Metastatic pathways of esophageal cancer

The metastatic pathways of esophageal cancer include:

(1) Lymph node metastasis: Lymph node metastasis of esophageal cancer, especially upper and middle esophageal cancer, is easy to metastasize to supraclavicular lymph nodes. Some patients do not have obvious dysphagia, but supraclavicular lymph nodes have already metastasized, which shows their importance. Therefore, when doctors contact patients, they always touch the supraclavicular area first. If there is swollen supraclavicular lymph nodes, at least it is not in the early stage. If pathology confirms that it is undifferentiated small cell carcinoma, chemotherapy should be the first choice, followed by radiotherapy. If the swollen lymph nodes disappear after chemotherapy, surgery can be performed to remove the primary lesion, and then additional radiotherapy including mediastinum and supraclavicular area can be performed after surgery. If pathology confirms that it is well-differentiated squamous cell carcinoma or adenocarcinoma, radiotherapy can be performed first in the lesion area, mediastinum and supraclavicular area. If the lesion is significantly reduced after radiotherapy, surgery can be performed to remove the primary lesion and surrounding lymph nodes and supraclavicular lymph nodes. If the supraclavicular lymph nodes are not obvious, radiotherapy can be performed instead of chemotherapy, because chemotherapy is not sensitive to well-differentiated squamous cell carcinoma and adenocarcinoma, but it is somewhat sensitive to radiotherapy.

(2) Metastasis to the lungs and pleura: The sides of the esophagus are covered by the pleura, and the front is the trachea, which is closely attached to the front wall of the esophagus. Especially for cancer in the middle esophagus, it is easy to invade the adjacent pleura, bronchi and hilum, or even lung tissue, while cancer in the upper esophagus is easy to invade the trachea. When invading the bronchus, it can cause coughing, which is characterized by irritation and often severe coughing without sputum. When invading the pleura, pleural effusion is easy to occur, and timely intrathoracic chemotherapy can help alleviate the condition. Advanced esophageal cancer can cause tracheoesophageal fistula due to invasion of the trachea, inducing pulmonary infection, so it should be treated first to prevent it. For metastatic lesions in the lungs, comprehensive treatment with chemotherapy as the main treatment should be given. For isolated small lesions, X-ray knife or gamma knife can be selected for treatment. If the above treatment can be combined with traditional Chinese medicine treatment, the effect will be better.

(3) Liver metastasis: Liver metastasis generally has no symptoms in the early stage and can only be detected by active examination or reexamination. This also shows the necessity of regular examination. In fact, liver metastasis is very important for esophageal cancer. It is reported that liver metastasis accounts for about 1/3 of esophageal cancer patients. A gratifying reality is that chemotherapy is more effective for esophageal cancer liver metastasis than for esophageal cancer primary lesions, so chemotherapy should be performed first: for isolated small lesions, ultrasound focused knife, radio frequency, microwave, helium-argon knife, etc. can be used according to the situation.

(4) Metastasis to other parts of the body: According to statistics, metastasis to organs such as bones, kidneys, adrenal glands, thyroid glands, omentum, pericardium, pancreas, stomach and small intestine has been reported, but the number is very small. Generally, chemotherapy and Chinese medicine are the main treatments. Doing a good job of treating esophageal cancer itself is the best way to prevent these metastases. For bone metastasis, local radiotherapy can also be used.