What signs on barium esophagography suggest esophageal cancer?

In general, the radiographic findings suggestive of esophageal cancer on barium swallow studies primarily include mucosal abnormalities, luminal narrowing, filling defects, niche shadows, and esophageal wall rigidity. These signs reflect pathological changes in the esophageal mucosa and wall, providing important evidence for the diagnosis of esophageal cancer. A detailed analysis is as follows:

1. Mucosal Abnormalities: Normally, esophageal mucosal folds are smooth, continuous, and regular. Disruption, disarray, destruction, or disappearance of these folds may indicate esophageal cancer. Tumor invasion into the mucosal and submucosal layers disrupts normal mucosal architecture, resulting in uneven coating of barium.

2. Luminal Narrowing: The growth of an esophageal tumor occupies space within the lumen, leading to narrowing. On imaging, localized stenosis of the esophageal lumen is observed, typically with irregular shapes such as eccentric or circumferential narrowing. Barium passage through the narrowed segment slows down or may even be obstructed.

3. Filling Defects: When a tumor protrudes into the esophageal lumen, it prevents normal barium filling at the site of the lesion, creating a filling defect. On radiographs, this appears as an irregularly bordered low-density area within the esophageal lumen; the shape of the defect correlates with the size and growth pattern of the tumor.

4. Niche Shadow: Some esophageal cancers develop ulcers, and the ulcerated depressions can retain barium, forming a niche shadow on imaging. These niches are usually located within the esophageal wall, have irregular shapes, and exhibit uneven margins. Surrounding mucosal folds may converge toward the niche but often show interruption or destruction at the periphery.

5. Esophageal Wall Rigidity: Tumor invasion into the muscularis propria and adventitia causes loss of normal elasticity in the esophageal wall, making it rigid. On barium studies, markedly reduced or absent wall motion is observed at the affected segment. The esophageal wall fails to dilate normally during barium passage, appearing as a stiff, pipe-like structure.

Upon identification of these findings, further evaluation via endoscopy with tissue biopsy is required to confirm the diagnosis. Once diagnosed, treatment should be planned based on tumor staging and the patient's overall health status. Additionally, dietary modifications are recommended, including consumption of soft, easily digestible foods to minimize irritation to the esophagus.