The human digestive tract is a muscular canal that starts from the mouth and passes through the throat, esophagus, stomach, small intestine, large intestine, and finally the anus. The esophagus connects the oropharynx to the stomach, and usually the esophagus is the passage through which food enters the stomach. The health of the esophagus is crucial, but in recent years, esophageal cancer and other esophageal diseases have gradually shown an upward trend, which seriously threatens human life and health and leads to a decline in quality of life.
First, the incidence and death of esophageal cancer
In 2021, GLOBOCAN 2020 released data on global cancer-related morbidity, mortality, and incidence trends. The data comes from the incidence and mortality of 36 cancers in 185 countries and regions around the world. The data shows that in 2020, the number of new cancer cases worldwide reached 19292789 million, exceeding the number of new cancer cases in 2018 by nearly 1.2 million. According to the data released this time, according to the number of new cancer cases, the number of deaths due to cancer may reach 10 million.
The incidence of esophageal cancer is grim
Globally, esophageal cancer ranks in the top ten in terms of morbidity and mortality. In 2020, the number of new cases of esophageal cancer worldwide exceeded 600,000, and the number of deaths exceeded 370,000, which means that more than half of all new esophageal cancer patients will die.
There are significant regional differences in esophageal cancer
The incidence of esophageal cancer shows obvious regional differences, with esophageal cancer being the most common in East Asia and relatively rare in developed countries such as Europe and the United States. China is a big country with esophageal cancer, and more than half of the new esophageal cancer cases in the world every year are concentrated in China, accounting for about 55%, ranking first in the world.
In China, the geographical distribution of esophageal cancer incidence also varies significantly. The central and eastern regions of China, especially the southern foothills of the Taihang Mountains at the junction of Henan, Hebei and Shanxi provinces, are high incidence areas of esophageal cancer, with an incidence of 1 in 1000. In rural areas, the incidence of esophageal cancer is higher, about twice the incidence of urban population. In addition to obvious geographical differences in the incidence of esophageal cancer, there are also obvious gender differences, and the incidence of esophageal cancer in men is significantly higher than that in women. The same is true globally, with data released by GLOBOCAN 2020 showing that more than 410,000 of the more than 600,000 new cases of esophageal cancer are male.
2. What is esophageal cancer?
The esophagus is a muscular tubular structure that connects the oropharynx to the stomach, and the malignant tumor that occurs in the epithelium of the esophageal mucosa is esophageal cancer, also known as esophageal cancer, which is more likely to occur in the middle of the esophagus. It is a very common malignancy of the digestive tract. Middle-aged and elderly men are at high risk of esophageal cancer, and progressively exacerbated dysphagia is a typical symptom of esophageal cancer. Because most of the esophageal cancer is in advanced stages when it has obvious symptoms, it has a high mortality rate, poor prognosis, and a five-year survival rate of less than 20%.
There are two types of esophageal cancer, namely esophageal adenocarcinoma and esophageal squamous cell carcinoma. In Europe and the United States, the type of esophageal cancer is mainly esophageal adenocarcinoma, accounting for about 70%. Esophageal cancer in mainland China is dominated by squamous cell carcinoma, accounting for 90% of the total. Squamous cell carcinoma of the esophagus occurs mainly in the upper and middle parts of the esophagus. The earlier the esophageal cancer is treated, the better the treatment.
3. What are the symptoms of esophageal cancer?
Progressively worsening dysphagia is a typical symptom of esophageal cancer. Patients with esophageal cancer may have symptoms such as laborious swallowing, a feeling of infarction, a foreign body sensation, prolonged time to swallow food, or retrosternal pain when swallowing food. In the early stage of esophageal cancer, patients have difficulty swallowing similar solid foods such as steamed buns, and then cannot swallow congee semi-liquid foods, and as the disease progresses, it is finally so serious that it is impossible to swallow water and saliva.
1, typical symptoms
●Early stage: In the early stages of esophageal cancer, symptoms are not obvious, which is why most patients miss early detection of esophageal cancer. Although the symptoms of early esophageal cancer are not obvious, when swallowing food, patients may repeatedly experience different degrees of discomfort, such as infarction when swallowing food, retrosternal needle-like or pull-like pain, etc., these symptoms do not necessarily appear in each meal, and the degree of occurrence may be heavy or light.
●Middle and advanced stages: Due to the persistent aggravation of dysphagia, the patient's diet and nutrient intake are affected, and the patient often has symptoms such as wasting, fatigue, and anemia. Persistent dysphagia, chest pain, back pain, supraclavicular lymphadenopathy, and dyspnea indicate that esophageal cancer has advanced into an advanced stage.
2. Other symptoms
●Violation of the recurrent laryngeal nerve: there is a recurrent laryngeal nerve passing between the trachea and the esophagus, and as the tumor grows, it can invade and compress the recurrent laryngeal nerve, resulting in symptoms such as hoarseness and cough.
●Violation of the trachea and bronchi: Since the esophagus is located behind the trachea, if the tumor violates the trachea or bronchi, it may form an esophageal tracheal fistula or esophageal bronchial fistula, causing the patient to swallow water or food to enter the trachea or bronchi and cause a severe choking cough, and even cause bronchial and lung infections.
Fourth, what causes are related to the occurrence of esophageal cancer
The occurrence of esophageal cancer is related to the continuous stimulation of internal factors and external factors of the body, and normal esophageal cells are constantly injured and repaired due to repeated stimulation, resulting in esophageal squamous epithelial hyperplasia and columnar metaplasia in the process. That is, the normal squamous cells of the esophagus proliferate abnormally or are replaced by columnar epithelial cells, which have the potential to further develop into cancer cells. The causes of esophageal cancer are complex and are mainly related to the following factors:
1. Smoking and heavy drinking
Epidemiological studies have shown that smoking and heavy alcohol consumption are important factors in the cause of esophageal squamous cell carcinoma. A foreign study found that the incidence of esophageal squamous cell carcinoma in smokers was 3-8 times higher than that of non-smokers; the incidence of esophageal squamous cell carcinoma in drinkers, especially in alcoholics, was 7-50 times higher than that of non-drinkers.
alcohol
Data have shown that heavy alcohol consumption is associated with esophageal squamous cell carcinoma. The mechanism by which heavy alcohol consumption leads to esophageal cancer is that alcohol can reduce or reduce normal metabolic activity within cells, leading to decreased activity of detoxification enzymes on the one hand, and promoting oxidation on the other, leading to genetic mutations and increasing sensitivity to other environmental toxins. In layman's terms, the main component of alcohol is ethanol, and after drinking alcohol, ethanol will be oxidized to acetaldehyde by ethanol dehydrogenase in the body. It should be noted that acetaldehyde is carcinogenic, which explains why drinking alcohol, especially heavy alcohol, can lead to an increased incidence of esophageal cancer.
The International Agency for Research on Cancer (IRAC) defines alcohol-related acetaldehyde as a "Class I carcinogen" associated with esophageal, head and neck cancers, that is, identified carcinogens.
tobacco
Currently, smoking (both first- and second-hand) is a recognized risk factor for esophageal squamous cell carcinoma. Smoking is also a stronger risk factor for esophageal squamous cell carcinoma than other risk factors. The two risk factors of smoking and drinking alcohol have a synergistic effect on the occurrence and development of esophageal cancer.
More than 70 components of the smoke produced by tobacco combustion have been identified as carcinogens, such as aromatic amines, nitrosamines, polycyclic aromatic hydrocarbons, aldehydes and phenols. These substances can increase the risk of esophageal cancer.
Comprehensive statistics show that after 5-10 years of smoking cessation and alcohol cessation in women, the risk of esophageal squamous cell carcinoma can be reduced to the same level as that of women who have never smoked or drunk alcohol. In men, although smoking cessation and alcohol cessation do not reduce the risk of developing squamous cell carcinoma of the esophagus to the level of never smoking or never drinking alcohol, the associated risk of esophageal cancer is reduced.
2. Dietary factors
In addition to smoking and heavy alcohol consumption as high risk factors for esophageal cancer, dietary factors such as consumption of cured meats, vegetables and moldy foods, as well as nutritional disorders, are also high risk factors for the development of esophageal cancer. Studies have shown that processed meat, fatty meat and foods with high cholesterol can lead to an increased incidence of esophageal adenocarcinoma, while foods such as fruits and vegetables rich in dietary fiber and vitamins are conducive to reducing the incidence of esophageal cancer. In areas with a high incidence of esophageal cancer in China, most of the local residents' diets are deficient in selenium, zinc, folic acid, riboflavin, vitamin A, vitamin C, vitamin E and vitamin B12.
In addition, it is worth noting that dietary patterns also have a certain correlation with the occurrence of esophageal cancer. Some bad eating habits, such as like eating hot drinks, hot food, etc., repeatedly eating or drinking this high temperature food, long-term stimulation of esophageal mucosal cells, may lead to chronic inflammation of the esophagus, and the N-nitroso compound formed in this inflammatory process promotes the occurrence and development of esophageal cancer. According to statistics, people who drink hot water, drink heavily and smoke have a 5 times or even higher risk of developing esophageal cancer than people with these three habits.
3. Obesity
Elevated body mass index (BMI) and abdominal obesity are risk factors for an increased risk of developing adenocarcinoma in esophageal cancer. The higher the BMI, the higher the propensity for gastroesophageal reflux. For people with abdominal obesity, due to the increase in intra-abdominal pressure, it can lead to the destruction of the physiological structure of the esophagus, and these two factors have promoted the occurrence and development of esophageal cancer to a certain extent. According to reports, the higher the BMI, the higher the risk of esophageal cancer.
4. The influence of viruses and microorganisms
●Viruses: Studies have shown that viruses such as human papillomavirus (HPV), herpes simplex virus, cytomegalovirus, and Epstein-Barr virus are associated with the development of squamous cell carcinoma of the esophagus. HPV was the first virus to be identified associated with esophageal squamous cell carcinoma. HPV infection may promote the occurrence and development of esophageal squamous cell carcinoma.
●Bacteria: There is a certain link between a variety of specific bacteria and malignant tumors, such as chlamydia pneumonia and lung cancer. The occurrence of esophageal cancer is also related to specific bacteria, and the mainland research team has reported for the first time that Porphyromonas gingivalis (Pg) is closely related to esophageal cancer. Certain bacteria in the oral microbiome can lead to serious consequences such as chronic periodontitis and tooth loss. Epidemiological studies have shown that periodontal disease and tooth loss are closely related to gastrointestinal cancers such as esophageal cancer and stomach cancer, and may even affect the survival rate of patients. Infection with Porphyrinum gingivalis also enhances the proliferation, migration, invasion, and metastasis of esophageal squamous cell carcinoma cells.
5. Columnar epithelial metaplasia
The epithelial cells of the esophagus are squamous epithelial cells, and the squamous epithelium is transformed into a special intestinal columnar epithelium, that is, columnar metaplasia, which is related to the damage caused by chronic gastroesophageal reflux, and the columnar epithelial metaplasia can easily progress to esophageal adenocarcinoma.
5. Who is susceptible to esophageal cancer?
People over the age of 40 who live in areas with a high incidence of esophageal cancer for a long time, especially men. Long-term smoking, heavy alcohol consumption, a history of esophageal cancer or other malignant tumors in the immediate family, and those with precancerous diseases or precancerous lesions of esophageal cancer are all high-risk groups for esophageal cancer.
6. Will esophageal cancer be inherited?
Numerous studies have shown that esophageal squamous cell carcinoma has a genetic predisposition. According to studies in China and other countries with a high incidence of squamous cell carcinoma of the esophagus, it can be determined that patients with esophageal squamous cell carcinoma have a higher incidence of esophageal cancer than patients without a family history of esophageal squamous cell carcinoma. This may be related to the same environmental factors between family members, such as diet, smoking or passive smoking, and obesity.
6. How to prevent the occurrence of esophageal cancer?
Among the preventive measures for esophageal cancer, primary prevention and secondary prevention are crucial. Primary prevention is the prevention of the cause, and according to the cause and related risk factors, preventive measures are taken to prevent the occurrence of esophageal cancer. Secondary prevention is preclinical prevention, that is, early detection, early diagnosis, early treatment, and prevention of esophageal cancer precancerous lesions and other related disease progression by taking targeted measures.
1. Primary prevention of esophageal cancer
Quit smoking, quit drinking or ensure that you drink in moderation, develop good eating habits, chew slowly when eating, do not eat hot and high-salt foods; eat more fresh vegetables and fruits rich in dietary fiber, and eat appropriate meat intake. In addition, appropriate supplementation of selenium (eggs, meat and seafood, etc.), vitamin C (oranges, kiwifruit, peppers, etc.), β-carotene (carrots, broccoli, etc.), vitamin E (sesame, peanuts, soybeans, etc.), riboflavin (animal liver, milk, etc.) can reduce the risk of esophageal cancer.
In addition, attention should be paid to improving food storage and processing methods to prevent food from becoming moldy. Scientific and reasonable arrangement of diet, optimize the diet structure, reduce the intake of pickled foods and fermented foods.
2. Secondary prevention of esophageal cancer
Secondary prevention of esophageal cancer is mainly aimed at the intervention of precancerous lesions of esophageal cancer. Precancerous lesions of the esophagus include chronic esophagitis, Barrett's esophagus (Barrett esophagus), esophageal epithelial hyperplasia, esophageal polyps, esophageal ulcers, esophageal leukoplakia, esophageal diverticulum and achalasia, etc. Because these diseases can lead to histological changes, dysfunction, local long-term stimulation of the esophagus, and are prone to progression to esophageal cancer.
Therefore, for precancerous lesions of esophageal cancer, it is necessary to closely observe the changes in the condition, take active treatment methods and effective preventive measures. For example, endoscopic minimally invasive treatment, drug therapy and nutritional intervention for severe dysplasia can effectively prevent high-risk groups of esophageal cancer from developing into esophageal cancer patients and reduce the risk of esophageal cancer.
7. Do a good job of screening for esophageal cancer
Because the early symptoms of esophageal cancer are inconspicuous and inconspicuous, or some people do not notice their own symptoms, it is easy to be ignored. Most patients are already in the advanced or advanced stage of esophageal cancer when they present with symptoms such as recurrent dysphagia and chest pain, thus losing the best treatment opportunity, and the proportion of such patients can reach 90%. Patients with advanced and advanced esophageal cancer have low quality of life and poor prognosis, with an overall 5-year survival rate of less than 20%. Overall, the survival rate of esophageal cancer at 5 years after surgery is generally about 30%.
Although the overall survival rate of esophageal cancer is low, the 5-year survival rate of most patients can exceed 95% in most patients through endoscopic minimally invasive treatment for early esophageal cancer and precancerous lesions of esophageal cancer. Therefore, early screening for esophageal cancer is critical, as potential early esophageal cancer, precancerous lesions, and potential invasive cancers can be detected in advance. Accurate screening of esophageal cancer is the premise and effective means of early detection and early diagnosis, and it is also an effective measure to improve the prognosis of esophageal cancer and improve the survival rate of esophageal cancer patients.
1. Which groups of people need to be screened for early stage of esophageal cancer?
According to the epidemiological characteristics of esophageal cancer in mainland China, those who meet any of the following conditions in Articles 1 and 2-6 should be screened for early screening for esophageal cancer:
●Age over 40 years (40 years is the starting age for esophageal cancer screening);
●Born or long-term resident in Henan, Hebei and Shanxi provinces and other areas with high incidence of esophageal cancer;
●Associated upper gastrointestinal symptoms;
●An immediate family member has a history of esophageal cancer;
●Patients with precancerous lesions of esophageal cancer;
●There are high risk factors for esophageal cancer, such as hot and hot eating, long-term smoking, and heavy alcohol consumption.
2. What are the screening methods for esophageal cancer?
Cell biopsy and endoscopic stained tissue biopsy confirm the diagnosis, which is the current method of accurate screening and early diagnosis of esophageal cancer. By biopsying tissue specimens for tumor histopathology, immunohistochemistry, etc., the source, type, degree of differentiation and pathological stage of cancer cells can be determined. Intensive investigation of endoscopic esophageal cancer is the main method and gold standard for diagnosing esophageal cancer.
Primary program for esophageal cancer screening
The primary protocol for esophageal cancer screening is a combination of imaging, initial cytology screening, and endoscopic biopsy to confirm the diagnosis, and imaging tests include x-ray dual contrast contrast of esophageal barium or barium. The initial cytology screening is mainly a esophageal pull-net shedding cytology examination, which can detect early esophageal cancer, which is simple, effective and practical, but the missed diagnosis rate is high, and it is currently less used, mainly used for census in high-incidence areas.
Endoscopic screening protocol
Endoscopic screening programs are the best for screening for esophageal cancer, usually based on ordinary white light endoscopy, and the widely used routine test and biopsy method is the most basic technique for screening and diagnosing early cancer. However, endoscopic screening is to use the naked eye to judge the morphology and the accuracy of direct biopsy has certain limitations, and is related to the skill level of the operator, and occasionally there will be precancerous lesions and early esophageal cancer missed.
Iodine staining
Iodine staining is a mucosal staining method that can exceed 95% accuracy in diagnosing esophageal cancer and severe atypical hyperplasia. "Expert Consensus on Early Esophageal Cancer Screening and Endoscopic Diagnosis and Treatment in China" points out that endoscopic screening combined with magnification, esophageal mucosal iodine staining, and indicative biopsy is the gold standard for diagnosing early esophageal cancer and precancerous lesions, and is the most suitable and effective screening method at this stage in mainland China.
Follow-up is recommended every 2 to 3 years in patients with low-grade intraepithelial neoplasia (mild, moderate dysplasia) detected on screening. However, if the lesion site >1 cm in diameter or if multiple risk factors for esophageal cancer are present at the same time, annual screening is recommended, and microscopic therapy should be performed according to the standard requirements for severe dysplasia, and follow-up is recommended once a year.
Good mood is an important guarantee for defeating diseases
Worldwide, esophageal cancer, as a common malignant tumor of the digestive system, seriously threatens human life and health, and reduces the quality of life. Continental esophageal cancer rate and mortality rate are the highest in the world. Anxiety and depression are a very common comorbidity in patients with esophageal cancer and are independent risk factors for esophageal cancer. On the one hand, due to the influence of the disease, esophageal cancer patients have anxiety, depression and other emotions; on the other hand, this anxiety, depression and other negative emotions in turn will affect the patient's quality of life and the prognosis and outcome of esophageal cancer.
For patients with esophageal cancer who experience anxiety and depression, a combination of pharmacotherapy and non-pharmacological interventions can be used, such as pharmacotherapy combined with psychological interventions, which are more effective than single pharmacotherapy or psychotherapy. According to the different situations of patients, targeted personalized treatment plans are more conducive to the recovery of patients' conditions.
Although more than half of the world's esophageal cancer patients are concentrated in China, but esophageal cancer is also a preventable cancer, remove the high risk factors of esophageal cancer, high-risk groups for reasonable screening can effectively reduce the risk of esophageal cancer.
Author: Zhang Jing
Text Review: Bai Shuangling
Scientific review: Liu Zhengxin Chief Physician, Department of Gastroenterology, Beijing Chaoyang Hospital
This article is from: China Digital Science and Technology Museum