What causes esophageal cancer?

The exact cause of esophageal cancer is still unknown. Obviously, the environment and certain carcinogens are important risk factors. Today we will talk about this in detail.

1. Esophageal injury, esophageal disease and food irritation

Esophageal injury and certain esophageal diseases can trigger esophageal cancer. The incidence of esophageal cancer is higher in patients with corrosive esophageal burns and stenosis, esophageal achalasia, esophageal diverticulum or reflux esophagitis than in the general population. It is speculated that it is due to long-term chronic inflammation, ulcers, or chronic irritation caused by retention in the esophagus, which leads to esophageal epithelial hyperplasia and finally cancer. Epidemiological surveys have found that residents in areas with a high incidence of esophageal cancer have the habit of eating very hot food, drinking strong alcohol, eating a lot of pepper, chewing betel nuts or tobacco. These chronic physical and chemical irritations of the esophageal mucosa can cause local epithelial cell hyperplasia. Animal experiments have shown that diffuse or focal epithelial hyperplasia may be a precancerous lesion of esophageal cancer.

(ii) Malnutrition and trace element deficiency

Insufficient intake of animal protein and deficiency of vitamins A, B2, and C are common characteristics of the diet of residents in areas with a high incidence of esophageal cancer. However, esophageal cancer is not common in most areas with a high incidence of malnutrition, so this cannot be a dominant factor.

3. Genetic factors

The incidence of esophageal cancer often shows a family clustering phenomenon. According to a survey in Shanxi, Shandong, Henan and other provinces in my country, about 1/4 to 1/2 of the patients have a positive family history. In high-incidence areas, the proportion of patients with a positive family history is high, with the highest proportion in the paternal line, the second highest in the maternal line, and the lowest in the collateral line.

(IV) Nitrosamines and mycotoxins

It is now known that nearly 30 types of nitrosamines can induce animal tumors. In China, nitrosamine methylbenzylamine, nitrosamine ethylsarcosine, nitrosamine methylpentylamine, nitrosamine and diethylhexylamine have been successfully used to induce esophageal cancer in rats. A survey in my country found that the content of nitrates, nitrites and secondary amines in food and drinking water in high-incidence areas has increased significantly, and is positively correlated with the incidence of esophageal cancer and severe esophageal epithelial hyperplasia. These substances are easy to synthesize carcinogenic nitrosamines in the stomach.

Pathological changes of esophageal cancer

The location of esophageal cancer lesions varies from region to region in my country, but the most common location is in the middle segment (52.69% to 63.33%), followed by the lower segment (24.95% to 38.92%), and the least common location is in the upper segment (2.80% to 14.0%). Among the 622 cases in our hospital, 68.90% were in the middle segment, 26.40% in the lower segment, and 4.70% in the upper segment.

1. Clinical pathological staging and classification

1. Clinical pathology staging The clinical pathology of esophageal cancer is of great significance for the selection of treatment plans and the evaluation of treatment effects. The clinical pathology staging standard was formulated at the National Esophageal Cancer Working Conference in 1976.

Stage Lesion length Lesion range Metastasis

0 Not limited to the mucosal layer No metastasis

1 < 3 cm invasion into the submucosal layer without metastasis

23-5 cm invasion of part of the muscular layer without metastasis

3>5cm invasion into the muscularis or outer layer of local lymph nodes

4>5cm with obvious invasion of distant lymph nodes or organ metastasis

2. Histological classification

(1) Adenocarcinoma: It is less common and can be divided into simple adenocarcinoma, adenosquamous carcinoma, mucoepidermoid carcinoma and adenoid cystic carcinoma.

(2) Squamous cell carcinoma: the most common.

(3) Undifferentiated carcinoma: less common, but highly malignant.

The vast majority of cancers in the upper and middle esophagus are squamous cell carcinomas, while cancers in the lower esophagus are mostly adenocarcinomas.

3. Pathological morphology classification

(1) Pathological morphological classification of early esophageal cancer: Early esophageal cancer can be divided into latent type, erosive type, plaque type and breast type according to its morphology.

(2) Pathological morphological classification of middle and late stage esophageal cancer: It can be divided into medullary type, fungus type, ulcerative type, stricture type, intracavitary type and indeterminate type. Among them, the medullary type has the highest degree of development. A small number of middle and late stage esophageal cancers cannot be classified into the above types and are called indeterminate types.

2. Spread and metastasis of esophageal cancer

1. Spread within the esophageal wall: The underlying cells of the adjacent epithelium of the esophageal cancer may become cancerous or carcinoma in situ, which is one of the surface spreads of cancer. Cancer cells often infiltrate the lymphatic vessels of the esophageal lamina propria or submucosal layer.

2. Direct infiltration of adjacent organs. Upper esophageal cancer can invade the larynx, trachea, and soft tissues of the neck, and even the bronchi, forming a bronchoesophageal fistula. It can also invade the thoracic duct, azygos vein, hilum, and lung tissue. Some can invade the aorta to form an esophageal-aortic fistula, causing massive bleeding and distant disease. Lower esophageal cancer can often involve the cardia and pericardium.

3. Lymph node metastasis is relatively common, accounting for about 2/3 of the cases. Middle esophageal cancer often metastasizes to the paraesophageal or hilar lymph nodes, and can also metastasize to the cervical, pericardial and left gastric artery lymph nodes. Lower esophageal cancer often metastasizes to the paraesophageal, pericardial, left gastric artery and abdominal lymph nodes, and occasionally to the upper mediastinum and cervical lymph nodes. The lymph node metastasis sites are the diaphragm, abdomen, trachea and paratrachea, hilar and parabronchial.

4. Hematogenous metastasis is more common in patients in the advanced stage. The most common metastases are to the liver (about 1/4) and lungs (about 1/5), and other organs are bones, kidneys, adrenal glands, pleura, omentum, pancreas, heart, lungs, thyroid gland and brain.

The above is some disease knowledge about esophageal cancer that we have prepared for you today. I hope it can be helpful to you. If you have any other needs, you can also consult our online consulting experts of Fuhe Health Network. We are always here to answer your questions. Fuhe Health Network is always by your side and cares about your health problems! Fuhe Health Network wishes you good health!

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