Esophageal Cancer Differential Diagnoses

Updated: Apr 13, 2023
  • Author: Muhammad Masab, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Diagnostic Considerations

Esophageal lesions other than cancer that can cause dysphagia include the following:

Achalasia may be clinically indistinguishable from esophageal cancer. Patients present with a long history of regurgitation and slowly progressive dysphagia. Upper gastrointestinal imaging (eg, barium study) shows a typical "bird's beak" filling defect.

Caution is required to differentiate achalasia from  so-called pseudoachalasia, which can mimic this benign condition; it is crucial therefore to follow up with endoscopy for mucosal assessment and biopsy to rule out any malignant pathology. Esophagogastroduodenoscopy (EGD) has low sensitivity for the diagnosis of achalasia; results are often reported as normal in early achalasia. Esophageal manometry confirms the diagnosis by showing incomplete relaxation (increased resting pressure/tone) of the lower esophageal sphincter (LES)

Esophageal stricture is characterized by slowly progressive dysphagia and heartburn. EGD confirms the diagnosis.


Differential Diagnoses