Diagnosis and Differentiation of Terminal Esophageal Cancer

In the terminal stage of esophageal cancer, most malignant tumors have common terminal symptoms, such as cachexia, dehydration, systemic failure and coma. Local symptoms include mediastinitis, lung abscess, pneumonia, fatal hemorrhage, dyspnea, etc. This disease often needs to be differentiated from the following diseases:

(1) Esophageal achalasia: Patients are mostly young women, with a long course of illness and symptoms that vary from mild to severe. Esophageal barium meal examination shows a smooth funnel-shaped stenosis at the lower end of the esophagus, which can be dilated by the use of spasmolytics.

(2) Benign esophageal stricture: It can be caused by scarring caused by accidental ingestion of corrosive agents, esophageal burns, foreign body injury, chronic ulcers, etc. The course of the disease is long, and dysphagia will not worsen after it develops to a certain extent. It can be identified by detailed medical history and X-ray barium meal examination.

(3) Benign esophageal tumors: mainly rare leiomyoma, with a long course of disease: dysphagia is often intermittent. X-ray barium meal examination can show round, oval or lobed filling defects in the esophagus with neat edges and normal surrounding mucosal patterns.

(4) Globus hysterica: It is more common in young women, with occasional sensation of a foreign body in the pharynx that disappears when eating. It is often induced by psychological factors. In fact, there is no organic esophageal lesion in this disease, and it is not difficult to distinguish it from esophageal cancer.

(5) Iron deficiency pseudomembranous esophagitis: mostly occurs in women. In addition to dysphagia, other symptoms include microcytic hypochromic anemia, glossitis, gastric acid deficiency, and onychomycosis.

(6) Lesions of organs around the esophagus: such as mediastinal tumors, aortic aneurysms, thyroid enlargement, heart enlargement, etc. Except for mediastinal tumors invading the esophagus, X-ray barium meal examination can show smooth pressure marks in the esophagus and normal mucosal patterns.