Answers
1) Barium swallowing
2) Findings
- Irregular narrowing of the esophagus
- Esophagus proximal to the stenosis is dilated while distal to the stenosis is collapsed
- Filling defect with shouldering effect
- There is no leaking of contrast.
- Gastroespohageal junction is normal
3) Barium meal should be taken at different view and different time to exclude normal peristalsis movement of the esophagus. Pathological finding is consistently present at the same anatomical location in all view.
4) Esophageal carcinoma
5) Differential diagnosis
- Achalasia
- Esophageal stricture
6) Further questions to ask
- Nature of the dysphagia (initially solid, later progress to fluid)
- History of regurgitation
- Constitutional symptoms
- Risk factor for esophageal ca.
- Upper GI Bleed
-Compression/ local metastesize symptoms like hoarseness of voice, stridor, persistent cough and epigastric or retrosternal pain.
- Symptoms of distant metastasize
7) Further investigation
- Full blood count to look for hemoglobin level
- Renal function test/ Liver function test (Electrolyte imbalance and nutritional status)
- OGDS for direct visualization and tissue biopsy
- CT scan of the brain, thorax and abdomen to look for sign of metastasis
- Tumor marker (CEA, CA 125, CA 19.9)
- Endoscopic ultrasound.