Treatment and Rehabilitation of Esophageal Cancer

Treatment and Rehabilitation of Esophageal Cancer:

Treatment and Rehabilitation of Esophageal Cancer
Treatment and Rehabilitation of Esophageal Cancer

The treatment for early-stage esophageal cancer mainly involves surgery and radiation therapy. These two methods have a high treatment effectiveness and a high chance of cure. The 5-year survival rate for patients undergoing surgical treatment for early-stage cancer is 90% to 95%, and it is about 80% for those receiving radiation therapy. We have been performing surgical treatment for esophageal cancer for over 50 years, and the surgical techniques have significantly improved. The surgical resection rate has reached 80% to 90%, and the surgical mortality rate has decreased to 3% to 5%. The 5-year survival rate for early-to-mid-stage esophageal cancer after surgical treatment is 25% to 47%, and the 10-year survival rate is 19% to 24%. Generally, surgery is preferred for patients with suitable conditions and good physical health; radiation therapy is more commonly used for elderly patients who are unable to withstand surgery.

In recent years, comprehensive treatment has been adopted for some patients, which combines surgical treatment, radiation therapy, and chemotherapy in a planned and appropriate manner. This can improve the cure rate and enhance the quality of life for patients. For some late-stage esophageal cancer patients, stent placement or laser local treatment within the esophagus has been used to improve the patient’s eating condition.

The most important issue after treatment is dietary regulation. Patients should gradually transition from liquid diet to semiliquid diet, and then to soft food or regular diet. The food should be cooked more delicately and chopped into smaller pieces. Eat less at each meal and have more meals throughout the day. According to the patient’s physical condition, they can participate in some activities or labor.

Family members and surrounding people should show enthusiastic concern and care for the patient, do their best to help them adapt to their new life, and create a harmonious and respectful environment together. This includes showing respect to the elderly, assisting the weak, and maintaining a positive atmosphere within the family.

Adhering to the physician’s advice, it is crucial to have regular follow-up appointments at the hospital and undergo necessary examinations. Additional treatments should be administered based on the condition.

Esophageal Cancer Prevention:

(1) Improve drinking water quality and practice proper fertilization.

Nitrosamines and their precursors, nitrates, and nitrites mainly enter the body through diet. The highest levels of these substances are found in water from dry wells and ponds in high-risk areas, followed by river and shallow well water. Fresh spring water and deep well water contain the least amount. It is essential to gradually improve water supply facilities and water quality through rural sanitation infrastructure development, including the construction of water treatment plants. Promote rational fertilization and formula fertilization in farmland, avoiding excessive use of nitrate fertilizers, as excessive use can lead to water pollution.

(2) Ensure food safety and avoid consuming moldy or spoiled food.

Construct proper drying yards for crops to facilitate quick harvesting and storage facilities with ventilation, heat insulation, moisture prevention, and mold prevention. Strengthen food hygiene management, ensuring that stores have refrigerators for storing cooked food and do not sell expired products. Prevent food from becoming moldy during processing, distribution, and storage. Change dietary habits, avoiding consumption of moldy pickled vegetables and moldy or spoiled grains. Limit or avoid consumption of pickled meats, poultry, and fish. Promote the consumption of fresh food.

(3) Pay attention to balanced nutrition.

Consume more fresh vegetables and fruits, and have a balanced combination of meat, vegetables, coarse and fine grains. Supplement the diet with vitamins A, C, E, riboflavin, carotene, selenium, and other trace elements that may be lacking.

(4) Quit smoking and avoid alcohol consumption.

(5) Maintain good hygiene, especially by brushing teeth and rinsing the mouth daily, and paying attention to oral hygiene. Avoid eating habits such as consuming coarse, hard, hot, or fast food, and eating while squatting.

(6) In high-risk areas where conditions permit, conduct regular screening and early detection programs for esophageal cancer to facilitate early treatment.

(7) Early Detection and Treatment of Esophageal Cancer.

After 1995, the Chinese Academy of Medical Sciences Cancer Hospital conducted a census of individuals aged 40-65 in high-risk areas using endoscopy. A total of 22,285 people were examined. During the endoscopy, 1.2% iodine solution was used for esophageal mucosal staining. Multiple biopsy samples were taken from the unstained areas (positive areas) after staining. Patients with squamous cell hyperplasia, carcinoma in situ, mucosal cancer, submucosal invasive cancer, and advanced cancer were treated according to their conditions and lesions, such as traditional esophageal cancer resection surgery, endoscopic mucosal resection, and argon plasma coagulation (APC) therapy. Patients were followed up regularly after treatment.

Among this group of individuals, 742 cases of early esophageal squamous cell cancer were diagnosed by endoscopy and pathology, with an average age of 52.1 years. Early esophageal cancer can be divided into three types based on superficial mucosal changes:

  • Mucosal color change: red and white areas;
  • Mucosal thickening, transparency, and vascular structure changes;
  • Mucosal morphological changes, such as erosion (51.2%), plaques (33.9%), mucosal roughness (4.8%), and nodules (4.2%).

Among the 742 cases of esophageal superficial mucosal cancer, there were 172 cases of carcinoma in situ, 207 cases of mucosal cancer, 306 cases of submucosal invasive cancer, and 57 cases of severe atypical hyperplasia with canceration.

When the lesion is located in the superficial mucosal layer, has a diameter of 3cm, and involves less than half the circumference of the esophagus, endoscopic mucosal resection is performed to avoid the significant damage and pain caused by open chest esophageal resection surgery. In this group, 141 cases of endoscopic mucosal resection were performed, utilizing four different mucosal resection techniques: manual resection, suction-assisted resection through a sheath, suction-assisted ligation and resection through a sheath, and suction-assisted resection through a transparent cap. Based on the experience, it was concluded that the suction-assisted resection through a transparent cap yielded better results.

All patients underwent endoscopic follow-up examination four months after the surgery, and three cases of local recurrence were identified. The recurrent cases were treated with argon plasma coagulation therapy. Among the 141 cases, 22 cases reached a follow-up period of five years, resulting in a 100% five-year survival rate. On-site research found that severe and some moderate cases of atypical hyperplasia are precancerous lesions. By focusing on treating this group, the risk of cancer development in high-risk individuals can be effectively reduced, leading to a two-thirds decrease in the incidence of esophageal cancer.

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