Diagnosis
Dysphagia occurring in anyone over the age of 40 must be assumed to be secondary to carcinoma of the esophagus until proved otherwise. The diagnosis depends on biopsy of a suspicious lesion or more rarely on cytological examination. An esophagogram, preferably a double-contrast study, is the first step in the evaluation of a patient suspected of having an esophageal carcinoma. If a suspicious area is noted, fiberoptic esophagos-copy is then carried out in order to obtain a number of biopsy specimens from deep within the abnormal area, sometimes supplemented by brush cytology specimens. The distinction between a tumor and a benign stricture can be very difficult to make on radiographic grounds alone, so that esophagoscopy should be carried out in most cases.CT of the chest is very useful in delineating the extent of the tumor and its mediastinal spread, as part of staging. Ultrasound or isotopic scans of the liver are indicated as well as part of staging if the diagnosis has been established. Early results suggest that gallium-67 is picked up by some tumors and their metastases and may prove useful in staging.