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Diagnosis

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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:


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