A 69 year old smoker has had increasing dysphagia when eating solid food

A 69 year old smoker has had increasing dysphagia when eating solid food which has been on going for the past 3 months. He has notice a drop of 8 kg in weight in the past few months. What SINGLE investigations is most likely to lead to a diagnosis?

A. Barium swallow
B. Chest X-ray
C. Computed tomography chest
D. Endoscopy and biopsy
E. Videofluoroscopy

The likely cause is oesophageal cancer where a malignant stricture or mass has resulted in difficulty in swallowing. An endoscopic biopsy is the definitive investigation. Oesophageal cancer Adenocarcinoma has now overtaken squamous cell carcinoma as the most common type of oesophageal cancer

Risk factors • Smoking → risk factor for both adenocarcinoma and squamous cell carcinoma, but associated with a much higher risk for squamous cell carcinoma than adenocarcinoma. • Alcohol • GORD • Barrett’s oesophagus → which is a precursor of adenocarcinoma • Achalasia → Chronic inflammation and stasis from any cause increase the risk of oesophageal squamous cell carcinoma

Very often in the stem, there would be a patient with a history of gastro-oesophageal reflux disease (GORD) or Barrett’s oesophagus. Sometimes, they would give a history of increasing dysphagia and weight loss.

Diagnosis • Upper GI endoscopy with brushings and biopsy of any lesion seen is the first line test • CT or MRI scan of the chest and upper abdomen is performed for staging purposes