Which of the following is a red flag indicating urgent evaluation for potential malignancy in dysphagia?

• A. Weight loss
• B. Intermittent dysphagia that improves with meals
• C. Nocturnal choking spells
• D. Feeling of fullness after meals

Answer: (A)

Weight loss signals a systemic problem such as cancer and is a red flag in dysphagia that prompts urgent investigation. If a patient is losing weight while experiencing swallowing difficulty, cancer could be narrowing the esophagus or at the gastroesophageal junction, requiring prompt endoscopy and imaging to diagnose early.

The other signs can be seen with non-malignant issues: dysphagia that comes and goes and improves with meals often points to motility problems or intermittent obstruction rather than a fixed tumor; nocturnal choking can relate to reflux or aspiration; fullness after meals can occur with benign gastric or obstructive processes. While these deserve evaluation, they are not as strongly indicative of malignancy as unexplained weight loss.