Diagnosis, Results and Treatment

How oesophageal and stomach cancer are diagnosed

You usually start by seeing your GP and if cancer is suspected you will be referred to see a specialist or you may go directly for endoscopy (OGD).

Endoscopy

A doctor or specialist nurse will put a thin, flexible tube (endoscope) into your oesophagus, down into the stomach and through to the small bowel. There is a tiny light and camera on the end of the tube and this helps the endoscopist to see any abnormal areas. They may take a small sample (biopsy) to examine under the microscope and this can usually confirm if there is a cancer.

Further tests

If there is an abnormal area identified in the oesophagus or stomach, the endoscopist usually orders some further tests, even before the biopsy results are available. This is to ensure that if this is cancer, that all your investigations are completed as quickly as possible. Scans are used to confirm the cancer diagnosis and also to see if there has been spread to other parts of the body. You may have further tests even if no cancer was found and the biopsy results are unclear.

CT (computerised tomography) Scan

A CT scan takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan takes 10 to 30 minutes and is painless. You will be asked not to eat and drink for at least four hours before the scan.

You may be given a drink or injection of a dye, which allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let the staff in the CT department know if you are allergic to iodine or have asthma because you may have a more serious reaction to the injection.

PET-CT Scan – is usually only required for oesophageal cancer

This is a combination of a CT scan and a PET (positive emission tomography) scan. A PET scan uses low-dose radiation to measure the activity of cells in different parts of the body. PET-CT scans give more detailed information about the part of the body being scanned. The PET-CT scanners are in the Royal Victoria Hospital, Belfast and the Belfast City Hospital. You cannot eat for six hours before the scan, although you may be allowed to drink. A mild radioactive substance is injected into a vein, usually in your arm. The radiation dose is very small and the scan is done after an hour’s wait. It usually takes 30 to 90 minutes.

Extra investigations that are required will be organised as quickly as possible.

Results

Your endoscopy, biopsy, scans and investigations will be discussed at the Upper GI Cancer Multidisciplinary Team (MDT) meeting in the Northern Trust and also at the regional MDT meeting in the Belfast Trust. The MDT is a well-established group of specialists comprising of doctors, nurses, radiographers and other healthcare professionals who are specialists in oesophageal and stomach cancer.

The MDT will take into account a number of factors, when advising you of the best course of action, including your general health, the type and size of the tumour and whether it has spread to other parts of the body.

A member of the team will discuss your diagnosis with you and explain the decision from the MDT discussion.

Treatment

Oesophageal and stomach cancer can be treated in a number of ways, or with a combination of:

• Surgery
• Chemotherapy
• Radiotherapy

Each person is different and your treatment will be tailored to suit your needs. Your specialist team will tell you about the benefits, risks and side-effects of the treatment being offered to you. Your treatment will be discussed fully with you before proceeding.

All surgery, chemotherapy and radiotherapy for oesophageal and stomach cancers are provided in the Belfast City Hospital.

There are other treatments, for example the insertion of a stent and stretches of the oesophagus which can be offered in the Northern Trust.