Esophageal cancer differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]Hadeel Maksoud M.D.[3]


Esophageal cancer must be differentiated from gastroesophageal reflux disease (GERD), Barrett's esophagus, esophageal achalasia, gastritis, gastric ulcer, and stomach cancer.

Differentiating Esophageal cancer from other Diseases

Approach to dysphasia

Oropharyngeal dysphagia
Esophageal dysphagia
Solids only
Solids and Liquids
Solids only
Solids and Liquids
❑Zenker's diverticulum
❑Myasthenia gravis
❑Connective tissue disorder
❑Myotonic dystrophy
❑Heart burn
Barium swallow
Mental status
❑Pill esophagitis
❑Caustic injury
Non progressive
❑Zenker's diverticulum
❑Plummer-Vinson syndrome
Chest pain and manometry
Barium swallow
Weight loss
Increase LES pressure
❑Esophageal cancer

Differentiating Esophageal cancer from other Diseases

Disease Signs and Symptoms Barium esophagogram Endoscopy Other imaging and laboratory findings Gold Standard
Dysphagia Weight loss Heartburn Other findings
Esophageal carcinoma Gradual progressive dysphasia to solid and liquid + ±
Case courtesy of Dr Bruno Di Muzio,, rID: 4232f
Plummer-Vinson syndrome Gradual non-progressive dysphagia to solids ± -
  • Glossitis
  • Koilonychia
  • Weakness
  • Pale color of the skin
  • Cold intolerance
  • Reduced resistance to infection
  • Altered behavior
  • Craving for for unusual items (such as ice or cold vegetables)
Barium esophagogram (Source: Case courtesy of Dr Hani Salam,, rID: 14029)
Triad of
Esophageal stricture Sudden onset and gradual progressive dysphasia to solids ± ±
  • Sacculations
  • Fixed transverse folds
  • Esophageal intramural pseudodiverticula   
Case courtesy of Dr Ahmed Abd Rabou,, rID: 23008
Diffuse esophageal spasm Sudden non-progressive dysphagia to solid and liquid + +
  • Nonperistaltic and nonpropulsive contractions
  • Corkscrew or rosary bead esophagus
Barium swallow appearance of DES
Source:By Nevit Dilmen [CC BY-SA 3.0 (
  • Inconclusive
Achalasia Gradual non-progressive dysphagia to solid and liquid ± -
  • "Bird's beak" or "rat tail" appearance
  • Dilated esophageal body
  • Air fluid level (absent peristalsis)
  • Absence of an intragastric air bubble
Case courtesy of Dr Mario Umana,, rID: 38071
  • Residual pressure of LES > 10 mmHg
  • Incomplete relaxation of the LES
  • Increased resting tone of LES
  • Aperistalsis
Systemic sclerosis Gradual progressive dysphasia to solid and liquid ± + Positive serology for
Zenker's diverticulum Gradual dysphasia to solid ± -
  • Outpouching of posterior pharyngeal wall
  • Exclude the presence of SCC
  • CT & MRI shows out-pouching over the posterior esophagus in the Killian's triangle
Stroke (Cerebral hemorrhage) Sudden progressive dysphasia to solid and liquid + ±
Motor disorders (Myasthenia gravis) Gradual progressive dysphasia to solid and liquid ±
  • Stasis in pharynx and pooling in pharyngeal recesses
  • Anti–acetylcholine receptor antibody test
GERD Sudden onset gradual progressive dysphasia to solid ± +
Esophageal web Gradual progressive dysphasia to solid and/or liquid - ±
  • Smooth membrane not encircling the whole lumen


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