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Upper GI Cancer Service

Upper gastrointestinal Cancers (Upper GI)

The Upper GI Team is based at Russells Hall Hospital.

The MDT Lead Clinician is Dr Frost.

Clinical Nurse Specialists are Helen Knott and Sister Jenny O’Grady Ext 2443

The Multi-Disciplinary Team (MDT) takes place weekly on a Wednesday.

 

Upper Gastrointestinal Cancers

Upper gastrointestinal cancers include oesophageal cancer, stomach cancer, small bowel cancer, pancreatic cancer, liver cancer and cancers of the biliary system.

There are seven main types of gastrointestinal cancer: oesophageal cancer, stomach cancer, pancreatic cancer, duodenal cancer, gall bladder and bile duct cancer, liver cancer and small bowel cancer. Together they account for approximately 11% of the cancers in the UK.

Oesophageal Cancer

This can develop anywhere along the length of the oesophagus (gullet/’food pipe’). Two common types are adenocarcinoma of the oesophagus, and squamous cell carcinoma. These are named after the type of cells they originate from. 

Main symptoms of oesophageal cancer

There are many possible symptoms of oesophageal cancer, but they might be hard to spot, such as burping a lot.

They can affect your digestion, such as:

Other symptoms include:

  • a cough that is not getting better
  • a hoarse voice
  • loss of appetite or losing weight without trying to
  • feeling tired or having no energy
  • pain in your throat or the middle of your chest, especially when swallowing

If you have another condition, such as gastro-oesophageal reflux disease, you may get symptoms like these regularly.

If you have Oesophageal cancer and would like more information visit www.gutscharity.or.uk 

Barrett’s oesophagus

Barrett’s oesophagus is a medical condition where some of the cells in your oesophagus grow abnormally.

If you have Barrett’s oesophagus you are slightly more likely to get oesophageal cancer. But this is not common. It is sometimes called a pre-cancerous condition.

Barrett’s oesophagus often does not have any symptoms. But you may have symptoms of indigestion and heartburn. 

Stomach cancer

Most stomach cancers develop in cells lining the stomach. This type of cancer is called an adenocarcinoma of the stomach. This usually develops slowly. Other stomach cancers include gastrointestinal stromal tumours (GISTs) or neuroendocrine tumours (NETs). These are relatively rare and can occur anywhere in the gastrointestinal tract (digestive system). 

Main symptoms of stomach cancer

There are many possible symptoms of stomach cancer, but they might be hard to spot.

They can affect your digestion, such as:

Other symptoms include:

  • feeling tired or having no energy 

Pancreatic Cancer

The pancreas produces insulin and digestive enzymes. It sits below the stomach and has a duct which allows the enzymes which it produces to enter the duodenum (the first part of the small bowel). The pancreas is divided into head, neck, body and tail which all have different roles. Cancer can occur in any area.

Symptoms of Pancreatic Cancer

Pancreatic cancer may not have any symptoms, or they might be hard to spot.

Symptoms of pancreatic cancer can include:

  • the whites of your eyes or your skin turn yellow (jaundice), you may also have itchy skin, darker pee and paler poo than usual
  • loss of appetite or losing weight without trying to
  • feeling tired or having no energy
  • a high temperature, or feeling hot or shivery

Other symptoms can affect your digestion, such as:

  • feeling or being sick
  • diarrhoea or constipation, or other changes in your poo
  • pain at the top part of your tummy and your back, which may feel worse when you are eating or lying down and better when you lean forward
  • symptoms of indigestion, such as feeling bloated

If you have another condition like irritable bowel syndrome you may get symptoms like these regularly.

You might find you get used to them. But it’s important to be checked by a GP if your symptoms change, get worse, or do not feel normal for you.

For more information if you have been diagnosed with Pancreatic cancer visit www.pancreaticcancer.org.uk 

Duodenal cancer

The duodenum is the first part of the small intestine (bowel) below the stomach. Foods which have been mixed with stomach acid in the stomach are then released into the duodenum where they are mixed with bile (made in the liver and stored in the gall bladder) and with digestive juices from the pancreas. Duodenal cancer is relatively rare compared to stomach (gastric) cancer and colorectal cancer.

Biliary tract or gallbladder ( cholangiocarcinoma) cancer

This develops either in the gall bladder itself, or in the system of tubes which bring the bile (‘gall’) which the gallbladder stores, to the duodenum where it is used in the digestive process.

For more information if you have Cholangiocarcinoma visit www.ammf.uk 

Liver cancer

Primary liver cancer develops from liver cells that have become malignant. It is also possible to get secondary liver cancer, which is where cancers in other organs then spread (metastasise) to the liver. These are called by the name of the original (‘primary’) cancer – e.g. ‘pancreatic cancer metastases in the liver’.

Diagnosis

When we have received the referral from your GP, we will arrange for you to come to talk to us at a clinic appointment or to have any investigations which we feel may be helpful. These may be in the Endoscopy or Radiology Departments. You may also be asked to visit our Pathology Department to have a blood test taken. You will receive an appointment letter which will describe where to come, what investigations will be done and what treatment to expect, as well as any instructions you may need about preparation for the test.

After your investigations, the specialists involved in your case may feel it is appropriate to arrange for you to have further tests, or they may send an appointment for you to speak with them in our outpatient clinic. If there are no concerns about your symptoms and investigations, they will refer you back to your GP, who will continue with your care.

If tissue samples (biopsies) have been taken during your tests, these will be looked at in the lab and if there is anything of concern then your specialist may refer you to a cancer nurse specialist (CNS). Your CNS will support you through any further investigations and treatment if necessary. Unless you are told you have cancer, do not presume that you have cancer. Being referred to a CNS does not in itself mean that you have cancer.

If we do find that you have cancer, your situation will be discussed in one of the multi-disciplinary team (‘MDT’) meetings, where all the specialists who might need to be involved in your care will discuss the best possible treatment plan for you. This speeds up the process of starting any treatment which is necessary. You will be contacted soon after this meeting by one of our CNSs or other specialists, to discuss your results either over the telephone (if you have indicated that this is your preference) or in an outpatient clinic appointment. The possible treatment options will be discussed with you; this may include surgery, chemotherapy, radiotherapy, endoscopic intervention or a combination of these. Any possible side effects will be discussed with you so that you can have all the information you need in order to make the right decision for your treatment and care.

Investigations

Investigations for diagnosis, to rule out cancer or to identify how extensive any cancer progress is (‘staging’), can include:

X-ray

X-rays are similar to visible light, but they have a shorter wavelength and so can pass easily through soft tissues, but not so easily through bones. A beam of x-rays is sent through the area that we want to see an image of, to a receptor or ‘film’ on the other side. Where the x-rays are absorbed by a bone or other hard structure, the receptor image is left white, and where the x-rays pass through easily, the image goes dark. The end result is a back-and-white image picture of the area that has been x-rayed.

Barium swallow

A barium swallow involves swallowing a drink which contains barium, which coats the oesophagus, stomach and small intestine and shows up on x-ray. X-rays are then taken which show these areas.

CT/PET scan (Computerised Tomography/Positron Emission Tomography)

These scans use specialised x-ray equipment in the form of a doughnut-shaped scanner, to take multiple images of your body to build up a 3-D picture of your organs and surrounding structures. They can also identify the way in which organs are working through things such as blood flow, oxygen and glucose use etc. You may be asked to swallow a solution (radiotracer or contrast medium), or this may be injected. Contrast mediums help to create a clearer picture of structures, whereas radiotracers collect more in cancer cells because these use more energy than healthy cells. The machine then takes many images and records many measurements, which together are used to create a comprehensive view of the area being investigated. The radiation you are exposed to is a very low amount, and the radiation risk is very low, compared to the potential benefits. However, if you may be pregnant or are breastfeeding, you must inform us before the test is performed. Please also tell us if you are diabetic. 

MRI (Magnetic Resonance Imaging)

This is the test where you lie on a flat bed which moves in and out of a large tunnel. It uses a magnetic field and pulses of radio-wave energy, to create a detailed 3D image of internal body structures. It provides different information from a CT or PET scan, x-rays, ultrasound or endoscopy.

Ultrasound scan

A small device called an ultrasound probe is used, which gives off high-frequency sound waves which can’t be heard by the human ear. The probe is passed over the part of the body of interest and the sound waves reflect back from the different structures inside which are then turned into an image which is seen on a screen.

Endoscopy – gastroscopy

Endoscopy is a general term for when the inside of a part of the gastrointestinal system is viewed by use of a tiny camera on the end of a long, flexible tube (‘scope’). A gastroscopy is where the oesophagus (gullet), stomach and duodenum (first part of the small bowel) are viewed by passing an endoscope through the mouth and down the oesophagus.

Endoscopic ultrasound

This is where an ultrasound probe is passed down the inside of an endoscope during a gastroscopy or ERCP (see below) to create ultrasound pictures of the surrounding structures in the body. Because the ultrasound probe is inside the body, this creates clearer pictures in comparison to normal ultrasound scans.

ERCP (Endoscopic Retrograde Cholangiopancreatography)

This is an extended endoscopy under x-ray, where contrast medium is used to display a clear view of the bile duct and associated structures under x-ray. ERCPs can be diagnostic (to help with diagnosis) or therapeutic (to assist in treatment). The name is a description of what is being done:
Endoscopic: with an endoscope
Retrograde: this describes the angle the endoscopist needs to take
Cholangio: bile duct and associated structures
Pancreato: pancreas
Graphy: image creation
i.e. this is the creation of an image of the bile duct, pancreas and other nearby structures, by use of an endoscope.

PTC (Percutaneous Transhepatic Cholangiography)

This is where contrast medium is injected into the bile duct to be seen under x-ray, without the use of an endoscope. Percutaneous means ‘through the skin’ which is the way in which the injection is given. This allows us to look at the biliary tract when ERCP is not suitable or has been unsuccessful. Like with ERCP, therapeutic interventions can be done under PTC.

Treatment

Treatment for upper gastrointestinal cancers can include endoscopic intervention (where the problem is treated during an endoscopy), surgery, chemotherapy, radiotherapy or other medical intervention (e.g. taking tablets to slow the growth of a tumour) or any combination of the above.

Your treatment options will be considered at the multi-disciplinary team (MDT) meeting, where consultants from all the associated fields of medicine will combine their knowledge to produce the best possible treatment plan for you. We work closely with the teams in Wolverhampton and Birmingham hospitals to co-ordinate your treatment, which may be changed according to your own wishes or depending upon your response to any treatment so far. At every step, you can discuss your treatment with your cancer nurse specialist, your doctors or anyone else involved in your care- and if you have questions, you must ask.

Local support if you have an Upper GI Cancer

Our living with and Beyond Cancer (LWBC) team, based within the hospital, are there to support you with any physical, practical, emotional and spiritual concerns you may have. They can offer a listening ear, information and support as well as signposting to other services whether it be regarding financial concerns or counselling support.

Contact them on 01384 456111 ext 5315 or email dgft.lwbcteam@nhs.net

Or visit their web page on the trust website http://www.dgft.nhs.uk/services-and-wards/living-with-and-beyond-cancer-lwbc/