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Upper gastrointestinal tract cancers

oesophageal cancer – Types
○ adenocarcinoma ( commonest now )
○ squamous cell cancer
○ undifferentiated cancers
○ rare types eg melanoma , lymphoma , sarcomas Over 8000 diagnosed /year in UK Men more likely to be affected Five year survival rate is ~ 15 %. Risk factors
○ male sex
○ low socioeconomic status
○ smoking
○ excessive alcohol
○ GORD
○ Barrett’s oesophagus
○ obesity
○ family hx of oesophageal , stomach , oral or pharyngeal cancer
○ high temp beverages and foods
○ low intake of fresh foods and vegetable Presentation can be variable- classical is dysphagia often with pain , acid reflux , loss of appetite and weight ( anaemia may occur )

dysphagia or
 aged 55 and over with weight loss
and any of the following
○ upper abdominal pain
○ reflux
○ dyspepsia- Offer urgent direct access upper GI endoscopy to be done within 2 weeks

People aged 55 or over –treatment-resistant dyspepsia or upper abdominal pain with low haemoglobin levels or raised platelet count with any of the following
○ nausea
○ vomiting
○ weight loss
○ reflux
○ dyspepsia
○ upper abdominal pain or
 nausea and vomiting with any of the following
○ weight loss
○ reflux
○ dyspepsia
○ upper abdominal pain
-Haematemesis Consider non-urgent direct access upper GI endoscopy

stomach cancer –Mostly adenocarcinomas Rare types can include
○ lymphoma
○ GIST – gastrointestinal stromal tumour
○ neuroendocrine tumour
○ leiomyosarcoma
○ squamous cell carcinoma Over 7000 diagnosed / year in UK GP likely to diagnose one stomach cancer every 3-5 yrs Incidence highest in eastern Asia , eastern Europe and S America Seen more in men ( twice as common ). Risk factors include
○ H Pylori infection
○ cigarette smoking
○ high alcohol intake
○ excess dietary salt
○ lack of refrigeration
○ inadequate fruit and vegetable intake
○ pernicious anaemia
○ family history Presentation can be vague and non-specific posing diagnostic challenge Symptoms overlap with oesophageal cancer- hence NICE guidance is very similar for both Five year survival rate is poor ~ 20 %

Upper abdominal mass consistent with stomach cancer-Consider a USC to be seen within 2 weeks.People aged 55 or over-treatment-resistant dyspepsia or upper abdominal pain with low haemoglobin levels or raised platelet count with any of the following
○ nausea
○ vomiting
○ weight loss
○ reflux
○ dyspepsia
○ upper abdominal pain or
 nausea and vomiting with any of the following
○ weight loss
○ reflux
○ dyspepsia
○ upper abdominal pain
-haematemesis -Consider non-urgent direct access upper GI endoscopy

dysphagia OR
 aged 55 and over with weight loss and any of the following
○ upper abdominal pain
○ reflux
○ dyspepsia-Offer-urgent direct access upper GI endoscopy to be done within 2 weeks

Gall bladder cancer – People with upper abdominal mass consistent with an enlarged gall bladder-Consider an urgent direct access 
ultrasound to be done within 2 weeks

liver cancer-People with an upper abdominal mass consistent with an 
enlarged liver-Consider an urgent direct access
 ultrasound to be done within 2 weeks

References
 The diagnosis and management of gastric cancer BMJ 2013 ;347:f6367 Cancer research UK website -https://www.cancerresearchuk.org CKS -gastrointestinal tract ( upper ) cancers -recognition and referral BMJ Best Practice – Stomach cancer and Oesophageal cancer Suspected cancer : recognition and referral NICE guideline NG 12 June 2015

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