Which study establishes the diagnosis of esophageal carcinoma when biopsy is included?

• A. CT scan
• B. Chest X-ray
• C. Barium esophagram
• D. Endoscopy

Answer: (D)

Direct visualization of the esophagus with tissue sampling is the definitive way to diagnose esophageal carcinoma. Endoscopy lets you see mucosal abnormalities and obtain biopsies right from the lesion, providing histopathology that confirms cancer and identifies the histologic type. Imaging tests like CT scans, chest X-rays, and barium studies can show the location, extent, and complications of disease, and help with staging, but they do not establish a cancer diagnosis without a tissue sample. After diagnosis, further staging with imaging and procedures such as endoscopic ultrasound may be used to assess depth of invasion and nodal involvement.