(1) Dysphagia: Dysphagia is the main symptom and the most common complaint of advanced esophageal cancer. About 90% patients have this symptom, which is the most prominent symptom of esophageal cancer.
Esophagus is a muscular tubular organ with dilation function. Only when the tumor invades most of the local inner diameter or circumference of the esophagus will the patient have symptoms of esophageal obstruction, that is, dysphagia.
Because the esophageal wall has good elasticity and expansibility, when the cancer does not involve more than half of the esophagus, the symptoms of dysphagia are not significant. The degree of dysphagia is related to pathological types, and constrictive and medullary types are more serious than other types. About 10% cases have symptoms or initial symptoms that are difficult to swallow, accounting for about 20% ~ 40%, which leads to the delay in the diagnosis of esophageal cancer. Many patients will consciously change their original eating habits when they have difficulty swallowing. When eating meat or hard food, they chew it carefully and then swallow it. Sometimes, after drinking water or soup, they will swallow food smoothly. Some patients change to a liquid or semi-liquid diet. When patients see a doctor because of dysphagia, the symptoms often last for about 6 ~ 8 months, and some are longer.
Dysphagia is caused by mechanical obstruction of esophageal tumor, or by pathological changes and dysfunction of neuromuscular control of swallowing function.
The main clinical manifestation of more than 80% patients with esophageal cancer is dysphagia. Dysphagia is sometimes manifested as slight discomfort behind the sternum when eating, which is often transient and will not appear for weeks or months thereafter; Some patients have swallowing pain and even complete obstruction of esophageal cavity. The typical clinical symptom is progressive dysphagia, suggesting that the tumor blocks the esophageal cavity; This typical symptom will also appear when the tumor invades more than 2/3 of the circumference of the local esophageal wall and causes esophageal cavity stenosis, but there are exceptions. At first, dysphagia was intermittent, but it soon became persistent. At first, patients feel difficulty swallowing when eating solid food, then they feel difficulty swallowing when eating soft food, and finally they feel difficulty swallowing when eating liquid food. Patients with severe esophageal obstruction sometimes have difficulty drinking water.
(2) Pain: Some patients have swallowing pain, retrosternal or scapular pain when swallowing food. According to the tumor site, it is suggested that the invasion has caused esophagitis, mediastinitis or deep esophageal ulcer. Pain caused by lower thoracic tumor can occur under xiphoid process or upper abdomen. If there is persistent chest and back pain, it is mostly caused by tumor invasion and/or compression of pleura and spinal nerve.
Esophageal cancer itself and inflammation can reflexively increase the secretion of esophageal glands and salivary glands, and cause cough and pneumonia through esophageal peristalsis. Unlike the pain in the early stage of cancer, some are severe and lasting. The nature is dull pain, burning pain or tingling, which will get worse every time you eat or drink water. The pain site is often consistent with the lesion site, which mostly occurs in patients with ulcer type.
Persistent chest and back pain is mostly caused by tumor invading paraspinal fascia and aorta.
The tumor causes esophageal spasm above the obstruction site after esophageal obstruction, or the stimulation of cancerous ulcer formed by esophageal cancer. When food passes through the tumor site, it causes the expansion of local esophageal cavity and the contraction of esophageal wall muscle tissue. Most patients have chest pain or transient chest and back pain, and some patients complain of transient retrosternal pain, which can dissipate to the back or neck.
This kind of pain symptom has more clinical significance than persistent retrosternal discomfort or epigastric pain, and most of them reflect that cancer has invaded the esophageal wall to a considerable extent. Once the tumor invades the intercostal nerve and retroperitoneal nerve, the patient's chest and back pain is often persistent and intense, sometimes unbearable, affecting the patient's rest and sleep.
Cases with pain as the first symptom account for about 10% of the total number of patients with esophageal cancer. Careful analysis of the location and nature of pain, combined with the imaging examination data of esophageal cancer, is of great significance for diagnosis and prognosis.
(3) hoarseness: when the cancer tissue invades or oppresses the recurrent laryngeal nerve, vocal cord paralysis occurs, and the patient's voice is hoarse or even aphonia, which is more common in upper esophageal cancer involving the left recurrent laryngeal nerve, and sometimes swollen metastatic lymph nodes oppress the recurrent laryngeal nerve. Patients have hoarseness symptoms, often choking due to food intake, and sometimes cause aspiration pneumonia. Laryngoscopy showed that the vocal cords of the affected side were not abducent and located in the midline, suggesting vocal cord paralysis. Generally speaking, the affected vocal cords are the left vocal cords and occasionally the right vocal cords.
(4) Hiccup: It is often the manifestation that esophageal cancer itself and metastatic mediastinal lymph nodes invade (oppress) the phrenic nerve, leading to diaphragm paralysis and motor dysfunction.
(5) Vomiting: It often occurs when dysphagia is aggravated. At first, I choked and vomited, then I vomited when I ate, and in severe cases I vomited when I didn't eat. Vomiting is mostly something that can't be swallowed, mainly mucus and food trapped above esophageal stenosis.
(6) Respiratory symptoms: When aspiration and tumor directly invade trachea and bronchus, patients will have cough, dyspnea and pleurisy-like chest pain. When swallowing liquid, high esophageal cancer can cause cough and dyspnea because of esophageal lesions that make the liquid flow back to the trachea. In addition, due to the invasion of cancer tissue, if the tumor penetrates tracheobronchial, mediastinum or great vessels in mediastinum, patients will have tracheoesophageal fistula, acute mediastinitis and even fatal hemorrhage.
At the level of tracheal carina, the front edge of the left main bronchus is adjacent to the middle esophagus. If the middle esophageal cancer penetrates the left main bronchus, causing esophagotracheal fistula and aspiration pneumonia, characteristic choking may occur after swallowing. Severe cases may be complicated with pneumonia and lung abscess, and some patients have hemoptysis.
(7) Weight loss: Weight loss is the second common symptom of patients with esophageal cancer. According to the analysis of a large number of esophageal cancer cases (1000 cases or more), about 40% patients lose weight, which is mainly related to dysphagia, vomiting and pain, and also related to the consumption caused by the tumor itself. If the patient has obvious emaciation and systemic malnutrition, it means that the tumor has reached the advanced stage, which is also one of the clinical manifestations of cachexia.