Will esophageal cancer recur after resection?

Written by Luo Peng
Thoracic Surgery
Updated on September 14, 2024
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This depends on the actual situation and the specific postoperative pathology of the patient. Generally, a comprehensive examination is conducted before esophageal cancer surgery, and surgery is only performed if there is no metastasis and the patient's physical condition permits it. Therefore, postoperatively, if it is very early-stage esophageal cancer, the likelihood of recurrence is generally small. However, if it involves mid-to-late stages, the possibility of recurrence must be considered. However, essentially, all cases of esophageal cancer are prone to recurrence after resection.

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The difference between esophagitis and esophageal cancer

The differences between esophagitis and esophageal cancer are significant. Esophagitis is an inflammation and is benign, but esophageal cancer is malignant, marking a stark contrast between the two. However, both esophagitis and esophageal cancer can have similar clinical symptoms, such as acid reflux, hiccups, heartburn, pain behind the breastbone, discomfort, and a burning sensation behind the breastbone, so symptoms can be similar. However, a more typical symptom of esophageal cancer is a sensation of swallowing obstruction, since there is actually something in the esophagus. Inflammation, after all, is just that, and it does not involve a mass forming inside the esophagus that could block it, hindering the ability to drink water, eat food, or swallow.

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How is esophageal cancer staged?

The staging of esophageal cancer includes a preoperative clinical staging and a postoperative pathological staging. Clinical staging involves completing various systemic examinations, determining the extent of the tumor, whether there are lymph node metastases, and whether there are distant metastases to organs such as the liver and lungs. This requires thorough assessments, including esophageal endoscopic ultrasound and whole-body examinations like PET-CT, to conduct clinical staging. Postoperative pathological staging, on the other hand, is determined based on the depth of tumor invasion reached during surgery and the status of lymph node metastasis, among other factors.

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Early symptoms of esophageal cancer

The early symptoms of esophageal cancer are not very typical. In the early stages, there may be discomfort, a sensation of blockage, or burning and pinching feelings during swallowing. There might also be pain behind the breastbone. Other atypical gastrointestinal symptoms can include acid reflux, heartburn, belching, hiccups, and vomiting. However, as esophageal cancer progresses, the most typical symptom becomes difficulty swallowing, obstruction, and the sensation that swallowed items cannot pass down, including severe cases where even drinking water feels obstructed and leads to vomiting.

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What are the precancerous lesions of esophageal cancer?

The most common precancerous lesion of esophageal cancer is Barret's esophagus, which is formed by the chronic stimulation of the esophageal epithelium by chronic reflux esophagitis. Of course, this includes some chronic esophageal ulcers and long-term leukoplakia of the esophagus. These recurrent esophageal ulcers could potentially transform into atypical hyperplasia and then further into carcinoma in situ. However, the progression from precancerous lesions to actual cancer can take a very long time, possibly many years or even over a decade. Therefore, having a precancerous lesion does not necessarily lead to esophageal cancer.

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Written by Luo Peng
Thoracic Surgery
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Esophageal cancer screening methods

The screening methods for esophageal cancer primarily involve checks of the esophagus, including upper gastrointestinal barium meal and gastroscopy. Gastroscopy, in particular, is a relatively accurate method for examining patients. This is because during a gastroscopy, biopsy samples can be taken, and pathology can definitively determine whether cancer is present. There might be issues regarding whether a patient can undergo a gastroscopy as it requires significant patient tolerance. Therefore, depending on the patient's health condition, if a gastroscopy is not feasible, an upper gastrointestinal barium meal can be conducted first.