Upper GI cancers
Cancers of the oesophagus (food pipe) and stomach. They are often found late because early symptoms feel like ordinary acidity.
What are upper GI cancers?
The upper gastrointestinal (GI) tract carries food from your mouth to your small intestine. The two main cancers in this area are:
- Oesophageal cancer, in the food pipe that runs from the throat to the stomach
- Stomach cancer, also called gastric cancer
Warning signs
See a doctor if any of these last for more than two to three weeks:
- Difficulty swallowing, or a feeling that food is getting stuck
- Losing weight without trying
- Indigestion, burning or upper abdominal pain that does not settle with the usual medicines
- Feeling full after eating very little
- Vomiting, especially vomiting blood, or black, tar-like stools
- Tiredness caused by low haemoglobin (anaemia)
Most of the time these symptoms have a less serious cause, but they always need to be checked.
How it is diagnosed
- Endoscopy. A thin, flexible camera is passed through the mouth to look inside the food pipe and stomach. A small piece of tissue (a biopsy) is taken from anything abnormal.
- CT scan of the chest and abdomen, and sometimes a PET-CT scan, to check whether the cancer has spread.
- Endoscopic ultrasound for some patients, to measure how deep the tumour goes.
- Staging laparoscopy for some stomach cancers: a short keyhole procedure to check the lining of the abdomen before a major operation.
Treatment
Treatment depends on the stage of the cancer and on your general health. Surgeons, medical oncologists and radiation oncologists plan it together.
- Surgery removes the tumour together with the nearby lymph nodes. For the food pipe this operation is called an oesophagectomy. For the stomach it is a partial or total gastrectomy.
- Chemotherapy, with or without radiotherapy, is often given before surgery to shrink the cancer, and sometimes afterwards.
- Very early cancers can sometimes be removed through an endoscope, without an operation.
Keyhole and robotic surgery
Many oesophagus and stomach operations can be done through small cuts using laparoscopic (keyhole) or robotic surgery. For suitable patients this can mean less pain and a quicker recovery than open surgery. Dr. Suraga will explain whether it is right for you.
Recovery and life after surgery
- You start with liquids and move slowly to small, frequent meals.
- A dietitian helps you adjust what and how you eat.
- Regular follow-up visits and scans check that the cancer has not come back.
Common questions
Is long-standing acidity a sign of cancer?
Usually not. But acidity that starts for the first time after the age of 45, does not settle with medicines, or comes with weight loss, difficulty swallowing or vomiting should be checked with an endoscopy.
Can I eat normally after my stomach is removed?
Most people return to a varied diet. You will eat smaller meals more often, and a dietitian will guide you through the first few months. Some people need vitamin B12 injections and iron supplements long term.
Will I need chemotherapy as well as surgery?
Many patients do. Chemotherapy, sometimes with radiotherapy, is often given before the operation to shrink the cancer and after it to lower the chance of it coming back. Your treatment plan depends on the stage of the cancer.