Which of the following statement(s) is/are correct concerning the diagnostic studies for esophageal carcinoma?

c.Bronchoscopy should be performed in all patients with carcinoma of the upper and middle thirds of the esophagus

e.Endoscopic ultrasound is a potentially sensitive examination for the staging of esophageal cancer

A barium swallow examination is the first study that should be obtained in a patient who complains of dysphagia. Tumors of the cervical esophagus are difficult to identify by barium swallow examination and carcinoma of the cardia may be confused with achalasia or esophageal spasm. Nevertheless, the barium swallow examination localizes obvious esophageal pathology in preparation for subsequent esophagoscopy and allows the endoscopist to predict the level at which the tumor is located and the area which requires the most careful examination. The chest and upper abdominal CT scan is now the standard radiographic technique for staging esophageal carcinoma. Esophageal wall thickness, regional adenopathy or pulmonary, liver, adrenal or distant nodal metastasis can be identified. Although CT is suggested to have a role in evaluating resectability of esophageal carcinoma, it is particularly limited in its ability to detect invasion of the gastric cardia or aortic invasion. Bone scan is not warranted unless the patient has specific complaints suggesting that bone metastases exists. Similarly, routine brain scans are not indicated as brain metastases from carcinoma of the esophagus are uncommon. Bronchoscopy should be performed in patients with carcinoma of the upper and middle thirds of the esophagus to exclude invasion of the posterior membranous trachea or mainstem bronchi, which precludes a safe esophagectomy. Endoscopic ultrasound is being used with increasing frequency as an adjunct to the standard radiologic and endoscopic assessment of esophageal disease. It offers the potential for more sensitive staging of esophageal carcinoma by detecting the depth of invasion and the presence of abnormal mediastinal adenopathy.