Esophageal cancer is a malignant tumor that occurs in the esophageal mucosa epithelium. Ranked as the eighth cancer in the world, approximately 460,000 people die from esophageal cancer every year. my country is one of the areas with high incidence of esophageal cancer, with an average of about 270,000 deaths every year, accounting for more than half of the world's total. Both new cases and deaths rank first in the world.

Anatomical features of the esophagus

1 Epidemiology 1-1 There are high-incidence areas. The difference can be 100 to 200 times in different regions and countries. The average incidence rate in Europe, America, and Oceania is very low. my country is a high-incidence area, especially in the Taihang Mountains, Sichuan Basin, northwest Sichuan, Inner Mongolia, etc., with the highest incidence rate in Handan, Hebei. Heci County, Henan Lin County and Hebi City. Among them, Lin County in Henan Province ranks the highest in the country: the incidence rate is 478.87/100,000. 1-2 Men outnumber women 2:1 1-3 Increases with age, mostly after the age of 50 1-4 There are genetic factors, and multiple people in the same family may be affected.

2 Etiology 2-1 Nitrosamine compounds Symmetric nitrosamines cause liver tumors, and asymmetric nitrosamines cause esophageal cancer and pharyngeal cancer. 2-2 Aflatoxins are mainly found in fermented and moldy foods 2-3 Nutrition and trace elements Molybdenum, copper, iron, zinc, and nickel are all low in the human external environment in high-incidence areas. 2-4 Local damage caused by tobacco, alcohol and esophagus can be increased by 3-8 times by smoking and 7-50 times by drinking alcohol, especially low-quality high-quality liquor. 2-5 Genetic factors such as esophageal cancer oncogenes 2-6 Chronic inflammation of the esophagus, long-term hot food, high alcohol stimulation

special risk factors

Superficial esophageal cancer 1 Insidious type, the mucosa is congested or rough, indicating carcinoma in situ 2 Erosive type is later than the previous type 3. Plaque type: the mucous membrane is raised and uneven, resembling psoriasis 4 Papillary type: The cancer cells are well differentiated and are the latest type of early cancer.

Intermediate and advanced esophageal cancer 1 Medullary type: Most of the type is gray-white in cross-section, like the brain marrow, growing outside the cavity, and the resection rate is low. 2. Fungi type grows into the cavity and has a high resection rate 3. Ulcer type obstruction occurs late and is difficult to detect and often affects the entire circumference. 4 Coarctation type detected early 5 Intracavitary type has the highest resection rate and good effect

Early symptoms 1 Burning and pins-like pain behind the sternum when swallowing food 2 Food passes slowly or feels stagnant 3 Mild choking feeling These are not specific. Sometimes chronic esophagitis and eating hard or hot food can also cause the same symptoms.

Middle and late symptoms 1 Difficulty swallowing 2 obstruction 3 pain 4 bleeding 5 hoarse voice 6 End-stage symptoms: Respiratory symptoms, such as tracheal compression or tracheal fistula; neurological symptoms, such as invasion of recurrent laryngeal nerve and phrenic nerve; cancer metastasis, most commonly supraclavicular or ascites and liver metastasis, cachexia will occur at the latest

According to the American Joint Cancer Committee (AJCC), the eighth edition of the International Union Against Cancer (UICC) T: primary tumor N: Regional lymph nodes N1 (metastasis of 1-2 regional lymph nodes), N2 (metastasis of 3-6 regional lymph nodes), N3 (metastasis of more than seven lymph nodes) M: distant transfer

T stage

N stage

M stage

① Direct infiltration

②Lymphatic metastasis

③ Blood supply transfer

1 X-ray barium meal

2 Exfoliative cytology examination

3 fiber optic endoscope

4 CT scan

5 Esophageal endoscopic ultrasonography

* B-ultrasound examination of abdomen

1. External pressure changes in the esophagus: such as the thyroid gland in the chest, etc. 2 Abnormal esophageal function: such as achalasia, etc. 3 Benign esophageal stricture: such as chemical burns of the esophagus, etc. 4 Benign esophageal lesions: such as esophageal leiomyoma, Esophageal varices 5 Other rare diseases: such as esophageal tuberculosis, etc.

When the diagnosis is confirmed and the cancer staging examination is completed, the patient's health status, the stage of the cancer, and the type of cancer must be considered when selecting a treatment plan. Surgery, Chemotherapy, Radiation, Combination of these techniques.

Esophageal cancer surgical goals 1 Remove the cancerous area 2 Peripheral lymph node dissection 3 Rebuilding esophageal function

Principles of surgical procedure selection 1. The area where the cancerous lesion is located has different diameters in the upper, middle and lower segments. 2. The relationship between the cancer lesion area and the surrounding tissue. For example, if the middle esophageal cancer is closely related to the descending aorta, three incisions should be made. 3. Availability of expected replacement organs: the stomach is the best, but if there are gastric lesions or the stomach has been operated on before, other replacement organs such as jejunum, colon, etc. should be selected. 4. Have you ever received preoperative chemoradiotherapy? 5. Surgeon’s preference

Surgical treatment (1) Select the appropriate case: According to the general condition, Cancer location, tumor length, etc. (2) Surgical approach: left chest, thoracoabdominal joint, cervical Chest and abdomen, neck and abdomen, etc. (3) Materials for esophageal reconstruction: stomach, colon, empty Intestines etc. (4) Transplantation routes for esophageal replacement: esophageal bed, intrathoracic, Retrosternal tunnel and prethoracic subcutaneous tunnel, etc.

Surgical treatment (1) Surgical complications a. Pulmonary complications b. Anastomotic complications: anastomotic leakage and stenosis c. Chylothorax d. Others such as arrhythmia, diaphragmatic hernia, gastric torsion, simple empyema, etc. (2) Factors affecting the long-term effect of surgical treatment of esophageal cancer: TNM staging, lymph node metastasis, esophageal cancer Invasion extent and residual cancer at resection margin

1 Surgical treatment 2 Radiotherapy 3 Chemotherapy 4 Comprehensive treatment Latest developments: Gastroscopy and thoracoscopic treatment of esophageal cancer Thoracoscopic treatment: total thoracoscopy or thoracoscopy plus laparotomy

1 Etiological prevention 2 Regular physical examinations for high-risk groups 3. Medical staff should be familiar with early symptoms, signs, etc. and conduct appropriate auxiliary examinations.