Table 4.

Recommended workup for a patient previously irradiated for lung cancer and presenting with late-onset dysphagia

Investigation	Findings
History and physical examination	• Symptoms of recurrent disease (weight loss, worsening respiratory status, hoarseness) • Evaluate oral cavity for thrush • Cervical or supraclavicular lymphadenopathy may be suggestive of disease recurrence • Respiratory examination can rule out aspiration pneumonia
Barium swallow	• Esophageal stricture • Impaired peristalsis is demonstrated by peristaltic waves above and below the irradiated segment of esophagus
CT chest/abdomen	• Mediastinal lymphadenopathy causing extrinsic esophageal compression • Characterization of stricture(s) (location, number, severity) • Fistulaa
Upper endoscopy	• Stricture • Ulceration • Fistulaa • Biopsy

Note:

^aBronchoscopy may be required if there is a concern regarding bronchoesophageal fistula.

Abbreviation: CT, computed tomography.