OncologyTier 2Topic

Endoscopy in oncology

Role

Endoscopy (upper GI endoscopy, colonoscopy, bronchoscopy, cystoscopy) provides direct visualisation and tissue sampling of luminal organs - central to both diagnosing and locally staging many cancers
Screening colonoscopy programs have measurably reduced colorectal cancer incidence and mortality by detecting and removing precancerous adenomas before malignant transformation

Endoscopy allows direct visual assessment of tumour appearance/extent plus biopsy for histological diagnosis - the combination of visual and tissue information that imaging alone cannot provide
Endoscopic ultrasound (EUS) adds local depth-of-invasion (T-stage) and adjacent nodal assessment for luminal GI cancers (oesophageal, gastric, pancreatic, rectal) beyond what standard endoscopy can assess

Site-specific screening/surveillance programs exist where evidence supports benefit (colonoscopy for colorectal cancer in average and high-risk populations, endoscopic surveillance in Barrett's oesophagus)
Any suspicious lesion identified on endoscopy requires biopsy for tissue diagnosis before treatment planning - visual appearance alone is not sufficient for a cancer diagnosis

Endoscopy is also therapeutic in selected early cancers - endoscopic mucosal resection (EMR)/endoscopic submucosal dissection (ESD) can be curative for early, superficial lesions without lymph node involvement, avoiding more invasive surgery
Endoscopic therapy for early-stage disease is increasingly replacing surgery where the lesion is superficial and lymph node involvement risk is low, reflecting a broader shift toward less invasive, organ-preserving cancer treatment where oncologically appropriate

Colorectal cancer screening, Barrett's oesophagus surveillance, early gastric/oesophageal cancer, lung cancer (bronchoscopy)

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