- My primary differential diagnosis is oesophageal carcinoma , most likely a squamous cell carcinoma because he presented with progressive dysphagia, weight loss, retrosternal pain as well as positive histories of alcohol intake, tobacco use and regular consumption of very hot soups and drinks. Definitive investigations would include an upper GI endoscopy and biopsy for a definitive diagnosis. Contrast-enhanced chest and abdominopelvic CT scans to help stage the disease and assess for resectability and baseline investigations including full blood counts, renal and liver function tests, viral markers, nutritional assessment. It would also be good to an endoscopic ultrasound to properly assess the T stage. as well as a PET-CT scan to stage the disease. In Nigeria where there is resource constraints and patients usually have to pay out of pocket, I would advise an upper GI endoscopy and biopsy but if its not available or patient can't afford it, a barium meal and follow through would help delineate the tumour and show its extent locally. Also ctscans to stage and check for resectabilitity. But if ctscans are not available or too expensive, maybe a chest x-ray and abdominopelvic ultrasound scan to check for metastases and then baseline investigations.
- The most likely histological diagnosis is oesophageal squamous cell carcinoma. This is supported by his long standing tobacco use, chronic alcohol consumption and regular consumption of hot teas and soups. adenocarcinoma of the oesophagus is usually associated with GERD, Barrets oesophagus, and obesity. If the primary tumour was located within the gastrooesophageal junction, its risk factors would be similar to that of an oesophageal adenocarcinoma.