Upper Gastrointestinal (Upper GI) Cancer

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

What are the signs and symptoms?

The symptoms of oesophageal and gastric cancers 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 such as weight loss, bloating, or pain are often jaundiced or vague abdominal symptoms.

Do I need any tests to confirm the diagnosis?

Some essential investigations for upper gastrointestinal and hepatobiliary cancers will involve scans and endoscopies.

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

Our specialist endoscopy and specialist interventional radiology services include:

• an endoscopic ultrasound service enables accurate staging of upper GI cancers and 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 includes bile duct stent insertion and direct visualisation of the bile duct (Spyglass).

• This team is supported by a tertiary interventional radiology department that undertakes percutaneous transhepatic cholangiography (PTC) for biliary drainage.

What treatments are available?

Depending 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 Anti-Cancer Treatment, which includes 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 provides expert systemic anti-cancer treatments. It is actively involved in clinical research and clinical trials for patients with oesophageal, gastric, pancreatic, 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 Anti-Cancer Treatment (SACT) is offered on-site in the Trevor Howell Day Unit, which is part of our European Society of Medical Oncology (ESMO) accredited Oncology service. SACT is available in both a day case and inpatient setting. All patients on systemic therapy have access to a 24-hour emergency oncology triage service to ensure our patients are always supported during treatment. After discussion at the appropriate specialist MDT, patients for neoadjuvant chemotherapy before radical resection will also receive this at St George’s.

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

What happens if I do not get treatment?

Patients 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

What treatments are available?

Thyroid cancer is usually treated with surgery to remove the whole thyroid gland, plus or minus lymph nodes in the thyroid bed or neck. Radioactive iodine treatment may also be required after surgery. In selected low-risk patients with small tumours less than 2cm, surgery to remove one-half of the thyroid gland may be all that is necessary. All thyroid cancer patients will need close follow-up and ongoing surveillance for some years after treatment.

The thyroid surgery team at St George’s Hospital is one of the largest in the United Kingdom. It performs the full complement of surgical procedures for thyroid cancer, within the South West London area, including minimally invasive robotic surgery. St George’s Hospital is also the regional centre for all thoracic surgery. The thyroid surgeons at St George’s Hospital work closely with thoracic surgeons on-site should access to the chest be required for complex cases. We are a joint cancer centre with the Royal Marsden Hospital, where radiotherapy, radioactive iodine, and chemotherapy treatments are provided.

Support and Rehabilitation

Patients and their carers have access to the following:

• Our specialist head and neck nursing staff on the Florence Nightingale ward
• A clinical nurse specialist for information and support throughout the cancer pathway.
• Highly specialist speech and language therapists and Dietitians are providing pre and post-therapy, ongoing rehabilitation in the hospital, and an outreach service closer to home.
• Our physiotherapy team offer rehabilitation on the ward and onward referral if further therapy is required.
• Access to our Macmillan cancer psychological team (CaPS)
• Access to Macmillan information and financial advice
• Access to complementary therapy on the ward
• Tracheostomy clinic

What is Personalised Cancer Care?

 Personalised Cancer Care means your team will support you to take an active role in your cancer care by giving choices and control based on what matters most.

Together with your key workers’ team, like your Clinical Nurse Specialist and Macmillan Support worker, we will aim to help you access the care and support that meets your individual needs from the moment you receive your cancer diagnosis so that you can live as full, healthy and active a life as possible.

You will be invited to complete a Holistic Needs Assessment (HNA) to identify any concerns you may have when you have been diagnosed with cancer. These concerns may be physical, emotional, practical, financial and spiritual.

You will answer a simple set of questions or fill in a checklist about all areas of your life. It is to find out about the concerns you may have. You are often asked to rate how important these concerns are to you. It could help you decide what to discuss first during the assessment.

Once you have completed the assessment, your Clinical Nurse Specialist will discuss your needs, maybe face-to-face in a clinic or over the phone. During the discussion, you and your Clinical Nurse Specialist will agree on the best ways to manage your needs and concerns. They will write down what you have decided in a document called a care plan.  They may write it during the discussion. Or they may make notes and send them to you afterwards. Your care plan will record the following:

• The main concerns you talked about
• Suggestions and actions to help you manage your concerns
• Services that may be able to support you, and any referrals that are made
• What is already being done to help – for example, the services you are already using
• Information about who to contact if you need more help
• The details of other health or social care professionals with whom you have agreed to share the information.

You may not wish to complete the holistic needs assessment at this time. The care you receive will not be affected in any way, and we will be happy to discuss this again in the future

 Health and wellbeing information and support also include:

• Access to the Macmillan Information & Support Centre to find out what support is available in the community, e.g., practical, financial, and how to access it
• Help with understanding cancer and its treatment and how to manage its impact through videos and workshops run by healthcare professionals at St George’s and in the community.
• Attend wellbeing activities which are great opportunities for you and your carers to get together with others affected by cancer.