Diagnosis method of esophageal cancer

For patients with dysphagia, especially those over 40 years old, unless it has been confirmed to be a benign lesion, they should be examined multiple times and re-examined regularly to avoid missed diagnosis and misdiagnosis. The main examination methods are:

1. Barium swallow X-ray of the esophagus Barium swallow X-ray of the esophagus is one of the most important methods for diagnosing esophageal cancer. Early X-ray signs include: ① thickening, tortuosity or dotted interruption of mucosal folds, or hair on the edge of the esophagus; ② small filling defects, or flat or polyp-like; ③ small ulcer niches; ④ localized tube wall stiffness or barium retention. X-ray barium meal examination of the esophagus in the middle and late stages can show that the barium is stagnant at the cancer site, and the barium flow in the lesion segment is narrow; the esophageal wall is stiff, the peristalsis is weakened, the mucosal pattern becomes thick and disordered, and the edge is rough; the esophageal cavity is narrow and irregular, the upper segment of the obstruction is slightly dilated, and there may be changes such as ulcer niches and filling defects.

2. Esophageal cytology test The esophageal cytology test, which was first used in my country, can achieve a positive rate of 90%-95% for early lesions. In addition to being able to make a clear diagnosis, the segmented cytology test can also be used for positioning. It is a simple and easy method for screening and diagnosis.

3. Fiber esophagogastroscopy can directly observe the lesions of the esophageal mucosa, and can make a clear diagnosis through brushing and biopsy. The diagnosis rate for mid- and late-stage esophageal cancer can reach 100%, and the diagnosis of early esophageal cancer is also significantly superior to X-ray examination. Patients suspected of early esophageal cancer by X-ray examination should undergo this examination routinely. The patient suffers less pain during the examination, and even patients with poor physical fitness can tolerate it. The wide application of this examination has played an important role in the diagnosis of esophageal cancer. When early lesions are difficult to distinguish under endoscopy, 1%-2% toluidine blue or 3%-5% Lugol iodine solution can be used to stain the esophageal mucosa. The former will not stain the normal epithelium, but will stain the tumor tissue blue; the latter will stain the normal esophageal squamous epithelium brown-black, and the tumor tissue will not be stained by iodine but bright.

4. Computerized tomography (CT) CT can clearly show the relationship between the esophagus and the adjacent mediastinal organs. CT scanning is significantly superior to other diagnostic methods in showing the size of esophageal cancer lesions, the scope and extent of tumor invasion.

5. Esophageal endoscopic ultrasound (EUS) The endoscopic ultrasound system works by filling a water balloon. The advantages of this new inspection method are: ① It can accurately measure the depth of lesions infiltrating the esophageal wall with an accuracy rate of 90%. ② It can detect abnormally enlarged lymph nodes outside the wall, including lymph nodes far away from the lesion, with a display rate of 70%. ③ It can quickly and easily distinguish whether the lesion is inside the esophagus or outside the wall.

In addition to a clear diagnosis, clinical staging of esophageal cancer should also be performed. In 1976, Chinese scholars proposed a staging method based on indicators such as lesion length, lesion depth, lymph node metastasis, and organ metastasis at the National Esophageal Cancer Treatment Experience Conference held in Yangquan, Shanxi. In 1987, the International Union Against Cancer (UICC) staged esophageal cancer according to tumor size (T), lymph node metastasis (N), and the presence or absence of distant metastasis (M).