Endoscopic treatment of esophageal cancer

By | January 20, 2012

Of the esophagus (mostly associated with cardiac) high incidence of morbidity and mortality of their rank in the world, in our digestive system cancer in the highest rate of esophageal cancer 2 or 3, is threatening the life of our people One of the important disease, but the time of diagnosis and more radical surgery lost opportunities, or surgery, radiotherapy and chemotherapy after recurrence, the endoscopic treatment of esophageal cancer as esophageal remove the obstruction, to relieve symptoms and improve quality of life and prolong the life of an important measures.
(1) Microwave treatment: can be exposed through the endoscopic microwave antenna directly to the lesion, followed by poly burning from top to bottom, each point 1 – 3 seconds, so that all the white tumor, once a week, until all the tumor necrosis off, until the lumen patency, usually 2-4 times as a course of treatment. Major complications: chest pain, symptomatic treatment can disappear after a few patients may have bleeding and perforation.
(2) the treatment of esophageal endoscopic laser treatment: advancing from the proximal to the distal points of Graded treatment, 1 week, 38 weeks a course of treatment. The main complication: the laser penetration, prone to perforation.
(3) oxygen knife treatment: the gastroscope, the oxygen electrode into the tumor 0.5cm knife at the start burning treatment, week 1, 3 – 8 weeks for a course of treatment. Oxygen knife rare bleeding and perforation.
(4), photodynamic therapy (PDT): give patients intravenous injection of photosensitizer, static point after 24 hours, 48 hours, 72 hours a laser, each point of light 15 – 20 minutes, the exposure point should include the naked eye can see lesions on the lower end of the 1 -2 em "normal teaching film" fast one week after irradiation, the dark for 1 month. 1 week after treatment, symptoms can be significantly improved food obstruction, a month or so to return to normal. Major complications: a small number of patients with substernal burning pain and a small amount of light bleeding, a large number of individual consumption by patients after treatment the lesion appeared perforated, causing a tracheal esophageal thin, such as not pay attention to dark skin phototoxic reactions can occur. 1 week before PDT is best combined with chemotherapy, PDT should be performed 1 month after radiotherapy.
(5) electrochemical treatment: first in the X line by nasal or oral cancer will be placed in a proximal ring electrode, and then under the guidance of endoscopic placement of another cancer center of the electrode accurately, to be fully electrode and tumor tissue contact and fixed exit endoscopy, the electrode wire and apparatus connected to cancer, start power, usually every 10 days of treatment 1, 3 times for a course of treatment.
(6), endoscopic treatment of esophageal cancer local drug injection: At present, the use of 5 – FU and mitomycin C (MMC) for local chemotherapy injection. The specific method is the 5 – FU 500 mg + MMC 8 mg dissolved in 20 ml water for injection diluted after mixing with endoscopic injection needle under the guidance of the endoscopic intratumoral injection, according to tumor size points to do injections, generally every times can be injected around 10 points, each point of injection of 1-2, the 7-10 days of injection of a second consecutive injections 3 times. The main complication is a small number of patients after injection of a small amount of bleeding, per other adverse reactions.
(7) brachytherapy: intracavitary irradiation is a supplementary external irradiation, the use of installed capacity to do after high dose brachytherapy, 1 times / week, were done 2-3 times, the total radiation dose was 1000 – 5000cGy.
(8), esophagus, cardia stricture dilation: The main mechanism is the use of mechanical pressure to narrow the esophagus – responsible for the door to further expansion. Esophageal stricture dilation yellow door to use more Savary bougie and balloon expansion cone dilator, the current expansion of the majority of scholars using Savary bougie, and it includes 5,7,11,13,15 mm diameter bougie different thickness 6 root, together with guide wires. How the first thermal ablation therapy, and endoscopic biopsy holes will guide wire inserted into the antrum, body at the junction of the fixed guide wire exit endoscopy, under the guidance of the guide wire with a diameter of 9 mm before the Savary bougie expansion expansion 5 minutes, if patients have no discomfort reaction can be followed with 11,13,15 mm bougie expansion, each expansion time in about 10 minutes, if not ready to place the stent can be expanded bougie pulled together with the guide wire termination of treatment, every 7-10 days, the time necessary to conduct further expansion can be. The main complications of upper gastrointestinal bleeding, mostly small, symptomatic treatment can be improved by a small number of patients may have vomiting blood, black stools, must be actively processing; esophageal perforation is a serious complication, less frequent.
(9) in stenting: the situation can be selected according to the patients memory alloy stent, or stainless steel frame, with no film or stents, anti-reflux stents, radioactive particles in the length of different types of stents and other stents, or that may occur a thin tracheal esophageal stents must be selected on the lower esophageal and cardiac patients should use anti-reflux stent. How: First, do receive a meal or endoscopy to determine the extent and length of the lesion to determine stent size; then will guide wire in the endoscopy or X ray guidance to insert the antrum, body junction, and then with stent propulsion through the guide wire, the lesion slowly into the distal esophagus, the slow-eluting stent, and then use the self-expanding stent endoscopic observation of the situation. Antibiotics and hemostatic agent after 3 days, starting from the day can turn into liquid, semi-liquid, soft normal diet, 3 days after the return to normal diet, but the non-food cold, Mongolian food and excellent food. The main complication was infection, bleeding, stent obstruction and stent migration and food loss, some patients have transient chest pain and foreign body sensation, after symptomatic treatment can be gradually disappearing.
(10), endoscopic treatment of esophageal cancer combined therapy: for advanced esophageal and cardiac late to take a more comprehensive treatment approach, such as the combination of two or more methods.
Duplex treatment: can be taken to freeze or heat ablation treatment with the stent people, local injection of chemotherapeutic agents such as any combination of the two methods. A doctor on 300 patients with esophageal cancer treated by microwave + expansion, obstruction were relieved after treatment, the 1., 2,3 year survival rates were 66%, 22.7%, 11%; also a doctor with 127 patients with esophageal cancer Microwave and cavity injection with 5-FU and MMC chemotherapy alone compared to local injection, that the former significantly better than the latter; foreign scholars with esophageal stent expansion + in esophageal cancer, has also made significant effect.
triple therapy: a doctor on the progress of advanced esophageal, gastric cardia cancer by local injection of microwave + MMC + 5-FU and photodynamic therapy, the recent obstruction of 100% remission rate, long-term effects are good; abroad with stenting and radiotherapy + chemotherapy alone with stenting and 17 were 12 cases of treated patients compared to the former average survival 318 days, which average survival 157 days, of the three treatment at the same time that more single treatment effect. Using the particle (particles of radioactive particles + chemotherapy) treatment of esophageal stent, but also the desired effect.
a variety of sequential therapy: the extension of life of patients, can be used simultaneously or sequential treatment of a variety of methods: one using microscope hyperthermia (laser, microwave, oxygen
, knives, etc.), local injection of chemotherapeutic agents (5 … FU + MMC), photodynamic therapy, Savary bougie expanding stent. Second, according to type of endoscopic treatment of cancer eye on the above 5 ways to use different order, specifically: Grass umbrella / medullary, first with hyperthermia and local injection of 5-FU and MMC, to be mirror;5 -FUMMC;(luminal endoscopic or see that there is a very small chamber I saw), with the main first-line use of hyperthermia or frozen top-down style circumferential ablation, when the lumen and the mirror appears again when the body is basically given by photodynamic therapy, photodynamic therapy to be formed after the shedding of tumor necrosis film as there is still residual tumor after the uplift to be supplemented by hyperthermia / local injection of chemotherapeutic drugs / or arterial intervention. Third, immediately after the completion of the treatment Savary bougie used to further expand the lumen to 13 mm, immediately after stent placement item.

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