Diagnosis

National Institute for Health and Clinical Excellence (NICE) guidelines recommend that patients presenting with symptoms suggestive of upper gastrointestinal cancer should be referred to a specialist unit. Urgent referral for endoscopy should be done in

• patients of any age presenting with dyspepsia associated with alarm symptoms - dysphagia, vomiting, anorexia, weight loss and symptoms associated with gastro-intestinal blood loss
• patients aged 55 or more with persistent, recent onset and unexplained dyspepsia (1)

Diagnostic evaluation of oesophageal carcinoma includes:

• upper gastrointestinal endoscopy
  • is the first line investigations in most patients
  • allows direct visualisation of the oesophageal mucosa and any lesions present
  • biopsies should be taken from all suspect areas.
  • combination of histology and cytology increases the diagnostic accuracy to more than 95%
  • can be used therapeutically to dilate, so improving nutrition before a definitive operative intervention
• Barium oesophagography
  • used as the initial investigations in some patients
  • characteristic image of an irregular stricture with shouldered margins, 4-10 cm long and often tortuous
  • a tracheo-oesophageal fistula may also be demonstrated
• other possible staging investigations include:
  • CT of the chest and abdomen - to exclude lung parenchyma or mediastinal involvement, to assess liver metastases or celiac, aortic, or retroperitoneal lymph node spread
  • endoscopic ultrasonography
  • F-fluorodeoxyglucose PET (FDG-PET)
  • bronchoscopy - for midoesophageal or upper-oesophageal lesions
  • liver function test (1,2,3)

Reference:

• (1) Rashid N et al. Current management of oesophageal cancer. BJMP 2015;8(1):a804
• (2) Pennathur A et al. Oesophageal carcinoma. Lancet. 2013;381(9864):400-12.