According to the Global Cancer Burden data released by the International Agency for Research on Cancer, esophageal cancer is one of the top 10 cancers worldwide. 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 across Henan, Shanxi and Hebei. Let's learn about the prevention and treatment of esophageal cancer.
Esophageal cancer-prone sites
The esophagus of a healthy adult is about 25 cm long and is a muscular duct with an upper end at the lower border of the sixth cervical vertebra or the lower border of the cricoid cartilage, which originates in height from the pharynx, and the lower end is located on the left side of the 11th thoracic vertebra, followed by the cardia of the stomach.
The esophagus is mainly divided into three segments: neck, chest, and abdomen, and each node may become the growth site of esophageal tumors, especially the three physiological strictures of the esophagus.
This is because food stays in the stricture for a longer period of time than in other areas. As a result, certain carcinogens in food and the three strictures of the esophagus are exposed to and stay in the esophagus much longer than others. At the same time, because of its small diameter, esophageal stricture is more likely to rub against hard food, resulting in a certain degree of mechanical damage, which is easy to cause chronic inflammation or injury in the long run, which is also one of the important reasons for esophageal cancer.
3 physiological strictures of the esophagus:
The first stricture is located at the beginning of the esophagus, i.e., at the junction of the pharynx and esophagus, corresponding to the cricoid cartilage and the inferior border of the sixth cervical vertebra, and is surrounded by the cricopharyngeal muscle and cricoid cartilage;
The second stricture is 7 cm below the entrance to the esophagus, located at the point where the left bronchia crosses the esophagus, corresponding to the sternal angle or the level between the fourth and fifth thoracic vertebrae, and is formed by the passage of the aortic arch from its left side and the left bronchus from the front of the esophagus, which is the place where foreign bodies in the esophagus tend to remain;
The third stricture is where the esophagus passes through the diaphragm, which is diagonally inclined from right to left. During esophageal barium swallow enography, these 3 indentations of the esophagus can be seen.
These groups of people are highly susceptible to esophageal cancer
The causes of esophageal cancer are complex. It is generally believed that the occurrence of esophageal mucosal epithelial tumors is the result of a combination of factors and long-term chronic stimulation.
According to the definition of the "Expert Consensus on Screening for Early Esophageal Cancer and Precancerous Lesions in China", those aged 40 and above who meet one of the following 6 points are at high risk of esophageal cancer:
1
People who live in areas with a high incidence of esophageal squamous cell carcinoma for a long time
In mainland China, the most intensive areas of esophageal cancer are located on the south side of Taihang Mountain at the junction of Hebei, Henan and Shanxi provinces, especially in Cixian County, with an age-standardized incidence rate of more than 100/10,000, and there are also relatively concentrated high-incidence areas in Qinling, Dabie Mountain, northern Sichuan, Fujian and Guangdong, northern Jiangsu, Xinjiang and other places.
2
Poor eating habits
For example, eat fast, like hot food, high-salt diet, and like pickled vegetables.
"Eat while hot" is the traditional eating habit of Chinese for many years, and many foods are indeed better when they are hot, but this "heat" must be grasped well. Studies have shown that long-term consumption of hot drinks or foods above 65°C increases the risk of esophageal cancer. Hot food can cause physical damage to the esophageal mucosa, and long-term repeated injuries are prone to dysplasia, which increases the risk of esophageal cancer.
3
Smoking, drinking alcohol and other bad habits
4
First-degree relatives with a history of esophageal cancer
Esophageal cancer runs in families, which may be related to the same genetic background of the same family members or because the same family members are 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 developing esophageal squamous cell carcinoma increases with the number of affected first-degree relatives. In addition, individuals with both parents having esophageal squamous cell carcinoma have a significantly increased risk of developing esophageal squamous cell carcinoma.
5
Poor oral hygiene
Tooth loss, low brushing frequency, poor periodontal health, etc., 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 decreased esophageal microbial abundance and reduced salivary microbial diversity may be more likely to develop esophageal squamous epithelial cell dysplasia (precancerous stage of esophageal squamous cell carcinoma). In addition, a team led by Chinese scholar Gao Shegan found that Porphyromonas gingivalis, an important periodontitis pathogen, has been recognized as one of the high-risk pathogenic factors for esophageal cancer in recent years. Porphyromonas gingivalis colonizes human esophageal epithelial cells, causing chemotherapy tolerance in esophageal cancer and is significantly associated with a worse prognosis for esophageal cancer.
6
Symptoms of the gastrointestinal tract
People with nausea, vomiting, acid reflux, bloating, chest pain, etc.
Esophageal adenocarcinoma is closely related to gastroesophageal reflux, especially when gastroesophageal reflux is prolonged and severe. Gastroesophageal reflux with obesity further increases the risk of esophageal adenocarcinoma.
7
Previous precancerous lesions or diseases of esophageal cancer
People such as esophageal squamous epithelial dysplasia, esophageal intraepithelial neoplasia, etc.
8
I have a history of head and neck tumors
These changes occur in the body
May be an early warning of esophageal cancer
1
The esophagus passes slowly and there is a feeling of retention or choking
Patients with esophageal cancer often have a smaller esophageal opening, difficulty swallowing food, and a sense of self-suspension. These symptoms appear only when food is swallowed, disappear after eating, and have nothing to do with the nature of the food, even when drinking water.
2
A foreign body sensation in the esophagus
Patients with esophageal cancer may feel like a foreign body in the esophagus, feel that food adheres to the esophagus, or are suspected of swallowing a foreign body by mistake and remain in the esophagus, and there are similar rice grains or vegetable fragments attached to the esophagus, unable to swallow, neither painful nor related to eating, even if they do not swallow, there is still a feeling of foreign body. The location of the foreign body sensation often coincides with the location of the lesion in esophageal cancer.
3
Progressive dysphagia
The most obvious symptom of esophageal cancer is a choking sensation when swallowing. As the disease progresses, the symptoms become more and more pronounced. It often manifests as small local esophageal mucosal congestion, swelling, erosion, superficial ulcers, and small plaque lesions, and when food passes through, there is a feeling of discomfort or difficulty swallowing. If the disease progresses further, a choking sensation may occur, most likely when swallowing foods such as pancakes, dry buns, or other foods that are not easy to chew thoroughly. The natural history of the disease progresses from not being able to swallow solid food to not being able to swallow liquid food.
4
Retrosternal pain
This manifestation is more common in patients with early-stage esophageal cancer. Often when swallowing food, there is a slight pain behind the sternum and the painful area can be felt. The nature of the pain may be burning, pins and needles, or pulling and rubbing.
The severity of the pain depends on the nature of the food, from severe pain when swallowing coarse, hot or irritating foods, to mild pain when swallowing liquid, warm foods. The pain when swallowing food is reduced or even disappeared after eating. Most of these symptoms can be treated with medication and temporarily relieved. However, after a few days or months, the condition recurs and recurs for a longer period of time.
5
Hoarseness
The recurrent laryngeal nerve from the vagus nerve is distributed in the muscles of the larynx and is involved in innervating normal vocalizations. Recurrent laryngeal nerve injury from any cause can cause hoarseness. Once hoarseness is noticed, it is important to go to the hospital to determine the cause of the hoarseness.
Esophageal cancer lesions and metastases to lymph nodes can directly invade or compress the recurrent laryngeal nerve, causing hoarseness. Therefore, if hoarseness occurs, it is necessary to consider the possibility of esophageal cancer, and complete relevant examinations to find possible lesions.
6
Gastrointestinal symptoms
People with digestive symptoms are more likely to develop esophageal cancer, such as gastroesophageal reflux, melena, and hematemesis. This is because long-term irritation of the esophagus by adverse symptoms will cause the cells of the esophagus to become cancerous due to the influence of carcinogens during the proliferation process, so people with gastrointestinal symptoms will have a higher risk of developing the disease than the general population.
Precautions for the recovery period of esophageal cancer patients
1
Eat a reasonable diet and exercise appropriately
Eat more protein-rich foods, eat more vegetables and fruits, limit the intake of refined sugars, and in a word, follow a dietary pattern of "high quality protein, moderate proportion of fat, low sugar, and high dietary fiber".
Do not eat spoiled and moldy food, do not eat indigestible or sticky food, such as rice dumplings, rice cakes, glutinous rice balls, crude fiber vegetables, etc., so as not to cause obstruction.
For patients with esophageal cancer surgery, appropriate exercise can reduce the risk of thrombosis (lying still for a long time after surgery, blood clots are prone to occur), can promote gastrointestinal function and improve appetite, active functional exercise can minimize the damage caused by surgery, moderate exercise can improve sleep and restore physical strength, etc.
When exercising, you need to choose the appropriate exercise item, exercise intensity and exercise time, and try to focus on gentle exercise.
2
Quit smoking, stop drinking, and balance your mind
On the one hand, most people know that after they have cancer, they will have strong psychological fluctuations, and in severe cases, they will even have "stress shock". After that, the patient will be in a chaotic state of mind, and in the long run, the body's immune function, nervous and endocrine systems will be affected, and the internal environment will be difficult to stabilize. These, in turn, exacerbate the likelihood of metastatic recurrence. Therefore, it is very important to try to help patients overcome their fear of cancer.
On the other hand, although there is still controversy about whether personality can cause cancer, or whether cancer patients have clear personality tendencies, personality differences do have a certain relationship with cancer metastasis and recurrence. By encouraging patients to actively participate in relevant club activities, they can gradually change or optimize their personality in the continuous interaction with cancer friends. As a first step, it is necessary to kindly tell the patient's personality strengths and weaknesses and help them analyze and optimize their personality.
3
Pay attention to the combination of work and rest, and develop good work and rest habits
4
Regular physical examination and timely review
Regular follow-up is a compulsory course for every patient discharged from the hospital for esophageal cancer. For example, after surgery, patients are generally evaluated on an outpatient basis at 1 month, 3 months, and 6 months after surgery. Thereafter, the examination will be repeated every 6 months for 5 years. If no disease progression is detected within 5 years, repeat tests are performed annually thereafter.
Generally speaking, 2~3 years after cancer patients receive treatment, the high incidence of recurrence and metastasis is 2~3 years, and there is no metastasis recurrence within 4~5 years, or the biological indications related to the tumor have been relatively stable, and the probability of subsequent metastasis recurrence will be greatly reduced, which also indicates that the control of cancer has been achieved. But many patients will also slack off because of this. In fact, after 5 years, it is not a period of complete health with peace of mind, and the longest can be a relapse after a few decades.
To a certain extent, the follow-up of cancer patients should be lifelong. In this way, the signs of tumor recurrence, metastasis or the possibility of other tumors can be detected in time, and timely treatment will achieve better results.
Source: CCTV News