm from the incisors, irregular bulges from the lower esophagus to the gastric junction, occupying the lumen of the tube for half a week, the surface mucosa is stained, the focal mucosa is hyperemic and eroded, the biopsy is rotten and easy to bleed, and the endoscopy can still pass". After a week of uneasiness, the pathological result was: esophageal cancer (high-grade squamous intraepithelial neoplasia, focal carcinoma).
Although the nature of malignant tumors is clear, gastroscopy and pathological biopsy cannot provide a complete basis for diagnosis and treatment, and local lesions and systemic conditions need to be considered. Therefore, Mr. Li came to Shanghai MeizhongJiahe Medical Imaging Diagnostic Center for PET/CT full body examination.
U.S.-China and PET/CT images
Fig. 1: The walls of the esophageal duct at the gastric-esophageal junction (thoracic 10-11 vertebral level) are significantly thickened with mass formation, the maximum cross-section is about 3.5 cm× 1.9 cm, the length of the involvement is about 4 .8cm, FDG uptake is increased, and SUVmax=12.4.
Fig. 2: Multiple lymph nodes in the cardia and peritoneum show that the larger ones have a short diameter of about 0.9 cm, FDG is mildly uptaken, and SUVmax =2.3.
conclusion:
Upper FDG uptake is considered at the proximal gastric-esophageal junction of the lower esophagus (at about thoracic 10-11 vertebral level), and multiple lymph nodes in the cardia and perica stomach show mild uptake of some FDGs, considering the possibility of lymph node metastasis.
The tumor is successfully removed:
Cardiothoracic Surgery General Anesthesia VATS (video-assisted thoracic surgery) Two-incisional radical resection of esophageal cancer, as seen by the naked eye: cauliflower mass in the lower esophagus, size 6 cm×4 cm×1 cm, circumvention of the esophagus for one week, in addition, removal of perristrical lymph nodes and paracardia lymph nodes for examination.
Pathological diagnosis:
(Esophageal + gastric) squamous cell carcinoma, grade II, invasion of the deepest to superficial muscle layer, intraveal carcinoma plug, nerve no tumor invasion, foci of tumor necrosis, detection of incision margin and gastric incision margin did not see tumor involvement, 5 peri-gastric lymph nodes, one of which saw tumor metastasis (1/5+), 1 left lymph node of the stomach was sent for examination, tumor metastasis (1/1+), 1 cardia lymph node was sent for examination, no tumor metastasis was seen (0/1+)
Immunohistochemistry: CK(+), Ki67 (40%+), SY(-), CD56(-), P53(+), Vim (Interstitial+), P63(+), Villin(-).
Why do half of the world's esophageal cancer cases occur in China?
Esophageal cancer, also known as esophageal cancer, is a malignant tumor that occurs in the epithelial tissue of the esophagus, accounting for 2% of all malignant tumors. China is the world's high incidence of esophageal cancer, the annual incidence and death of the number of cases are the first, according to a statistical study published in the "Lancet Gastroenterology and Hepatology" shows that half of the world's esophageal cancer cases occur in China. According to the pathological type, esophageal cancer is divided into two types: squamous cell carcinoma and adenocarcinoma, squamous cell carcinoma is mostly located in the middle and upper part of the esophagus, and is more common in Asian African countries, and adenocarcinoma is mostly located in the lower part of the esophagus, at the junction of the esophagus and the stomach, which is the mainstream type in Europe and the United States.
Why are there so many esophageal cancer patients in China? In fact, this has a lot to do with the eating habits of Chinese. Whether it is at a family gathering or a friend dinner, the most heard sentence is probably "eat while hot", which is almost a convention in Chinese food culture, and esophageal cancer is also inextricably linked to "eating while hot".
Why does eating hot food cause esophageal cancer?
The temperature range of our mouth and esophagus is about 36.5 ~ 37.2 ° C, and it is generally believed that the highest temperature that the mouth and esophagus can withstand is between 50 and 60 ° C. When food temperatures exceed 65°C, it damages our esophageal mucosa.
You know, the human esophagus is a channel composed of muscles, which is covered with a layer of mucous membranes that are easily injured. Usually, the mucous membrane of the esophagus has a strong self-healing function, if we only eat hot food occasionally, it does not matter, it can repair itself to a healthy state. However, if you often eat very hot food, the mucosa of the esophagus will continue to be damaged and repaired, forming hyperplasia, and then cancer may occur.
Why is there a clear regional difference in the incidence of esophageal cancer in China?
The study found that the incidence of esophageal cancer in China has obvious regional differences, and the Taihang Mountains, Qinling mountains and Dabie Mountains in North China, the junction areas of Fujian, Guangdong and Gansu, and chaozhou in Guangdong are considered to be high incidence areas of esophageal cancer. Geographical environmental factors do not play a role in the incidence of esophageal cancer, and people living in these areas, their eating habits and living environment are the causes of the high incidence of esophageal cancer, love to eat pickles, love to drink hot tea, love to eat hot food, these eating habits are the cause of esophageal cancer.
What are the "esophageal killers" related to eating?
The causes of esophageal cancer are not only "hot", but also many "esophageal killers" who also need to be vigilant.
First, there is alcohol and cigarettes. A large amount of alcohol abuse, especially high-concentration liquor above 60 degrees, will be more obvious to the esophageal mucosa. The carcinogens in tobacco may act on the esophagus with saliva or food, swallow or absorb it, and act on the esophagus to cause cancer.
Secondly, many parts of China like to pickle food, high-salt foods or pickled foods have a high content of nitrite, such as salted fish, salted meat, fish sauce, shrimp paste and so on.
Many Chinese elderly people are still accustomed to eating leftovers, but as everyone knows, the longer the meal is leftover, the more nitrite content there is. When we eat such food, nitrite will metabolize in our body to form a high carcinogen - nitrosamines.
In addition, eating rough and hard foods, such as corn, purple rice, and sorghum, can also cause damage to the mucous membranes of the esophagus if eaten too quickly or chewed adequately.
What are the imaging diagnostic methods for esophageal cancer?
Advances in screening and endoscopic technology have led to increased diagnostic rates for patients with early-stage esophageal cancer. It is recommended that people (especially those who are in or from high-prevalence areas) start screening with gastroscopy from the age of 40. Because esophageal cancer generally takes several years or even more than ten years from atypical hyperplasia to cancerous growth. If there is a feeling of choking in the lower pharynx (especially eating dry or hard food), dry throat and tightness in the neck, or even coughing up blood, hoarseness, loss of appetite, feeling tired or pain in the middle of the chest, please check for medical treatment in time. If progressive dysphagia occurs, it may be a sign of advanced esophageal cancer.
Treatment of esophageal cancer begins with an accurate histopathological diagnosis and clinical TNM staging. PET/CT provides valuable information on lymph node and metastasis staging, and the use of PET/CT in staging of patients with esophageal cancer can guide treatment strategies and detect metastases in up to 20% of patients. Metastasis of esophageal cancer can occur in unexpected locations, and systemic PET/CT can detect these metastases. Therefore, PET/CT is considered to be the most important method for detecting unknown metastases, which is beneficial to M staging. In one meta-analysis, PET/CT had a sensitivity of 67% and specificity of 97% for the diagnosis of distant metastatic lesions. A multicenter study involving 496 patients with squamous cell carcinoma of the esophagus reported that PET/CT staging was an important means and independent factor in improving survival in patients with esophageal cancer resection.
PET/CT equipment in the Center
How to prevent esophageal cancer?
The best way is to start taking precautions from your daily life, eat more fresh vegetables and fruits, stay away from pickled, smoked and grilled foods, and quit smoking and limit alcohol. Dietary contraindications to overheating, chewing carefully and swallowing slowly. Don't eat spoiled leftovers.
Keep the following in mind:
Eat less hot food and don't eat too fast
Do not eat rotten and moldy food
Eat less salted fish cured meat and fried smoked foods
Quit smoking and don't drink alcohol
Fruits and vegetables are eaten every day
Regular medical check-ups
I hope that after reading this article, you can get some inspiration from today's case, if you have stepped on these "minefields" in your previous living habits, you still have to adjust them, develop a good lifestyle and the habit of regular physical examination, in order to help us "eat Ma Ma Xiang, the body is great"!