Upper G.I: Key Points

Incidence:

    Oesophagus:    Approx 6,000 cases p.a.
    Stomach:         Approx 10,000 cases p.a.
    Pancreas:         Approx 6,000 cases p.a.

    The incidence of stomach cancer is decreasing, whereas the incidence of oesophageal cancer is increasing. Tumours at the junction between the stomach and oesophagus are increasing particularly rapidly.

Age:
  • For all three tumour types 99% of cases occur over 40 years.
  • 90% of gastric cancers occur over 55 years.
  • The chance of a dyspeptic patient under the age of 55 having gastric cancer is one in a million.
  • 55 is the cost effective age for investigation of gastric cancer under the Markov model.
Risk Factors:
    Smoking
    Alcohol

Common Symptoms in Cancer Patients

Any Upper G.I Cancer: Weight Loss 60%
Anaemia 50%
Vomiting 25%
Oesophagus: Heartburn 80%
Reflux 50%
Dysphagia 85%
Stomach: Epigastric Pain 90%
Dysphagia 40%
Pancreas: Jaundice 80%

Dysphagia is a relatively uncommon symptom in a community/general practice setting. Patients with difficulty swallowing food should always be referred for further investigation.

Dyspepsia is an extremely common problem in a community/general practice setting. The index of suspicion of cancer is very considerably raised if dyspepsia is combined with an ‘alarm’ symptom (weight loss, vomiting, anaemia). In patients aged over 55 years recent onset of dyspepsia and/or continuous symptoms is associated with an increased risk of cancer.

Local arrangements should be made to determine whether patients requiring urgent assessment are seen in a clinic setting or are directly referred for endoscopy. However, GPs and hospital providers will wish to ensure that the wait for the diagnostic test is kept to a minimum.

 

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