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Introduction
Introduction The mid-term symptoms of esophageal cancer are most common in the sense of inferior phlegm. Esophageal cancer is a common malignant tumor in humans, accounting for 2% of all malignant tumors, accounting for more than 90% of esophageal tumors. It ranks second only to gastric cancer in retrospective investigation of all malignant tumor deaths. It is estimated that about 200,000 people die of esophageal cancer every year in the world. China is a high-risk area for esophageal cancer and one of the most common malignant tumors that are extremely harmful to people's lives and health. The age of onset is more than 40 years old, more men than women. However, in recent years, the number of people under the age of 40 has a growing trend. The occurrence of esophageal cancer is related to chronic nitrosamine stimulation, inflammation and trauma, genetic factors, and trace element content in drinking water, food and vegetables.
Cause
Cause
There are many factors in the development of esophageal cancer. The occurrence of esophageal cancer is a gradual process. There must be a major factor and several secondary factors in the process of canceration. These factors play a synergistic role in carcinogenesis, and have a large number of domestic and international The survey considers that there are two main factors:
First, due to changes in diet structure and living habits, a large number of acidic foods are eaten, and the body is acidified. Cancer cells do not die like normal cells due to environmental acidification. In fact, cancer cells are normal cells in order to grow in an acidic environment, taking active mutations. And continue to grow.
The other is an external factor: 1 chemical factor. 2 germ pollution related. 3 mental factors are also an important cause of this disease.
Among the two factors, internal factors play a decisive role, and acidification of the body provides a good space for the survival of cancer cells.
Examine
an examination
Related inspection
Esophageal contrast chest radiograph
Symptoms and signs:
Early signs of early signs are absent. In the advanced stage, snoring and dysphagia may occur, and due to difficulty in eating, the patient may suffer from malnutrition and signs of weight loss, anemia, loss of water or cachexia.
When the cancer metastasizes, it can reach a swollen and hard superficial lymph node, or a swollen and nodular liver. There may also be jaundice, ascites, and the like. Other rare signs are skin, nodules at the abdominal line, and inguinal lymph nodes.
Diagnosis
Differential diagnosis
Differential diagnosis of sputum:
Esophageal varices
Patients often have other signs of portal hypertension. X-ray examination showed thickening of the mucosal folds in the lower esophagus, distortion, or a bead-like filling defect. Severe varicose veins under the fluoroscopy showed that the esophageal peristalsis was weakened and the expectorant passed slowly. However, the wall of the tube is still soft, and the elasticity is also present. There is no local stenosis or obstruction, and esophagoscopy can be further identified.
2.
Also known as achalasia, due to vagus nerve and esophageal plexus degenerative lesions, or excessive sensitivity to gastrin, causing esophageal peristalsis and esophageal sphincter achalasia, so that food can not pass through the cardia, the general course of disease is longer The patient is more common in young women. The symptoms are light and heavy, and the difficulty of swallowing is mostly intermittent. It is often accompanied by post-sternal pain and reflux. The use of antispasmodic drugs can often relieve symptoms. Bloody mucus. Generally there is no progressive weight loss (but in the late stage of achalasia, when the obstruction is severe, the patient may have weight loss). X-ray examination of the lower end of the esophagus was smooth beak-like or funnel-shaped stenosis, smooth edges, inhalation of isoamyl nitrite and the cardia gradually dilated, allowing the tincture to pass smoothly. Endoscopic biopsy without evidence of cancer can be identified.
3. Esophageal tube
Less common, generally secondary, such as proliferative lesions or the formation of tuberculomas, can lead to varying degrees of obstruction, difficulty swallowing or pain. The progress of the disease is slow, and there are more young and middle-aged patients, and the average age of onset is less than that of esophageal cancer. There is often a history of tuberculosis, OT test is positive, there are symptoms of tuberculosis, endoscopic biopsy helps identify. There are three manifestations of esophageal angiography:
1 filling and defect in the esophagus and ulcer, the lumen of the lesion is slightly narrow, the wall of the tube is slightly stiff, the shadow is large and obvious, the edge of the shadow is not complete, and the surrounding filling defect is not obvious.
2 The side wall of the esophagus is filled with defects, and the mass formed by the mediastinal lymph node tuberculosis around the esophagus oppresses the esophageal cavity and invades the esophageal wall. 3 esophageal fistula formation. It is characterized by a small protruding shadow of the esophageal wall, like a small shadow, with no filling defects around it. For mediastinal lymph node tuberculosis, complicated with lymph node esophageal fistula. Finally, the diagnosis is determined by esophageal cytology or esophagoscopy.
4. Esophagitis
Esophageal hiatus hernia complicated with reflux esophagitis, similar to early stinging or burning pain of esophageal cancer, X-ray examination of mucosal texture rough, mild stenosis of the lower esophageal lumen, retention of expectorant, some cases can see mucosal shadow . For cases that are not easily confirmed, esophageal cytology or esophagoscopy should be performed.
Iron deficiency pseudo esophagitis
The disease is more common in women, in addition to difficulty in swallowing, there are small cell hypochromic anemia, glossitis, gastric acid deficiency and anti-A. After iron treatment, the symptoms improved quickly.
5. Esophageal diverticula
It can occur in any part of the esophagus. The more common is the traction diverticulum. It is mostly asymptomatic at the beginning. It can show different levels of dysphagia and reflux afterwards. It can smell "squeaky" when drinking water, chest tightness or burning pain behind the sternum. Symptoms such as heartburn or foreign body sensation after eating. Due to the long-term accumulation of food in the sputum room, there may be obvious bad breath. Sometimes, due to changes in body position or nighttime sleep, diverticulum fluid may cause aspiration and cough. X-ray multi-axis fluoroscopy or pneumatic double contrast check can show the diverticulum.
6. Benign stricture of the esophagus
There were many history of acid and alkali chemical burns. X-ray showed esophageal stricture, mucosal wrinkles disappeared, the wall was stiff, and the stenosis gradually transitioned to the normal esophageal segment. Clinically, be wary of the possibility of cancer on the basis of long-term inflammation.
7. Esophageal benign tumor
The general course of disease is long, the progress is slow, and the symptoms are mild. Most of them are esophageal leiomyoma. In typical cases, the symptoms of dysphagia are mild and the progress is slow. X-ray and esophagoscopy show a swelling of the surface mucosa. The round or "ginger" wall is in the filling defect, and the surface mucosa is flattened. "Smear", but no ulcers. The local lumen is dilated normally, and the endoscope can see a circular mass that rises under the normal mucosa, and the phenomenon of "sliding" under the mucosa can be seen in the peristalsis of the esophagus. Sometimes it is not easy to distinguish from a small amount of esophageal cancer that grows on a side wall and mainly spreads under the mucosa, but the latter does not see "sliding" under endoscopy.
8. Esophageal musculocutaneous tumor
Generally seen in two forms, one is polyp type and the other is infiltrated. Polypoid type can be seen in the esophageal cavity nodular or polypoid mass, the tumor perimeter is clear, uplift, valgus. There is an ulcer in the center, the ulcer surface is uneven, and the mass protrudes out of the cavity. X-ray showed that the polyp type was obviously dilated in the esophageal lumen. When there was a huge mass in the cavity, there were many polypoid filling defects of different sizes. There were shadows in the mucosal destruction, the turbulence was not smooth, and the lumen was displaced. Common soft tissue masses outside the lumen, much like mediastinal tumors, but can be seen in esophageal angiography and the esophageal wall is clearly diagnosed. Infiltrating X-ray findings are similar to esophageal cancer.
9. Changes in esophageal pressure
It refers to oppression and dysphagia caused by abnormalities in the organs adjacent to the esophagus. Some diseases such as lung cancer mediastinal lymph node metastasis, mediastinal tumor, mediastinal lymph node inflammation, etc. can cause partial or severe stenosis of the esophagus, resulting in severe dysphagia symptoms, sometimes misdiagnosed as esophageal cancer. Esophageal barium meal imaging can often rule out the disease of the esophagus itself.
10.
The disease is a functional disease, the incidence is related to mental factors, more common in young women. Patients often have a pharyngeal foreign body sensation that can disappear when eating, often induced by mental factors. There is no organic esophageal lesion in this disease, and endoscopy can be differentiated from esophageal cancer.
11. Iron deficiency pseudomembranous esophagitis
Mostly women, in addition to difficulty in swallowing, there may be small cell hypochromic anemia, glossitis, gastric acid deficiency and anti-A performance.
12. Esophageal organ disease
Such as mediastinal tumor, aortic aneurysm, goiter, heart enlargement and so on. In addition to the mediastinal tumor invading the esophagus, X-ray barium meal examination showed a smooth compression of the esophagus and normal mucosal lines.
