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Supporting Healthcare Professionals in Early Diagnosis, Treatment Pathways, and Patient Care

Over 9,000 people are diagnosed with oesophageal cancer annually in the UK. Early diagnosis dramatically improves outcomes, from 5% to 70% five-year survival rates.

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  • Essential Resources

Supporting Healthcare Professionals in Early Diagnosis, Treatment Pathways, and Patient Care

Over 9,000 people are diagnosed with oesophageal cancer annually in the UK. Early diagnosis dramatically improves outcomes – from 5% to 70% five-year survival rates.

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The Clinical Challenge

“Gastric and oesophageal cancers are mostly diagnosed at a late stage when curative treatment might not be possible. There is a real need for early detection.” – Imperial College London research

The challenge is significant:

  • Less than 1/3 of patients diagnosed with early disease
  • 15% diagnosed after emergency admission have reduced treatment options
  • Long-term survival ~15% UK-wide

But evidence shows improvement is possible through systematic early detection strategies.

Reference Links:

Recognising the Early Signs

Research shows more than 80% of patients with gastro-oesophageal cancer report at least one red-flag symptom predictive of underlying cancer.

NICE Criteria for Urgent Investigation

Urgent direct access endoscopy (within 2 weeks) for:

  • New onset dysphagia (any age)
  • Weight loss + upper GI symptoms (aged 55+)
  • Upper abdominal mass consistent with stomach cancer

“All patients with new dysphagia, gastrointestinal bleeding, recurrent aspiration or emesis and weight loss and/or loss of appetite should undergo upper intestinal endoscopy” – ESMO Guidelines

Reference Links:

Evidence-Based Practice Standards

Current guidelines have evolved based on substantial new evidence. Key changes in NICE NG83 (2023 update) reflect improved understanding of optimal care pathways.

What the Evidence Shows:

  • Centralisation of services has reduced post-operative mortality
  • Specialist MDT approach improves outcomes
  • Early detection programs can significantly improve survival

 

Reference Links:

Barrett's Oesophagus Management

BSG guidelines recommend risk-stratified surveillance based on clinical and histopathological criteria rather than one-size-fits-all approaches.

Current Surveillance Intervals:

  • Non-dysplastic: Every 2 years
  • Low-grade dysplasia: 6 months, then annual if confirmed
  • High-grade dysplasia: MDT referral for ablation therapy

International Consensus:

  • Short-segment BE (<3cm) without dysplasia: Every 5 years
  • Long-segment BE (≥3cm) without dysplasia: Every 3 years
  • Indefinite dysplasia: Optimise PPI therapy, repeat in 3-6 months

Reference Links:

Treatment Pathways

NHS cancer network reorganisation has established specialist centres with improved outcomes:

  • Reduced variation in practice
  • Improved access to specialist care
  • Better coordination between centres

Multidisciplinary Team (MDT) Approach

NICE Recommendation: All patients with oesophago-gastric cancer should have access to an oesophago-gastric clinical nurse specialist through their MDT

Treatment Modalities Overview

Surgical Options:

  • Endoscopic mucosal resection or submucosal dissection for early disease
  • Oesophagectomy or oesophagogastrectomy for advanced localised disease

Non-surgical Treatments:

  • Chemotherapy before/after surgery or with radiotherapy
  • Immunotherapy and targeted drugs for advanced disease

Reference Links:

Patient Support Resources

NICE recommends providing patients with information in appropriate format to review in their own time after diagnosis discussions.

Available Resources:

  • Patient information leaflets
  • Treatment option explanations
  • Support group contact details
  • Nutritional guidance

Palliative Care Integration

For patients requiring palliative management, provide personalised information on:

  • Life expectancy discussions (if patient wishes)
  • Available treatments and access pathways
  • Dietary changes and specialist dietetic support
  • Sources of reliable public information

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Quality Improvement Metrics

Key Performance Indicators

National audit data shows:

  • 30-day post-operative mortality has fallen year-on-year
  • 3-year survival rates have improved from ~33% to current levels through service reorganisation

Current Survival Outcomes:

  • Current 3-year survival: ~50% stomach tumours, ~45% oesophageal tumours when suitable for curative treatment
  • 30-day post-operative mortality: 1.7% oesophageal, 1.1% stomach cancer
  • Early diagnosis (mucosal layer): >70% 5-year survival
  • Advanced disease with metastases: ~5-7% 5-year survival

Reference Links:

Key Warning Signs

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