Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Complete obstruction, aspiration or fistula
Inability to swallow saliva, recurrent aspiration, airway compromise, sepsis, major bleeding or coughing immediately with swallowing can indicate complete malignant obstruction, aspiration pneumonia, perforation or tracheo-oesophageal fistula.
Action: Use ABCDE care, keep nil by mouth when aspiration or perforation is possible, give oxygen, suction, antibiotics and resuscitation as indicated and obtain urgent upper-GI, respiratory, radiology and oncology input for CT, endoscopic airway or oesophageal stenting, drainage, radiotherapy or feeding access without delaying physiological rescue.
Synopsis
Recognise progressive dysphagia early, obtain endoscopic histology, stage locoregional and distant disease accurately and coordinate endoscopic, surgical, chemoradiation, systemic, nutritional and symptom-directed treatment by histology and intent.
Progressive dysphagia and weight loss is oesophageal cancer until promptly investigated; urgent upper-GI endoscopy with multiple biopsies is the first diagnostic route.
Adenocarcinoma usually affects distal oesophagus or gastro-oesophageal junction and is associated with Barrett reflux and obesity; squamous cancer more often affects upper or mid oesophagus and tobacco–alcohol exposure.
The diagnostic reference standard is histology from endoscopic biopsy; repeat with deeper or image-guided sampling when visible or radiological suspicion remains despite non-diagnostic tissue.
Key red flags
Progressive dysphagia, especially solids followed by liquids, requires urgent upper-GI endoscopy and biopsy rather than empirical reflux treatment.
Advanced local invasion
Chest or back pain, hoarseness, stridor, cough on swallowing or haemoptysis suggests neural, airway or mediastinal extension.
Investigation priorities
01
First-line upper-GI endoscopy with biopsyFirst stepFirst line
Locate and characterise tumour, assess obstruction and obtain multiple tissue samples for definitive histology.
02
First-line contrast CT chest and abdomenFirst line
Assess local mediastinal relationships, regional nodes, liver, lung, adrenal and other distant disease and identify biopsy targets.
Management branches
DysphagiaObtain tissue before symptom-only treatment
An adult develops progressive dysphagia, food sticking, weight loss or another alarm upper-GI symptom.
Assess hydration, aspiration, ability to swallow saliva, bleeding and nutrition and arrange urgent endoscopy rather than a prolonged empirical acid-suppression trial.
Biopsy the lesion adequately and use targeted CT or ultrasound-guided sampling if endoscopic tissue is non-diagnostic or a metastatic site is safer.
Key medicines
Perioperative FLOT for eligible adenocarcinomaA common 14-day specialist cycle gives docetaxel 50 mg/m², oxaliplatin 85 mg/m² and leucovorin 200 mg/m² intravenously on day 1 followed by fluorouracil 2,600 mg/m² over 24 hours, usually four cycles before and four after surgery.
Weekly carboplatin and paclitaxel with radiotherapyA common neoadjuvant chemoradiation protocol gives carboplatin AUC 2 and paclitaxel 50 mg/m² intravenously once weekly for 5 weeks during 41.4 Gy radiotherapy, with exact dates and fields set by the specialist protocol.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.