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St George’s Hospital provides both diagnostic and specialist care for patients with cancers of the upper gastrointestinal tract and hepatobiliary organs (UGI and HPB), which includes the diagnoses of oesophageal, gastric, pancreatic and hepatobiliary and gastrointestinal neuroendocrine cancers.

What are the signs and symptoms

For oesophageal and gastric cancers, the symptoms are usually related to changes in swallowing (dysphagia), and reflux. Other symptoms can be vague and include weight loss, abdominal bloating or pain.

For hepatobiliary cancers, symptoms are often jaundice, or vague abdominal symptoms such as weight loss, abdominal bloating or pain.

Do I need any tests to confirm diagnosis?

Some of the key investigations for upper gastrointestinal and hepatobiliary cancers will involve scans and endoscopies.

At St George’s hospital, we are proud to have several tertiary specialties as part of our wider team. Our endoscopy unit has an international teaching reputation for upper GI endoscopy and is JAG Joint Advisory Group (JAG) accredited.

Our specialist endoscopy and specialist interventional radiology services include:
• an endoscopic ultrasound service which enables accurate staging of upper GI cancers as well as allowing further assessment and biopsy of pancreatic lesions.
• an endoscopic retrograde cholangiopancreatography (ERCP) service for endoscopic diagnosis and treatment of patients with pancreatic or hepatobiliary tumours which include bile duct stent insertion and direct visualisation of the bile duct (Spyglass).
• This team is also supported by a tertiary interventional radiology department who undertake percutaneous transhepatic cholangiography (PTC) for biliary drainage.

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 for patients with upper GI or hepatobiliary cancers include:
• Surgery
• Systemic therapy (which include chemotherapy, immunotherapy, or targeted therapy)
• Radiotherapy

Patients who are potentially suitable for radical therapy and/or surgery are identified by the UGI and HPB MDT. We have well-established referral pathways for these patients to the network specialist teams at The Royal Marsden Hospital for surgery for oesophageal and gastric cancers and King’s College Hospital for surgery for hepatobiliary and pancreatic carcinomas and neuroendocrine cancers.

We are also very proud to have our specialist liver department be awarded IQILS level 2 accreditation from the Royal College of Physicians recognising the superior quality of the liver services.

Our oncology department provide expert systemic cancer treatments and are actively involved in clinical research and the running of clinical trials for patients with oesophageal, gastric, pancreatic and hepatobiliary and gastrointestinal neuroendocrine cancers.

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

Systemic therapy is offered on site in the Trevor Howell Chemotherapy Day Unit which is part of our European Society of Medical Oncology (ESMO) accredited Oncology service. Systemic therapy is available in both a day case and inpatient setting, with all patients on systemic therapy having access to a 24-hour emergency oncology triage service to ensure our patients are always supported during treatment. Patients for neoadjuvant chemotherapy prior to radical resection will also receive this at St George’s after discussion at the appropriate specialist MDT.

St George’s partners with The Royal Marsden Hospital to provide radiotherapy treatment.

What happen if I do not get treatment?

Patient who may benefit from supportive and palliative care are identified and referred to the hospital support team or their local community team.

Is there anything I can do to help myself?

Patients with cancer of the upper gastrointestinal tract or hepatobiliary tract often require additional support from our wider team. This will include support from our dieticians. Macmillan Cancer Psychological Support (CaPS) Team, and physiotherapist. They will advise on how best to optimise a patient’s lifestyle whilst going through treatment and beyond.