How is esophageal cancer definitively diagnosed?

• A. Barium swallow
• B. Upper endoscopy with biopsy
• C. Chest X-ray
• D. Esophageal manometry

Answer: (B)

Definitive diagnosis of esophageal cancer requires histologic confirmation from tissue obtained directly from the lesion. Upper endoscopy lets you directly visualize the esophageal mucosa and identify suspicious areas, and it provides the opportunity to take targeted biopsies. Those tissue samples are examined by a pathologist to confirm cancer and determine its type (such as squamous cell or adenocarcinoma). Imaging tests like a barium swallow or chest X-ray can raise suspicion or show advanced disease but cannot prove malignancy, and esophageal manometry assesses motility rather than tissue pathology.