Do you have symptoms worrisome for esophageal cancer and are wondering if a barium swallow test can rule out this horrible disease?

Symptoms of Esophageal Cancer

• Difficulty getting food down the “food pipe”

• A sensation of difficulty swallowing

• Food coming back up (regurgitation) soon after swallowing

• Pain or pressure in the chest with each swallow

• Chest pain at other times of the day

• A burning feeling in the chest

• Coughing

• Vomiting

• Black bowel movements

• Unexplained weight loss

• Unexplained fatigue

A barium swallow test is much easier than an upper endoscopy for the patient to tolerate.

If someone’s been having any of the above-mentioned symptoms and fears esophageal cancer, he or she may be wondering if a negative or normal barium swallow exam absolutely rules out this disease.

“Barium is a radiopaque material so that, like bones, X-ray do not penetrate it,” says Alex Little, MD, a thoracic surgeon with a special interest in esophageal and lung cancer.

“A barium swallow is an X-ray taken while a patient drinks a barium solution.

“If a cancer is present in the esophagus and is large enough, the X-ray shows an indentation in the column of barium called a filling defect.

“However, if the cancer is early in its development and small, it does not create a filling defect and would not be detected.

“Therefore, if there is clinical suspicion because of difficulty swallowing, if there is a possibility of Barrett’s esophagus (for example, in someone with newly diagnosed GERD), or if someone is being followed for known Barrett’s — then an endoscopic exam of the esophagus (esophagoscopy) is the only way to absolutely rule out esophageal cancer.

Upper endoscopy. Yuya Tamai, CC BY

“Of course, if the barium swallow shows a filling defect, an esophagoscopy is also necessary to confirm the suspicion with a biopsy, and search for and biopsy adjacent lymph nodes if cancer is found.”

Risk Factors for Esophageal Cancer Include Smoking, Chewing Tobacco, Heavy Drinking and Obesity

Yes, smokeless tobacco is a risk factor for esophageal cancer. Quit NOW.

Alex Little, MD, trained in general and thoracic surgery at the Johns Hopkins University School of Medicine; has been active in national thoracic surgical societies as a speaker and participant, and served as president of the American College of Chest Physicians. He’s the author of “Cracking Chests: How Thoracic Surgery Got from Rocks to Sticks,” available on Amazon.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


Top image: Normaler_Schluck-00.jpg (and others): Hellerhoffderivative work: Anka Friedrich/CC BY