Key points for diagnosis of esophageal cancer

In the early stage of esophageal cancer, there may be a choking sensation when swallowing food, pain in the esophagus when swallowing, dull pain behind the sternum, discomfort and bloating, a foreign body sensation in the esophagus when swallowing, dryness and tightness in the throat, and a few patients may feel that food is slowly passing through and being retained. As the disease progresses, there may be symptoms such as progressive dysphagia and distension and pain in the chest and back.

Patients in the early stage may have no physical changes, while patients in the middle and late stages may have enlarged lymph nodes in the supraclavicular fossa and neck on both sides. When esophageal cancer is confined to the esophagus, there are often no positive physical signs during physical examination. In the late stage, there are cachexia symptoms, tracheal compression causing shortness of breath and dyspnea, and vocal cord paralysis and hoarseness when the recurrent laryngeal nerve is invaded. The supraclavicular area is the most common site of lymph node metastasis.

Barium swallow X-ray double contrast method is helpful to show mucosal structure and find small lesions of bulge or depression. In the early stage of esophageal cancer, it can be manifested as thickening of mucosal folds, rupture of folds, rigidity of tube wall, filling defect or niche shadow. In the late stage, it can be manifested as stenosis of tube cavity, obstruction of barium passage, soft tissue mass shadow, esophageal tracheal or bronchial fistula, etc.

The thickness of the esophageal wall is generally 3mm. When it exceeds 5mm, you should be alert to the occurrence of esophageal cancer. When CT finds that the lymph nodes are larger than 1cm, lymph node metastasis should be considered. When the fat gap between the esophagus and adjacent tissues and organs disappears, esophageal cancer invasion should be considered. Moss divided the CT examination of esophageal cancer into 4 stages:

(1) Stage I tumor is confined to the esophageal cavity, with esophageal wall thickness ≤ 5 mm;

(2) Stage II tumor site esophageal wall thickness >5 mm;

(3) Stage III tumors invade adjacent structures of the esophagus;

(4) Stage IV tumors have already metastasized to distant sites.