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