Esophageal cancer originates from the esophageal mucosal epithelium. In Asia, squamous cell carcinoma is the predominant histological subtype, and both its incidence and mortality rates remain high. Early symptoms are often subtle and nonspecific, resulting in most patients being diagnosed at an intermediate or advanced stage. However, with early endoscopic screening and comprehensive multidisciplinary treatment, the 5-year survival rate for patients with early-stage disease can exceed 80%.
·Long-term smoking and heavy alcohol consumption
·Frequent consumption of excessively hot, coarse, or pickled foods
·Deficiencies in vitamins and trace elements
·Chronic esophageal diseases, such as achalasia and gastroesophageal reflux disease
·Obesity and familial genetic predisposition
Metabolites derived from tobacco and alcohol directly damage the DNA of the esophageal mucosa, while the accumulation of carcinogens such as nitrosamines leads to mutations in tumor suppressor genes, including TP53. Chronic, long-standing inflammation further promotes epithelial dysplasia, which can ultimately progress to malignant transformation.
Early-stage disease may present only with retrosternal discomfort. The classic manifestation is progressive dysphagia, initially affecting solid foods and later progressing to difficulty swallowing liquids. This may be accompanied by acid reflux, chest pain, and weight loss. In advanced stages, patients may develop hoarseness, aspiration cough, and cervical lymphadenopathy.
· Surgery: Early-stage disease may present only with retrosternal discomfort. The classic manifestation is progressive dysphagia, initially affecting solid foods and later progressing to difficulty swallowing liquids. This may be accompanied by acid reflux, chest pain, and weight loss. In advanced stages, patients may develop hoarseness, aspiration cough, and cervical lymphadenopathy.
· Minimally invasive therapy:Endoscopic mucosal resection can completely remove early-stage lesions. In patients with advanced obstructive disease, self-expanding metal stents may be placed endoscopically to relieve dysphagia, while laser ablation or photodynamic therapy can be used for palliative tumor debulking.
· Chemoradiotherapy: Concurrent chemoradiotherapy is the standard treatment for locally advanced and unresectable lesions and may also be administered as neoadjuvant therapy before surgery or as adjuvant therapy after surgery.
· Targeted and immunotherapy: Targeted therapy is recommended for HER2-positive patients, and immune checkpoint inhibitors have been widely used as first-line and subsequent-line treatments for advanced disease, significantly improving survival outcomes.
· Other treatments: Nutritional support, psychological care, and pain management are implemented throughout the treatment process to improve quality of life.
Upper gastrointestinal endoscopy with biopsy is the gold standard for diagnosis, while endoscopic ultrasound is used to assess the depth of tumor invasion. CT and MRI are employed for disease staging. Regular detailed endoscopic screening is recommended for high-risk populations.
