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)