In the 1950s and 1960s, there was a high incidence of esophageal cancer in Linzhou City, Henan Province, with a prevalence rate seven times higher than the national average, which attracted widespread attention. After more than 60 years of unremitting efforts, the incidence rate of esophageal cancer in Linzhou City has dropped by 50%, and the mortality rate has dropped by 60%, achieving a phased victory. So, what are the reasons for the high incidence of esophageal cancer? What methods can effectively combat esophageal cancer? Let's step into this battle against cancer together.
What is esophageal cancer?
Esophageal cancer is a malignant tumor that occurs in the epithelium of the esophageal mucosa. It is one of the more common gastrointestinal tumors. About 300000 people die of esophageal cancer every year in the world. Its incidence rate and mortality vary greatly among countries. China is one of the high-risk areas for esophageal cancer in the world, with an average of about 150000 deaths per year. There are more males than females, and the age of onset is mostly over 40 years old. The typical symptoms of esophageal cancer are progressive difficulty swallowing, starting with dry food that is difficult to swallow, followed by semi liquid food, and finally inability to swallow water and saliva.
The population distribution of esophageal cancer is related to factors such as age, gender, occupation, race, region, living environment, dietary habits, and genetic susceptibility. Economic survey data shows that esophageal cancer may be a disease caused by multiple factors. The proposed causes are as follows:
1. Chemical causes
Nitrosamines, which are widely distributed compounds and their precursors, can form in vivo and in vitro, and have strong carcinogenicity. The nitrite content measured in the diet, drinking water, pickled Chinese cabbage, and even the saliva of patients in high incidence areas is far higher than that in low incidence areas.
2. Biological etiology
Fungi. Multiple fungi can be isolated from grains in certain high-risk areas, upper gastrointestinal tract of esophageal cancer patients, or excised esophageal cancer specimens, some of which have carcinogenic effects. Some fungi can promote the formation of nitrosamines and their precursors, which further promotes the occurrence of cancer.
3. Lack of certain trace elements
Molybdenum, iron, zinc, fluoride, selenium, etc. have low levels in grains, vegetables, and drinking water.
4. Lack of vitamins
Lack of vitamin A, vitamin B2, vitamin C, as well as insufficient intake of animal protein, fresh vegetables, and fruits, is a common characteristic in high incidence areas of esophageal cancer.
5. Factors such as smoking, alcohol, hot food, hot drinks, and unclean mouth may be related to the occurrence of esophageal cancer, including long-term consumption of strong alcohol, smoking habits, hard and overheated food, and eating too quickly, which can cause chronic irritation, inflammation, trauma, or unclean mouth, dental caries, etc.
6. Genetic susceptibility factors for esophageal cancer.
The treatment of esophageal cancer
Like other malignant tumors, esophageal cancer emphasizes early diagnosis and treatment. During gastroscopy, if it is confirmed to be a precancerous lesion or early cancer, endoscopic dissection or local surgical resection can be used. If it is confirmed that the cancer cells have not infiltrated deeply into the esophageal wall, chemotherapy is not necessary; But when cancer cells infiltrate deeply into the esophageal wall, doctors will recommend surgical treatment and recommend radiation therapy or chemotherapy. Upper esophageal cancer is located near the throat, making surgery more difficult. Radiotherapy can be the main treatment, and the effect is similar to surgical resection. Surgical resection is the preferred treatment for middle and lower esophageal cancer, combined with chemotherapy, radiotherapy, and other symptomatic supportive treatments.
The tumor lesion is in the advanced stage and difficult to remove, but in order to alleviate symptoms such as food problems, tumor reduction surgery, diversion surgery, or fistula surgery can be performed. Early cancer resection can achieve curative effect, and patients with distant metastasis are generally not suitable for surgery and can only be treated with palliative care or chemotherapy. Thoracoscopic esophagectomy for esophageal cancer causes minimal damage to the chest wall, has minimal impact on cardiovascular and pulmonary function, results in delayed postoperative recovery, and has fewer complications. Clinical data shows that this surgery can achieve curative resection for early and mid stage cancer. The key to surgery lies in lymph node dissection, which is closely related to the surgeon's experience. Patients with advanced esophageal cancer who cannot eat, or have esophageal stenosis or esophageal fistula can undergo endoscopic stent implantation to alleviate esophageal obstruction.
In summary, it is recommended to adopt the principle of individualized comprehensive treatment for esophageal cancer in clinical practice, which involves the planned and rational application of existing treatment methods based on the patient's physical condition, tumor pathological type, invasion range, and development trend, in order to achieve maximum cure, tumor control, and improve the patient's quality of life.