What Are the Different Types of Esophageal Cancer Surgery?

Esophageal cancer is a common tumor of the digestive tract, and about 300,000 people die from it every year worldwide. Its morbidity and mortality vary widely from country to country. China is one of the regions with the highest incidence of esophageal cancer in the world, with an average of about 150,000 deaths each year. More men than women, the age of onset is more than 40 years old. The typical symptom of esophageal cancer is progressive dysphagia, first of which is difficult to swallow dry food, then semi-liquid food, and finally water and saliva cannot be swallowed.

Basic Information

nickname: Esophageal cancer
English name: esophageal carcinoma
Visiting department: Oncology

Multiple groups: 40 years and over
Common causes: May be caused by a variety of factors such as the environment and eating habits
Common symptoms: Pharyngeal food tingling sensation, pain behind the sternum, progressive dysphagia
Contagious: no

Causes of esophageal cancer

The population distribution of esophageal cancer is related to age, gender, occupation, race, region, living environment, eating habits, genetic susceptibility, etc. Existing survey data indicate that esophageal cancer may be a disease caused by many factors. Proposed causes are as follows:

Chemical cause

Nitrosamine. These compounds and their precursors are widely distributed, can be formed in vivo and in vitro, and are highly carcinogenic. In diets, drinking water, sauerkraut, and even patient saliva in high-incidence areas, the measured nitrite content was much lower than in high-incidence areas.

2. Biological causes

Fungus. A variety of fungi can be isolated in food in some high-incidence areas, in the upper digestive tract of patients with esophageal cancer, or in resected esophageal cancer specimens, and some of them have carcinogenic effects. Some fungi can promote the formation of nitrosamines and their precursors, and promote the occurrence of cancer.

3. Lack of certain trace elements

Molybdenum, iron, zinc, fluorine, and selenium are low in grain, vegetables, and drinking water.

4. lack of vitamins

Lack of vitamin A, vitamin B2, vitamin C, and insufficient intake of animal protein, fresh vegetables, and fruits are a common feature of high incidence areas of esophageal cancer.

5. Tobacco, alcohol, hot food, hot drinks, dirty mouth and other factors

Long-term drinking of hard alcohol, smoking habit, hard food, overheating, eating too fast, causing chronic irritation, inflammation, trauma or dirty mouth, dental caries, etc. may be related to the occurrence of esophageal cancer.

6. Genetic susceptibility to esophageal cancer.

Clinical manifestations of esophageal cancer

Early

Symptoms are often insignificant, but there may be varying degrees of discomfort when swallowing hard and hard foods, including food swallowing, sternal burning, acupuncture, or frictional pain. Food passes slowly with a sense of stagnation or foreign bodies. Infarct stagnation often disappears after swallowing water. Symptoms are mild and severe, and progress is slow.

Middle to late

The typical symptom of esophageal cancer is progressive dysphagia, first of which is difficult to swallow dry food, then semi-liquid food, and finally water and saliva cannot be swallowed. Mucus-like sputum is often spit, which is the saliva of the hypopharynx and the secretion of the esophagus. The patient gradually became thin, dehydrated, and weak. Persistent chest or back pain is indicated as advanced symptoms and cancer has invaded extraesophageal tissue. When the inflammation and edema caused by cancerous obstruction temporarily subsides, or some cancerous tumors fall off, the symptoms of obstruction can be temporarily reduced, and the condition is often mistaken for improvement. If the cancer invades the recurrent laryngeal nerve, hoarseness can occur; if the cervical sympathetic ganglion is compressed, Horner syndrome can be produced; if it invades the trachea or bronchus, it can form an esophagus, trachea or bronchial fistula, and severe cough when swallowing water or food , And respiratory infections occurred. Finally, a cachexia state appeared. If liver, brain and other organs are transferred, jaundice, peritoneal effusion, and coma may occur.

During physical examination, special attention should be paid to the presence of enlarged metastases on the clavicle, the presence of masses in the liver, and the presence of distant metastases such as peritoneal effusion and pleural effusion.

Esophageal cancer examination

For suspicious cases, double contrast X-ray imaging of barium swallowing in the esophagus should be performed. It can be seen early: the esophageal mucosa folds are disordered, rough or interrupted; small filling defects; localized tube wall stiffness, interrupted peristalsis; small diaphragm. In the middle and late stages, there are obvious irregular stenosis and filling defects, and the wall of the tube is stiff. Sometimes the esophagus on the upper side of the stenosis is dilated to varying degrees. B-ultrasound check for liver metastases. Laboratory tests for anemia and carcinoembryonic antigen testing. CT scan for brain and lung metastases.

Differential diagnosis of esophageal cancer

When there is no early dysphagia, it should be distinguished from esophagitis, esophageal diverticulum, and esophageal varices. If dysphagia is already present, it should be distinguished from benign tumors of the esophagus, achalasia of the cardia, and benign stenosis of the esophagus. Differential diagnosis methods mainly rely on barium swallowing X-ray esophageal radiography and fiber esophagoscopy.

Esophageal Cancer Treatment

Divided into surgical treatment, radiation treatment, chemotherapy and comprehensive treatment.

Surgical treatment

Surgery is the preferred method for treating esophageal cancer. If the whole body is in good condition, has good cardiopulmonary function reserve, and no obvious signs of distant metastasis, surgery can be considered. Generally, the length of cervical cancer is less than 3 cm, the length of upper breast cancer is less than 4 cm, and the length of lower breast cancer is less than 5 cm. However, there are also tumors that are not too large but have been closely adhered to the main organs, such as the aorta and trachea, and cannot be removed. For large squamous cell carcinoma, it is estimated that the possibility of resection is not high and the patient's general condition is good, you can use preoperative radiotherapy first, and then surgery after the tumor shrinks.

Contraindications for surgery: The general condition is poor, and cachexia has been shown. Or severe heart, lung or liver, kidney dysfunction. The scope of lesion invasion is large, and there are obvious signs of external invasion and perforation, such as hoarseness or esophageal and tracheal fistula. Already have a distant transfer.

2. Radiation therapy

Comprehensive radiation and surgery treatment can increase surgical resection rate and improve long-term survival rate. After preoperative radiotherapy, it is more appropriate to rest for 3 to 4 weeks before surgery. Metal markings are performed on the residual cancer tissue that is not completely removed during the operation, and postoperative radiotherapy is generally started 3 to 6 weeks after the operation. Radiation therapy alone is mostly used for cervical and upper thoracic esophageal cancer. Such patients often have difficult operations, many complications, and unsatisfactory curative effects. They can also be used for patients who have contraindications to surgery and the disease is not long, and the patient can still tolerate Radiotherapy.

3. Chemotherapy

The combination of chemotherapy and surgery or combined with radiotherapy and traditional Chinese medicine can sometimes improve the curative effect, or alleviate symptoms and prolong survival of patients with esophageal cancer. But regularly check blood and liver and kidney function, and pay attention to drug reactions.

Esophageal cancer prevention

China began research on esophageal cancer prevention and control in the late 1950s, and established prevention and control research sites in rural areas with high incidence. The general population of high-incidence areas should be educated and applied with esophageal cytology to conduct general surveys in order to seek early detection and early treatment and improve the cure rate.