Until recent times oesophageal cancer was most commonly due to a squamous cell carcinoma but the incidence of adenocarcinoma is rising rapidly.

Features

Key diagnostic factors:

*presence of risk factors - male, smoking, alcohol, GORD, Barrett’s

• dysphagia: the most common presenting symptom (worsening - solids first then liquids)
• Odynophagia
• anorexia and weight loss
• Short time frame of symptoms - cancer enlarges until large enough to suddenly cause symptoms (a structural blockage)

Other possible features include:  hoarseness, hiccups, cough

A late sign - referred otalgia

On examination - neck lymphadenopathy

Investigations

First line Ix:

• Upper GI endoscopy with biopsy for diagnosis
• Metabolic profile - (in advanced cases) - hypokalaemia, ⬆️ creatinine, ⬆️ serum urea/nitrogen

Others:

• CT TAP- Visualisation, Staging and mets