For medical professionals only
Beware of Esophageal Cancer!
The esophagus is the muscular passage of food between the pharynx and stomach. Esophageal cancer is a malignant tumor with strong regional distribution, and the incidence varies greatly in different countries and regions in the world.
Esophageal cancer has a high incidence in my country, ranking fourth among malignant tumors, with more than 150,000 new cases annually, accounting for more than half of the world’s total annual cases.
However, because early esophageal cancer can have no symptoms, or only have some symptoms similar to “chronic pharyngitis”, it is often ignored by people.
Let’s look at two real-world cases first.
■Case one
Mr. Wang, 48, has been feeling dry and itchy throat recently. He thought it must be caused by drinking, smoking, and socializing too much. Something like this, but the symptoms are still not getting better, and I always feel that there is something in the throat, but I can’t cough or swallow.
He suspected and worried that he had pharyngitis and went to see an ENT. The doctor suggested a gastroscopy, but was diagnosed with early esophageal cancer.
Seeing the diagnosis report, he still couldn’t believe it, obviously it was a common pharyngitis, how could it be esophageal cancer?
■Case Two
A few months ago, 63-year-old Wang Laohan felt that the food did not go down smoothly when he was eating, and he suspected that the old problem was serious pharyngitis. I just bought medicine in a small clinic, but it didn’t work, and it became more and more serious.
As a last resort, I came to the Endoscopy Center to have a gastroscope.
During gastroscopy, a space-occupying lesion was seen in the lower part of the esophagus, and a huge pitting ulcer was seen in the lower cardia and the inner edge. A diagnosis of esophageal and cardia cancer (stomach cancer invading the esophagus) was made.
So, what are the symptoms of esophageal cancer?
Esophageal cancer is more common in men after the age of 50, especially the elderly in rural areas. Most of them have the hobby of smoking and drinking. Therefore, as children, we must pay attention to some inconspicuous symptoms, and do not take them lightly. pharyngitis.
■Early symptoms
The early symptoms of esophageal cancer are often atypical, nonspecific, intermittent, and recurring. Common discomforts include:
Choking on solid food
This is the most common early symptom. It usually appears when the first bite is eaten, and disappears after that. It appears once in a few days to several months and is easy to be ignored. There are also persistent ones, but they are often mistaken for pharyngitis or esophagitis, which can be relieved after taking anti-inflammatory drugs. In fact, the symptoms can also be relieved without taking any drugs, because the occurrence of the symptoms is not caused by the mechanical obstruction of the disease, but is related to the disease. Inflammation, nerve reflex, esophageal spasm and other factors at the lesion site are related. As the disease progresses, the interval between onset of symptoms gradually shortens and the symptoms become more pronounced. It is easy to be misdiagnosed clinically.
Foreign body sensation in the esophagus
About 15%-21% of patients perceive a foreign body sensation in the esophagus when swallowing. Some patients feel that there is a foreign body adhering to the esophagus wall when eating, and there is an uncomfortable feeling of being unable to spit or swallow. The site of foreign body sensation is mostly consistent with the site of esophageal lesions.
Retrosternal pain, discomfort, or choking
Mild retrosternal pain with or without food, sometimes absent, more common with hot food. Sometimes stagnation or mild choking sensation in one area when swallowing food.
Lower esophageal cancer can also cause subxiphoid or epigastric discomfort, hiccups, and belching
■Advanced symptoms
The vast majority of patients with esophageal cancer are in the middle and late stages when they go to the hospital. The clinical symptoms of advanced esophageal cancer mainly include:
Difficulty swallowing
About 90% of patients present with this symptom and then seek medical attention, and the dysphagia symptoms are progressively worsened over time. Appears when eating large pieces of food, gradually develops to when eating rice-sized foodIt also needs to be washed down with boiling water or porridge, and then develops to >Only eat semi-liquid or liquid diet, in severe cases no last drop of water. This process generally only takes 3-6 months.
Obstruction
In severe cases, eating is completely obstructed, and is often accompanied by persistent frothy mucus at the mouth. This is due to the increased secretion of esophageal and salivary glands caused by the infiltration and inflammatory reflex of esophageal cancer. Mucus accumulation in the esophagus can lead to reflux, vomiting and even choking, and in severe cases, aspiration pneumonia.
Pain
Most of the pain is swallowing when eating. In the advanced stage, there is persistent retrosternal or back pain, which is dull or dull in nature, also has burning pain or tingling, and is accompanied by a heavy feeling. The location of pain may be inconsistent with the location of the lesion. Pain often indicates that the tumor has invaded, causing periesophageal inflammation and mediastinitis, but it can also be caused by the tumorCaused by deep ulcers. For those with severe pain and inability to sleep or with fever, not only the possibility of surgical resection is small, but also the possibility of tumor perforation should be noted.
Bleeding
A small number of esophageal cancer patients also come to the hospital for vomiting blood or black stools. Tumors can infiltrate large blood vessels, especially the thoracic aorta, causing fatal hemorrhage. For cases with penetrating ulcers, especially those with thoracic aorta invasion by CT examination, attention should be paid to the possibility of bleeding.
hoarse voice
It is usually caused by the direct invasion of the tumor or the compression of the recurrent laryngeal nerve after lymph node metastasis in the tracheoesophageal groove.
■Other systemic symptoms, metastatic symptoms and complications
Weight loss and fever
Eating less due to obstruction, poor nutrition, weight loss and dehydration often appear one after another. Weight loss, fever, etc. can also occur when the tumor spreads. Tumor fever mostly occurs in the afternoon, around 38 degrees, and body temperature is often normal in the morning and morning.
Complications
Tumor infiltration penetrates the esophagus and invades the mediastinum, trachea, bronchi, pulmonary hilum, pericardium, large blood vessels, etc., causing mediastinitis, abscess, pneumonia, lung abscess, tracheobronchial fistula, and fatal hemorrhage, etc. .
Symptoms associated with extensive systemic metastases
For example, in lung metastasis, cough, chest tightness, dyspnea, etc.; abdominal lymph node metastasis, abdominal pain, loss of appetite, etc.; liver metastasis, right upper quadrant pain, loss of appetite, jaundice, ascites , hemorrhage, coma, etc.
cachexia, dehydration, exhaustion
Shows extreme weight loss and exhaustion, often with water and electrolyte disturbances.
I suspect esophageal cancer, what tests should I do?
■Gastrointestinal barium meal
Only when the lesions have obvious anatomical and morphological changes, it can be displayed. The positive rate of early diagnosis of esophageal cancer is low, and the accuracy rate is only about 50%. Therefore, X-ray imaging alone cannot be used independently. Methods for the diagnosis of early esophageal cancer.
Angiography may show thickening, tortuous, disordered and interrupted mucosal folds, small ulcer niches, small filling defects, and localized wall stiffness. The presence of these features suggests that the disease is not very early, at least early invasive cancer.
■Gastroscope or Esophagoscope
Endoscopy is of great significance in the diagnosis of esophageal cancer. It can directly see the cancer, and can also perform a tumor biopsy to obtain a pathological diagnosis. The diagnosis rate can reach 80%.
It can better visualize lesions, especially small early esophageal cancers, than upper GI imaging.
When patients have symptoms such as discomfort swallowing or chest pain after eating, and upper gastrointestinal angiography fails to show esophageal abnormalities, fiberoptic gastroscopy should be performed without hesitation to exclude esophageal cancer.
■Endoscopic ultrasonography
Endoscopic ultrasound is a new technology that combines endoscopy and ultrasound technology. The morphological changes in the esophageal cavity are directly observed through endoscopy, and real-time ultrasound scanning is performed at the same time to obtain the esophagus. The histological features of all layers of the wall can obtain richer information than X-ray, CT and endoscopy.
High-frequency ultrasound can differentiate between mucosal and submucosa carcinomas, intraepithelial carcinomas, the earliest invasive carcinomas involving the lamina propria (intramucosal carcinomas), and early invasive carcinomas that invade the muscularis mucosae (submucosal carcinoma).
Compared with endoscopy, endoscopic ultrasonography can detect earlier esophageal mucosal lesions and has more important value in the detection of early esophageal cancer.
Source: Lao Du said health
Editor in charge: Wen Jiaxin
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