In a patient with a history of GERD and dysphagia, what is the recommended next step to evaluate for cancer?

In a patient with a history of GERD and dysphagia, what is the recommended next step to evaluate for cancer?

• A. Barium swallow study
• B. Endoscopy to rule out cancer
• C. Trial of proton pump inhibitor
• D. CT scan of chest

Answer: (B)

Dysphagia in someone with a history of GERD is a red-flag symptom that warrants direct visualization of the esophagus to rule out cancer. Endoscopy allows the doctor to see the esophageal lining and take tissue samples from any suspicious areas, providing a definitive diagnosis through histology. A barium swallow can outline a stricture or motility problem, but it won’t provide biopsies or a tissue diagnosis, and it can miss subtle or early cancers. Trying a proton pump inhibitor might help reflux symptoms, but it doesn’t diagnose cancer and can delay necessary evaluation. A CT scan of the chest is useful for staging once cancer is known or for evaluating other concerns, not for initial cancer detection.

Dysphagia in someone with a history of GERD is a red-flag symptom that warrants direct visualization of the esophagus to rule out cancer. Endoscopy allows the doctor to see the esophageal lining and take tissue samples from any suspicious areas, providing a definitive diagnosis through histology.

A barium swallow can outline a stricture or motility problem, but it won’t provide biopsies or a tissue diagnosis, and it can miss subtle or early cancers. Trying a proton pump inhibitor might help reflux symptoms, but it doesn’t diagnose cancer and can delay necessary evaluation. A CT scan of the chest is useful for staging once cancer is known or for evaluating other concerns, not for initial cancer detection.