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


  • 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)