Esophageal cancer

Introduction to esophageal cancer Esophageal cancer is a malignant tumor that occurs in the esophageal epithelium, accounting for 2% of all malignancies. About 200,000 people die of esophageal cancer every year in the world. China is a high-risk area for esophageal cancer. The death of esophageal cancer is second only to that of gastric cancer. The age of onset is more than 40 years old. Men are more than women, but in recent years, There is a growing trend among people under the age of 40. The occurrence of esophageal cancer is related to chronic nitrosamine stimulation, inflammation and trauma, genetic factors, and trace element content in drinking water, food and vegetables. But the exact reason is not clear and needs to be studied. Esophageal cancer often has no obvious symptoms in the early stage, and occasionally manifests as painful discomfort after the sternum. As the tumor enlarges, the patient may experience swallowing discomfort or foreign body sensation while eating. Often expressed as a slower eating speed and often need soup to deliver rice. After several months, because the tumor is further enlarged and the esophageal lumen is blocked, the patient can only eat fluid. When the tumor completely blocks the lumen, the patient appears to be "difficult to drip." basic knowledge The proportion of illness: 0.013% Susceptible population: The age of onset is more than 40 years old, more men than women. Mode of infection: non-infectious Complications: jaundice, ascites, coma, upper gastrointestinal bleeding

Causes of esophageal cancer

Pathogenic factor

The exact cause of esophageal cancer is unknown. Obviously, the environment and certain carcinogens are important pathogenic factors.

Nitrosamines and mycotoxins (20%):

Nearly 30 kinds of nitrosamines are known to induce animal tumors, and methylbenzyl nitrosamine, sarcosine ethyl nitrosamine, methyl valerate, nitrosamine and diethyl sulfinamide have been successfully used in China. Inducing esophageal cancer in rats, China's investigation found that the content of nitrate, nitrite and secondary amine in food and drinking water in high-incidence areas was significantly increased, and positively correlated with the prevalence of esophageal cancer and esophageal epithelial hyperplasia. These substances are easy to synthesize carcinogenic nitrosamines in the stomach.

Esophageal injury (20%):

Esophageal injury and certain esophageal diseases can promote esophageal cancer. In patients with corrosive esophageal burns and stenosis, esophageal achalasia, esophageal diverticulum or reflux esophagitis, the incidence of esophageal cancer is higher than that of the general population. It is speculated that long-term chronic inflammation, ulcers, or chronic irritation, and esophageal epithelial hyperplasia, eventually lead to cancer, due to retention in the esophagus, epidemiological investigation found that residents with high incidence of esophageal cancer have a very hot diet, drink The habit of eating a lot of pepper, chewing betel nut or shredded tobacco, and the chronic physicochemical stimulation of these esophageal mucosa can cause local epithelial cell proliferation. Animal experiments have shown that diffuse or focal epithelial hyperplasia may be a precancerous lesion of esophageal cancer.

Malnutrition and trace element deficiency (20%):

Insufficient intake of animal protein and vitamin A, B2, C deficiency, is a common feature of the diet of high-level esophageal cancer residents, but most of the high-risk areas of malnutrition, esophageal cancer is not high, so this can not be a dominant factor.

Genetic factors (10%):

The incidence of esophageal cancer often shows family aggregation. In the surveys of Shanxi, Shandong, Henan and other provinces in China, it is found that there is a positive family history of about 1/4 to 1/2, and there is a high proportion of positive family history in high-incidence areas. Among them, the father is the highest, the mother is the second, and the side is the lowest.

Pathological change

The lesions of esophageal cancer are reported in different parts of China, but they are most in the middle (52, 69% to 63, 33%), followed by the lower (24, 95% to 38, 92%), and the least in the upper part (2, 80) %~14, 0%), of the 622 cases in our hospital, the middle part accounted for 68, 90%, the lower part accounted for 26, 40%, and the upper part accounted for 4, 70%.

(1) Clinical pathological staging and typing

1. Clinical pathological staging

The clinical pathology of esophageal cancer is of great significance to the selection of treatment options and the evaluation of therapeutic effects. The clinical pathological staging criteria developed by the National Conference on Esophageal Cancer in 1976.

(1) Pathological morphological classification of early esophageal cancer: Early esophageal cancer can be divided into concealed type, erosive type, plaque type and nipple type according to its morphology.

(2) Pathological morphological classification of advanced and advanced esophageal cancer: it can be divided into medullary type, sputum type, ulcer type, narrowed type, intraluminal type and unshaped type, of which medullary type is the most developed, a few, Advanced esophageal cancer cannot be classified as above, and is called undetermined.

2, histological classification

(1) Squamous cell carcinoma: the most common.

(2) adenocarcinoma: less common, can be divided into simple adenocarcinoma, adenosquamous carcinoma, mucoepidermoid carcinoma and adenoid cystic carcinoma.

(3) Undifferentiated cancer: less common, but high degree of malignancy.

On the esophagus, the majority of the cancer in the middle stage is squamous cell carcinoma, and the carcinoma of the lower esophagus is mostly adenocarcinoma.

(B) the spread and transfer of esophageal cancer

1. Diffusion in the wall of the esophagus

The underlying cells of the esophageal cancer adjacent to the cancer or cancer in situ are one of the surface diffusion modes of cancer, and the cancer cells often have no lymphatic invasion of the submucosal layer of the esophageal membrane.

2, direct infiltration of adjacent organs

Upper esophageal cancer can invade the larynx, trachea and soft tissues of the neck, and even invade the bronchus to form a bronchial-esophageal fistula; it can also invade the thoracic duct, azygous vein, hilar and lung tissue, and partially invade the aorta to form the esophagus-aorta. Hey, causing massive bleeding and long-term, the lower esophageal cancer can often involve the cardia and pericardium.

3, lymphatic metastasis

More common, accounting for about 2 / 3 of the case, the middle esophageal cancer often metastasis to the esophageal or hilar lymph nodes, can also be transferred to the neck, around the cardia and lymph node in the left gastric artery, the lower esophageal cancer can often be transferred to the esophagus, Beside the cardia, lymph nodes such as the left gastric artery and the abdominal cavity can even be located in the upper mediastinum and cervical lymph nodes. The lymphatic metastasis is followed by the septum, the abdomen, the trachea and the trachea, the hilar and the bronchi.

4, blood transfer

More common in advanced patients, the most common metastasis to the liver (about 1/4) and lung (about 1/5), other organs are bone, kidney, adrenal gland, pleura, omentum, pancreas, heart, lung, thyroid And brain and so on.

Esophageal cancer prevention

1, primary prevention

Primary prevention, ie etiological prevention, is the fundamental way to reduce the incidence of esophageal cancer. It is closely related to the progress of epidemiological research and etiology research. This is the most ideal method, but it is very difficult, and it is still difficult to carry out comprehensively. .

(1) Changing the habit of eating mildew food: There is sufficient evidence to show that the consumption of mildew food, especially sauerkraut, moldworm and fish sauce, is one of the important factors in the pathogenesis of esophageal cancer. Therefore, it is necessary to vigorously promote such food pairs. The harm of human health makes the people eat less or not, and encourages the cultivation of vegetables and fruits to increase the intake of fresh vegetables and fruits and to supplement vitamin C. Mildew foods, on the one hand, produce mycotoxins or metabolites, on the one hand promote the internal synthesis of nitrosamines, which is the main cause of esophageal cancer. Eating more fresh vegetables or supplementing vitamin C can block the synthesis of nitrosamines in the body. It can reduce the content of nitrosamines in the stomach, thereby reducing the exposure level of nitrosamines in the stomach. In addition, Lin County's nutritional prevention test found that supplementation of riboflavin and niacin can reduce the incidence of esophageal cancer by 15%. At the same time, we should actively study scientific methods for making and preserving sauerkraut to meet the traditional eating habits that have been developed by local residents since generations.

Change bad eating habits, don't eat moldy food, eat less or not eat sauerkraut. Improve water quality and reduce nitrite content in drinking water. Promote trace element fertilizers and correct the trace elements such as molybdenum deficiency in soil. The application of Chinese and Western medicine and vitamin B2 in the treatment of esophageal epithelial hyperplasia to block the process of cancer. Active treatment of esophagitis, esophageal leukoplakia, achalasia, esophageal diverticulum and other diseases associated with esophageal cancer. Susceptible people to monitor, popularize anti-cancer knowledge and improve anti-cancer awareness.

(2) Anti-mildew of grain: Mild grain food contains a variety of carcinogenic toxins, so it is very important to actively carry out anti-mildew and detoxification work of food, especially the importance of anti-mildew for household grain storage. Generally, the water content of grain is below 13% to meet the requirements of mildew proof. Once the grain has been mildewed, it should be taken after diligence, picking when eating, washing twice and adding alkali, which can effectively reduce the intake of mycotoxins.

(3) Strengthening the hygiene management of drinking water: It has been found that the content of nitrosamines in the high-incidence area of esophageal cancer is significantly higher than that in the low-incidence area. Therefore, it is very important to do a good job in environmental sanitation and prevent water pollution. Gradually reduce the area where drinking pond water is used and promote soil tap water. The bleached powder disinfection should also be carried out on the ditch pond water, which can significantly reduce the nitrosamine content in water and kill other infectious diseases.

(4) Prevention of genetic pathogenic factors: Esophageal cancer has a relatively common family aggregation phenomenon, indicating that the cancer susceptibility of family history of esophageal cancer does exist, and the monitoring work of the same generation should be strengthened. When the patient is a male, the male monitoring is strengthened, especially in the pre-49-year-old population. The patient is a female, and the female monitoring is strengthened, especially in the 50-69 age group, and 2 or more esophagus should occur in 3 generations. A family that has died of cancer is considered a dangerous family. Members of these families who are 40 to 69 years old are considered as risk groups. Regular medical examinations, provision of preventive drugs or vitamins, and persuasion to change lifestyle habits are positive for reducing the incidence of esophageal cancer. significance.

2, secondary prevention

For esophageal cancer, it is impossible to completely achieve primary prevention at present. Due to the long-term occurrence and development of esophageal cancer, it is a realistic and feasible method for tumor prevention if early detection, early diagnosis and timely treatment, especially the prevention of the development of precancerous lesions.

(1) Census: The high-incidence area is over 35 years old, family history of esophageal cancer, or patients with esophageal epithelial hyperplasia are classified as high-risk groups, and key monitoring is carried out, and residents over 35 years old in areas with high incidence of esophageal cancer should be investigated as much as possible. The census is mainly based on esophageal cytology. When suspicious patients are found, endoscopy should be performed as soon as possible to achieve early diagnosis. The early manifestations of esophageal cancer, such as "swallowing discomfort" should be well known to the general population in high-incidence areas, and the patient's visit time can be advanced for early diagnosis and treatment.

(2) drug prevention of precancerous lesions: precancerous lesions of esophageal cancer mainly refer to severe hyperplasia of the esophageal epithelium, with anti-cancer B III tablets (Soybean root, Sabina, white sable, yellow medicine, Prunella, grass river car) Six kinds of anti-cancer tablets containing anti-cancer tablets, 2mg 5-fluorouracil, anti-cancer tablets and Tailuolong treatment of severe hyperplasia of esophageal epithelium, the cancer rate of the untreated group was 7.4%; the cancer rate of the treatment group: anti-cancer B group III 2, 5%, 1,4% in the anti-cancer group, 2, 3% in the tyloron group, were significantly different from the untreated group and more normal than the untreated group.

Since 1983, the Chinese Academy of Sciences has conducted a study on the treatment of esophageal precancerous lesions in Heshun Township, Lin County, Henan Province, and Leikou Township, Anyang County. Through esophageal cytology screening, 2,531 patients with esophageal epithelial recurrence were randomly divided into three groups, taking anti-cancer tablets, retinoic esters and placebo. A total of 3393 people were detected and randomly divided into two groups, taking riboflavin and placebo. In 3 and 5 years, the patient's medication rate was over 90%. After 3 and 5 years of medication, esophageal cytology was reviewed. The results were confirmed. Anti-cancer B tablets reduced the cancer rate of esophageal re-increase by 52% and 2%, reaching the target. Valetamine and riboflavin also showed a certain blocking effect, which reduced the cancer rate of esophageal re-increase and mild increase by 37, 3% and 22, 2%, respectively, and found that the dose of retinoic ester was appropriately increased. Significantly improve its anti-cancer effect. After taking riboflavin for 5 years, the cancer rate of esophageal deliberation decreased by 34% and 8%, which was 22% and 2% higher than that of 3 years after taking the drug, which increased by 56% and 8%, indicating that the longer the riboflavin was taken, The effect of inhibiting mild carcinogenesis is more obvious. The anti-cancer tablets used in the experiment are made of six traditional Chinese medicines, which are unique in China and low in price and easy to promote. Retinoids are currently the most abundant and promising class of cancer preventives. The retinoic ester has a strong action, low toxicity and good preventive effect. Riboflavin is an essential vitamin for the human body. If it can further confirm its anti-cancer effect, it has far-reaching significance.

Esophageal cancer complications Complications jaundice ascites coma upper gastrointestinal bleeding

Complications of esophageal cancer are more common in advanced patients.

1, cachexia

In advanced cases, due to the difficulty of swallowing, the long-term hunger leads to negative nitrogen balance and weight loss, which has a direct impact on the incidence of complications and operative mortality after resection of esophageal cancer. In fact, every patient with advanced esophageal cancer with obstructive symptoms has different degrees of dehydration and total body fluid loss due to difficulty in oral feeding. The patient developed cachexia and marked loss of water, which was characterized by high weight loss, weakness, dry skin and dryness, and was in a state of exhaustion.

2, bleeding or hematemesis

Some patients with esophageal cancer have vomiting. Individual esophageal cancer patients have hematemesis due to tumor invasion of large blood vessels, and occasionally hemorrhage. According to Wu Yingwei and Huang Guojun (1974), 24 (2, 8%) of a group of 841 patients with esophageal and cardiac cancer had hematemesis, blood from esophageal cancer, cancerous lungs or large blood vessels in the chest. . Hematemesis is generally a clinical symptom of patients with advanced esophageal cancer.

3, organ transfer

If there are important organs such as lungs, liver, and brain, there may be specific symptoms of dyspnea, jaundice, ascites, and coma. Esophageal cancer patients with esophageal-tracheal fistula, supraclavicular lymph node metastasis and other organ metastasis, recurrent laryngeal nerve palsy and cachexia are all advanced esophageal cancer.

4, sympathetic ganglion compression

Compression of the sympathetic ganglia in cancer produces sympathetic paralysis (Homer syndrome).

5, water, electrolyte disorders

Patients with difficulty in swallowing have a tendency to develop severe hypokalemia and muscle weakness. Normal people secrete about 1 to 2 liters of saliva per day, and the inorganic substances include sodium, potassium, calcium and chlorine. The concentration of potassium in saliva is higher than the concentration of potassium in any other gastrointestinal secretions, typically 20 mmol/ml. Therefore, patients with esophageal cancer may have significant hypokalemia when they are unable to swallow saliva due to difficulty in swallowing.

Some squamous cell carcinomas can produce parathyroid hormone and cause hypercalcemia, even if the patient can have hypercalcemia without bone metastasis. Patients with esophageal cancer without bone metastases before surgery have hypercalcemia, which is often a sign indicating poor prognosis.

6, aspiration pneumonia

Due to aspiration and aspiration pneumonia caused by esophageal obstruction, patients may have symptoms of fever and systemic poisoning.

7, caused by cancer metastasis

Such as cancer cells invading the recurrent laryngeal nerve causing vocal cord paralysis and hoarseness, tumor compression and invasion of trachea, bronchi caused by shortness of breath and irritating dry cough, invading the phrenic nerve, causing paralysis of the diaphragm, invading the vagus nerve, accelerating heart rate, invading the brachial plexus, causing Brachial acid, pain, paresthesia, compression of the superior vena cava, causing superior vena cava compression syndrome, liver, lung, brain and other important organ cancer metastasis, can cause jaundice, ascites, liver failure, dyspnea, coma and other complications .

8, esophageal perforation

Advanced esophageal cancer, especially ulcerated esophageal cancer, causes perforation due to localized erosion and severe ulceration of the tumor. Different symptoms appear due to different perforation sites and adjacent organs. Wearing a snorkel caused by esophageal tracheal fistula, sputum anatomy when entering the diet, especially in the intake of fluid diet symptoms; penetrating into the mediastinum can cause vertical sputum inflammation, chest tightness, chest pain, cough, fever, heart rate and white blood cells, etc. Puncture into the lungs causes lung abscess, high fever, cough, sputum purulent, etc., through the aorta, causing esophageal aorta spasm, can cause massive bleeding and lead to death.

9, other

According to reports in the literature, some esophageal squamous cell carcinomas have hypertrophic osteoarthrosis, some patients with occult esophageal cancer have dermatomyositis, and some patients with esophageal obstruction have "swallow syncope" (swallow syncope) ) may be a vagus-medium response.

Esophageal cancer symptoms Common symptoms Hiccups, hoarseness, acid reflux, difficulty swallowing, urgency, dry cough, esophageal body smooth muscle...

Esophageal cancer often has no obvious symptoms in the early stage, and occasionally manifests as painful discomfort after the sternum. As the tumor enlarges, the patient may experience swallowing discomfort or foreign body sensation while eating. Often expressed as a slower eating speed and often need soup to deliver rice. After several months, because the tumor is further enlarged and the esophageal lumen is blocked, the patient can only eat fluid. When the tumor completely blocks the lumen, the patient appears to be "difficult to drip." It usually takes about one year from the onset of symptoms to complete obstruction. Therefore, you should go to the hospital as soon as possible if you have suspicious symptoms.

Early symptoms of esophageal cancer

1, swallowing sputum sputum sensation: the most common, can be selected to disappear and relapse, does not affect eating. Often occurs when the patient's mood fluctuates, so it is easy to be mistaken for functional symptoms.

2, sternal and xiphoid pain: more common. When swallowing food, there is pain in the back of the sternum or under the xiphoid. Its nature can be burnt, acupuncture or pull-like, with rough, hot or irritating food. It is intermittent at the beginning, and when the cancer invades nearby tissues or has penetration, it can have severe and persistent pain. The pain site is often not completely consistent with the lesion in the esophagus. Most of the pain can be temporarily relieved by the antispasmodic agent.

3, food retention infection and foreign body sensation: when swallowing food or drinking water, there is a feeling of slow and stagnant food, as well as the feeling of tightness behind the sternum or food adhesion to the esophageal wall, disappeared after eating. Most of the symptoms occur in the same area as the lesion in the esophagus.

4, throat dryness and tightness: dry and rough food is especially obvious, the occurrence of this symptom is often related to the patient's mood fluctuations.

5, other symptoms: a small number of patients may have sternal swelling, discomfort, anterior pain and hernia.

Intermediate symptoms of esophageal cancer

1, swallowing sputum sputum sensation: the most common, can be selected to disappear and relapse, does not affect eating. Often occurs when the patient's mood fluctuates, so it is easy to be mistaken for functional symptoms.

2, sternal and xiphoid pain: more common. When swallowing food, there is pain in the back of the sternum or under the xiphoid. Its nature can be burnt, acupuncture or pull-like, with rough, hot or irritating food. It is intermittent at the beginning, and when the cancer invades nearby tissues or has penetration, it can have severe and persistent pain. The pain site is often not completely consistent with the lesion in the esophagus. Most of the pain can be temporarily relieved by the antispasmodic agent.

3, food retention infection and foreign body sensation: when swallowing food or drinking water, there is a feeling of slow and stagnant food, as well as the feeling of tightness behind the sternum or food adhesion to the esophageal wall, disappeared after eating. Most of the symptoms occur in the same area as the lesion in the esophagus.

4, throat dryness and tightness: dry and rough food is especially obvious, the occurrence of this symptom is often related to the patient's mood fluctuations.

5, other symptoms: a small number of patients may have sternal swelling, discomfort, anterior pain and hernia.

Typical symptoms of mid-stage esophageal cancer: progressive dysphagia, post-sternal pain during swallowing, and mucus-like sputum.

Late symptoms of esophageal cancer

1, difficulty in swallowing progressive difficulty in swallowing: is the main symptom of most patients at the time of treatment, but it is a more advanced manifestation of the disease. Because the esophageal wall is elastic and expandable, it is difficult to swallow only when about 2/3 of the esophageal circumference is infiltrated by the cancer. Therefore, after the above-mentioned early symptoms appear, the condition gradually worsens within a few months, and it is impossible to swallow from the inability to swallow solid food to develop liquid food. Such as cancer with esophageal wall inflammation, edema, sputum, etc., can increase the difficulty of swallowing. The location of the blockage is often consistent with the hand cancer.

2, food reaction: often appear in the difficulty of swallowing, the reverse flow is not large, containing food and mucus, can also contain blood and pus.

3, other symptoms: when the cancer compression of the recurrent laryngeal nerve can cause hoarseness, invading the phrenic nerve can cause hiccups or paralysis of the phrenic nerve, compression of the trachea or bronchus can appear anxious and dry cough, erosion of the aorta can produce fatal bleeding. When the esophagus-tracheal or esophageal-bronchial spasm or cancer is located in the upper part of the esophagus, the cervical sympathetic paralysis group can often be produced when swallowing fluid.

Sign

Early signs are absent. In the advanced stage, snoring and difficulty in swallowing may occur. And because the patient's eating difficulties can lead to malnutrition and signs of weight loss, anemia, water loss or cachexia. When the cancer metastasizes, it can reach a swollen and hard superficial lymph node, or a swollen and nodular liver. There may also be jaundice, ascites, and the like. Other rare signs are skin, nodules at the abdominal line, and inguinal lymph nodes.

Esophageal cancer examination

1, X-ray barium meal inspection

Esophageal X-ray barium meal examination can show that the expectorant is stagnant at the cancer point, the stenosis of the lesion is narrow, the esophageal wall is stiff, the peristalsis is weakened, the mucosal pattern becomes thick and disordered, the margin is rough, the esophageal lumen is narrow and irregular, and the upper segment of the obstruction Mild dilatation, and there may be changes in ulceration tick and abandonment of the defect. Regular X-ray barium meal examination is often difficult to find superficial and small cancer, and sodium methyl cellulose and tincture are used for double contrast angiography. It can more clearly show the esophageal mucosa and improve the discovery rate of esophageal cancer.

2, fiber esophagoscopy

The morphology of the cancer can be directly observed, and biopsy can be performed under direct vision to determine the diagnosis.

3, esophageal mucosal exfoliative cytology

Apply the net balloon double-lumen tube cell harvester to the esophagus, inflate the balloon through the lesion, then slowly pull out the balloon, take the net cover and wipe the smear for cytological examination, the positive rate can reach more than 90% It is often found that some early illnesses are an important method for large-scale screening of esophageal cancer.

4, esophageal CT scan

CT scan can clearly show the relationship between esophagus and adjacent mediastinal organs. The boundary between normal esophagus and adjacent organs is clear. The thickness of esophageal wall is less than 5mm. If the thickness of esophageal wall increases, and the boundary between surrounding organs is blurred, it indicates the presence of esophageal lesions.

5, other inspection methods

The use of toluidine blue or iodine in vivo staining endoscopy for the early diagnosis of esophageal cancer has a certain value, this method has the advantages of simplicity, easy positioning, and accurate determination of the extent of cancer.

Diagnosis and diagnosis of esophageal cancer

diagnosis

Esophageal swallowing x-ray examination should be performed for any suspicious cases. The early x-ray signs of esophageal cancer are:

1. Localized mucosal folds are thickened and broken.

2. Localized esophageal wall stiffness.

3. Limited filling loss.

4, small sputum, late in the filling defect, stenosis or obstruction, highly suspected and unclear, should be esophagoscopy and biopsy, esophageal pull-net cytology and radioisotope 32P, there Helps early diagnosis of cancer.

Differential diagnosis

1, esophageal achalasia

Patients are more common in young women, with a long course of disease, light and heavy symptoms, esophageal barium meal examination showed a smooth funnel-shaped stenosis at the lower end of the esophagus, which can be expanded when using an antispasmodic agent.

2, benign esophageal stricture

It can be caused by scars caused by accidental swallowing of corrosive agents, esophageal burns, foreign body damage, chronic ulcers, etc. The course of disease is longer, and the difficulty of swallowing develops to a certain extent, which is no longer aggravated. It can be identified by detailed medical history and X-ray barium meal examination.

3, esophageal benign tumor

Mainly for the rare leiomyomas, the course of disease is longer, and the difficulty of swallowing is mostly intermittent. X-ray barium meal examination can show that the esophagus has a round, oval or lobulated filling defect, the edges are neat, and the surrounding mucosa is normal.

4, globus

More common in young women, when there is a pharyngeal ball-like foreign body sensation, disappeared when eating, often induced by mental factors, the disease does not actually have esophageal esophageal lesions, it is not difficult to diagnose with esophageal cancer.

5, iron deficiency pseudomembranous esophagitis

Mostly women, in addition to difficulty in swallowing, there may be small cell hypochromic anemia, glossitis, gastric acid deficiency and anti-A performance.

6, esophageal organ disease

Such as mediastinal tumor, aortic aneurysm, goiter, heart enlargement, etc., in addition to the mediastinal tumor invading the esophagus, X-ray barium meal examination can show a smooth compression of the esophagus, mucosal lines are normal.

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