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Oesophageal cancer — MCCQE Part 1 MCQ

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HardSwallowing DifficultyOesophageal cancerMCCQE Part 1

A 64-year-old man presents with 4 months of progressive dysphagia, initially to solids and now to liquids. He has lost 8 kg and has a 40 pack-year smoking history. Physical examination is unremarkable. What is the most appropriate investigation?

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Correct answer: A — Urgent upper endoscopy with biopsy

Progressive dysphagia from solids to liquids with weight loss is an alarm presentation for oesophageal malignancy, requiring urgent endoscopy and biopsy. A proton pump inhibitor trial is inappropriate when cancer features are present. Barium swallow may help in selected cases, but it cannot provide tissue diagnosis.

Reference: Canadian Association of Gastroenterology guidance; MCC Objectives—Dysphagia