What investigations are recommended for confirming a diagnosis of oesophageal cancer in primary care?

In primary care, the recommended investigation to confirm a diagnosis of oesophageal cancer is urgent direct access upper gastrointestinal endoscopy. This is indicated particularly for patients presenting with dysphagia or those aged 55 years and over with weight loss accompanied by upper abdominal pain, reflux, or dyspepsia. Endoscopy allows direct visualisation and biopsy of suspicious lesions, which is essential for histological confirmation of oesophageal cancer NICE NG36,NICE NG12,NICE CKS.

Non-urgent endoscopy may be considered in patients aged 55 and over with haematemesis or treatment-resistant dyspepsia, or with upper abdominal pain combined with low haemoglobin or raised platelet count and symptoms such as nausea, vomiting, weight loss, reflux, or dyspepsia. However, urgent referral is preferred when cancer is suspected based on symptoms NICE NG12,NICE CKS.

Imaging such as CT or PET-CT scans are not routinely performed in primary care for diagnosis but may be used in secondary care for staging and further assessment once cancer is confirmed. The initial diagnostic step remains endoscopy with biopsy NICE NG36,NICE NG231.

Symptom recognition in primary care is critical, as dysphagia and weight loss with upper gastrointestinal symptoms have the highest predictive value for oesophageal cancer, supporting the need for prompt endoscopic investigation. This is consistent with evidence from systematic reviews highlighting the diagnostic value of these symptoms in primary care settings Astin et al. 2015.