Symptoms of esophageal cancer

1. Early symptoms

(1) Sense of choking on swallowing food: Early symptoms are atypical, and there are often symptoms of increased salivation and discomfort in swallowing, which usually can be eaten in ordinary food without affecting health, sometimes there is a sense of stagnation when swallowing food. Symptoms are often associated with the patient's mood swings.

(2) Retrosternal pain or stuffy discomfort: about half of the patients complained of slight pain or stuffy discomfort in the retrosplenial region when swallowing food, and the pain was obvious when swallowing rough and hard food, hot food, or stimulating food, and the pain was light when eating liquid and warm food, and the pain was reduced or disappeared when swallowing food, and the pain was heavier and persistent, and the patients' self-awareness of the pain site was inconsistent with the esophageal lesions. The patient's conscious pain is not consistent with the lesion in the esophagus.

(3) Foreign body sensation in the esophagus: The patient feels that there are similar grains of rice or pieces of vegetables attached to the wall of the esophagus, which cannot be swallowed or spit out, and it has nothing to do with eating, and there is a sense of foreign body sensation even if the patient doesn't do any swallowing, and the location of the sensation of foreign body sensation is the same as the location of the esophageal lesion.

(4) Dryness of the throat: 1/3 of the patients complained of dryness and tightness of the throat, with unfavorable or slight pain in swallowing food, which was especially obvious in dry or rough food.

(5) A feeling of slow passage and retention of food, and the same feeling with drinking water. In addition, some patients have symptoms such as back heaviness and belching. More than half of the patients have more than one year from the appearance of symptoms to the diagnosis, and some of them have as long as four years, which is of great clinical significance for early diagnosis and treatment of early esophageal cancer.

2. Symptoms in middle and late stages

(1) Dysphagia: Progressive dysphagia is the most typical symptom of middle and late esophageal cancer, which starts from solid food not being able to be swallowed smoothly, or being swallowed after being rinsed with soup and water, and then semi-liquid diet is also blocked, and finally fluid diet is also difficult to be swallowed. The degree of dysphagia is closely related to the type of pathology, with the constrictive and medullary types being more severe.

(2) Pain: Chest pain or back pain is one of the common symptoms of middle and late stage esophageal cancer. The pain is dull, hidden, burning or stabbing, and may be accompanied by a feeling of heaviness, and the chest and back pain is often caused by peri-esophageal inflammation, mediastinitis caused by cancer tumor invasion, and even involves the neighboring organs, nerves and paravertebral tissues. Ulcerated type and medullary type with ulcers are more common.

(3) Spitting mucus: esophageal lesions caused by esophageal changes in the esophagus caused by incomplete or complete obstruction of the esophagus, so that the secretion drainage is not smooth, accumulated in the upper part of the esophageal stenosis, stimulating esophageal retrograde peristalsis and then spit out.

(4) Neck and supraclavicular mass: it is a common sign of advanced esophageal cancer. The mass is painless, increasing progressively and hard, mostly on the left side but also on both sides.

(5) Hoarseness: when the tumor directly invades or the metastatic foci compress the recurrent laryngeal nerve, there will be paralysis of vocal cord, resulting in hoarseness, and a part of the patients can be improved due to the effective treatment of hoarseness.

(6) Hemorrhage: necrosis, ulceration or invasion of cancerous tissues into large blood vessels can cause vomiting of blood or black stool, and when the tumor invades into the aorta, it can cause hemorrhage and death.

(7) Dry cough: shortness of breath and dry cough can occur if the trachea is compressed, and choking on food can occur if esophageal fistula is formed.

3. End-stage symptoms

(1) widespread systemic metastases appear corresponding symptoms and signs, jaundice, ascites, liver function abnormalities, respiratory difficulties, cough, headache, coma and so on.

(2) Tumor invasion of esophageal epithelium caused esophageal perforation, esophageal-tracheal fistula, esophageal-mediastinal fistula.

(3) Obstruction of the esophagus by the tumor causes complete obstruction, dehydration, electrolyte disorders, cachexia, and systemic failure.

Signs of esophageal cancer

Esophageal cancer in early stage may have no obvious signs. In the middle stage, there may be malnutrition, emaciation, and in the late stage, malnutrition worsens, emaciation, dehydration, and systemic failure with malignant fluid. There may be signs caused by tumor metastasis, such as enlarged supraclavicular lymph nodes; compression of superior vena cava, causing superior vena cava compression syndrome; liver metastasis, causing jaundice, ascites, and so on.

Complications of esophageal cancer

Complications of esophageal cancer are mostly seen in advanced stage patients.

1. Vomiting blood, blood in stool; caused by tumor ulceration.

2. Caused by cancer metastasis, such as vocal cord paralysis and hoarseness caused by cancer cells invading recurrent laryngeal nerve; shortness of breath and irritating dry cough caused by tumor compression and invasion of trachea and bronchus; invasion of phrenic nerve causing diaphragm paralysis; invasion of vagus nerve accelerating the heart rate; invasion of brachial plexus nerve causing arm soreness, pain and abnormal sensation; compression of superior vena cava, causing superior vena cava compression syndrome; liver , lung, brain and other important organs cancer metastasis, can cause jaundice, ascites, liver failure, respiratory difficulties, coma and other complications.

3. Esophageal perforation: advanced esophageal cancer, especially ulcerative esophageal cancer, can cause perforation due to local erosion and serious ulceration of tumor. Different symptoms appear due to different perforated parts and neighboring organs. Perforation into the bronchus causes esophageal tracheal fistula, which appears choking anatomy when eating and drinking, especially the symptoms are obvious when eating liquid diet; perforation into the mediastinum can cause mediastinitis, which occurs with tightness of chest, chest pain, cough, fever, accelerated heart rate, and elevation of white blood cells, etc.; perforation into the lungs causes pulmonary sepsis, which occurs with high fever, coughing, and pus sputum; and perforation into the aorta causes esophago-aortic fistula, which can cause hemorrhage and lead to death.

Conventional treatment

(1) Traditional Chinese medicine treatment:

Professor Gu Huatai has been inspired by Mr. Congzheng and Mr. Danxi's treatments for more than 40 years in the clinical treatment of esophageal cancer. The causes of esophageal cancer are internal injuries to the seven emotions, external injuries to the qi and blood, the decline of the evil and the accumulation of the disease for a long period of time, and the accumulation of blood stasis, phlegm condensation, yin and yang junctions.

The treatment method first spit under the two methods, discharge of septic blood, stubborn phlegm, so that the diaphragm pain disappears, continued to use the smooth nourishment of blood and fluids, lowering the fire and scattering the knot, replenish the gas and blood, nourish the yin to replenish the stomach, tonifying the gas to the good afterward, and achieve satisfactory results. Now the clinical cases, representative of the public after.

Taking "Zhenxiang capsule" as the main anticancer medicine, often serving medicine, eliminating phlegm and dispersing knots, detoxifying and resolving blood stasis, "Zhenxiang capsule", 6-8 capsules at a time, 3 times a day, it is suitable to be served with lukewarm boiled water or honey water, and for those who have difficulty in swallowing, the outer shell of the capsules can be removed, and the medicine will be mixed with honey to be served after meals. If you have difficulty swallowing, you can remove the shell of the capsule, mix the honey in the capsule and take it with honey after meals; clinically, you can also take Chinese medicine according to the diagnosis and treatment, respectively. About one hour after taking the capsule, the best time to take Chinese medicine soup is: 9:30-10:00 am, 3:30-4:00 pm.

Diagnosis and treatment:

(1) Liver depression and stagnation of qi type: evidence of discomfort in the pharynx, belching, occasional mild obstruction of choking, chest and ribs, pain in the ribs, or pain in the back of the sternum, dizziness and vertigo. The tongue is pale red, the moss is thin and yellow, and the pulse is fine. The treatment is to soothe the liver and regulate qi.

(2) phlegm and blood stasis mutual knot type: see swallowing difficulties, water and drink difficult to swallow, food and drink easy to vomit, sticky saliva is very much, the back of the chest is fixed pain, or such as a cone thorns feeling, there may be spit down like red bean juice. The tongue is thick and greasy or yellowish, with petechiae, and the pulse is slippery or astringent. Treatment is recommended to dissolve phlegm and soften hardness, activate blood circulation and dissipate blood stasis.

(3) heat and toxicity injury to the yin type: the evidence of dry mouth and lips, sore throat, irritability, obstruction, burning pain in the chest and back, low fever in the afternoon, or night sweats, large and easy to knot, or hoarseness of voice. Tongue with yellow coating, reddish texture and little fluid, and thin stringy pulse. The treatment is to nourish yin and promote the production of fluids, clear heat and remove toxins.

(4) qi and blood deficiency: the evidence of choking, hard to eat, face color, yellowish, emaciated, withered and weak, withered bones, cold limbs, face and feet swelling. The tongue is pale, the moss is thin, and the pulse is stringy or thin. The treatment should benefit Qi and nourish blood, with the aid of dispelling evil spirits.

2. Surgical treatment

Indications for surgery

(1) Early esophageal cancer.

(2) Stage II previous cases without serious complications.

(3) Stage III cases, the comprehensive treatment method of preoperative radiotherapy can be considered, and the lower esophageal cancer which is 7 centimeters long can also be considered for surgery.

(4) For those who have recurrence after radiotherapy, the lesion is not big in scope and has no distant metastasis, and the conditions permit, surgery should also be pursued.

(5) If the esophagus is highly obstructed, and the patient's general condition is good, the retrosternal colon can be considered to substitute for the esophagus and radiotherapy can be given afterwards.

Contraindications

(1) X-ray esophagography or CT examination of the invasion of neighboring vital organs.

(2) Those with distant metastases.

(3) Those with severe cardiopulmonary insufficiency.

(4) Malignant disease.

Factors affecting surgical resection

The success of surgical treatment of esophageal cancer depends on whether the lesion spreads to tissues outside the esophagus or not. The resection rate of stage 0 and stage Ⅰ is 100%; the resection rate of stage Ⅱ is more than 95%; the resection rate of stage Ⅲ is 80%; and stage Ⅳ is about 50%. In general, the resection rate of the lower segment is high, and the resection rate of the middle and upper segments is low. Adhering to the traditional Chinese medicine "Zhenxiang capsule" before the operation can increase the patient's ability to resist the disease, thus improving the surgical resection rate.

The resection length of esophageal cancer is generally more than 5cm from the upper and lower margins of the tumor, including the connective tissues around the esophagus and the enlarged lymph nodes should be cleared as well.

2. Radiation therapy for esophageal cancer

The indications of radiation therapy for esophageal cancer are wide, except for esophageal fistula formed by perforation of the esophagus, distant metastasis, obvious malignant fluid, serious heart, lung, liver and other diseases, all of them are feasible to be treated with radiation therapy.

Five hospitals led by Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine and Cancer Hospital of Sun Yat-sen University of Medical Science, Guangzhou, carried out the phase II clinical trial of esophageal cancer treatment, and verified the clinical efficacy of traditional Chinese medicine "Zhenxiang Capsule": the quality of life of patients after radiotherapy was significantly improved compared with that of radiotherapy alone in both groups of pure Zhenxiang Capsule and Zhenxiang Capsule + radiotherapy. The patients' quality of life after radiotherapy was significantly improved compared with that of radiotherapy alone.

Indications:

(1) the patient's general condition is above moderate;

(2) the length of the lesion is not more than 8cm;

(3) there is no metastasis to the supraclavicular lymph nodes, no paralysis of the vocal cords, and no distant metastasis;

(4) the patient can eat semi-fluid or ordinary food;

(5) there is no sign of perforation before the perforation, and there is no significant pain in the chest and back;

(6) there are no signs of perforation, and there is no significant pain in the chest and back. ;

(6) There should be a cytologic or pathologic diagnosis, especially of superficial esophageal cancer.

Note: Pre-perforation signs of esophageal cancer: ①spike protrusion: the lesion is spiky and protrudes like a burr in small cases and like a wedge in large cases; ②nickel shadow formation: it is a large ulcer; ③diverticulosis-like change: the formation of diverticulum is similar to that of esophageal diverticulum in general, and it occurs mostly after radiotherapy; ④twisted angle: the esophageal wall loses its normal alignment, which seems to be a misalignment of the bone after fracture of the bone; ⑤mediastinitis: the shadow of the mediastinum is broadened, and the patient's body temperature is elevated, pulse is accelerated, and chest and back pains are present. The patient's temperature rises, pulse rate accelerates, and chest and back pain. The prognosis after perforation is very poor, and most patients die within a few months.

Irradiation dose and time: usually the amount of irradiation of the tumor is 60Gy～70Gy/6～7 weeks.

Response of external irradiation

(1) Esophageal response: when irradiating the tumor for 10～20Gy/1～2 weeks, the esophageal mucous membrane edema can aggravate the difficulty in swallowing, which can be left untreated, and when irradiating the tumor for 30～40Gy/3～4 weeks, the patient can have pain in swallowing and posterior chest pain, which is suitable for symptomatic treatment.

(2) Tracheal reaction: cough, mostly dry cough with little sputum.

Comorbidities

(1) Bleeding: the incidence is about 1%. Special care should be taken in the selection of patients with obvious ulcers, especially those with burr-like protruding deeper ulcers, reducing the dose of each irradiation, prolonging the total treatment time, and frequent X-ray barium meal observation should be made during the course of radiotherapy.

(2) Perforation: the incidence is about 3%, can penetrate into the trachea, forming esophagotracheal fistula or penetrate into the mediastinum, causing mediastinal inflammation.

(3) Radiomyelopathy: Radiomyelopathy is one of the serious complications of radiation therapy for malignant tumors of the head, neck and chest. The incubation period is mostly 1 to 2 years after irradiation.

3. Chemotherapy

Chemotherapeutic drugs, although more, but less effective, domestic bleomycin effect is still possible. When combining drugs, cell cycle non-specific drugs (e.g. cyclophosphamide) should be used first, and then cell cycle specific drugs (e.g. bleomycin, 5-fluorouracil, etc.) should be used. Because the cell cycle of esophageal cancer is long and the effect of clinical chemotherapy is far away from the radical cure; therefore, the course of treatment should be prolonged appropriately and should be multi-procedure treatment, and should not be stopped too early to avoid recurrence. Commonly used drugs are cisplatin, pingyangmycin, etc. Although its effective rate is about 50%, its long-term efficacy is not ideal.

At the same time, the Chinese medicine "Zhenxiang capsule" can not only enhance the effect of chemotherapy, but also reduce the nausea, vomiting, hair loss, chest pain, constipation and other symptoms caused by chemotherapy, and it has a certain effect of pain relief. Clinical studies have proved that the Chinese medicine "Zhenxiang Capsule" has obvious counteracting effects on the toxic side effects such as leukopenia, atrophy of immune organs and weight loss caused by chemotherapeutic drugs. It can improve the body's immune function and inhibit tumor recurrence and metastasis.

Experience and experience

I: How to prevent tumor metastasis

One of the basic characteristics of malignant tumors is metastasis, and metastasis is the main reason for treatment failure of most of the patients. In preventing the metastasis of cancer cells, the modern western medicine is helpless, and traditional Chinese medicine has the irreplaceable advantage in preventing tumor metastasis.

By using traditional Chinese medicine "Zhenxiang Capsule" to enhance the phagocytosis and clearing ability of mononuclear phagocyte system, improve the killing effect of NK cells, prompt other quiescent cells to divide, increase the number of lymphocytes and promote the transformation of lymphocytes to improve the level of cellular immunity and humoral immunity of the organism, so as to make it lose the ability of metastasis and disintegrate. ability and disintegration. Thus, the effect of inhibiting the metastasis of tumor cells is achieved.

Two: how to improve the long-term curative effect of esophageal cancer

Radiation therapy and surgery are local treatments for tumor, which have almost no effect on tumor cells spreading all over the body. Clinical observation shows that some patients are prone to metastasis of the tumor in the absence of effective systemic treatment. Chemotherapy and immunotherapy are systemic treatments, but they are powerless to the oxygen-poor cells with insufficient blood supply in the center of the tumor. Chemotherapy has completely lost its therapeutic significance for patients who have developed drug resistance after repeated chemotherapy. Therefore, the best way to improve the therapeutic effect is to adopt reasonable comprehensive treatment. Through our long-term clinical practice, traditional Chinese medicine treatment can be carried out throughout the treatment. The traditional Chinese medicine "Zhenxiang Capsule" can increase sensitivity and reduce toxicity, inhibit cancer and relieve pain, improve the immune function of the body and control tumor metastasis and recurrence. Musk (musk is pungent, fragrant and strong, can open and close the orifices, can move qi, activate blood circulation, disperse knots and fix pain) and ice tablet have unexpected curative effects on patients with esophageal cancer, difficulty in swallowing and cancerous pain (chest and back pain). The Chinese medicine "Zhenxiang Capsule" has been proved by clinical and experimental researches, and the convenient dosage form has laid the foundation for improving the long-term therapeutic effect. Therefore, the comprehensive treatment program of "Zhenxiang capsule" and other therapies is the best clinical treatment for esophageal cancer.