Esophageal Cancer and Radiotherapy

I. Incidence

According to the 91st National Cancer Registry report of the National Health Service of the Executive Yuan, Department of Health of the Chinese People's Republic of China, the incidence of esophageal cancer in Chinese people is the ninth highest among men, and the death rate is the sixth highest among men. Ninth in the top ten cancers overall.

Common symptoms

Esophageal cancer is usually asymptomatic in the early stage, usually when the tumor gradually grows, and the esophageal transport function is blocked. At this time, the tumor is mostly large, and the treatment effect will be affected. Common symptoms are:

   Difficulty swallowing: This is the most common symptom of esophageal cancer. Patients may have difficulty swallowing hard food (such as dry bread, meat, raw vegetables, etc.), that is, they feel that the food is stuck behind the sternum. When the tumor gradually grows, the esophagus will gradually narrow. First, it is impossible to eat dry rice and noodles, and then it is difficult to swallow even the porridge. Finally, it is impossible to drink even milk or water.

   Weight loss: This is also one of the common symptoms. This is because the difficulty in swallowing makes it difficult for the patient to eat and causes weight loss.

   Cough: Because saliva secreted from the mouth can also accumulate in the esophagus above the tumor, saliva is sucked into the trachea and causes a cough. When the tumor continues to grow, causing a tracheal fistula, food will be sucked into the trachea directly from the esophagus, causing complications such as aspiration pneumonia.

   Others: hoarseness, chest pain, major bleeding, dyspnea, anemia, hemoptysis and other symptoms.

Third, the treatment

The treatment of cancer needs to determine the cancer stage, and then select the treatment method according to the stage. The main treatment methods are as follows:

   Surgical treatment: It is suitable for patients with early esophageal cancer and the tumor is located in the middle and lower esophagus. The tumor and nearby lymph are removed, and the remaining esophagus is reconnected to the stomach. The colon can sometimes be used to replace the resected esophagus. Ask your colorectal surgeon for details.

   Radiation therapy: It is suitable for patients with upper stage esophageal cancer or advanced esophageal cancer. Most esophageal cancers are already in the advanced stage at the time of discovery and cannot be surgically removed. The best local treatment at this time is radiation therapy. The following treatments are available for radiation treatment (please ask the radiation oncologist for details):

1. Preoperative radiotherapy: used before surgery, the main purpose is to shrink the tumor before surgery.

2. Adjuvant radiation therapy: used in surgery, pathological examination found lymph node metastasis, tumors penetrate the esophagus wall, and other high-risk patients, the main purpose is to prevent local recurrence of cancer.

3. Whole course radiotherapy: If there is a tumor with a large local invasion at the time of diagnosis, the condition is no longer suitable for effective surgical resection. At this time, radiotherapy has become the main treatment method.

4. Mitigating radiation therapy: used in patients with extensive metastasis, the purpose of treatment is to relieve symptoms, such as easing symptoms of dysphagia caused by primary tumor, reducing pain caused by bone metastasis, etc.

5. Proximity radiation therapy: Place the radiation directly on the tumor location for local irradiation.

   Chemotherapy: Chemotherapy can be given in conjunction with pre-, post- or radiotherapy to reduce the risk of distant metastases. Ask your hematologist for details.

4. Possible side effects and precautions of radiation therapy

   Acute side effects: usually appear in the third or fourth week of the course of treatment, including swallowing pain, sore throat, or a small amount of sputum, mainly due to the inflammation of the trachea and esophagus caused by the cumulative radiation dose, usually at the end of the course of treatment It will gradually ease over the next two to three weeks. Pay attention to the cooking of soft or liquid diet to reduce esophageal irritation, if necessary, you can use a variety of painkillers in a timely manner. Very few patients have side effects that are too severe to eat enough calories, and may temporarily require a nasogastric tube or gastrostomy to maintain adequate nutrition and recover smoothly.

   Subacute side effects: Between half a month and three months after the end of the course of treatment, a small number of patients will develop radiation pneumonia or radiation pericarditis. This must first exclude other infectious causes to determine the diagnosis. Treatment options include the use of small amounts of steroids to suppress the inflammatory response and sometimes the need to drain pericardial effusion.

   Late side effects: they begin to occur six months after the end of the course of treatment, including pulmonary fibrosis caused by radiation exposure, which reduces lung function; esophageal fibrosis causes esophageal stricture, which causes symptoms similar to dysphagia at the time of onset, and must be ruled out The possibility of cancer recurrence. Treatment options include dilation of the esophagus or placement of an artificial tube in a narrowed esophagus to dilate the esophagus.