diagnosis
Last reviewed 06/2021
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)
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