Esophageal cancer in the elderly
Introduction
Introduction to esophageal cancer in the elderly Esophageal cancer (carcinomaofesophagus) is a malignant tumor mainly originating from esophageal squamous epithelium and columnar epithelium. Squamous cell carcinoma accounts for about 90%, and adenocarcinoma accounts for about 10%. The most typical clinical manifestation of esophageal cancer is progressive dysphagia. basic knowledge Sickness ratio: 0.1% Susceptible people: the elderly Mode of infection: non-infectious Complications: trachea, bronchoconstriction
Cause
Esophageal cancer in the elderly
Physical factors (25%):
Smoking and drinking, long-term smoking and heavy drinking, especially for hard alcohol, are much higher than those who do not smoke or drink.
Disease factors (20%):
Local damage to the esophagus, long-term treatment of esophagitis.
Dietary factors (15%):
Food contains nitrosamines that are too high and moldy.
Infection factor (10%):
Fungal action, it has been proved that feeding small animals with aflatoxin, A. oxysporum, Fusarium can cause cancer.
Body factor (5%):
Malnutrition and low trace elements.
Genetic factors (3%):
Other factors (5%):
If you eat too fast, eat hard food, eat hot food, congenital disease of the esophagus, long-term exposure to dust such as asbestos, sputum, lead and so on.
Pathogenesis
Pathological type
(1) Pathological types of early esophageal cancer: Patients with early esophageal cancer have no obvious symptoms of dysphagia. In the high-incidence area, early cases can be found by cytology and endoscopy. The macroscopic view of early esophageal cancer is mostly limited to the mucosal surface. No obvious lumps were found. Chinese scholars divided the early type of esophageal cancer into the following 4 types based on the pathology of surgically resected specimens combined with endoscopy and X-ray findings.
1 concealed type (or hyperemia type): mucosa redness at the cancerous stage (due to the intimal membrane papillary microvascular hyperplasia, hyperemia), no other obvious abnormalities, after the formaldehyde solution is fixed, the mucosal surface is slightly depressed and wrinkled, the range is below 1cm, histology Diagnosis of all intraepithelial neoplasia, the intrinsic membrane has more lymphocytes and plasma cells infiltration.
2 erosive type: the mucosa of the cancerous area is slightly erosive, the shape is irregular, the color of the erosion is deep, and it is fine granular. The microscopic examination shows that the cancerous epithelium is thin, the intrinsic membrane inflammation is more obvious, and the cancer tissue infiltration is mostly limited to the mucosal muscle layer.
3 plaque type: cancerous mucosa swelling and bulging, rough surface, showing the thickness of the granules and psoriasis-like appearance, esophageal folds are interrupted, the extent of lesions vary, individual cases of cancer invasion and the esophagus all circumference, half of the invasion Mucosal muscle layer and submucosa.
4 nipple type: the tumor has a prominent nodular bulge, papillary or scorpion-like.
The above types are common with plaque type and erosion type, and nipple type and conceal type are less common.
(2) Pathological types of advanced esophageal cancer: The clinical pathological classification of esophageal cancer has certain clinical and prognostic significance. According to clinical symptoms, X-ray angiography (or other imaging examinations), gross specimens and pathological findings are classified into 4 types. .
1 medullary type: patients often have obvious dysphagia, esophageal angiography is more common symmetry stenosis or eccentric stenosis, the esophageal lumen above the lesion.
Gross specimens can be seen in the esophageal wall, infiltrating and thickening of the wall, involving all or most of the esophageal circumference to cause stenosis, the upper and lower mucosal surfaces are sloping, and the mucosa in the middle of the lesion There are often ulcers, the tumor surface on the cut surface is grayish white, uniform, hard and solid mass, the contour of the muscle layer disappears or becomes thick due to tumor infiltration, and the cancer tissue has penetrated the muscular layer and reached the esophageal fibrous membrane.
Microscopic examination: The mucosa of the tumor site often has ulcers. The cancer tissue is sneak infiltrated in the submucosa and muscle layer, forming a very thick mass. The connective tissue in the interstitial is generally not much, or mild to moderate hyperplasia. Inflammatory cells infiltrate lighter, this type is more common, because there is often more obvious invasion, the rate of surgical resection is lower, the prognosis of surgical treatment is poor, radiotherapy, chemotherapy effect is moderate, and the recurrence rate is also high.
2 ulcer type: clinically, the patient's dysphagia is not serious, but the pain behind the sternum is often obvious. The main feature of esophageal angiography is irregular edge, deeper, larger ulcers, and usually only a small amount of esophagus The wall is damaged, the expectorant passes smoothly, and the tumor seen in the mucosal surface is a depressed and well-defined deep ulcer. It often reaches the muscular layer or penetrates most of the muscle layer. The tumor is thinner on the cut surface and the tissue at the bottom of the ulcer is thinner. There are not many tumor tissues around the ulcer.
Microscopic examination showed that the mucosal ulcer was mostly necrotic tumor tissue, and the hemorrhage and inflammatory cell infiltration were more obvious. The sneak infiltration at the edge of the tumor was not obvious, and there were more connective tissue and inflammatory cells in the interstitial.
This type of esophageal cancer is rare, and other types of esophageal cancer often have ulcers. It should be noted that ulcerated esophageal cancer is often more obvious but less restrictive, and the resection rate is moderate. This type has perforation risk and chemotherapy effect is better. However, special attention should be paid to radiotherapy, chemotherapy or selective arterial infusion chemotherapy.
3 umbrella type: patients with dysphagia and other symptoms are milder, the medical history is longer, angiography shows that the upper and lower edges of the lesion are curved, the edges are clear and sharp, the middle of the lesion has a shallow and wide shadow, and the tumor on the mucosal surface is often oval. Flat shape, peripheral protrusion or eversion, the boundary is clear, like a mushroom, so the name is umbrella, the middle part of the lesion has a shallow and wide shadow, the cut surface can be seen that the tumor edge is bulged into the cavity, but the tumor is thin, the esophageal wall is thickened. obvious.
Microscopic examination: tumors on the mucosal surface often have protrusions. The cancer cells are in a large sheet shape, arranged in a block shape, and the infiltration is often limited. There are few connective tissues in the interstitium, and sometimes there are more blood vessels on the mucosal surface of the tumor. Infiltration with inflammatory cells.
The umbrella type is also more common. Because the external invasion is not obvious and has a high surgical resection rate, the radiation sensitivity is high, and the radiotherapy or chemotherapy effect is satisfactory.
4 narrowed type: the patient's progressive dysphagia is more prominent, esophageal angiography can see a shorter but significant centripetal stenosis, the elixir passes difficult, and the esophagus above it expands significantly.
The tumor seen in the gross specimen infiltrated in the esophageal wall, forming a ring-shaped stenosis, generally about 3cm long, rarely more than 5cm, the tumor showed a concentric contraction, so that the upper and lower esophageal mucosa were radially shrunk, and the cancer tissue was visible on the cut surface. Harder, fibrosis is obvious.
Microscopic examination: for typical hard cancer, the cancer cells are arranged in a small and long cable. The multi-infiltrated esophageal muscle layer sometimes penetrates the whole layer. There is a large amount of fibrous tissue in the interstitial. The collagen fibers are often transparent and the inflammatory cells are not. many.
This type of esophageal cancer is rare, although the lesion is short, but the external invasion is often more serious, the possibility of resection is general, non-surgical treatment is difficult to make the symptoms significantly relieved.
The characteristics of the above-mentioned esophageal cancer classification are not obvious in some advanced cases, which makes it difficult to type. In addition, a small number of esophageal cancers have pedicled polyps protruding into the esophagus, so some scholars believe that this is another esophageal cancer. Type - endoluminal type.
According to the analysis of a large number of pathological materials by many authors in China, it is agreed that the medulla type is the most common in all types of esophageal cancer, accounting for 56.7% to 58.5%; the paralyzed umbrella is the second, accounting for 17% to 18.4%; the ulcer type is second, accounting for 11% to 13.2%; the narrowest type is the least, accounting for 8.5% to 9.5%, and the other types are 2.9% to 5%.
2. Organization type
According to the histological features of esophageal cancer, it can be divided into five types: squamous cell carcinoma, adenocarcinoma, adenoma, small cell undifferentiated carcinoma and carcinosarcoma. Among them, squamous cell carcinoma is the most common, accounting for about 90%. Adenocarcinoma (including adenoma) is second, accounting for about 7%, and other types are rare.
(1) squamous cell carcinoma: most of the esophageal squamous cell carcinoma is poorly differentiated, and there is little keratinization. Most invasive carcinomas have different degrees of keratinization, and are classified into grade 3 according to the degree of differentiation of cancer cells. Grade: Cancer cells often have obvious keratinization or cancer bead formation. The cancer cells are large in size, polygonal or round, with more cytoplasm and less morphicity. Nuclear division is rare. Grade II: keratinized beads are rare. The pleomorphism of cancer cells is obvious, and nuclear fission is more common. Grade III: Most of the cancer cells are fusiform, long elliptical or irregular, with smaller cancer cells, less cytoplasm, more common mitosis, and no keratinization. Or the formation of cancer beads, pleomorphism can be more obvious.
(2) adenocarcinoma: esophageal primary adenocarcinoma is relatively rare, domestic literature reports mostly in 3.8% to 8.8%, the diagnosis of lower esophageal adenocarcinoma, must exclude the possibility of gastric adenocarcinoma or gastric cardia adenocarcinoma to the esophagus, esophageal gland Two specific types of cancer are adenoid carcinoma and cystic adenoid cancer.
(3) Small cell undifferentiated carcinoma: similar to histological small cell carcinoma of the lung, domestic reports accounted for 0.18%, relatively rare, foreign reports accounted for 2.4%, and other small cell carcinoma, although often in cancerous Squamous cell carcinoma and adenocarcinoma components are also found in the middle, but most of the esophageal small cell carcinomas show differentiation into neuroendocrine tissues, suggesting that the primary tumors have the potential to differentiate in different directions.
(4) Carcinosarcoma: a tumor containing malignant transformation of both epithelial and mesenchymal tissues. Two major tumor components can be seen under the microscope. One of them is cancerous tissue, which is mostly distributed on the surface or base of the tumor and its vicinity. Most of the cancerous tissues are well-differentiated squamous cell carcinomas, and a few are undifferentiated carcinomas, basal cell carcinomas or cystic adenoid carcinomas. The sarcoma components are mostly shuttle-like cells, and often have abnormal tumor giant cells.
3. Diffusion and transfer
There are three ways to spread esophageal cancer:
(1) Direct diffusion: Direct diffusion occurs at most in the submucosa at the earliest, and its diffusion range can usually be more than 1cm from the main body of the cancer. It is not uncommon to exceed 5cm. Most of the submucosal diffusion is not obvious in the naked eye. Only microscopic examination can confirm Therefore, the scope of surgery or radiotherapy should include the esophageal tissue detected by the naked eye above 5cm above and below the cancer. Most of the advanced esophageal cancer has muscle involvement at the time of diagnosis, but its range is smaller than that of the submucosa.
Because the esophagus has no serosal layer, the cancerous tumor penetrates the muscular layer and easily passes through the loose esophageal adventitia to reach adjacent organs. According to the tumor, the most common invasion in the esophagus is still trachea, bronchus, lung, pleura. , pericardium, aortic adventitia, large vein, thyroid, recurrent laryngeal nerve, diaphragm and left lobe of the liver.
(2) lymphatic metastasis: lymph node metastasis can present a "jump" phenomenon, but generally occurs first in the submucosal lymphatics, through the muscle layer to reach the lymph nodes corresponding to the tumor site, the upper esophageal cancer can invade the esophageal, after the throat Cervical depth and supraclavicular lymph nodes, middle esophageal cancer, when the local esophageal lymph node metastasis, can further invade the cervical lymph nodes, involving the lymph nodes around the gastric cardia, or along the trachea, parabronchial lymph nodes to the lungs The door expands, and the lower segment of the cancer, in addition to invading the local lymph nodes, often invades the gastric cardia, the left gastric and abdominal lymph nodes.
(3) Blood-borne metastasis: Although the submucosal layer of esophageal cancer is rich in wall venous plexus, and there are large veins in the periphery of the esophagus and nearby, 1/3 of the patients died due to local complications of esophageal cancer, at autopsy At the time of autopsy of 1535 cases of esophageal cancer, 38% of the cases had neither lymphatic metastasis nor hematogenous metastasis. The common sites of hematogenous metastasis were: liver, lung and pleura, bone, kidney, omentum and peritoneum. Adrenal gland and so on.
Prevention
Elderly esophageal cancer prevention
Third-level prevention
At present, in many areas of China, a prevention and treatment base has been established in areas with high incidence of esophageal cancer, and primary prevention of the disease (prophylactic prevention) has been carried out. Specific measures include:
1 Anti-mildew: fast food and quick-drying, strengthen storage, eat fresh vegetables and fruits, and change bad traditional eating habits.
2 Deaminating: Treating drinking water with bleaching powder, the nitrite content in the water is reduced, and vitamin C is often taken to reduce the formation of nitrite in the stomach.
3 Molybdenum fertilizer: to avoid the accumulation of nitrous acid in vegetables.
4 to the esophageal epithelial cells moderate or severe hyperplasia to the crude riboflavin, and should correct the vitamin A deficiency, regular implementation of esophageal exfoliative cytology in high-risk groups, this is secondary tumor prevention (early investigation, early diagnosis, early The main measures in the treatment of esophageal cancer should also be taken seriously.
5 Active treatment of reflux esophagitis, esophageal-cardiac achalasia, Barrett's esophagus and other diseases associated with esophageal cancer, and the use of vitamin E, C, B2, folic acid and other treatment of esophageal epithelial hyperplasia to block the process of cancer.
2. Risk factors and interventions
The exact cause of the disease is not fully understood, but the long-term stimulation of certain physical and chemical factors and excessive carcinogens in food, especially nitrates, are important causes of esophageal cancer, while genetic mutations, genetic factors, and trace elements are also lacking. May be an important incentive.
(1) Genetic background: The incidence of esophageal cancer has obvious family aggregation, which is related to the susceptibility of the population and environmental conditions. In the high incidence area of esophageal cancer, the family of patients with esophageal cancer for 3 consecutive generations or more is not uncommon. The surveys of Shanxi, Shandong, Henan and other provinces in China found that there were about 1/4 to 1/2 patients with positive family history of esophageal cancer. The proportion of positive family history in the high-incidence area was the highest in the father, the mother was the second, and the collateral was the lowest. Immigrants from low-incidence areas in high-incidence areas have a relatively high incidence rate even after more than one hundred years. The living environment also affects the incidence of esophageal cancer. It has been found that esophageal cancer that has lived with the family for more than 20 years in the high-incidence area Patients accounted for 1/2. The influence of genetic and environmental factors on the pathogenesis of esophageal cancer may be a change at the molecular level. It has been found that in some high-incidence families of cancer, there are often tumor suppressor genes, such as point mutation or heterozygosity of P53. Loss of sex, in this group of people, if the acquired factor causes another allele mutation, it will cause abnormal expression of oncogene and form cancer. In recent years, it has been shown that patients with esophageal cancer do There are mutations in oncogenes and tumor suppressor genes.
(2) Esophageal injury, esophageal diseases and food stimulating effects: esophageal injury and certain esophageal diseases can promote esophageal cancer, corrosive esophageal burns and stenosis, esophageal achalasia, esophageal diverticulum or reflux esophagitis patients Among them, the incidence of esophageal cancer is higher than that of the general population, which may be associated with long-term inflammation of the esophageal mucosal epithelium, ulceration and acidity, and alkaline reflux to cause esophageal epithelial hyperplasia and carcinogenesis. Research data show that reflux esophagitis The patient's lower esophageal squamous epithelium can sometimes be replaced by columnar epithelium to form Barrett's esophagus. Barrett's esophagus has an average cancer risk of 1%/year, and its canceration rate is 30 to 125 times higher than that of the same age control group. Epidemiological investigation found that esophagus Some living habits of residents with high incidence of cancer are related to the incidence of esophageal cancer, such as the habit of drinking hot drinks or chewing irritating tobacco leaves.
(3) Nitrosamines and mycotoxins: It is known that nearly 30 kinds of nitrosamines can induce tumors in experimental animals. Domestically, benzylnitrosamine, sarcosine, nitrosamine, and methylammonium have been successfully used in China. Nitrosamine, diethylnitrosamine, etc. induced esophageal cancer in rats; at the same time, Chinese scholars also reduced esophageal cancer in high-incidence areas by reducing the content of nitrates in food and drinking water in high-risk areas of esophageal cancer in China. The incidence rate, the carcinogenic effect of mycotoxins has long been noticed. The results of research on esophageal cancer in Linxian County of China prove that the local residents like sauerkraut contain a lot of white fungi and high concentrations of nitrates, nitrites and secondary amines. Including nitrosamines, the amount of edible sauerkraut is positively correlated with the incidence of esophageal cancer, and esophageal epithelial cells adjacent to the fungal infection site may present with simple hyperplasia, mild-to-severe dysplasia, and even cancerous, adjacent to esophageal carcinoma in situ. Pure strains of Candida albicans can be isolated from the epithelium. These phenomena suggest a close relationship between fungal infection and esophageal cancer. In addition, studies have shown that the lack of cellulose A, C, E, etc. can strengthen nitrates. The carcinogenic effects of substances and the lack of trace elements have similar effects. The lack of elements such as molybdenum and selenium may be related to the pathogenesis of esophageal cancer.
3. Community intervention
The incidence of esophageal cancer is increasing. Community health stations should conduct regular census work for high-risk groups, especially the elderly, and do a good job in anti-cancer publicity work, and guide patients in the rehabilitation period.
Complication
Esophageal cancer complications in the elderly Complications, trachea, bronchoconstriction
The main complications are difficulty breathing, esophageal bronchospasm, and major bleeding.
Symptom
Esophageal cancer in the elderly Common symptoms Dysphagia, weight loss, abdominal discomfort, loss of water, dyspnea, edema, old age, thin eating, esophageal obstruction, hoarseness
Early symptoms
In the early stage of esophageal cancer, local lesions are relatively early, and their symptoms may be local lesions that cause esophageal motility or paralysis caused by esophagus, or local inflammation, tumor infiltration, esophageal mucosal erosion, superficial ulcers, and symptoms are generally mild. Short duration, often repeated, light and heavy, may have asymptomatic intermittent period, duration of up to 1 to 2 years, or even longer, the main symptoms are post-sternal discomfort, burning sensation or pain, when food passes There is a local sense of foreign body or friction. Sometimes swallowing food has a sense of stagnation or mild obstruction in a certain part. The lower part of the cancer can also cause discomfort under the xiphoid or upper abdomen, hiccups, and suffocation.
2. Late symptoms
(1) Dysphagia is a typical symptom of esophageal cancer: dysphagia is often intermittent at the beginning, can be aggravated by food blockage or local inflammation and edema, but also can be alleviated by tumor necrosis or inflammation, but the overall trend is persistent. Existence, progressive aggravation, if there is obvious dysphagia, the tumor often involves more than 2/3 of the esophageal circumference. The degree of dysphagia is related to the pathological type of esophageal cancer. The narrowed and medullary type of cancer is more serious. About 10% of patients have no obvious difficulty swallowing at the time of presentation.
(2) Infiltration and inflammation of reflux esophageal cancer reflexively cause increased secretion of mucus in esophageal glands and salivary glands. When tumor hyperplasia causes esophageal obstruction, mucus accumulates in the esophagus and causes reflux. Patients can express frequent mucus and spit. Mucus can be mixed with food, blood, etc., reflux can also cause cough, even aspiration pneumonia.
(3) Pain in the back of the sternum or between the back and shoulders often causes esophageal cancer to infiltrate, causing inflammation around the esophagus, mediastinal inflammation, pain can also be caused by deep esophageal ulcer caused by tumor; lower thoracic or cardia tumor The pain can be located in the upper abdomen.
(4) Other tumors invade large blood vessels, especially the thoracic aorta, causing fatal bleeding; tumor compression of the recurrent laryngeal nerve can cause hoarseness, invasion of the nerve can cause hiccups; compression of the trachea or bronchus can cause shortness of breath or dry cough; When the trachea or esophagus-bronchial spasm or tumor is located in the upper esophagus, it may often cause difficulty breathing or coughing when swallowing food.
3. Signs
Early signs are not obvious. In the advanced stage, due to difficulties in eating, the nutritional status is worsening. Patients may experience weight loss, anemia, malnutrition, water loss and cachexia. When the tumor has metastasis, a large amount of ascites may form.
4. Clinical staging program
At the National Esophageal Cancer Work Conference in 1976, the clinical pathological staging criteria based on the length range and metastasis of the lesions were adopted. The program divided them into early, middle, and late stages. Clinically, early stage esophageal cancer included phase 0 and In stage I, the symptoms are mild and intermittent; in the middle stage II, III, the symptoms of dysphagia are significant, progressively worse; late stage IV, severe symptoms, with cachexia or other complications, this staging plan is simple and clear It has been valuable for the selection of treatment methods and the estimation of prognosis. It has been widely used.
5. Comparison of TNM staging of international esophageal cancer and clinical cleanup staging in China
The TNM staging of esophageal cancer as listed in the 1987 International Union Against Cancer (UIC) "TNM Classification of Malignant Tumors" (Fourth Edition) is as follows:
(1) TNM classification of esophageal cancer:
T-primary tumor
Tx primary tumor cannot be determined
T0 has no primary tumor evidence
Tis carcinoma in situ
T1 tumor only invades the lamina propria or submucosa
T2 tumor invades the muscular layer
T3 tumor invasion of the esophageal membrane
T4 tumor invades adjacent organs
N-regional lymph nodes, cervical esophageal cancer: including the neck and supraclavicular lymph nodes; thoracic esophageal cancer: including the mediastinum and gastric lymph nodes, excluding the para-aortic lymph nodes.
NX regional lymph nodes cannot be determined
NO no regional lymph node metastasis
N1 has regional lymph node metastasis
M-distance metastasis, lymph node or organ metastasis outside the area of esophageal cancer
MX distant transfer cannot be determined
MO has no distant transfer
M1 has a distant transfer
(2) TNM staging is compared with the staging of esophageal cancer in China. According to the staging plan of TNM classification of esophageal cancer, the size of the tumor and the length of the lesion are irrelevant. The range of the primary tumor (T) is based on the invasion of the wall. Depending on the depth, the TNM staging system can more comprehensively reflect the stage and development of esophageal cancer. To perform this staging, careful pathological examination and surgical records are required.
Comparing the international TNM (1987) staging criteria with the clinical pathological staging in China, the 0 and I phases are the same, but the II, III, and IV phases in China have early premature phenomena. In order to adapt to the increasing international exchanges, the science of strengthening the clinical work of esophageal cancer is strengthened. Sexuality and predictability, the use of TNM system in China's esophageal cancer is imperative, and it is constantly summarized in the actual work to improve the accuracy and practicability of the staging criteria.
Examine
Elderly esophageal cancer examination
Exfoliative cytology: esophageal exfoliative cytology is simple and safe, patient compliance is good, and the accuracy rate is over 90%. It is an important means of esophageal cancer screening, but it is poor in general condition, or has high blood pressure and heart disease. Patients with advanced pregnancy; those with bleeding tendency should be used with caution or not.
X-ray inspection
(1) esophageal barium meal examination: examination can observe the peristalsis of the esophagus, wall diastolicity, esophageal mucosal changes, esophageal filling defects and obstruction, esophageal peristalsis or reverse peristalsis, local stiffness of the esophageal wall can not be fully expanded, esophageal mucosa Disorders, interruptions and destruction, esophageal stenosis, irregular filling defects, ulcer or fistula formation and esophageal axial abnormalities are all important signs of esophageal cancer. Low-end double contrast imaging is more effective than conventional angiography in detecting early esophageal cancer. .
(2) CT examination of esophagus: CT examination can clearly show the relationship between esophagus and adjacent mediastinal organs. The boundary between normal esophagus and adjacent organs is clear. The thickness of esophagus does not exceed 5mm. If the thickness of esophageal wall increases, the boundary with surrounding organs is blurred. Esophageal lesions exist, CT examination can also fully display the size of esophageal cancer lesions, the extent and extent of tumor invasion, and the results of CT examination can also help determine the surgical approach, develop radiotherapy plans, etc. In 1981, Moss proposed CT staging of esophageal cancer. Stage I: The tumor is confined to the esophageal lumen, the esophageal wall thickness is 5mm; Phase II: esophageal wall>5mm; Stage III: thickening of the esophageal wall, and the tumor extends to adjacent organs, such as trachea, bronchi, main Arterial or atrial; Stage IV: Tumors have distant metastases, but esophageal CT has limited value in the discovery of early esophageal cancer.
2. Endoscopy
Observing the tumor size, shape, location range and living tissue and cytology examination under direct vision is the most reliable method for the diagnosis of esophageal cancer. The morphology of early esophageal cancer under endoscopy: 1 lesion mucosal congestion, micro-lift, The color is deeper than the normal mucosa, and the boundary with the normal mucosa is unclear, and it is easy to bleed, but the wall is diastolic; 2 the mucosa of the lesion is erosive, the normal mucous membrane is lost, there is a small ulcer, and the surface is yellow or white with a white coating. Bleeding, but the wall diastolicity is good; 3 lesions have white spot-like changes in the mucosa, micro-bumping, mucous membrane color around the white spot is deep, mucous membrane is interrupted, the esophageal wall is hard, it is not easy to hemorrhage, endoscopic advanced esophageal cancer diameter Generally it is more than 3cm, and its morphology has its own characteristics according to different types.
Diagnosis
Diagnosis and diagnosis of esophageal cancer in the elderly
When the elderly have sternal discomfort, difficulty swallowing or sensation, the first thing to consider is to check the esophagus. The usual method is X-ray barium meal examination; convenient, less painful, economic, high diagnostic rate, esophagoscopy, Intuitive, high accuracy of live examination, as well as examination of esophageal exfoliated cells, advanced equipment examinations such as CT scan of esophageal cancer, have improved the detection rate of early esophageal cancer.
Esophageal cancer should be differentiated from achalasia, esophagitis, benign esophageal tumors, and other tumors in the chest that compress the esophagus.
Differential diagnosis
Differential diagnosis of this disease should be identified with the following diseases
Esophageal - achalasia
Dysphagia is also one of the obvious symptoms of this disease, but it will not aggravate after reaching a certain level. Emotional fluctuations can induce the onset of symptoms. When the esophageal barium meal is examined, the lower end of the esophagus can be seen as a smooth funnel-like or "birdbill"-like stenosis. Esophageal manometry is of great value in the diagnosis of this disease.
2. Benign stricture of the esophagus
Can be caused by accidental swallowing agents, esophageal burns, foreign body damage, scars caused by chronic ulcers, esophagus and vinorelbine (isovinblastine) should be effective chemotherapy drugs for the treatment of esophageal cancer, but only paclitaxel monotherapy clinical trials include Appropriate cases of esophageal adenocarcinoma, these drugs only show moderate anti-tumor activity in the treatment of esophageal cancer, few have complete remission, and the remission period is shorter.
Barium meal examination showed esophageal stenosis, mucosal disappearance, tube wall stiffness, stenosis and normal esophageal segment gradually transition, endoscopic and direct biopsy biopsy pathological examination can confirm the diagnosis.
3. Esophageal benign tumor
Mainly for the rare leiomyomas, dysphagia is mild, slow progress, long course of disease, esophageal barium meal, endoscopy and endoscopic ultrasonography are helpful for diagnosis.
4. Esophageal organ disease
Such as mediastinal tumor, aortic aneurysm, goiter, heart enlargement, etc. can cause different degrees of esophageal stenosis, esophageal barium meal and other tests to help identify.
5. Hemorrhoids
Also known as "Mei nuclear gas", more common in young women, when there is a foreign body sensation in the pharynx, but there is no obstacle to eating, its incidence is often related to mental factors. Recently, with the promotion of esophageal manometry, it has been found that nearly half The patient with this disease has an upper esophageal sphincter disorder, which is not a neurosis as previously thought. Therefore, patients with this disease should have esophageal barium meal and endoscopy to exclude the esophageal organic disease. Esophageal manometry should also be performed.
