# Oesophageal Cancer - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD28.02 - condition scope only, no dose · NICE NG12: Suspected cancer: recognition and referral (recommendation 1.2.1) - https://www.ncbi.nlm.nih.gov/books/NBK555330/ · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care - Oesophageal Cancer - disease-level clinical article (oesophageal-cancer-clinical.txt) ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text OESOPHAGEAL CANCER Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class DD28.02 - condition scope only, no dose · NICE NG12: Suspected cancer: recognition and referral (recommendation 1.2.1) - https://www.ncbi.nlm.nih.gov/books/NBK555330/ · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against No dose - referral pathway, no medicine given in primary care, Oesophageal Cancer - disease-level clinical article (oesophageal- cancer-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (7) - Progressive difficulty swallowing solids that later includes liquids as the tumor narrows the lumen [difficulty swallowing] - Unplanned weight loss from reduced oral intake and the tumor's higher metabolic demand [weight loss] - Painful swallowing that patients find quite distressing [painful swallowing] - Chest discomfort when the tumor sits in the mid or lower esophagus [chest pain] - Hoarseness signals invasion of the recurrent laryngeal nerve and more advanced disease [hoarseness] - Adenocarcinoma of the lower oesophagus and of the junction with the stomach is rising, and Barrett oesophagus is why - Carcinomatosis produces ascites and abdominal pain first, then severe loss of appetite, a bowel that stops working, and partial or complete obstruction [abdominal pain · ascites · poor appetite] SIGNS - what you find (7) - Cachexia or visible malnutrition from significant weight loss [weight loss] - Tachycardia or pallor reflecting chronic blood loss anemia [anaemia · pallor · tachycardia] - Enlarged cervical or supraclavicular nodes suggesting metastatic spread [metastasis] - Hepatomegaly or a mass in the left upper quadrant pointing to liver spread or a large advanced tumor [hepatomegaly] - A weak or hoarse voice from vocal cord paralysis when the tumor involves the recurrent laryngeal nerve [hoarseness · vocal cord paralysis] - It spreads to the liver, the lungs, distant lymph nodes, bone and the peritoneum - Red flag: carcinomatosis reaches 10% to 15% of these adenocarcinomas, above all the diffuse or mixed types and the ones with signet-ring features TESTS (6) - Diagnosis is confirmed on biopsy taken at upper endoscopy - CT of the chest, abdomen and pelvis maps disease extent and possible metastases - Endoscopic ultrasound assesses depth of tumor invasion and samples suspicious nodes - PET scanning checks lymph node involvement and finds occult metastatic disease - Diagnostic laparoscopy looks for hidden peritoneal spread in advanced junctional or gastric tumors - Bloodwork commonly shows iron deficiency anemia from ongoing tumor blood loss IF NOT THIS - what else fits (8) - GERD produces similar heartburn and dysphagia; endoscopy with biopsy distinguishes it from cancer - Eosinophilic esophagitis causes similar dysphagia and chest pain; biopsy confirms it and excludes malignancy - Esophageal motility disorders such as achalasia cause similar dysphagia and chest pain; manometry with endoscopy tells them apart - Benign strictures from longstanding GERD, radiation, or caustic injury mimic the dysphagia and weight loss; biopsy on endoscopy separates them from cancer - Infectious esophagitis (viral, fungal, or bacterial) causes similar odynophagia and dysphagia; endoscopy with biopsy and microbiology pin down the cause - Esophageal tuberculosis is a rare mimic; biopsy with acid-fast staining and culture confirms it - Esophageal leiomyoma, a benign smooth-muscle tumor, can cause similar dysphagia and chest pain; EUS characterizes it and biopsy confirms it - Esophageal diverticula cause similar dysphagia, regurgitation, and halitosis; barium swallow and endoscopy rule out malignancy Source StatPearls "Esophageal Cancer" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Presents with progressive difficulty swallowing. GP recognises this red-flag symptom, supports nutrition and acid suppression, and refers urgently for endoscopy. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Presents with progressive difficulty swallowing. GP recognises this red-flag symptom, supports nutrition and acid suppression, and refers urgently for endoscopy. Caution RED FLAG - Hematemesis, melena, or profound iron deficiency anemia: assess urgently and refer. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. RED FLAG - Warning signs requiring prompt evaluation include odynophagia (painful swallowing) and weight loss in addition to dysphagia. RED FLAG - Progressive difficulty swallowing, solids first and then liquids. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)