How Do I Choose the Best Esophageal Cancer Treatment?

This disease is a common malignant tumor in some countries and regions of the world. China is a country with a high incidence of esophageal cancer in the world. It is also one of the countries with a high mortality rate for esophageal cancer in the world. The average annual mortality rate is 1.3-90.9 per 100,000, while the world population's standardized mortality is 2.7-110.6 per 100,000. Esophageal cancer has obvious geographic clustering in China, and the areas with high morbidity and mortality are quite concentrated. The incidence rates are in Hebei, Henan, Jiangsu, Shanxi, Shaanxi, Anhui, and Hubei.

Esophageal cancer, also called esophageal cancer, is a malignant tumor that occurs in the epithelial tissue of the esophagus, accounting for 2% of all malignant tumors. Esophageal cancer is divided into early, middle and advanced stages. The usual treatment methods include surgery, chemotherapy, and drug treatment. The treatment experts include Zhou Shizhang and Ling Yaoxing. The diet of esophageal cancer is mainly nutritious and easy to digest. The etiology is related to chronic nitrosamine irritation, inflammation and trauma, genetic factors, and trace element content in drinking water, food and vegetables. Smoking and drinking are the causes of esophageal cancer. China is a high-risk area for esophageal cancer. In the north, there are more men than women, but more men than women. Most people are over 40 years old.

Introduction to Esophageal Cancer

Cancer of the esophagus

Early symptoms of esophageal cancer

1. Swallowing infarction is most common and can disappear and recur spontaneously without affecting eating. It often occurs when the patient's mood fluctuates, so it is easy to be mistaken for functional symptoms.

2. Pain is more common behind the sternum and under the xiphoid. When swallowing food, there is pain behind the sternum or xiphoid. Its properties can be burning, acupuncture, or traction, with rough, hot or irritating food being swallowed. It is intermittent at first, and when the cancer invades and nearby tissues or penetrates, there can be severe and persistent pain. The pain site is often not completely consistent with the lesion in the esophagus. Pain can be temporarily relieved by antispasmodics.

3. Food retention infection and foreign body sensation. When swallowing food or drinking water, there is a feeling of food falling slowly and staying, and a feeling of tightening behind the sternum or food sticking to the wall of the esophagus. Symptoms occur mostly in the same location as the lesion in the esophagus.

4. Throat dryness and tightening sensation is especially obvious when dry and rough food is swallowed. The occurrence of this symptom is often related to the mood swings of patients.

5. Other symptoms A small number of patients may have symptoms such as swollen discomfort, pain, and belching.

Esophageal cancer intermediate symptoms

1. Swallowing infarction is most common, and it can be optional to disappear and relapse without affecting eating. It often occurs when the patient's mood fluctuates, so it is easy to be mistaken for functional symptoms.

2. Pain is more common behind the sternum and under the xiphoid. When swallowing food, there is pain behind the sternum or xiphoid. It can be hot, acupuncture, or stretchy in nature, with swallowing rough, burning, or irritating food. It is intermittent at first, and when the cancer invades and nearby tissues or penetrates, there can be severe and persistent pain. The pain site is often not completely consistent with the lesion in the esophagus. Pain can be temporarily relieved by antispasmodics.

4. Throat dryness and tightening sensation is especially obvious when dry and rough food is swallowed. The occurrence of this symptom is often related to the mood swings of patients.

5. Other symptoms A small number of patients may have symptoms such as discomfort, analgesia, and belching after sternum.

Typical symptoms of intermediate esophageal cancer: progressive dysphagia. May have pain behind the sternum and spit mucus-like sputum when swallowing.

Advanced symptoms of esophageal cancer

1. Dysphagia Progressive dysphagia is the main symptom of most patients at the time of consultation, but it is a more advanced manifestation of the disease. Because the wall of the esophagus is elastic and expandable, swallowing difficulties occur only when about two-thirds of the esophagus is infiltrated by the cancer. Therefore, after the above-mentioned early symptoms appear, the condition gradually worsens within a few months, from the inability to swallow solid food to liquid food and not swallow. Such as cancer accompanied by inflammation of the esophagus wall, edema, spasm, etc., can increase the difficulty of swallowing. The location of the sense of obstruction often matches the location of the hand cancer.

2. Food reactions often occur when the difficulty in swallowing increases, and the reverse flow is not large. It contains food and mucus, and it can also contain blood and pus.

3. Other symptoms When the tumor compresses the recurrent laryngeal nerve, it can cause hoarseness; invasion of the phrenic nerve can cause hiccup or phrenic nerve paralysis; compression of the trachea or bronchi can cause shortness of breath and dry cough; erosion of the aorta can cause fatal bleeding. Complicated esophageal-tracheal or esophageal-bronchial fistula or cancer in the upper esophagus, swallowing fluid can often produce cervical sympathetic paralysis signs.

Signs of esophageal cancer

Early signs are missing. Umbrella, swallowing difficulties may occur in the later stages. And because the patient has difficulty eating, it can lead to malnutrition and signs such as weight loss, anemia, dehydration, or cachexia. When the cancer has metastasized, it may touch a swollen and hard superficial lymph node, or a swollen, nodular liver. Jaundice and ascites can also occur. Other rare signs include nodules on the skin and ventral white line, and inguinal lymphadenopathy.

Causes of esophageal cancer

1. Eating habits, long-term smoking and drinking alcohol, long-term eating hot foods, foods that are too hard to chew, etc. have a certain relationship with the occurrence of esophageal cancer.

2. Carcinogens (1) Nitrosamines: Nitrosamines are a group of strong carcinogens. Residents of Lin County, Henan Province, with a high incidence of esophageal cancer, prefer sauerkraut, which contains ammonium nitrite. Practice has proven that the amount of sauerkraut consumed is directly proportional to the incidence of esophageal cancer. (2) Mold: Some people in China have been feeding moldy food for a long time to induce esophageal cancer.

3 The susceptibility of people with genetic factors is related to genetic and environmental conditions. Esophageal cancer has a relatively prominent family gathering phenomenon, and families with esophageal cancer in three or more consecutive generations in high incidence areas are common.

4 Precancerous lesions and other disease factors such as chronic esophageal inflammation, esophageal hyperplasia, esophageal mucosal damage, Plummer-Vinton syndrome, esophageal diverticulum, esophageal ulcers, leukoplakia, esophageal scarring, hiatal hernia, and achalasia Is a precancerous lesion or precancerous disease of esophageal cancer.

5. Lack of vitamins, proteins, and essential fatty acids in the diet of nutrients and trace elements can cause esophageal mucosa to proliferate and degenerate, which can further cause cancer. The lack of trace elements iron, molybdenum, zinc, etc. is also related to the occurrence of esophageal cancer.

Genetic background factors for esophageal cancer

The onset of esophageal cancer has obvious familial aggregation, which is related to the susceptibility of the population and environmental strips. In high incidence areas of esophageal cancer, families with esophageal cancer in 3 consecutive generations or more are common. Surveys in Shanxi, Shandong, and Henan provinces in China found that about 1/4 to 1/2 of patients with esophageal cancer have a positive family history. The proportion of positive family history in the high-incidence area is highest in patrilineal, followed by maternal, and lowest in paralog . Immigrants who move from high-incidence areas to low-incidence areas have a relatively high incidence even after more than a hundred years. The living environment also affects the incidence of esophageal cancer. It has been found that 1/2 of the patients with esophageal cancer who have lived with their families for more than 20 years in high incidence areas. The influence of genetic and environmental factors on the incidence of esophageal cancer may be a change in molecular level. It has been found that in some cancer-prone families, there is often a tumor suppressor gene such as point mutation or loss of heterozygosity of P53. In the population, if the acquired factor causes a mutation in another allele, it will cause abnormal expression of oncogenes and cause cancer. Recent data show that mutations in oncogenes and tumor suppressor genes do exist in patients with esophageal cancer.

Esophageal cancer pathology

Early esophageal cancer can be classified into concealed type (not easy to detect with the naked eye, confirmed under a microscope), erosive type (mild erosion defect of the mucosa), plaque type (mucosa on the mucosal surface has different sizes, and the mucosa is significantly thickened at the cancer site) Papillary type (tumor is nodular, papillary, or polyp-like bulge, and the edge is clearly demarcated from the surrounding mucosa).

(A) clinical pathological staging and classification

1. Clinicopathological staging The clinicopathological staging of esophageal cancer is of great significance for the selection of treatment options and the evaluation of treatment effects. The clinical and pathological staging criteria formulated by the 1976 National Conference on Esophageal Cancer are shown in Table 18-7. Table 18-7 Clinicopathological stages of esophageal cancer Staging length Lesion range Metastasis status 0 Not limited to no metastasis in the mucosal layer 1 <3 cm invasion in the submucosa 23 to 5 cm invasion in part of the muscle layer 3> 5 cm Myometrial or outer layer local lymph node metastasis 4> 5 cm has obvious invasion of distant lymph nodes or organ metastases.

2. Pathological typing

(1) Pathological classification of early esophageal cancer: Early esophageal cancer can be classified into hidden type, erosive type, plaque type, and nipple type according to its morphology. Among them, the plaque type is the most common, accounting for about 1/2 of early esophageal cancer, and this type of cancer cell has better differentiation. Erosive type accounts for about one third, and the cancer cells have poor differentiation. Concealed lesions are the earliest and are all carcinoma in situ, but they only account for about 1/10 of early esophageal cancer. Papillary lesions are relatively late. Although cancer cells are generally well differentiated, it is rare to see carcinoma in situ in surgery.

(2) Types of pathological morphology of middle and advanced esophageal cancer: can be divided into medulla type, mushroom type, ulcer type, constricted type, intraluminal type and untyped type. Among them, the medullary type has the highest degree of malignancy and accounts for more than 1/2 of the middle and advanced esophageal cancer. This type of cancer can invade all layers of the esophagus wall and expand to the inside and outside of the cavity. All or most of the esophagus circumference and the connective tissue around the esophagus can be affected. Mushroom umbrella type accounts for about 1/6 to 1/5 of middle and advanced esophageal cancer. Most cancerous tumors are round or oval-shaped masses, showing mushroom-shaped protrusions in the esophagus cavity, which can affect most of the esophageal wall. . The ulcerative type and constrictive type account for about 1/10 of the middle and advanced esophageal cancer. Most ulcerative surfaces have deeper ulcers, bleeding and metastasis earlier, and obstruction occurring later. The constricted type grows in a ring shape, and it affects the entire circumference of the esophagus. The esophageal mucosa contracts concentrically, so the obstruction occurs earlier, and bleeding and metastasis occur later. The intraluminal type is relatively rare. The cancerous tumors protrude into the esophagus and are round or oval-shaped bulges. The pedicle is connected to the esophagus wall, and the surface often has erosions or ulcers. Tumors can invade the muscle layer, but are shallower than the above types. A small number of intermediate and advanced esophageal cancers cannot be classified into the above types, which are called untyped.

3 Histological typing

(1) Squamous cell carcinoma: most common.

Squamous cell carcinoma HE staining (2) Adenocarcinoma: Rarely, it can be divided into simple adenocarcinoma, adenosquamous carcinoma, mucoepidermoid carcinoma and adenoid cystic carcinoma.

(3) Undifferentiated cancer: rare, but high degree of malignancy. Most of the upper and middle esophageal cancers are squamous cell carcinomas, and most of the lower esophageal cancers are adenocarcinomas. Of the 622 cases of esophageal cancer in our hospital, 441 cases were examined pathologically, of which 87.3% were squamous cell carcinoma, 10.6% were adenocarcinoma, 1.5% were undifferentiated cancer, and 0.6% were other cancers.

Esophageal cancer complications

Common complications of esophageal cancer

1. Cachexia in advanced cases, due to increasing swallowing difficulties, leading to long-term starvation leading to negative nitrogen balance and weight loss, has a direct impact on the incidence of complications and surgical mortality after esophageal cancer resection. In fact, every patient with advanced esophageal cancer who has symptoms of obstruction has difficulty in eating orally, and has different degrees of dehydration and total body fluid reduction. The patient developed cachexia and obvious dehydration, showing high weight loss, weakness, loose and dry skin, and a state of exhaustion.

2. Hemorrhage or vomiting Some esophageal cancer patients have vomiting. Individual esophageal cancer patients have vomiting due to tumor invasion of large blood vessels and occasionally major bleeding. Wu Yingkai

Esophageal cancer image He Huangguojun (1974) reported that in a group of 841 patients with esophageal and cardiac cancer, 24 (2.8%) had vomiting blood from cancerous ulcers of esophageal cancer, tumors eroded large blood vessels in the lung or chest. Hematemesis is generally a clinical symptom of patients with advanced esophageal cancer.

3. Organ metastasis If there are important organs such as lung, liver, and brain, specific symptoms such as dyspnea, jaundice, ascites, and coma may occur. Patients with esophageal cancer who have esophageal-tracheal fistula, metastasis of supraclavicular lymph nodes and other organs, recurrent laryngeal nerve palsy and cachexia are all advanced esophageal cancer.

4. Sympathetic ganglion compressed cancerous tumor compresses the sympathetic ganglion, which results in sympathetic nerve paralysis (Homer syndrome).

5. Water and electrolyte disorders due to hypopharyngeal difficulties. Such patients have a tendency to develop severe hypokalemia and muscle weakness. Normal people secrete about 1 to 2 liters of saliva every day, among which inorganic substances include sodium, potassium, calcium and chlorine. The concentration of potassium in saliva is higher than that of any other gastrointestinal secretion, typically 20 mmol / ml. Therefore, when patients with esophageal cancer cannot swallow saliva due to difficulty in swallowing, significant hypokalemia can occur.

Some squamous cell carcinomas can produce parathyroid hormone and cause hypercalcemia, even if patients have no bone metastases. Patients with esophageal cancer without bone metastases before surgery have hypercalcemia, which is often a sign of poor prognosis.

6. Aspiration pneumonia Aspiration and aspiration pneumonia due to esophageal obstruction, patients may have symptoms of fever and systemic poisoning.

7. Caused by cancer metastasis, such as paralysis of the vocal cords and hoarseness caused by cancer cells invading the recurrent laryngeal nerve; shortness of breath and irritating dry cough caused by tumor compression and violation of trachea and bronchi; violation of phrenic nerve, causing diaphragmatic paralysis; violation of vagus nerve, making heart rate Acceleration; Invasion of brachial plexus nerves, causing brachial acid, pain, paresthesia; compression of the superior vena cava, causing superior vena cava compression syndrome; metastasis of liver, lung, brain and other important organ cancers, which can cause jaundice, ascites, and liver failure , Dyspnea, coma and other complications.

8. Esophageal perforation: Advanced esophageal cancer, especially ulcerative esophageal cancer, is caused by local erosion and severe ulceration of the tumor. Different symptoms occur depending on the site of the perforation and adjacent organs. Perforating the trachea causes esophageal and tracheal fistulas. Anatomy of coughing when eating, especially when entering a liquid diet. Symptoms can cause mediastinitis, chest tightness, chest pain, cough, fever, increased heart rate, and increased white blood cells. Penetration into the lungs causes lung abscess, high fever, cough, sputum, etc .; Perforation of the aorta causes esophageal aortic fistula, which can cause major bleeding and lead to death.

9. Other reports have reported that some esophageal squamous cell carcinomas have hypertrophic osteoarthropathy, some patients with recessive esophageal cancer have dermatomyositis, and some patients with obstruction of the esophagus have "swallowing syncope". (Swallow syncope), may be a vagus-media response.

Postoperative complications of esophageal cancer

(1) Anastomotic fistula: This is a serious complication after esophageal cancer surgery, and the general incidence is about 7%. The incidence of anastomotic fistula is related to the surgical method and method. The incidence of cervical anastomotic fistula is higher than that of intrathoracic anastomotic fistula; the incidence of esophagogastric anastomotic fistula is lower than that of esophageal intestinal fistula. The reasons are mainly related to the surgical technique, the tension of the anastomosis, the secondary infection of the anastomosis, and the nutritional status of the patient before the operation. Anastomotic fistula usually occurs 4-6 days after surgery, but it also occurs late to 10 days or later. If the anastomotic fistula occurs in the chest, it may have symptoms such as increased body temperature, rapid heartbeat, chest pain, and dyspnea. In severe cases, it may have shock symptoms such as pale, sweaty, weak pulse, irritability or apathy. Neck anastomotic fistulas mostly show low fever, and gas, saliva, or food debris from the neck overflows from the neck wound. Generally, the neck anastomosis can be healed after incision and drainage. Intrathoracic anastomotic fistula requires closed chest drainage, reopening of the anastomosis, anastomotic fistula repair, and external esophageal surgery according to the physical condition of the patient, the time of the anastomotic fistula, and the original anastomosis. At the same time, patients should be given adequate nutrition and maintain water and electrolyte balance.

(2) Anastomotic stenosis: Generally, the diameter of the anastomotic stoma is less than 1 cm, which is an anastomotic stenosis. It is another complication after esophageal cancer surgery. Patients will have different degrees of difficulty in swallowing. Postoperative anastomotic stenosis mostly occurs 2 to 3 weeks after the operation, and dysphagia begins to occur after 2 to 3 months. It is mostly related to anastomosis technology, anastomotic infection, anastomotic fistula, and the patient's own scar. . If the diagnosis is confirmed that the anastomosis is narrow, esophageal dilatation can be performed, and more can be cured. A few esophageal dilatation failures can be treated with esophageal stent surgery, anastomotic stricture resection, and reanastomosis.

(3) Pulmonary complications: Patients with esophageal cancer and cardia cancer are mostly patients over 40 years old. Most of the male patients smoke for many years and suffer from chronic bronchitis or emphysema to varying degrees. During surgery, the lungs must be squeezed and stretched for a long time due to the need for surgical operations. After the operation, the stomach is put into the chest cavity, the lungs are compressed, and the incision is painful. The patient is afraid to cough and expel sputum, which can cause sputum to remain in the trachea. In addition, the anesthesia drugs and tracheal intubation damage the tracheal mucosa during anesthesia, which may easily cause pulmonary complications such as bronchitis, bronchopneumonia, and atelectasis. These pulmonary complications mostly occur 24 to 72 hours after surgery. Patients may have symptoms such as shortness of breath, dyspnea, sweating, and temperature rise. Physical examination and chest X-ray can assist diagnosis. In order to prevent pulmonary complications, elderly patients with chronic bronchitis and emphysema should be given preventive treatment before surgery. Intramuscular antibiotics can be given and asthma and phlegm can be treated. Smoking patients should be ordered to smoke after admission.

(4) Chylothorax: Normal people have a thoracic duct with draining lymph in the middle and lower part of the esophagus. It may be damaged when the esophagus is separated during surgery. If esophageal cancer invades the surrounding tissues severely, surgery Thoracic duct injury is more likely to occur.

(5) Simple empyema: A simple empyema is an empyema that occurs in the absence of an anastomotic fistula. Under normal circumstances, bacteria are present in the esophageal cavity, so esophageal surgery is a contaminated operation, and empyema may occur after the operation.

Esophageal cancer diagnosis

Diagnosis method of esophageal cancer

Fiber endoscopy for the diagnosis of esophageal cancer: Since fiber optic microscopy gradually replaced metal rigid tubes in the 1970s, it has become a test for upper gastrointestinal diseases due to its flexibility, good lighting, wide vision, safety and accuracy. (Esophageal cancer, gastric cancer, etc.) a reliable method for routine clinical diagnosis, postoperative follow-up, and efficacy observation. In early esophageal cancer, the detection rate of fiber endoscope can reach more than 85%.

Esophageal endoscopic ultrasonography for diagnosis of esophageal cancer: In recent years, endoscopy of esophagus has been gradually applied to the clinic. The advantage is that the depth of infiltration of the lesion in the esophagus wall can be measured more accurately; abnormally enlarged lymph nodes outside the wall can be measured; the lesion can be easily distinguished in the wall of the esophagus.

Esophageal shedding cytology test for diagnosing esophageal cancer: This method is simple, less painful, and has a low false-positive rate. It has been proved in practice that a large-scale census in a high-incidence area of esophageal cancer is feasible and the total positive rate can reach 90% Is the preferred method for early diagnosis of esophageal cancer.

X-ray barium meal angiography for diagnosis of esophageal cancer: In addition to the extremely early esophageal cancer, which is not easy to display, the experienced radiologist fully adjusts the barium agent, so that the patient swallows in small steps, carefully observe from multiple directions and double barium radiography, most of them Can find thickening, tortuous or dotted interruption of esophageal mucosa; or hair on the edge of the esophagus; or small filling defects; or small shadow; or localized wall stiffness; or signs of earlier cancer such as barium retention.

Chest CT scan of esophageal cancer diagnosis method: The role of esophageal cancer in the diagnosis of esophageal cancer is mixed, but it is helpful for the stage of esophageal cancer, the possible judgment of resection, and the estimation of prognosis.

X X-ray examination of esophagus cancer

(1) Examination of esophagus barium meal: Examination can observe the peristalsis of the esophagus, the relaxation of the wall of the tube, changes in the esophageal mucosa, esophageal filling defects and the degree of obstruction. Esophageal stagnation or reverse peristalsis, local stiffness of the esophagus wall cannot be fully expanded, esophageal mucosa disorder, interruption and destruction, esophageal lumen narrowing, irregular filling defects, ulcer or fistula formation, and abnormal esophageal axial are all important for esophageal cancer Sign. Low tonic double angiography is more effective in detecting early esophageal cancer than conventional angiography.

(2) CT examination of the esophagus: CT examination can clearly show the relationship between the esophagus and adjacent mediastinal organs. The boundary between the normal esophagus and adjacent organs is clear, and the thickness of the esophagus does not exceed 5mm. If the thickness of the esophagus wall increases and the boundary between the esophagus and the surrounding organs is blurred, it indicates that esophageal lesions exist. CT examination can also fully show the size of esophageal cancer lesions and the extent and extent of tumor invasion. At the same time, the CT examination results can also help determine the surgical method and make a radiotherapy plan. In 1981, Moss proposed the CT staging of esophageal cancer. Stage : the tumor is confined to the esophagus cavity, and the thickness of the esophagus wall is 5mm; stage : the esophagus wall is> 5mm; Adjacent organs expand, such as the trachea, bronchi, aorta, or atrium; Stage IV: Tumors have distant metastases.

Esophageal Cancer Treatment

Esophageal Cancer Surgical Treatment

1. Major surgical treatment: Surgery is the first choice for early esophageal cancer. Patients with esophageal cancer should undergo surgical treatment as soon as their physical conditions permit. According to the condition can be divided into palliative surgery and radical surgery. Palliative surgery is mainly used for patients who cannot be cured radically or after radiotherapy. In order to solve the difficulty of eating, esophagogastric bypass, gastrostomy, and esophageal lumen are used. Radical surgery depends on the location of the lesion and the patient's specific circumstances. In principle, most of the esophagus should be removed, and the range of esophageal removal should be at least 5cm from the tumor. The surgical resection rate of the lower segment of the cancer was 90%, that of the middle segment was 50%, and the average resection rate of the upper segment was 56.3% -92.9%. Currently, radiotherapy is preferred for cervical and upper esophageal cancer, radiotherapy or surgery for middle esophageal cancer, and surgery for lower esophageal cancer. Due to the difficulty and risk of cervical and upper esophageal cancer surgery, especially for some elderly patients, the efficacy of middle esophageal cancer surgery and radiotherapy is not much different, and the overall prognosis is not much different, and the surgical resection rate of lower esophageal cancer is higher. Therefore, surgery is recommended. Mainly.

Contraindications to surgery are: clinical x-ray examinations confirm that esophageal lesions are extensive and involve adjacent organs, such as the trachea, lungs, mediastinum, and aorta. Patients with severe cardiopulmonary or liver and kidney dysfunction or cachexia can not tolerate surgery.

2. Minor surgery: It is generally recommended that advanced patients (patients who can hardly eat or patients with only a small amount of fluid) perform esophageal stenting to open the narrow esophagus.

Esophageal Cancer Radiotherapy

Radiotherapy for esophageal cancer has a wide range of indications. Except for esophageal fistula formed by perforation of esophagus, metastasis in the distance, obvious cachexia, severe heart, lung, liver and other diseases, radiotherapy can be performed, including radical radiotherapy and palliative radiotherapy.

1) Indications: (1) The general condition of the patient is above moderate; (2) The length of the lesion should not exceed 8cm; (3) No supraclavicular lymph node metastasis, no vocal cord paralysis, no distant metastasis; Liquid food or general food; (5) no signs of perforation; (6) cytological or pathological diagnosis, especially superficial esophageal cancer.

Note: Pre-perforation signs of esophageal cancer: sharp spikes: sharp spikes at the lesion, small ones like burrs, large ones like wedges; shadow formation: a large ulcer; diverticulum-like changes: formation and general esophagus Diverticula are similar, mostly occurring after radiotherapy; Twisted into an angle: The esophagus wall loses normal running, as if dislocated after a long bone fracture; Mediastinitis: The mediastinal shadow widens, the patient's temperature rises, the pulse speeds up, and chest and back pain. The prognosis is poor after perforation, and most patients die within months.

2) Irradiation dose and time: Usually the tumor dose is 60Gy 70Gy / 6 7 weeks.

3) Response to external irradiation: (1) Esophageal response: When the tumor volume reaches 10-20Gy / 1 to 2 weeks, there is mild

Esophageal cancer Esophageal mucosal reaction, at 30 40Gy / 3 4 weeks, esophageal mucosa congestion and edema are further aggravated, manifested as dysphagia, swallowing pain, and mild cases can be left untreated. In severe cases, antibiotic antibiotics can be used to reduce the reaction, if necessary Rehydration nutritional support treatment. Individual severe cases need to suspend radiotherapy. At this time, explain the work to patients and their families to avoid misunderstandings. (2) tracheal reactions: cough, mostly dry cough, less sputum, mainly symptomatic. .

4) Complications (1) Bleeding: the incidence is about 1%. When selecting patients, special care should be taken for those who have obvious ulcers, especially deep ulcers with burr-like protrusions, to reduce the dose per exposure and prolong the total treatment time. During radiotherapy, X-ray barium meals should be observed frequently (2) Perforation: the incidence is about 3%, which can penetrate into the trachea, form esophageal tracheal fistula or penetrate into the mediastinum, causing mediastinal inflammation. (3) Radiation myelopathy: Radiation myelopathy is one of the serious complications of radiation therapy for head, neck and chest malignant tumors. The incubation period is mostly 1 to 2 years after irradiation.

Esophageal cancer chemotherapy

At present, concurrent chemoradiotherapy for advanced esophageal cancer is advocated, and the drugs are mainly DDP and 5-FU.

Chinese medicine treatment of esophageal cancer

Chinese medicine believes that the root cause of esophageal cancer is weak yang, and the function of the body is reduced. The main treatment should be to warm the yang and benefit qi, help the righteousness and improve the function of the body. Therefore, the main treatment should reflect this principle of TCM treatment.

(1) Chinese medicine prescription: Chinese traditional medicine treatment has always been relatively western medicine with no negative effects and herbs, and it is increasingly accepted in the west. Chinese herbal medicine is still relatively safe and safe for esophageal cancer therapy, whether it is the results of scientific research units or private Well-known prescription.

(2) Chinese patent medicine esophageal cancer should be treated with surgery, radiotherapy and chemotherapy. Traditional Chinese medicine treatment is also a very important component. Among them, proprietary Chinese medicines have the advantages of stable dosage components, convenient taking, and convenient curative effects.

(3) TCM Syndrome Treatment

Chinese herbal medicine treatment, the effect of relieving evil

Air stagnation type

Main evidence: early esophageal cancer manifestation, no obvious difficulty swallowing, just to feel esophageal blockage, foreign body sensation or burning pain when swallowing, chest depression and discomfort and back tightness, sometimes hidden when swallowing. X-ray examination is mainly for the lesions of early esophageal cancer. The tongue is pale, the tongue is thin and white, and the pulse strings are thin.

Governing Law: Shugan Qi, Wenyang Yiqi, righting and suppressing tumor.

Infarcted

Main symptoms: simple symptoms, mild infarction or unfavorable swallowing. X-ray examinations are mostly early and middle medulla type and mushroom umbrella type esophageal cancer. The tongue is dull, the fur is yellow and white, and the pulse strings are thin.

Governing Law: Anti-cancer dispersal, qi reduction and inverse, Wenyang righting.

3. Withered and sunken

Main symptoms: late onset, difficulty in swallowing, near obstruction, nausea and inverse gas, weight loss, shortness of breath, fatigue, dry lips, dry stools, faeces, dull tongue, thinness, little or no moss There are also dry and cracked moss yellow and black, and the pulses are thin or weak.

Governing law: prolong life, nourish yin and nourish yang, nourish qi and nourish blood.

Chinese herbal medicines can currently treat esophageal cancer, cardia cancer, gastric cancer caused by phagocytosis, continuous sticky sputum, vomiting after eating, reflux food, difficulty swallowing, weight loss, hoarseness, chest tightness, fatigue, focal reflex pain, etc. The symptoms have a good effect.

Qin's Miracle Ritual Therapy divides patients with esophageal cancer into four types: 1. Type of phlegm obstruction:

Main symptoms: Obstruction of swallowing, chest tightness, dry mouth and dry throat. The tongue is reddish, the tongue is thin, and the pulse strings are slippery.

Governing Law: Regulating Qi and Stagnation, Resolving Phlegm and Moistening Dryness.

2. Jin deficiency heat knot type:

Main symptoms: painful swallowing infarction, difficult to enter solid food, soup can be down, the body gradually lose weight, dry mouth, dry throat, dry stool, five upset fever. The tongue is red and dry or cracked, and the pulse strings are fine.

Governing law: nourishing body fluid, purging fever and dissolving.

3. Internal stasis type:

Main symptoms: Pain in the chest, vomiting after eating, or even drinking water, the stool is as firm as sheep feces, or the spit is like red bean juice, and the skin is dull. The tongue is red and shaojin, and the pulse is fine.

Governing law: nourishing yin and nourishing blood, breaking knots and stasis.

4. Qi Wei Yang Deficiency Type:

Main symptoms: long-term diet, mental exhaustion, shortness of breath, salivation, floating face, swollen feet, and abdominal distension. The tongue is pale and white with thin veins.

Governing method: warm the spleen and kidney, nourishing Qi and solidifying.

Esophageal Cancer Biotherapy

The basic principle of esophageal cancer biological therapy is to defend tumors by regulating the body's inherent ability, which is to give patients certain biological immune factors or biological immune stimulating factors to activate or enhance the body's immune cells to kill tumor cells, thereby achieving tumor treatment or prevention The purpose of tumor metastasis. Tumor biotherapy is most suitable for patients whose tumors have shrunk to a minimum by surgery or medication. The biological treatment methods for esophageal cancer mainly include the following categories:

1. Cytokines: Cytokines are produced by immune effector cells and other related cells in the body. They have important biologically active cell regulatory proteins. They can kill tumor cells through direct or indirect effects. At present, immune cells that have been applied to clinical biological cell immunotherapy with good results include dendritic cells (DC), cytokine-induced killer cells (CIK), and so on.

2. Immunologically active cells: Lymphokines activate killer cells, that is, LAK cells. TIL cells are tumor infiltrating lymphocytes. They treat tumors primarily by their direct killing effect on tumor cells.

3 Tumor molecular vaccines: Currently the main research direction is to prepare tumor-specific vaccines for active immunization, but they have not been applied clinically.

4. Guided therapy: application of specific monoclonal antibodies combined with toxins, anticancer drugs or radionuclides, and after injection into the body, they bind to tumor cells and kill tumor cells.

Taboo during chemotherapy for esophageal cancer

Many patients with esophageal cancer or other tumors are convinced of the anti-cancer and anti-cancer effect of vitamin C and often take vitamin C drugs by themselves; in fact, there is little evidence to support the anti-cancer and anti-cancer effect of vitamin C. On the contrary, a long-term overdose of vitamin C will cause a series of adverse reactions such as dizziness, fatigue, low back pain, and headache.

During chemotherapy, if a large amount of vitamin C supplementation will acidify the urine, it is not conducive to the dissolution and discharge of uric acid crystals, and it is easy to form stones, leading to hematuria, renal colic, and even worsening renal function damage. In particular, patients with tumors that are sensitive to chemotherapy, such as small cell lung cancer, malignant lymphoma, and leukemia, often advocate drinking more water to ensure sufficient urine output and help dissolve uric acid crystals instead of vitamin C supplementation.

Radish leaves, rapeseed, parsley, tomatoes and other vegetables are often recommended for cancer patients because they are rich in vitamin C.

Esophageal cancer To improve their immunity. It needs to be emphasized that the vitamin C obtained in the diet can basically meet the needs of cancer patients, and it is not necessary to take extra vitamin C pills, especially during chemotherapy, excessive vitamin C supplementation can weaken the efficacy of chemotherapy drugs and affect the effect of chemotherapy.

In addition, esophageal cancer patients with gout, hyperoxaluria, diabetes, hemochromatosis and other conditions should not supplement vitamin C. Patients with tumors with venous thrombosis often use antiplatelet drugs, and vitamin C can prevent aspirin excretion and increase blood concentration. Therefore, for this type of patients, do not blindly follow the medication, and follow the doctor's instructions. Consume normally.

Esophageal Cancer Care

Esophageal Cancer Care Goals

Reduce anxiety

2. Strengthen nutrition

3. Reduce or avoid postoperative complications

4. Learn effective eating methods.

Care measures for esophageal cancer

First, preoperative care

1. Psychological nursing patients have progressive difficulty swallowing, become thinner, have poor tolerance to surgery, lack confidence in treatment, and have a problem with surgery.

Esophageal cancer Some degree of fear. Therefore, the patient's psychological state should be explained, comforted and encouraged, and a fully trusted nurse-patient relationship should be established so that the patient realizes that surgery is a thorough treatment and makes him happy to undergo surgery.

2. Enhancing nutrition Those who can still eat should be given a high-calorie, high-protein, high-vitamin liquid or semi-liquid diet. Those who cannot eat should be supplemented with water, electrolytes and calories intravenously. Patients with hypoproteinemia should be corrected by blood transfusion or plasma protein.

3. Gastrointestinal preparation

Pay attention to oral hygiene

Place gastric tube and duodenal dropper before surgery

Fasting before surgery, food retention, flushing the esophagus with isotonic saline the night before surgery will help reduce tissue edema and reduce the incidence of postoperative infection and anastomotic fistula

Those who plan to replace the esophagus with colon should be prepared and treated according to colon surgery before surgery. See Preoperative preparation for colorectal cancer.

4. Practice pre-operative exercises to teach patients deep breathing, effective cough, expectoration, and defecation on the bed.

Second, postoperative care

In addition to observing vital signs and other routine care, you should also:

1. Keep the gastrointestinal decompression tube open and drain a small amount of blood 24 to 48 hours after surgery, which should be considered normal. If a large amount of blood is drawn, report it to the doctor immediately. Gastrointestinal decompression tubes should be kept for 3 to 5 days to reduce anastomotic tension and facilitate healing. Note that the gastric tube is connected accurately and securely to prevent prolapse and smooth drainage.

2. Closely observe the thoracic drainage and the nature of thoracic drainage. If abnormal bleeding, turbid fluid, food residues, or chyle is found, it indicates that there is active bleeding in the thoracic cavity, esophageal anastomotic fistula, or chylothorax, and appropriate measures should be taken. Clear diagnosis and treatment. If there are no abnormalities, remove the drainage tube 1 to 3 days after surgery.

3. Strictly control the diet. The esophagus lacks the serosa layer, so the anastomosis heals slowly. Postoperative fasting and water should be strictly avoided. During fasting, fluids are given intravenously daily. If a duodenal drip tube is placed, after the peristalsis of the intestine is restored on the second day after the operation, the nutrient solution is dripped through the catheter to reduce the amount of infusion. On the 5th day after surgery, if there is no special change in the condition, milk can be taken orally, 60ml each time, every 2hl times, and the same amount of water can be given during the interval. If there are no adverse reactions, it can be increased daily. The slag-free semi-liquid diet was changed on the 10th to 12th days after the operation, but care should be taken to prevent overeating and excessive eating.

4. Observe the symptoms of anastomotic fistula

The clinical manifestations of esophageal anastomotic fistula are high fever, fast pulse, dyspnea, severe chest pain, intolerance; low respiratory sounds on the ipsilateral side, dullness on percussion, elevated white blood cells and even shock. Principles of treatment: drainage of the pleural cavity to promote lung swelling; choose effective antibiotics to fight infection; supplement enough nutrition and calories. At present, complete gastrointestinal nutrition (TEN) is often used for gastrostomy and gavage treatment, and the results are accurate and satisfactory. Special treatment.

Third, diet care :

Pay attention to diet adjustment. During the treatment, light, nutrient-rich, and easy-to-digest foods should be given, and the color, aroma, taste, and shape of the food should be emphasized to increase appetite and ensure nutrition. It is advisable to give more blood and nourishment during the intermittent period of treatment. Foods with qi supplementation to improve the body's disease resistance.

Fourth, psychological care:

Strengthen emotional care, comfort patients, eliminate tension, fear, depression, depression, and other psychological issues, and patiently explain treatment. If you have hair loss, you can configure a hair cover. When the condition allows, you can organize patients to walk and entertain activities to try to make the patient in the best physical and mental state during chemotherapy.

Five, drug care:

The cooperation of traditional Chinese medicine is the foundation of nursing esophageal cancer. Through the use of Chinese herbal medicine, it can control the recurrence rate of esophageal cancer. Chinese herbal medicine is naturally non-toxic, beneficial and harmless. It is still very beneficial for preventing esophagus and nursing the esophagus.

6. Management of postoperative complications of esophageal cancer:

The management of postoperative complications of esophageal cancer is of great significance in the treatment of esophageal cancer. Postoperative complications of esophageal cancer are often accompanied by different degrees of complications. It is clinically pointed out that in addition to anastomotic fistula, patients with The occurrence of diarrhea, reflux esophagitis, functional thoracic and gastric emptying disorders, and respiratory infections, etc. The management of postoperative complications of esophageal cancer is mainly reflected in the following aspects:

1. Functional thoracic and gastric emptying disorders: After esophageal cancer resection, gastric dysfunction is often prone to cause thoracic and gastric functional emptying disorders and lead to retention of a large number of gastric contents, which is also one of the complications after esophageal cancer surgery.

Treatment measures: According to the specific situation, we should actively treat the inverted gastric tube drainage, gastric tube gastrointestinal decompression, jejunostomy or gastric fluid infusion, and give enteral and parenteral nutrition support and drug conditioning gastrointestinal function to improve The symptoms of nausea and vomiting promote the recovery of chest and stomach function and improve the quality of life.

2. Reflux esophagitis: It is a common complication after esophageal cancer. It is mainly manifested by acidic fluid or food flowing back from the gastroesophagus to the pharynx or mouth every time when lying forward after meals or lying in bed at night. Symptoms such as burning or pain behind the sternum, and difficulty swallowing.

Treatment measures: Patients with postoperative esophageal cancer should take a semi-recumbent or sitting position. Liquid or semi-liquid foods can be selected. Small meals should be taken. Slow swallowing movements. Avoid irritating foods such as tobacco, alcohol, and spicy food. Lie on your back after a meal. When you lie on your bed, raise the bedside 20-30cm trousers. The trousers should not be tightened too tightly to avoid various causes of high abdominal pressure.

3 Respiratory tract infections after esophageal cancer: manifestations of cough, chest tightness, dyspnea and other symptoms, is one of the most common complications after esophageal cancer.

4 Severe diarrhea: gastrointestinal dysfunction after esophageal cancer resection leads to diarrhea. At present, it is generally considered to be related to vagus nerve cut-off and increased gastrin concentration.

Treatment measures: Antidiarrheal drugs should be actively given, and fluid should be given at the same time to prevent dehydration in patients.

In order to obtain a satisfactory treatment effect, we must first understand and grasp the possible postoperative complications of esophageal cancer, and then be fully prepared to actively treat the symptoms symptomatically. The incidence of post-complications.

Esophageal cancer diet related

Diet attention and adaptation to medicated diet:

The prominent symptom of esophageal cancer patients is dysphagia, which is also a serious dietary problem for esophageal cancer patients. Dysphagia in most patients with esophageal cancer occurs gradually and progressively. At the beginning, the patient only had a stubborn sensation when eating dry food, which gradually worsened, and even developed difficulties in eating soft food and semi-liquid food. Eventually, it became completely difficult to drink water and eat, making the patient's nutritional status worse and worse Causes cachexia. It can be seen that difficulty in feeding is a very serious problem for patients with esophageal cancer.

For patients with diagnosed early and middle stage esophageal cancer, we should take the opportunity to comprehensively add nutrition to patients, give patients soft or semi-liquid foods containing high protein and high vitamins, and use the gastrointestinal absorption function to supplement nutrition as much as possible, so that patients Have a better physical condition.

In order to make the chemotherapy go smoothly, while the drug is being treated, it should be supplemented with rich nutritional foods to improve the tolerance of the human body to the toxic and side effects of anticancer drugs. During chemotherapy, the patient's diet should be based on high calories and high protein, such as chicken, duck, fish, shrimp, lean meat, eggs, etc., so as to play an adjuvant therapeutic role. The diet should be diversified, pay attention to the diet mix, in order to complement each other with nutrients, improve the body's immunity. If you have five upset symptoms of fever and yin deficiency, you should take white fungus porridge or soak 0.15 grams of American ginseng as tea. Where economic conditions permit, stewed turtle soup can be stewed. Pay attention to the color, aroma, and taste of cooking. It is best to steam, cook, and stew. Do not eat or eat less smoked, fried, grilled food, eat less pickled food, do not smoke or drink alcohol. Alcohol can activate many carcinogens. Reduces immune function. The staple food of chemotherapy patients can choose buns, dumplings, ravioli, noodles, etc. according to their dietary habits and tastes. Patients with poor appetite may eat less frequently.

Unlike other tumors, esophageal cancer is not anorexia, but difficulty in swallowing and inability to eat, resulting in consumption of the body. Therefore, you should eat as much as possible into the esophagus, such as semi-liquid and full-flow, and pay attention to semi-liquid and full-flow. Quality, don't limit calories, be rich in nutrients, soft and easy to digest and absorb. If necessary, you can make homogeneous meals, elemental meals and mixed milk and other diets. A homogenized diet is a normal person's diet that has been stabbed and deboned, and then stirred with a high-speed tissue masher to form a paste. The nutritional content is similar to that of a normal diet, but it has been crushed in vitro, which is easy to digest and absorb. Avoid long single diets and prevent constipation.

The main precautions in the diet:

1. Do not swallow forcibly when the patient feels stubborn, otherwise it will stimulate local cancer tissue bleeding, spread, metastasis and pain. In severe cases, liquid or semi-liquid food should be taken.

2. Avoid eating cold liquid foods, and keep cold noodles, milk, egg soup, etc. that are relatively old. Because esophageal stenosis is very obvious for cold food stimulation, it is easy to cause esophageal spasm, nausea, vomiting, pain and numbness. So eat warm food as well.

3 Do not eat spicy, spicy, stinky, fishy irritating foods, because these foods can also cause esophageal spasm and make patients uncomfortable. For patients with esophageal cancer who cannot eat at all, intravenous high nutrition method should be adopted to input nutrients to maintain the needs of the patient's body.

Clinical Study of Traditional Chinese Medicine for Esophageal Cancer

Traditional Chinese medicine believes that the occurrence of esophageal cancer is mainly related to the following aspects, which are specifically described below: 1; Inadequate diet: excessive fat, glycerin, and spicy products, excessive alcoholism, or heat-humidity, causing phlegm , Jiu phlegm and heat intersect each other, or accumulated heat and yin, Jinxue blood dryness, loss of esophagus moist, and cyanosis. 2; Internal injuries of emotion: "Inner diameter" states: "Isolation is blocked, and the upper and lower sides are not accessible, then the disease of sorrow is also caused." Xu Lingtai Suo Yun: "Hanging disease, there must be blood stasis, sputum and qi, and block Stomach qi. "3; Viscera and dysfunction disorders: Viscera and yin and yang disorders, and the deficiency of righteousness is the main internal cause of illness. Zhang Jingyue pointed out: Juveniles rarely see this card, but only those with moderate wear and tear. "Elderly kidney deficiency, insufficiency of sexual intercourse, or chronic illness can lead to insufficient blood and qi, loss of yin and jin, loss of esophagus to maintenance, and chronic illness. This shows that liver, spleen and kidney dysfunction causes qi. The sputum, blood and sputum are intertwined, and the dryness and dryness of the esophagus are the basic pathogenesis of the disease.

Traditional Chinese medicine has a complete theoretical ideological system for esophageal cancer. Through four diagnosis, accurate differentiation is made, and then prescription treatment is performed to adjust the patient's yin and yang, deficiency and reality, cold and heat, and achieve a new "yin and yang secret." Physiological and pathological processes, the treatment of esophageal cancer with Chinese medicine Lizhi Xiaocan Decoction can play a role in controlling and changing the living environment of its cancer cells, can alleviate symptoms, improve mental state, increase appetite, extend sleep time and reduce the occurrence of cachexia, Improve patients' physical and mental health. At the same time, Chinese medicine for esophageal cancer also has a two-way regulatory function, which can balance some biochemical and immune indicators too high or too low, and correct some disorders of the body, which is beneficial to maintaining quality of life; on the other hand, Chinese medicine treatment can The combination of righteousness and anti-evil has both a supportive and strong effect and an anti-cancer effect. The traditional Chinese medicine Lizhi Xiaocan Decoction has a slow effect in treating esophageal cancer, but it is not toxic. The disease can cure evil without harming the body and uprighting and helping the evil. Clinical research and animal experiments have confirmed that it can reduce the toxicity of radiotherapy and chemotherapy, protect the bone marrow, Improve appetite, increase physical strength, improve sleep and mental status, prevent cachexia, and delay the failure of patients with end-stage esophageal cancer.

Nasal feeding after esophageal cancer

Patients with esophageal cancer need nasal feeding during the first 5 days after surgery. Many patients and their families do not know much about it. Here we will introduce the importance and methods of nasal feeding after esophageal cancer.

First, why do patients with esophageal cancer need nasal feeding?

About 1-5 days after the operation, the anastomosis has not yet healed, the gastrointestinal function has not recovered well, and the digestive function is poor. If you eat blindly at this time, it is very detrimental to the recovery of the esophagus, so nasal feeding is needed to increase nutrition.

How to give nasal feeding to patients with esophageal cancer after surgery?

The so-called nasal feeding is to place a thin and special nutrition tube through the nose straight to the jejunum to deliver nutrition. Patients are mainly mixed with milk, vegetable juice, fruit juice, rice soup, etc. The injection volume can be infused from 500 ml on the first day, divided into 2 or 3 infusions, and thereafter increased to 1500 to 2000 ml per day according to the patient's tolerance. The temperature at the time of dropping should be approximately the same as the body temperature; the nasal feeding nutrient solution should try to meet the requirements of containing protein, fat, carbohydrates, vitamins, salt and water in an appropriate proportion.

Third, the symptoms should be noted

People should be aware of the following three symptoms in their lives:

-Dysphagia Progressive dysphagia is the main symptom of most patients at the time of consultation, but it is a more advanced manifestation of the disease. Because the wall of the esophagus is elastic and expandable, swallowing difficulties occur only when about two-thirds of the esophagus is infiltrated by the cancer. The condition often worsens within a few months, progressing from being unable to ingest solid food to liquid food. Such as cancer accompanied by inflammation of the esophagus wall, edema, spasm, etc., can increase the difficulty of swallowing.

-Food reflux often occurs when the difficulty in swallowing is increased, the reflux is small, and it contains food and mucus, and it can also contain blood and pus.

-Other symptoms: When the tumor compresses the recurrent laryngeal nerve, it can cause hoarseness; violation of the phrenic nerve can cause hiccups or phrenic nerve paralysis; compression of the trachea or bronchi can cause shortness of breath and dry cough; erosion of the aorta can cause fatal bleeding.

Cancer of the esophagus cannot be abused

Because malignant tumors are prone to recurrence and metastasis, they are more harmful to the body and have a poor prognosis. People often call them "tumours". One way to treat "tumours" is to adjust the body, increase resistance, and control tumor growth or metastasis, which is called tonication. The second is to attack tumors to destroy their growth ability and directly kill "tumor" cells or eliminate tumors, which is called attack method. In people's habits, attacking toxic tumors with toxic drugs is called attacking with poison. Almost all chemotherapeutics, such as cyclophosphamide, 5-fluorouracil, mitomycin, and noviben, are very toxic drugs. Traditional Chinese medicine commonly used anti-cancer drugs include red cockroaches, cantharis, leeches, croton, and gallbladder. These drugs have certain curative effects and scientific basis for treating tumors, but they are toxic whether used externally or internally.

What kind of patients is the method of attacking with poison suitable for? "The Nei Jing" puts forward: "The strong will cut it, the remaining will attack it, and the end will be scattered." This is to point to different approaches to the nature of tumors. Therefore, all toxic drugs must be carefully selected by the physician under the guidance of a good physical condition, especially those with normal liver, kidney and hematopoietic functions. If poison is used to attack the poison, it is believed that the greater the toxicity, the better the effect, and the unlimited application of highly toxic drugs will inevitably cause serious adverse consequences.

How to treat esophageal cancer

First of all, it is necessary to make clear that the late stage of cancer is not equal to the late stage of life, so patients with intermediate and advanced stages of esophageal cancer are reminded to maintain an optimistic attitude, do not have anxiety, and actively adopt effective treatment methods. Patients can quickly regain their health.

In the treatment of patients with advanced esophageal cancer, Chinese medicine has some unique features, and the effect is also significant. TCM refers to esophageal cancer as "". As far as the name of the disease is concerned, means difficulty swallowing, and the infarction is not smooth; is chest obstruction, and diet is not good. These descriptions are similar to the clinical manifestations of esophageal cancer with dysphagia, swallowing after swallowing, and chest pain. Traditional Chinese medicine believes that the incidence of esophageal cancer is mainly due to yang deficiency leading to low viscera function, qi deficiency and blood weakness, emptiness of the second pulse, dysfunction of qi and blood, resulting in dysfunction, qi stagnation and blood stasis, and long-term accumulation of sputum and poisoning. It becomes cancer in the body. Observing the development of the course of disease, it is because of the reality that it is caused by reality, and it is more because of reality.

Dissemination route

Dissemination in the esophagus wall

Direct infiltration: The tumor directly infiltrates into important organs such as the hilar bronchus and aorta, often reducing the tumor resection rate

Lymph node metastasis

Hematogenous metastasis: distant metastases from esophageal cancer are less common. Advanced hematogenous metastases are more common in liver, lung, bone, kidney, and omental peritoneal adrenals.

Transfer

Esophageal cancer treatment: The treatment of early esophageal cancer is mainly surgical resection (if the resection is complete), remembering that (completely) patients may have long-term survival. However, because of esophageal cancer surgery, the patient's body tissues are damaged and blood and blood are lost, which weakens the patient's constitution and easily leads to the recurrence of cancer and the spread and metastasis of cancer cells. If you can cooperate with Chinese medicine treatment in a timely manner after surgery, improve the solid foundation, improve the patient's diet and sleep, and strengthen the patient's physique, it will be of great benefit to prevent the recurrence and metastasis of cancer.

Most advanced esophageal cancers have spread and metastasized, and the chance of surgical resection is small, even if the operation is only palliative local resection. Clinically, the treatment methods of advanced esophageal cancer include radiotherapy, chemotherapy and traditional Chinese medicine, and the principle of treatment is the combination of traditional Chinese and western medicine. Chemotherapy is one of the common methods for the non-surgical treatment of esophageal cancer, but it has "there is no difference between the enemy and the enemy" (cancer cells are killed together with normal cells), the effective dose and the poisoning dose are very close It is more prone to toxic reactions), serious side effects such as toxic side effects, and the most obvious reactions are impaired digestive function and suppressed bone marrow hematopoietic function.

Obviously, patients with esophageal cancer often have difficulty responding to chemotherapy or unable to complete the entire course of treatment because of severe reactions. Therefore, at the same time as chemotherapy and after chemotherapy, it should be combined with traditional Chinese medicine treatments such as strengthening the spleen and stomach, nourishing qi and blood, and nourishing liver and kidney, which can alleviate the chemotherapy response and help the smooth progress of chemotherapy. Radiation therapy also has obvious radiotherapy response, which makes many patients have to discontinue radiotherapy. If combined with traditional Chinese medicine treatment such as tonifying qi and blood during and after radiotherapy, it will have a better effect on increasing the number of white blood cells and enhancing immune function. The superior hemostasis of traditional Chinese medicine cannot be surpassed by western medicine.

Therefore, patients should be detected, diagnosed and treated early, which is the key to treating esophageal cancer. The early symptoms of esophageal cancer are indeed not obvious. The cancer tissue is limited to the mucosal layer of the esophagus, and its range is generally less than 2 cm, but it is not without symptoms. Such as foreign body sensation in the esophagus, burning sensation, sometimes lingering or sternal tingling sensation when eating, these symptoms are mostly ignored by patients, thought to be caused by careless eating, or caused by pharyngitis. With the gradual aggravation of the disease, the patient may have a feeling of eating dysphoria and difficulty in eating and drinking. At this time, most of the patients were diagnosed with advanced stage esophageal cancer. It was difficult to eat for a long time, and the patients were malnourished. In addition, they were older and lost the chance of surgery. Therefore, in the early symptoms of esophageal cancer, you should go to the hospital for X-ray examination of esophagus barium meal. If the diagnosis is not clear, esophageal microscopy should be performed. The accuracy of esophageal fiber examination is 99%, and it is generally not missed. Early surgical treatment of esophageal cancer has a 5-year survival rate of more than 30%, so patients should be detected early, diagnosed and treated early. This is the key to treating esophageal cancer.

Esophageal cancer prevention: The following are the symptoms of esophageal cancer patients. You can use the following instructions to determine whether it is esophageal cancer.

1). Symptoms: Obstructed eating 2. Have a burning sensation of pain 3. Shoulder clavicle chest pain

4. Cough with sputum 5. People lose weight without spirit 6. Bloodshot eyes in severe cases

7. Dark or yellow skin 8. Snoring often

9. Nausea and vomiting Sleep well insomnia more dreams 11. I often swell my stomach

12. Dizziness, drowsiness, hemoptysis, diarrhea

Swallowing food, or eating irritating food, and delayed gastric motility, caused by eating too much food, will disappear naturally after tens of minutes. However, if the snoring is continuous and takes a long time, it is necessary to go to a regular hospital for examination as soon as possible, especially the elderly's immune system is weakened, the functions of various organs are reduced, and the occurrence of tumors must be especially guarded. Although the incidence of esophageal cancer is high, the cause of esophageal cancer is not clear, but chronic irritation caused by diet (such as long-term drinking of strong alcohol and strong irritating foods), eating too fast, overheating, excessively thick, chronic oral Inflammation, oral purulent lesions, and certain diseases of the esophagus (such as iron deficiency pseudomembranous esophagitis, esophageal mucosal leukoplakia, corrosive esophageal burns, and stenosis) may all be the cause of the disease.

Some patients with esophageal cancer say they have experienced persistent snoring. So far, snoring has not been considered a precursor to a possible cancer. However, a related study of 99 patients with esophageal cancer showed that 27% said they had experienced a constant snoring; and 6% said that this phenomenon prompted them to see a doctor .

Snoring is caused by involuntary spasms of the diaphragm. Eating too fast or too much, coughing, laughing, and drinking too much can trigger snoring. When snoring continues, people usually put a paper bag over their snouts and repeatedly breathe air from the bag to stop the snoring. Continuous snoring in patients with esophageal cancer may be related to their phrenic nerve, which is the motor nerve of the diaphragm. No one knows why this is, but it may be related to the vagus or phrenic nerve.

Esophageal Cancer Prevention and Care

Preventive measures: Do not eat moldy foods; do not eat overheated or hot foods, drink tea or porridge at 50 ° C or lower; prevent water pollution, improve water quality; do not smoke, do not drink strong alcohol; supplement the trace amount needed by the human body Element; eat more fruits and vegetables, increase intake of vitamin C. Surveillance of susceptible people, popularize anti-cancer knowledge, and improve anti-cancer awareness.

Esophageal Cancer and Diet

1. Don't eat too much meat, because the fat content in the meat is high, you can eat more fish and shrimp to meet the body's demand for protein.

2. Pickles, bacon, and other foods contain carcinogens, nitrites, and should be eaten less.

3 Moldy rice, noodles, peanuts and other foods contain carcinogenic aflatoxin. Once found, they should be discarded and not eaten.

4 Wash the rice before cooking rice and porridge to reduce the damage to the body caused by mildew.

5. Frequently frying food will increase the pollution of the kitchen and make people more vulnerable to lung cancer.

6. The water stored in the water tank should be renewed every 2 to 3 days. Do not always keep stubs, because the bacteria in the sediment at the bottom of the tank can reduce nitrate in the water to carcinogenic nitrite.

7. Eat more foods rich in cellulose, such as celery, chives, fresh dates, sweet potatoes and so on.

8. Smoked and grilled fish, meat, sausages and other foods contain carcinogenic tobacco tar and should be eaten less.

Do not put too much oil when cooking. Studies have shown that the occurrence of breast cancer, colorectal cancer, and ovarian cancer are all related to too much fat intake.

9. Don't buy cheap stale or rotten vegetables and fruits.

Tertiary prevention of esophageal cancer

Primary prevention:

Etiological prevention: Avoid water pollution, reduce nitrosamines and harmful substances in the water, adjust dietary habits, do not eat overheated food, do not eat rough and hard food, mold and detoxification; drink highly listed alcohol, do not smoke.

Epidemiology prevention: apply preventive drugs, actively treat esophageal hyperplasia, and deal with precancerous lesions, such as esophagitis, polyps, diverticulum, etc.

Secondary prevention: early detection, early diagnosis and early treatment. Those with one of the "four senses" symptoms should promptly seek treatment from an experienced specialist or suggest regular gastroscopy or radiology examinations.

Tertiary prevention: improve the cure rate, survival rate and quality of life of patients with esophageal cancer, pay attention to rehabilitation, palliative and analgesic treatment. Provide patients with standardized diagnosis and treatment programs, and provide guidance in physical, psychological, nutrition, and rehabilitation. Do a good job in clinical endeavors and improve the quality of life of advanced patients.

Principles of esophageal cancer treatment and protection:

1. Establish the scientific concept of continuing treatment during the rehabilitation period, and seek a personalized treatment plan for yourself.

2. Solve residual cancer cells, control and eliminate tiny lesions.

3. Rebuild the body's immune monitoring function and repair the human body's regulatory function.

Specific treatment and protection measures for esophageal cancer :

1. Maintain a positive mentality and believe that you have defeated cancer. Often participate in social activities, especially with cancer friends

Communication, combining "body training" and "heart training". Participate appropriately in physical exercise, qigong, tai chi, and dance. Pay attention to the combination of work and rest, and the combination of movement and static.

2. Dietary therapy is indispensable during the recovery period, especially the spleen and stomach are supplemented by diet. The spleen and stomach are the foundation of the day after tomorrow, the source of qi and blood biochemistry, not to mention that the spleen and stomach are often injured during tumor treatment. A scientific and reasonable diet combination is very important for the recovery of the spleen and stomach and for strengthening the patient's body.

Esophageal cancer 3. Apply protective preparations for tumor treatment as soon as possible to allow patients to recover as soon as possible.