According to the latest national cancer data report released by the National Cancer Center, the incidence of esophageal cancer, which is traditionally high in mainland China, continued to decline from 2000~2016, but the disease burden is still heavy. Today, through a real case, let's take a look at the symptoms of early esophageal cancer, how it differs from pharyngitis, and what tests can be used to detect esophageal cancer.
A real case
Lao Zhang, who just turned 55 this year, recently felt a dry and itchy throat, thinking that it was because of the dry weather, and he smoked and drank again, and got pharyngitis.
I went to the pharmacy and bought some fat sea, wheat winter, chrysanthemum, and licorice to soak in water and drink, and watermelon cream did not leave my mouth; And insist on not drinking, smoking, and not eating spicy food.
But half a month has passed, the symptoms have not been relieved, and I always feel that my pharynx is like a fish in my throat, and I feel that there is something, but I can't cough it up or swallow it.
At the urging of his children, Lao Zhang went to the otolaryngology department of the hospital for treatment. Director Sun of the Department of Otolaryngology, an old expert who has been practicing medicine for nearly 30 years, suggested that he go to the digestive endoscopy center and have a gastroscopy after a detailed consultation and examination.
Lao Zhang is very puzzled, I am pharyngitis, what are you doing gastroscopy? Since the doctor asked him to do it, Lao Zhang reluctantly did a gastroscopy the next day.
As a result, the endoscopist suspected esophageal cancer, and a few days later the pathological results came out, confirming the judgment.
Electronic gastroscopy shows:
29 cm~31 cm from the incisors, the irregular flaky mucosa is slightly rough, esophageal cancer?
Esophageal biopsy showed pathology:
Squamous epithelial high-grade intraepithelial neoplasia, due to the superficial biopsy does not rule out cancer.
That is, it is early esophageal cancer.
Because it was early days, a few days later, Lao Zhang underwent endoscopic mucosal resection (ESD). Has made a full recovery.
Lao Zhang still can't believe that it is a common pharyngitis, how can it be esophageal cancer?
What are the symptoms of early-stage esophageal cancer?
01
Foreign body sensation in the esophagus
There is a feeling similar to rice grains or vegetable fragments attached to the esophagus, and it is impossible to swallow, there is no pain, and even if you do not swallow, there is still a feeling of foreign body.
02
A feeling of dryness and urgency in the throat
I often feel that the food in my swallow is not smooth, and there is a slight pain, a little dry, tight feeling. This dry, tight sensation is especially noticeable when swallowing dry or coarse foods.
In addition, the occurrence of this early symptom is associated with mood swings.
03
Choking when swallowing food
In the early stage, because the lesions often manifest as small local esophageal mucosal congestion, swelling, erosion, superficial ulcers, and small plaque lesions, when food passes through, there will be a feeling of discomfort or difficulty swallowing.
If the disease progresses further, a choking sensation may occur, most likely due to swallowing foods such as pancakes, steamed buns, or other foods that are not easy to chew thoroughly.
04
The food passes slowly and has a sense of stagnation
The esophageal opening is often smaller, and food is difficult to swallow and there is a feeling of stagnation. These symptoms appear only when food is swallowed, disappear immediately after eating, and have nothing to do with the nature of the food, even when drinking water, there is a burning pain.
05
Discomfort of swelling behind the sternum
However, this kind of chest discomfort can only be vaguely felt, and it is difficult to point out the discomfort area, nor can it describe the specific situation of the discomfort. It is just a burning stinging pain in the abdomen, ranging from mild to severe, mostly appearing when swallowing food, which is reduced or disappeared after eating, and some are persistent dull pain.
06
Retrosternal pain
This manifestation is more common in patients with early-stage esophageal cancer. There is often a slight pain behind the sternum when swallowing food, and the pain 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, and it is more severe when swallowing coarse, hot or irritating food; Most of these symptoms can be treated with medication and are temporarily relieved, but the condition recurs after days or months, and recurs for a longer period of time.
What is the difference between pharyngitis and early esophageal cancer?
In the early stage of esophageal cancer and chronic pharyngitis, both can have symptoms of pharyngeal discomfort, such as dry and itchy pharynx, foreign body sensation, inability to cough, and inability to swallow. Pharyngitis is mainly caused by a foreign body sensation in the throat when swallowing, but not when eating; Esophageal cancer, on the other hand, is more pronounced when eating.
It is easy to ignore and confuse the following: in the early stage of esophageal cancer, symptoms such as retrosternal and subxiphoid pain, food retention and foreign body sensation, throat dryness and tightness, retrosternal swelling and discomfort, back pain and belching are not persistent, but intermittent or worsen after exertion and rapid eating.
To put it simply, esophageal cancer symptoms are mainly symptoms that occur only when eating, and if they are only simple when swallowing, they may not be esophageal cancer. Therefore, it is best to be vigilant, and it is more reliable and safe to have a painless gastroscopy when these symptoms appear.
What tests should be done if esophageal cancer is detected?
1. Barium swallow imaging of the digestive tract
It can only be shown when the lesion has obvious anatomical morphological changes, and the positive rate of early esophageal cancer is low, with an accuracy rate of only about 50%, so X-ray imaging alone cannot be used as a diagnostic method for early esophageal cancer independently.
Contrast may show thickening, tortuosity, disorganization, and disruption of mucosal folds in the lesion area, small ulcer niches, small filling defects, and localized wall stiffness. The presence of these features suggests that the lesion is not very early, at least early, invasive cancer.
2. Gastroscopy or esophagoscopy
Endoscopy is the gold standard for diagnosing esophageal cancer, which can directly see the cancer, magnify and stain, and perform tumor biopsy to obtain pathological diagnosis, with a diagnosis rate of 80%~95%.
It is better than upper GI imaging to visualize lesions, especially small early-stage esophageal cancers, and is able to detect millimeter-sized cancers.
Summary
Esophageal cancer is a high-incidence tumor in mainland China, accounting for half of the world's deaths, and it is more common in men over 50 years old than women. Therefore, middle-aged and elderly people with symptoms similar to pharyngitis should not be careless or arbitrarily defined as pharyngitis, and must be actively examined.
Gastroscopy is the gold standard for detecting early-stage esophageal cancer.