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Esophageal cancer
The main metastatic pathways of esophageal cancer
The main metastatic pathways of esophageal cancer include firstly, hematogenous spread, which can transfer to distant organs such as bones and the lungs or liver via the bloodstream. The second pathway is via the lymphatic system, which can lead to the metastasis of regional lymph nodes and other non-regional lymph nodes. For example, cervical esophageal cancer tends to metastasize to the supraclavicular and adjacent esophageal lymph nodes; in thoracic esophageal cancer, metastases may occur in the subcarinal, upper periesophageal, and lower periesophageal lymph nodes; metastasis can also be achieved through local spread and invasion of the tumor.
The difference between esophagitis and esophageal cancer.
Esophagitis and esophageal cancer have essential differences. Esophagitis is merely an inflammatory disease, which is relatively common in clinical settings and often related to excessive stomach acid, acid reflux, or other physical and chemical irritants. Esophageal cancer, on the other hand, is a malignant tumor. The mechanisms of their development, as well as the differences in prognosis and treatment plans, are very significant.
Esophageal cancer metastasis pathways
"In terms of the metastatic pathways of esophageal cancer, the first one is through the bloodstream, known as hematogenous spread. This primarily results in metastases to distant organs such as the lungs, liver, bones, etc. The second pathway is via the lymphatic system. Lymphatic spread leads to metastases in regional lymph nodes and distant lymph nodes. The third pathway is through local invasion by the tumor, where the esophageal cancer can invade nearby organs and spread. These are the pathways through which metastasis occurs."
What are the precancerous lesions of esophageal cancer?
The most common precancerous lesion of esophageal cancer is Barret's esophagus, which is formed by the chronic stimulation of the esophageal epithelium by chronic reflux esophagitis. Of course, this includes some chronic esophageal ulcers and long-term leukoplakia of the esophagus. These recurrent esophageal ulcers could potentially transform into atypical hyperplasia and then further into carcinoma in situ. However, the progression from precancerous lesions to actual cancer can take a very long time, possibly many years or even over a decade. Therefore, having a precancerous lesion does not necessarily lead to esophageal cancer.
How can esophageal cancer be diagnosed?
The diagnosis of esophageal cancer is primarily based on symptoms. In the early stages, symptoms are generally nonspecific or only mild and typically do not attract the patient's attention. In the mid to late stages, the most common symptom is progressive difficulty swallowing. Additional diagnostic methods include esophageal radiography, MRI, and CT scans. Moreover, cytological diagnosis, endoscopic ultrasound of the esophagus, direct endoscopic examination and pathological sampling under endoscopy are utilized. The gold standard for confirmation still requires pathological or cytological diagnosis.
What should I do about esophageal cancer?
Currently, effective treatments for esophageal cancer include surgical treatment, radiation therapy, and chemotherapy. Integrated treatment with surgery as the main approach is the primary method for treating esophageal cancer. This may include preoperative radiotherapy followed by surgery, preoperative chemoradiotherapy followed by surgery, preoperative chemotherapy followed by surgery, or direct surgery followed by adjuvant chemoradiotherapy. These are all major treatment methods for esophageal cancer. However, the choice of a personalized integrated treatment should be based on factors such as the stage of the disease, the location of the lesion, age, and physical condition.
Esophageal cancer screening methods
The screening methods for esophageal cancer primarily involve checks of the esophagus, including upper gastrointestinal barium meal and gastroscopy. Gastroscopy, in particular, is a relatively accurate method for examining patients. This is because during a gastroscopy, biopsy samples can be taken, and pathology can definitively determine whether cancer is present. There might be issues regarding whether a patient can undergo a gastroscopy as it requires significant patient tolerance. Therefore, depending on the patient's health condition, if a gastroscopy is not feasible, an upper gastrointestinal barium meal can be conducted first.
Will esophageal cancer recur after resection?
This depends on the actual situation and the specific postoperative pathology of the patient. Generally, a comprehensive examination is conducted before esophageal cancer surgery, and surgery is only performed if there is no metastasis and the patient's physical condition permits it. Therefore, postoperatively, if it is very early-stage esophageal cancer, the likelihood of recurrence is generally small. However, if it involves mid-to-late stages, the possibility of recurrence must be considered. However, essentially, all cases of esophageal cancer are prone to recurrence after resection.
What are the symptoms of esophageal cancer?
The symptoms of esophageal cancer generally include progressive difficulty in swallowing, because the esophagus itself is a tubular cavity, similar to a water pipe. Esophageal cancer typically forms a tumor within this tubular cavity, creating an obstruction. Consequently, the most common symptoms include difficulty swallowing and a sensation of blockage during eating, since food must pass through the esophagus. Other symptoms can include nausea, vomiting, acid reflux, heartburn, and pain below the breastbone. Moreover, the difficulty in swallowing generally worsens progressively, as the tumor grows from small to large, increasingly narrowing the esophagus and exacerbating the swallowing difficulties.
What are the early signs of esophageal cancer?
The early symptoms of esophageal cancer are often nonspecific and intermittent, thus many patients do not take them seriously and delay the condition. Clinically, common early symptoms of esophageal cancer include a choking sensation when swallowing food, which is more noticeable in patients who swallow dry food or other foods that are not well chewed in large bites. Additionally, there is discomfort or a feeling of fullness behind the sternum. Thirdly, there is a sensation of a foreign body in the esophagus, with about 20% of patients experiencing this sensation when swallowing, as well as dryness and a feeling of tightness in the throat. Furthermore, there is a slow passage and a sense of retention of food.