Esophageal cancer, also known as esophageal cancer, refers to a malignant tumor of esophageal epithelial origin, and is one of the eight most common malignant tumors in the world.
Mainland China is one of the countries with the highest incidence of esophageal cancer, with more than 220,000 new cases of esophageal cancer and about 200,000 deaths every year.
More than 90% of patients with esophageal cancer have progressed to the middle and advanced stages when diagnosed, and the overall 5-year survival rate is less than 20%. Early-stage esophageal cancer can usually be cured by endoscopic minimally invasive treatment, and the 5-year survival rate of patients can exceed 95%.
Therefore, "early diagnosis and early treatment" of esophageal cancer is the most effective measure to reduce mortality.
What is early-stage esophageal cancer?
Early-stage esophageal cancer is when the lesion is confined to the mucosal layer of the esophagus, with or without lymph node metastasis. Because cancer cells are invaded more shallowly, more than half of patients have symptoms that are lacking or inconspicuous and often go unnoticed.
This is also the horror of esophageal cancer, so that most patients have developed to the middle and advanced stages of the tumor when diagnosed, the difficulty of treatment has increased significantly, and the treatment effect is not ideal.
What are the symptoms of early esophageal cancer?
Early-stage esophageal cancer is often asymptomatic due to lesions in the early stages of the disease, or the symptoms are very atypical. Early esophageal cancer often has "three senses and one pain": choking sensation of swallowing, foreign body sensation, retrosternal discomfort, retrosternal pain, but these symptoms are not specific in daily life and are not easy to pay attention to.
Early symptoms of ductal cancer
1. There may be varying degrees of retrosternal discomfort when swallowing coarse foods;
2. Dryness and tightness in the throat;
3. Choking sensation when swallowing food, disappearing after drinking water;
4. Poststernal burning, needle-like, traction-like pain;
5. Foreign body sensation in the esophagus;
6. Food passes slowly through the esophagus and has a feeling of stagnation;
7. Post-sternal swelling discomfort;
8. Pain under the sword protrusion, etc.
These symptoms lack specificity, mild, transient, intermittent or recurrent, or even occur at intervals of several months, progress slowly, and are easily confused with other gastrointestinal diseases, chronic pharyngitis, etc.
Intermediate and advanced symptoms of esophageal cancer
1. Dysphagia
Progressive dysphagia is the most typical symptom of intermediate and advanced esophageal cancer, starting with solid food can not be swallowed smoothly, or swallowed after flushing with soup water, followed by a semi-liquid diet is also hindered, and finally into the liquid diet to swallow there is also difficulty. The degree of unfavorable swallowing is closely related to the pathological type, and the constricted type and myeloid type are more serious.
2. Pain
Chest pain or back pain is one of the common symptoms of middle and advanced esophageal cancer, pain is dull pain, vague pain or burning pain, tingling, can be accompanied by a feeling of heaviness, chest and back pain is often caused by peripheral esophageal inflammation, mediastinitis, and even involvement of adjacent organs, nerves and paravertebral tissues caused by external invasion of cancer.
Pain is more common in ulcerative and medullary forms with ulcers.
3. Spit mucus
Esophageal insufficiency or complete obstruction caused by esophageal lesions causes poor drainage of secretions, accumulates in the upper part of the esophageal stenosis, and stimulates the esophagus to reverse peristalsis and spit out.
4. Lump on the neck and clavicle
A common sign of advanced esophageal cancer, the mass is painless, progressively enlarged, hard, mostly left, or bilateral.
5. Hoarseness
Vocal cord paralysis occurs when the tumor directly invades or metastatic foci compress the recurrent laryngeal nerve, resulting in hoarseness, which can be improved in some patients due to effective treatment.
6. Bleeding
Cancerous tissue necrosis, rupture or invasion of large blood vessels causes hematemesis or melena, and tumor invasion of the aorta can cause massive bleeding and death.
7. Dry cough
If the trachea is pressed, there may be a shortness of breath and dry cough, and if an esophageal fistula is formed, a cough of eating occurs.
If there is dysphagia, esophageal foreign body sensation, go to the hospital as soon as possible to check for confirmation, and do treatment as soon as possible.
Early esophageal cancer manifests under gastroscopy
Endoscopic changes in early esophageal cancer:
Mucosal abnormalities under white endoscopic light microscopy (change in color, rough mucosa, disappearance of branch vascular network, etc.);
Compound iodine staining lightly or unstained;
Magnification-NBI (ME-NBI) can observe abnormal IPCL (refers to the esophagus under 80-fold magnification endoscopy to see capillary loops within the papilla of the mucosal mucosa of the esophagus).
White endoscopic mucosal changes in early esophageal cancer are:
Red Zone;
Erosion foci;
Plaque foci;
Nodules;
Rough mucous membranes;
Local mucosal epithelium thickening, mucosal vascular network disorder, deletion or truncation, etc.
Due to the lack of glycogen granules in tumor cells, iodine staining is not colored. It should be noted that early esophageal cancer iodine staining is not colored≠ tumor lesions, and the "pink sign" of the lesion area has important distinguishing significance. The NBI observed that the area of early cancer lesions of iodine destainment showed a "silvery-white sign".
Abnormal IPCL can be seen in the lesion area of early esophageal cancer under magnified NBI observation. IPCL typing is:
Inoue fractional type;
Arima typing;
Ab division of the Japanese Society of Internal Society.
According to IPCL typing, the nature, extent, and depth of the lesion can be predicted, and the treatment plan can be finally decided.
How is early esophageal cancer detected?
The best way to screen for esophageal cancer is with a gastroscope! Once the above symptoms of discomfort appear, do not panic, and go to the hospital for gastroscopy in time is the key to finding early esophageal cancer.
White light gastroscopy combined with Lugol's iodine staining or endoscopic narrowband imaging (NBI) is recommended as the preferred method of esophageal cancer screening, combined with magnification endoscopy, biopsy pathology and ultrasonic gastroscopy, to accurately detect early esophageal cancer.
Step 1: White light endoscopy to find lesions.
Step 2: NBI and Lugo's iodine staining, further observation of the lesion, and determination of the extent of the lesion.
Step 3: NBI magnification gastroscopy combined with biopsy pathology to further qualitative diagnosis, ultrasound endoscopy to determine the depth of infiltration.
Treatment of early esophageal cancer
Prevention of esophageal cancer
Maintain correct eating habits, do not eat hot and hard food, grasp the time to eat, and avoid eating too quickly.
Avoid excessive consumption of pickled and smoked vegetables, legumes and meat, and avoid the intake of nitrosamines and mycotoxins.
Actively treat esophageal diseases and deal with precancerous lesions in a timely manner, such as esophagitis, esophageal polyps, Barrett's esophagus, etc.
Quit smoking and limit alcohol, rectify bad habits.
Actively and regularly participate in screening and physical examinations, such as gastroscopy, ultrasound endoscopy, etc., early diagnosis, early treatment.
Source| Lao Du said healthy