How should esophageal cancer be treated in the middle and late stage?

Treatment of Intermediate Esophageal Cancer (Stage Ⅱ and Ⅲ)

The tumor invades the muscularis and adventitia, and regional lymph node metastasis may occur, with obvious dysphagia and progressive aggravation. Stage Ⅱ and Ⅲ patients may be surgically removed. Where T 1-T3

Even tumors with local lymph node metastasis (N 1) can be resected. Only T4 stage invaded by pericardium, pleura or diaphragm can be surgically removed. Stage T4 (involving the heart, great vessels, trachea or adjacent organs, including liver, pancreas, lung and spleen) is considered to be unresectable.

In stage II and III patients, cancer has infiltrated the muscularis and adventitia of esophagus and regional lymph node metastasis. It is best to synchronize chemoradiotherapy or chemotherapy (including interventional therapy) or radiotherapy before operation, and then operate two weeks later, and then chemotherapy about four weeks after operation. If there is residual cancer, according to the metal markers placed during the operation, set up field radiotherapy or concurrent radiotherapy and chemotherapy. Patients with well-differentiated cancer cells received postoperative chemotherapy for 4 ~ 6 cycles; Patients with low differentiation or regional lymph node metastasis or adhesion to surrounding organs were treated with chemotherapy for 4 ~ 6 cycles, immune reconstruction for 8 weeks and chemotherapy for 4 cycles. In the process of treatment, traditional Chinese medicine is always assisted to improve the sensitivity of chemotherapy and reduce toxicity. For patients who are unwilling or unable to tolerate surgery, radical radiotherapy and chemotherapy are the first choice.

Treatment of advanced esophageal cancer (stage IV)

Stage ⅳ esophageal cancer refers to patients with lymph nodes or distant organ metastasis outside the region, mainly palliative radiotherapy and chemotherapy. With the deepening of clinical research, some new treatment methods have been recognized, especially molecular targeted drugs have begun to establish their own position in tumor treatment.

First-line chemotherapy for stage ⅳ esophageal cancer is usually combined chemotherapy. However, due to the disease characteristics of stage ⅳ esophageal cancer, the failure rate of palliative first-line chemotherapy is high, which leads to the disease progress. Second-line chemotherapy schemes can be divided into simple chemotherapy or chemotherapy combined with molecular targeted drugs. At present, the only drug approved for targeted therapy of esophageal cancer in China is trastuzumab (Herceptin), which is used to treat esophageal adenocarcinoma amplified by HER2. Other targeted drugs for esophageal cancer that are expected to be approved for clinical use include nimotuzumab, gefitinib and bevacizumab.

Radiotherapy also plays an important role in the treatment of stage ⅳ esophageal cancer. Synchronous or sequential radiotherapy and chemotherapy can achieve better results than chemotherapy or radiotherapy alone. At present, concurrent chemoradiotherapy has been recommended by the National Comprehensive Cancer Network to treat patients with unresectable esophageal cancer.

In addition, other palliative therapies, such as esophageal stent implantation, water balloon dilatation, intracavitary brachytherapy, Nd laser ablation, photodynamic therapy and electrochemical therapy, can be used to relieve esophageal stenosis and swallowing obstruction. You can look at Yaming in the curtain.

Most patients with esophageal cancer will have cachexia characterized by emaciation, fatigue and anorexia in the late stage. Cachexia will weaken patients' response to radiotherapy and chemotherapy, which will lead to higher complications and mortality. Therefore, nutritional support should be started at the early stage of treatment. The commonly used nutritional support methods are nasal feeding and gastrostomy. Among them, nasal feeding, that is, feeding the stomach tube into the patient's stomach through the nasal cavity and directly dripping liquid diet or nutrition, is the first choice for short-term (< 1 month) enteral nutrition. Gastrojejunostomy is mostly suitable for patients who need nutritional support for a long time (> 1 month).