clinical features
Last reviewed 06/2021
Progressive dysphagia and weight loss are the most frequently presented features of oesophageal carcinoma:
- progressive dysphagia is present in around 74% of patients
- the patient may recount a short history of progressive dysphagia, initially affecting solids only, but gradually affecting the swallowing of fluids
- the interruption of the passage of food may cause the individual to slowly alter the diet from solid to liquid nutrition; success with this approach may be at the expense of early medical self-referral
- dysphagia can be graded as follows
- grade 1 - able to swallow most foods
- grade 2 - able to swallow soft foods only
- grade 3 - able to swallow liquids only
- grade 4 - unable to swallow anything
- the level at which difficulty in swallowing is encountered may be identifiable by the patient
- a short history of dysphagia in an elderly male is almost certainly carcinoma of the oesophagus or the cardia of the stomach
- an infrequent presentation is of the obstruction of a large bolus of food with no prior history of dysphagia
- dysphagia is usually associated with vomiting of undigested food (1,2,3)
Other presentations include:
- pain on swallowing food and liquids - odynophagia
- classically, retrosternally and in the interscapular region
- gastrointestinal bleeding
- non specific dyspeptic symptoms
- anorexia
- late symptoms
- hoarseness - due to involvement of the recurrent laryngeal nerve
- severe cough - linked with tumour fistula between the oesophagus and the respiratory tract
- signs of metastatic disease e.g. - ascites or palpable lymph node metastases
- oedema, due to a severe reduction in protein intake (1,2)
Secondary deposits occur in:
- lymph nodes
- in the liver causing jaundice
Note:
- an increasing number of asymptomatic oesophageal carcinoma patients are being recognised as part of screening and surveillance endoscopy
- typically, squamous cell carcinoma patients will have dysphagia associated with weight loss and a history of smoking and/or increased alcohol intake while patients with adenocarcinoma will be white males with a history of gastro-oesophageal reflux who had developed dysphagia (2,3)
Reference: