食道癌

维基百科，自由的百科全书

本條目正在從其他語言的維基百科內容翻譯成中文。
歡迎您積極參與翻譯與修訂。

維基百科的內容不可視作醫療意見。任何健康問題應諮詢專業的醫護人員。

zh-tw:食道癌;zh-cn:食管癌 zh-tw:食道癌;zh-cn:食管癌（esophageal cancer），為食道肿瘤。食道的腫瘤長會導致吞嚥困難（disphagia），疼痛和不舒服，並需要靠活組織切片檢查做診斷。小的且沒有轉移的腫瘤可靠外科治療。而侵犯性強的腫瘤則須靠化學療法、放射線療法或合併使用治療。此病的預後要看病症不同的程度而定，但普遍來說都是極差的。^[1]

[编辑] 症候及症狀

吞嚥困難（Dysphagia）是大多數患者的第一個症狀，吞嚥疼痛也可能會發生。液體和軟性食物通常可接受，而較硬的固體食物（如麵包或肉類）就會困難許多。體重下降可能同時是營養不足合併癌症活動的一個表現。疼痛, often of a burning nature, may be severe and worsened by swallowing, and can be spasmodic in character.

The presence of the tumor may disrupt normal 蠕動 (the organised swallowing reflex), leading to 噁心 and 呕吐, 逆流 of food, 咳嗽 and an increased risk of 吸入型肺炎. The tumor surface may be fragile and 出血, causing 嘔血 (vomiting up blood). Compression of local structures occurs in advanced disease, leading to such problems as 上腔靜脈症候群. 廔管 may develop between the esophagus and the 氣管, increasing the pneumonia risk; this symptom is usually heralded by 咳嗽, 发热 or aspiration.^[1]

If the disease has 轉移 to elsewhere, this may lead to symptoms related to this: 肝臟 metastasis could cause 黄疸 and 腹水, 肺 metastasis could cause 呼吸困難, 胸膜積液, etc.

[编辑] 原因及風險因素

[编辑] 增加風險

許多風險因素和食道癌有相關性。^[1] 一些特定類型的食道癌和其風險因素如下：

年齡：大部分的病人都超過60歲，在美國平均年齡是67歲。^[1]
性別：男性居多。
吸煙、嚼食檳榔和重度飲酒會增加風險，兩個因素合併則危險大增。
吞食氢氧化钠或其他腐蝕性物質。
某些特殊食材，例如醃漬物裡的亚硝胺。
有過頭頸部癌症病史者，會增加第二次頭頸部區域的癌症，包含食道癌。
卜拉蒙-文生氏症候群（Plummer-Vinson syndrome）：併發貧血與食道蹼(webs)的一種症候群。
胼胝症（Tylosis）和侯威-伊凡斯症候群（Howel-Evans syndrome）：遺傳性的手掌與腳底皮膚增厚症候群。
因其他疾病而在縱膈腔採取過放射線療法。^[1]
兒童脂肪便症和原發性膽汁鬱積性肝硬化（PBC）和鱗狀細胞癌有關。
逆流性食道炎（GERD）和其長期性結果巴瑞特氏食道症（Barrett's esophagus）會慢性刺激其黏膜層增生。此因素和腺癌關係較大，而其他風險因子則普遍和鱗狀細胞癌較相關。^[2]

[编辑] 降低風險

服用阿斯匹林（Aspirin）或相關藥物（非類固醇抗發炎藥）者會降低罹患風險。^[3]
關於幽門螺桿菌對於食道腺瘤（adenocarcinoma）的關係還不是很被確定，但在基礎生理的研究上發現其對於食道癌有保護的機制。^[4]^[5] It is postulated that 幽門螺桿菌 prevents chronic 胃炎, which is a risk factor for 逆流性食道炎, which in turn is a risk factor for esophageal adenocarcinoma.^[6]
According to the 美國國家癌症中心(NCI), "diets high in cruciferous (cabbage, broccoli, cauliflower) and green and yellow vegetables and fruits are associated with a decreased risk of esophageal cancer."^[7]
Some scientific studies claim that various kinds of berries, particularly raspberries and black raspberries, have protective properties against cancer of the esophagus and other kinds of cancer.^[8]
According to one Italian study of "diet surveys completed by 5,500 Italians" — a study which has raised debates questioning its claims among cancer researchers cited in news reports about it — eating 比萨饼 more than once a week appears "to be a favorable indicator of risk for digestive tract neoplasms in this population."^[9]

[编辑] 診斷

Although an occlusive tumor may be suspected on a 鋇劑吞食 or 鋇餐造影, the diagnosis is best made with 食管胃十二指腸鏡 (EGD, 內視鏡); this involves the passing of a flexible tube down the esophagus and visualising the wall. 切片檢查 taken of suspicious lesions are then examined 组织学 for signs of malignancy.

Additional testing is usually performed to estimate the tumor stage. X射线断层成像 (CT) of the chest, abdomen and pelvis, can evaluate whether the cancer has spread to adjacent tissues or distant organs (especially 肝臟 and 淋巴結). The sensitivity of CT scan is limited by its ability to detect masses (e.g. enlarged lymph nodes or involved organs) generally larger than 1cm. 正子射出型電腦斷層攝影(FDG-PET) scan is also being used to estimate whether enlarged masses are metabolically active, indicating faster-growing cells that might be expected in cancer. Esophageal 內視鏡超音波 (EUS) can provide staging information regarding the level of tumor invasion, and possible spread to regional lymph nodes.

Most tumors of the esophagus are malignant. A very small proportion (under 10%) is 平滑肌瘤 (平滑肌肉瘤) or 胃腸道間質瘤 (GIST). Malignant tumors are generally 腺癌, 鱗狀細胞癌(SCC), and occasionally small-cell carcinomas. The latter share many properties with small-cell 肺癌, and are relatively sensitive to chemotherapy compared to the other types.

The location of the tumor is generally measured by the distance from the teeth. The esophagus (25 cm or 10 inches long) is commonly divided into three parts for purposes of determining the location. Adenocarcinomas tend to occur distally and squamous cell carcinomas proximally, but the converse may also be the case.

[编辑] 治療方法

[编辑] 一般治療方法

The treatment is determined by the cellular type of cancer (adenocarcinoma or squamous cell carcinoma vs other types), the stage of the disease, the general condition of the patient and other diseases present. On the whole, adequate 营养学 needs to be assured, and adequate dental care is vital.

If the patient cannot swallow at all, a 血管內支架 may be inserted to keep the esophagus patent; stents may also assist in occluding fistulas. A 安置胃管 may be necessary to continue feeding while treatment for the tumor is given, and some patients require a 胃造口術 (feeding hole in the skin that gives direct access to the stomach). The latter two are especially important if the patient tends to aspirate food or saliva into the airways, predisposing for 吸入性肺炎.

[编辑] 腫瘤治療

外科手術 is possible if the disease is localised, which is the case in 20-30% of all patients. If the tumor is larger but localised, chemotherapy and/or radiotherapy may occasionally shrink the tumor to the extent that it becomes "operable"; however, this combination of treatments (referred to as neoadjuvant chemoradiation) is still somewhat controversial in most medical circles. 食管切除术 is the removal of a segment of the esophagus; as this shortens the distance between the throat and the stomach, some other segment of the digestive tract (typically the 胃 or part of the 大肠) is placed in the chest cavity and interposed. If the tumor is metastatic, surgical resection is not considered worthwile, but palliative surgery may offer some benefit.

激光 therapy is the use of high-intensity light to destroy tumor cells; it affects only the treated area. This is typically done if the cancer cannot be removed by surgery. The relief of a blockage can help to reduce dysphagia and pain. 光動力療法 (PDT), a type of laser therapy, involves the use of drugs that are absorbed by cancer cells; when exposed to a special light, the drugs become active and destroy the cancer cells.

化學療法 depends on the tumor type, but tends to be 順鉑（順一雙氨雙氯鉑，cisplatin）-based (or 卡鉑（顺二氨環丁烷铂，carboplatin）或奧沙利鉑（雙胺類環己烷草酸鉑，oxaliplatin）) every three weeks with 5-氟尿嘧啶(5-FU) either continuously or every three weeks. In more recent studies, addition of 泛艾黴素（Epirubicin, ECF）was better than other comparable regimens in advanced nonresectable cancer.^[10] Chemotherapy may be given after surgery (adjuvant, i.e. to reduce risk of recurrence), before surgery (neoadjuvant) or if surgery is not possible; in this case, cisplatin and 5-FU are used. Ongoing trials compare various combinations of chemotherapy; the phase II/III REAL-2 trial - for example - compares four regimens containing 泛艾黴素10公絲 and either 順鉑 or 奧沙利鉑 and either continuously infused fluorouracil or 卡培他濱（氟嘧啶氨基硝酸鹽，capecitabine）.

放射線療法 is given before, during or after chemotherapy or surgery, and sometimes on its own to control symptoms. In patients with localised disease but contraindications to surgery, "radical radiotherapy" may be used with curative intent.

[编辑] 後續追蹤及預後

Patients are followed up frequently after a treatment regimen has been completed. Frequently, other treatments are necessary to improve symptoms and maximize nutrition.

Prognosis of esophageal cancer is fairly poor. Even in patients who undergo surgery with curative intent, the five year survival rate is only 25%, and prognosis is poorer in those who are not fit for surgery. Early emphasis on symptom control and 临终关怀 may improve the 生活品質.

[编辑] 流行病學

Esophageal cancer is a relatively rare form of cancer, but some world areas have a markedly higher incidence than others: 中国、印度及日本, as well as the 英国, appear to have a higher incidence, as well as the region around the 裡海.^[11]

Annual incidence is between 3-11 per 100,000 for males and 0.6-6 per 100,000 for females.^[11]

[编辑] 參考文獻

^ ^1.0 ^1.1 ^1.2 ^1.3 ^1.4 Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med 2003;349:2241-52. PMID 14657432.
↑ Lagergren J, Bergstrom R, Lindgren A, Nyren O. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 1999;340:825-31. PMID 10080844.
↑ Corley DA, Kerlikowske K, Verma R, Buffler P. Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 2003;124:47-56. PMID 12512029. See also NCI - "Esophageal Cancer (PDQ®): Prevention".
↑ Wong A, Fitzgerald RC. Epidemiologic risk factors for Barrett's esophagus and associated adenocarcinoma. Clin Gastroenterol Hepatol. 2005 Jan;3(1):1-10. PMID 15645398
↑ Ye W, Held M, Lagergren J, Engstrand L, Blot WJ, McLaughlin JK, Nyren O. Helicobacter pylori infection and gastric atrophy: risk of adenocarcinoma and squamous-cell carcinoma of the esophagus and adenocarcinoma of the gastric cardia. J Natl Cancer Inst. 2004 Mar 3;96(5):388-96. PMID 14996860
↑ Nakajima S, Hattori T. Oesophageal adenocarcinoma or gastric cancer with or without eradication of Helicobacter pylori infection in chronic atrophic gastritis patients: a hypothetical opinion from a systematic review. Aliment Pharmacol Ther. 2004 Jul;20 Suppl 1:54-61. PMID 15298606
↑ NCI Prevention: Dietary Factors, based on Chainani-Wu N. Diet and oral, pharyngeal, and esophageal cancer. Nutr Cancer 2002;44:104-26. PMID 12734057.
↑ See scientific studies cited by advocates of alternative natural foods cancer therapies, such as "Healing Fruits": Ellagic Acid" (Australia). For study conducted at the Comprehensive Cancer Center at the Ohio State University, see Abstract of article published by Tong Chen, Hyejeong Hwang, Miranda E. Rose, Ronald G. Nines, and Gary D. Stoner, "Epidemiology and Prevention: Chemopreventive Properties of Black Raspberries in N-Nitrosomethylbenzylamine-Induced Rat Esophageal Tumorigenesis: Down-regulation of Cyclooxygenase-2, Inducible Nitric Oxide Synthase, and c-Jun." Cancer Research 2006 Mar. 1; 66: 2853-59. Cf. online resources hosted by Oregon State University and sponsored by the Oregon berry industry; e.g., Berry Health Benefits Network and "How to Increase Your Health Vocabulary with Just One Bite" ("Natural Health Properties of Oregon Raspberries and Blackberries").
↑ Gallus S, Bosetti C, Negri E, Talamini R, Montella M, Conti E, Franceschi S, La Vecchia C. Does pizza protect against cancer? Int J Cancer 2003;107:283-4. PMID 12949808. Cited and qtd. by WebMD and BBC News.
↑ Ross P, Nicolson M, Cunningham D, Valle J, Seymour M, Harper P, Price T, Anderson H, Iveson T, Hickish T, Lofts F, Norman A. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol 2002;20:1996-2004. PMID 11956258.
^ ^11.0 ^11.1 Stewart BW, Kleihues P (editors). World cancer report. Lyon: IARC, 2003. ISBN 92-832-0411-5.

[编辑] 外部連結

来自“http://zh.wikipedia.org../../../%E9%A3%9F/%E9%81%93/%E7%99%8C/%E9%A3%9F%E9%81%93%E7%99%8C.html”

页面分类: 翻譯請求 | 消化系統疾病 | 癌症

食道癌