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St George’s provides both diagnostic and local care for patients with cancer of the upper gastrointestinal tract, which includes diagnoses of oesophageal, gastric, pancreatic and hepatobilliary and GI neuroendocrine cancers.

There is a seamless relationship with the St George’s endoscopy unit which has an international teaching reputation for upper GI endoscopy and is JAG (Joint Advisory Group) accredited. The department has an endoscopic ultrasound service which enables accurate staging of upper GI cancers as well as allowing further assessment and biopsy of pancreatic lesions. A team of therapeutic endoscopists support management of patients who are being treated with radical and palliative intent with oesophageal and duodenal stenting, and insertion of long-term feeding tubes.

We have a tertiary endoscopic retrograde cholangiopancreatography (ERCP) service for endoscopic diagnosis and treatment of pancreatic or hepatobillary tumours and stent insertion.

We also have tertiary interventional radiology department who undertake percutaneous transhepatic cholangiography (PTC) for bilary drainage not successful by ERCP and TACE (transcatheter arterial chemoembolisation) as locoregional treatment of hepatomas.

The Upper GI cancer team is a specialist team formed of representatives of every part of the service a lung cancer patient might interact with during their diagnosis and treatment. The team has excellent dietetic support with a nutritional team available for all inpatients and a dietician present in outpatient clinics.

Do I need any test to confirm diagnosis

Patients will undergo a combination of tests to determine a diagnosis, including:

  • CT scan
  • MRI scan
  • PET-CT scan
What treatment are available?

Dependant on the type and staging of the disease, treatment options for upper GI cancer will vary.

The main treatment options include:

  • Surgery
  • Chemotherapy
  • Radiotherapy

Patients who are potentially suitable for radical therapy and/or surgery are identified by the local MDT. We have well-established referral pathways for these patients to the network specialist team at The Royal Marsden Hospital for oesophageal cancers and King’s College Hospital and The Royal Marsden for hepatobilary and pancreatic carcinomas and neuroendocrine cancers where specialist surgery takes place. However, patients for neoadjuvant chemotherapy prior to radical resection will receive this at St George’s after discussion at the appropriate specialist MDT.

There is provision for emergency surgery and palliative bypass surgery on site at St George’s, which also has an out-of-hours gastrointestinal haemorrhage service.

Patients who are not suitable for radical therapy or surgery, because of advanced stage of disease, comorbidities or poor performance status, are treated at St George’s Hospital.

All palliative approaches are available including:

  • Chemotherapy
  • Stenting (either by endoscopic or radiological control)
  • Loco-regional treatments (RFA and TACE) for
  • Hepatocellular cancer
  • Endoscopic laser treatment
  • Palliative surgery
  • Specialist palliative care

Chemotherapy is offered on site in both a day case and inpatient setting. St George’s partners with The Royal Marsden Hospital to provide radiotherapy treatment.