Early symptoms of esophageal cancer The pathological morphology of early esophageal cancer can be divided into concealed type, erosive type, plaque type and nipple type, among which plaque type is the most common, accounting for about 1/2 of early esophageal cancer. The symptoms of early esophageal cancer are: (1) choking sensation after swallowing. It is the most common, can disappear or recur on its own, does not affect eating, often occurs when patients' mood fluctuates, and is easily mistaken for functional symptoms. (2) Pain behind the sternum and under the xiphoid process. More common, there is pain behind the sternum or under the xiphoid process when swallowing food, and its nature can be burning, acupuncture or pulling, especially when swallowing rough, hot or irritating food, which is intermittent at first. When cancer invades nearby tissues or penetrates, there can be severe and persistent pain. The pain site is often not completely consistent with the lesion site in the esophagus, and the pain can be temporarily relieved by analgesic. (3) Food retention and foreign body sensation. When swallowing food or drinking water, there is a feeling that the food descends slowly and stays, as well as a feeling of retrosternal contraction or food sticking to the esophageal wall, which disappears after eating, and the location of symptoms is mostly consistent with the lesion in the esophagus. (4) dry and tight throat. Swallow and dry. Rough food is especially obvious, and the occurrence of this symptom is often related to the patient's emotional fluctuation. (5) Other symptoms. A few patients may have symptoms such as chest tightness and discomfort, back pain and belching. These early symptoms are not specific, and many other esophageal diseases may have similar symptoms, but we should pay attention to these symptoms and check them in time. At present, endoscopic examination is the most simple and reliable, with less pain. Biopsy of suspicious lesions under endoscope is very important for diagnosis. Clinically, there are the following diseases that are easily confused with esophageal cancer: 1. Esophagitis and severe hyperplasia of esophageal epithelial cells are clinically considered as precancerous lesions of esophageal cancer. This kind of patients often have symptoms similar to early esophageal cancer, and X-ray examination often has no abnormal findings. They can be differentiated by esophageal netting cytology, endoscopic staining and endoscopic ultrasound examination, but they often need regular review. 2. Iron-deficiency pseudomembranous esophagitis is mostly female, and besides dysphagia, there are manifestations such as small cell hypochromic anemia, glossitis, gastric acid deficiency and hypothyroidism. 3. Esophageal achalasia is a disease caused by esophageal neuromuscular dysfunction, such as esophageal spasm, dysphagia, esophageal achalasia, etc., especially achalasia can sometimes be accompanied by adenocarcinoma of the cardia. Patients show dysphagia, no contraction and peristalsis of the esophageal body, smooth esophageal mucosa and "bird's mouth" stenosis of the cardia on X-ray, and its attack is often intermittent, with a long course of disease and slow progress of symptoms. When antispasmodic is applied, it can be expanded. 4. Esophageal peripheral organ lesions: changes of esophageal external pressure: congenital abnormalities of blood vessels adjacent to esophagus, enlargement of heart, aortic aneurysm, intrathoracic thyroid, mediastinal tumor, mediastinal lymph node enlargement, and prolonged aortic arch, etc. Although the patient has difficulty swallowing, X-ray barium meal examination can show that the esophagus has smooth impression marks and the esophageal mucosa lines are normal and intact. Careful examination is not difficult to distinguish from esophageal cancer. 5. Esophageal benign stricture Esophageal benign stricture is mostly the sequela of chemical burns, which can be caused by swallowing corrosive agents, esophageal burns, foreign body injuries, esophagogastrostomy, or scar stricture caused by esophagitis and chronic ulcers. The course of the disease is long, and the difficulty in swallowing will not worsen if it develops to a certain extent. It can be distinguished by detailed medical history and X-ray barium meal examination. X-ray barium swallowing examination can show esophageal stricture, mucosal disappearance, rigid wall, neat edge of stricture and normal esophageal segment, and no sign of barium shadow defect. 6. Leiomyoma is a benign tumor of the esophagus, which can occur in any part of the esophagus, and is more common in the lower esophagus. Because it is an extramucosal tumor, it develops slowly, has a long course of disease, and has mild symptoms. The difficulty in swallowing is mostly intermittent, and sometimes there are no conscious symptoms. X-ray barium meal examination shows a smooth half-moon filling defect with neat edges and normal mucosal lines around it. Endoscopic examination showed that there was a raised tumor in the esophageal cavity, and the surface mucosa changed in color, but the mucosa was smooth without erosion and ulcer, and there was a sense of sliding when the endoscope passed. Endoscopic ultrasound showed a clear boundary, smooth appearance and regular contour with low echo, and it can distinguish which layer it belongs to. 7. Esophageal polyp is a benign tumor of esophagus, which mostly occurs near cervical esophagus and cricopharyngeal muscle. Polyps originate from esophageal submucosa and grow into the lumen, often with a pedicle of different lengths. X-ray shows that the esophageal cavity in the lesion site is spindle-shaped, and the upper esophageal cavity is not obviously dilated. Barium has shunt on the tumor surface or passes through one side wall, and the local wall dilates and contracts well. Occasionally malignant transformation, mucosal ulcer can be seen during malignant transformation, and sometimes it needs to be differentiated from intraluminal esophageal cancer. Other benign tumors, such as esophageal granular cell myoblastoma, esophageal hemangioma and esophageal adenoma, are rare and can be diagnosed by esophagoscopy and histological examination. 8. Gastroesophageal reflux disease refers to the symptoms caused by the reflux of gastroduodenal contents into esophagus, which are nausea, heartburn, swallowing pain and dysphagia. Reflux often enters the esophagus, which can cause mucosal inflammation. Endoscopic examination may have mucosal inflammation, erosion or ulcer, but no evidence of tumor was found. 9. globus hysteria is more common in young women, and sometimes there is a bulbous foreign body sensation in the pharynx, which disappears when eating, and is often induced by mental factors. In fact, this disease has no organic esophageal lesions, and it is not difficult to distinguish it from esophageal cancer.