Mass formation in the space of the esophagus

Introduction Esophageal space-forming masses are common in esophageal cancer. Esophageal cancer is a common malignant tumor in humans, accounting for 2% of all malignant tumors, accounting for more than 90% of esophageal tumors. It ranks second only to gastric cancer in retrospective investigation of all malignant tumor deaths. It is estimated that about 200,000 people die of esophageal cancer every year in the world. China is a high-risk area for esophageal cancer and one of the most common malignant tumors that are extremely harmful to people's lives and health. The age of onset is more than 40 years old, more men than women. However, in recent years, the number of people under the age of 40 has a growing trend. 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.

Cause

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

(a) Nitrosamines and mycotoxins: Nearly 30 nitrosamines are known to induce animal tumors. Esophageal cancer induced by rats such as benzyl nitrosamine, sarcosine nitrosamine, methyl valerate, nitrosamine and diethyl sulfinamide has been successfully used in China. China's investigation found that the content of nitrate, nitrite and secondary amine in food and drinking water in high-incidence areas increased significantly, and was positively correlated with the prevalence of esophageal cancer and esophageal epithelial hyperplasia. These substances are easily synthesized in the stomach. Carcinogenic nitrosamines.

(B) esophageal injury, esophageal diseases and food stimulation: 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 in the general population. It is presumed that it is caused by long-term chronic inflammation, ulceration, or chronic irritation due to retention in the esophagus, and then the esophageal epithelial hyperplasia eventually leads to cancer. Epidemiological investigations have found that residents with high incidence of esophageal cancer have a habit of eating a very hot diet, drinking spirits, eating a lot of pepper, chewing betel nut or shredded tobacco. These chronic physicochemical stimulation of 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.

(3) Malnutrition and trace element deficiency: Insufficient intake of animal protein and vitamin A, B2, and C deficiency are common features of residents in high-level esophageal cancer. However, most of the malnourished high-incidence areas, esophageal cancer is not high, so this can not be a dominant factor.

(4) Genetic factors: The incidence of esophageal cancer often manifests in family aggregation. In the surveys of Shanxi, Shandong, Henan and other provinces in China, it was found that there were about 1/4 to 1/2 of those with positive family history. There is a high proportion of positive family history in the high-incidence area, with the highest paternal line and the second female line.

(5) Obesity factors: A study completed by the Queensland Medical Research Center in Australia showed that the incidence of esophageal cancer in obese people was six times higher than that in normal weight. (Gut published online October 11, 2007) Whiteman et al. conducted a population-based case-control study. The study included 367 patients with esophageal adenocarcinoma, 426 patients with adenocarcinoma at the gastric-esophageal junction, and 1,580 controls. The results of the study showed that the risk of individual esophageal adenocarcinoma increased with the increase of body mass index (BMI) (P < 0.001). Patients with a BMI >40 kg/m2 (OR=6.1) had the highest risk of esophageal adenocarcinoma compared with those with normal body weight (BMI 18.5-24.9 kg/m2). In addition, the risk of esophageal adenocarcinoma in male obese patients (OR=2.6) is higher than that in female obese patients (OR=1.4); the risk of obesity in age <50 years old (OR=7.5) is higher than that in obesity >50 years old (OR=2.2). Obese patients with frequent gastroesophageal reflux symptoms have a significantly higher risk (OR = 16.5) than those with asymptomatic obesity (OR = 2.2) or those with reflux symptoms without obesity (OR = 5.6). A similar association was observed in obese people with adenocarcinoma occurring at the gastric-esophageal junction, but the degree of association was small. The study suggests that obesity itself increases the risk of esophageal adenocarcinoma in individuals, especially for men. Obese people with frequent gastroesophageal reflux symptoms are more likely to have esophageal adenocarcinoma.

an examination

Related inspection

Tumor associated antigen tumor gene P53 antibody (P53-AB) endoscopy

First, the early manifestations of esophageal cancer have the following performance:

(1) Swallowing food has sluggishness, retention or slight stagnation: in the early stage, this symptom is extremely mild and does not hinder eating. It can be resolved by itself, but it can appear again after a few days. If it appears repeatedly and gradually increases, it should be highly Pay attention to it.

(2) Pain during swallowing: When swallowing water or eating, there is always a sense of pain in the back of the sternum. After swallowing, this feeling will gradually fade. The area of pain is sometimes quite blurred. About 40% of patients have varying degrees of pain.

(3) Foreign body sensation in the esophagus: I usually feel that there are residual rice grains and vegetable scraps attached to the esophageal wall. About 10% of patients have this symptom early, due to swelling of the esophageal mucosal wall, local congestion, epithelial thickening or roughness.

In addition to the above three main symptoms, early esophageal cancer may also have subtle pain under the xiphoid, dull pain, swell after the sternum, conscious "stomach" discomfort, pharyngeal pain, etc. These symptoms are far less common than the first three types of symptoms. .

Second, the late symptoms of esophageal cancer:

1. Difficulty in swallowing: Progressive swallowing difficulty is the main symptom of most patients, but it is a more advanced manifestation of this disease.

2. Food reaction: often occurs when the difficulty of swallowing is aggravated. The reverse flow is not large. It contains food and mucus, and may also contain blood and pus.

3. Other symptoms: When the cancer compresses the recurrent laryngeal nerve, it can cause hoarseness; invading the phrenic nerve can cause hiccups or paralysis of the phrenic nerve; compression of the trachea or bronchus can cause shortness of breath and dry cough; erosion of the aorta can produce fatal bleeding.

Differential diagnosis

Differential diagnosis of esophageal space-forming masses:

(1) Esophageal achalasia

Patients are more common in young women, with a longer course of illness and lighter and heavier 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.

(B) 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 the disease is longer, and the difficulty in swallowing develops to a certain extent and is no longer aggravated. After detailed medical history and X-ray barium meal examination can be identified.

(C) esophageal benign tumors

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 round, oval or lobulated filling defects, the edges are neat, and the surrounding mucosa is normal.

(4) globule disease

More common in young women, when there is a pharyngeal ball-like foreign body sensation, disappearing when eating, often induced by mental factors. There is actually no organic esophageal lesion in this disease, and it is not difficult to distinguish it from 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) Lesions around the esophagus

Such as mediastinal tumor, aortic aneurysm, goiter, heart enlargement and so on. In addition to the mediastinal tumor invading the esophagus, X-ray barium meal examination showed a smooth compression of the esophagus and normal mucosal lines.

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