How to choose the method to diagnose esophageal cancer

There are many issues in diagnosing esophageal cancer because it involves the choice of treatment method. The patient's family can focus on the following questions with the doctor.

(1) Where is the cancer located in the esophagus: The esophagus can be divided into three sections: upper, middle and lower. Some sections can be divided into cervical, upper, middle and lower sections. So, where is the cancer located in the patient? Because different parts require different treatments. All of this can be clearly seen on the barium X-ray film: Although esophagoscopy cannot leave a film, the doctor can understand the upper and lower range of the lesion based on the scale marked on the esophagoscopy.

(2) Gross morphology of esophageal cancer: The gross morphology of esophageal cancer can be divided into the following types. ① Medullary type: The lesion area of ​​this type is often symmetrically narrowed: or eccentrically narrowed, with esophageal dilatation above the lesion: Patients of this type often have obvious dysphagia. This type accounts for about 60%. ② Fungus-shaped type: The lesion of this type often bulges into the esophageal cavity, and the upper and lower edges are arc-shaped, like a mushroom. Patients of this type often have mild dysphagia and are more sensitive to radiotherapy. ③ Stricture type: The lesions of esophageal cancer are mostly concentrically narrowed, with a stiff esophageal wall and obvious dilatation above the narrowing. ④ Ulcer type: On the esophageal X-ray, it can be seen that the edge of the lesion is irregular: there is an ulcer in the middle. Patients of this type often have no obvious dysphagia, but often have pain behind the sternum or in the back. Understanding the gross morphology of the lesion is important for choosing a treatment method.

The gross morphology of esophageal cancer is closely related to the early or late stage of the disease. For example, in the early stage of esophageal cancer, only local congestion or erosion is shown, while in the late stage, it is mostly medullary, fungus, ulcerative and stricture types.

(3) Pathological types of esophageal cancer: The above mentioned are the gross types, which are the classifications seen by the naked eye. The pathological types are the pathological cytological classifications seen under a microscope. Squamous cell carcinoma is the most common cytological type of esophageal cancer, accounting for about 90%, and mostly occurs in the middle and above parts; followed by adenocarcinoma: accounting for about 7%, mostly near the cardia; the rest are undifferentiated small cell carcinoma and carcinosarcoma. For squamous cell carcinoma and adenocarcinoma, there are also differences in high, medium and low differentiation. Squamous cell carcinoma is more sensitive to radiotherapy, especially poorly differentiated squamous cell carcinoma, which has considerable efficacy in radiotherapy and chemotherapy, and undifferentiated small cell carcinoma is even more so. Adenocarcinoma is relatively poor, and carcinosarcoma is more complicated to treat. Therefore, understanding the pathological type and degree of differentiation can be used as a reference for choosing a treatment method.

As discussed earlier, the degree of differentiation is closely related to metastasis: once the degree of differentiation is known, one can proactively explore the possible organ sites of metastasis and conduct corresponding examinations to verify.

(4) Stage of esophageal cancer: The essence of the stage is the extent of invasion of cancer lesions. There are many methods for staging. Doctors often use the TNM staging method because it is too complicated and there is no need to spend too much energy to study it. You can understand it in three stages: early, middle and late.

① Early stage: The lesion range of esophageal cancer is within 3 cm, and the depth only invades the submucosal layer, without any metastasis; ② Middle stage: The lesion size of esophageal cancer is 3 to 5 cm, and the range of lesion invasion is limited to the esophageal wall, and lymph node metastasis is limited to the vicinity of the lesion; ③ Late stage: The esophageal cancer lesion seen by esophagoscopy is more than 6 cm long, invading the surrounding tissues of the esophagus, and there is metastasis to distant organs or lymph nodes. The fundamental decision for treatment is staging.