MALIGNANT DYSPHAGIA

Difficulty in swallowing on attempted initiation of swallowing and can occur at any stage of the swallowing process. A symptom that is more common than appreciated and can be due to many causes. Carcinoma of the oesophagus/
cardia, for example, is the most common cause in the older age group for adults.

Clinical Presentation

  • There is progressive dysphagia with weight loss.
  • The presence of regurgitation suggests a cardia lesion.
  • Patients tend to be wasted in the late stages with associated dehydration.

Investigation

  • Barium swallow, oesophagoscopy and biopsy.
  • Staging with abdominal ultrasound, CT scan and other endoscopic techniques.

Management

  • Investigate the patient, including barium swallow and endoscopy if able at facility.
  • Initiate intubation or stenting.
  • Carry out surgical resection or,
  • Conduct curative surgery for early disease and palliative measures (including palliative surgery) for later disease.
  • Administer radiotherapy or chemotherapy.
  • Counsel the patient and relatives; it is important that they understand the prognosis of the disease from the onset.