Half of the world's esophageal cancer is in China, how to regulate the prevention and treatment?

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Guidelines for screening, early diagnosis and early treatment of esophageal cancer in China (2022, Beijing)

For more esophageal cancer guidelines, click here

1.

In China, esophageal cancer is mainly esophageal squamous cell carcinoma, with incidence rates of 26.

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2.

Specific dietary factors such as blanching diet, salted diet, spicy diet, fried diet, high-salt diet, moldy diet, hard diet, fast eating, and irregular diet are all risk factors for esophageal cancer

The results of a large-scale meta-analysis showed that the risk of esophageal cancer in those who smoked 1-9 cigarettes, 10-19 cigarettes and more than 20 cigarettes per day was 1.

Alcohol is also a major predisposing factor for esophageal cancer

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3.

Choking feeling when swallowing: In the early stage, mucosal congestion, swelling, and erosion will appear in the lesion site, and when food passes through, there will be a feeling of difficulty in swallowing

Foreign body sensation in the esophagus: It is similar to the feeling that rice grains are attached to the esophagus and cannot be swallowed, but the feeling has nothing to do with eating

Food retention: A self-perception that food is difficult to swallow and stay, even when drinking water, and disappears after eating

Throat dryness and tightness: Dryness and tightness are more noticeable when swallowing dry or rough foods

Retrosternal fullness and discomfort: The patient has chest discomfort and fullness, but cannot point out the location of discomfort, and it is difficult to describe the specific situation of the discomfort

Retrosternal pain: There is often slight pain behind the sternum when swallowing food, and the painful part can be felt, which can be burning pain, needle-like pain, pulling and friction-like pain

Subxiphoid pain: burning pain under the xiphoid, mostly when swallowing food

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4.
Screening high-risk groups The recommended starting age for esophageal cancer screening is 45 years old, and the screening should be terminated when the age is 75 years old or the life expectancy is less than 5 years
.
During screening, a new type of esophageal cell collector can be selected for primary screening of esophageal cancer and Barrett's esophagus.
The cell collector improved by Chinese scholars has a sensitivity of 90% and a specificity of 93.
7% in the community screening population
.

People at high risk of esophageal cancer should undergo endoscopy every 5 years
.
Patients with low-grade intraepithelial neoplasia should undergo endoscopy every 1 to 3 years
.
The choice of endoscopy is based on Lugol's solution chromoendoscopy or narrow-band imaging endoscopy, and ordinary white light endoscopy can be selected when conditions are insufficient
.
Patients should fast for more than 6 hours and water for more than 2 hours before endoscopic screening
.

5.
Treatment

early treatment

For patients with early-stage esophageal cancer who meet the indications for endoscopic resection, endoscopic submucosal dissection is the first choice
.

If endoscopic mucosal resection is performed, postoperative ablation is recommended
.

Endoscopic radiofrequency ablation can be used to treat esophageal squamous cell carcinoma confined to the lamina propria
.

For patients with stage T1b esophageal cancer whose depth of invasion reaches the submucosa, lymph node or vascular invasion, and poorly differentiated tumor, esophagectomy should be performed, and concurrent chemoradiotherapy can be performed for those who are inoperable
.

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advanced treatments

For patients with indications for surgery, surgery is the preferred treatment
.
Indications for surgery are: stage I, II and some stage III patients (except the cervical segment).
Neoadjuvant therapy is recommended for locally advanced stage
.
Salvage surgery for esophageal cancer is suitable for patients with local recurrence after radiotherapy and chemotherapy, no distant metastasis, resectable evaluation, and general conditions who can tolerate surgery
.

For inoperable patients, radical concurrent chemoradiotherapy can be selected
.
Some patients may regain the opportunity for surgery after chemoradiotherapy
.

EGFR-TKI targeted drugs, trastuzumab, and immunotherapy may have a certain effect on esophageal cancer, and related research is still under exploration
.

Reference 1.
He Jie, Chen Wanqing, Li Zhaoshen, et al.
Guidelines for screening, early diagnosis and early treatment of esophageal cancer in China (2022, Beijing) [J].
Chinese Journal of Oncology, 2022, 44(6): 491-522.
DOI: 10.
3760/cma.
j.
cn112152-20220517-00348.
2.
Chinese Medical Doctor Association Radiation Oncology Physicians Branch, Chinese Medical Association Radiation Oncology Branch, China Anti-Cancer Association Cancer Radiation Therapy Professional Committee.
Chinese Guidelines for Radiation Therapy of Esophageal Cancer (2021 2022) [J].
International Journal of Oncology, 2022, 49(1): 12-25.
DOI: 10.
3760/cma.
j.
cn371439-20211021-00002.