What is upper GI cancer?

Upper gastrointestinal or upper GI cancer is an abnormal, life-threatening growth that occurs either in the food pipe (also known as the oesophagus or gullet) or the stomach. The most common type of upper GI cancer in the United Kingdom is adenocarcinoma, however other types of cancer such as squamous cell carcinoma, gastro-intestinal stromal tumour (GIST) and lymphoma of the stomach are also seen.

What are the symptoms of upper GI cancer?

The most common symptoms include difficulty or pain on swallowing, persistent heartburn or acid reflux, unexplained weight loss and tiredness due to a low blood count (anaemia). Sometimes dark stool can be caused by bleeding from a tumour in the upper GI tract.

Because these symptoms are 'non-specific', meaning that they can be due to a wide variety of mostly benign conditions, they are often ignored or overlooked. As a consequence, the majority of patients who come to us with a diagnosis of upper GI cancer are at a stage where they cannot be cured. So, if you or anybody you know has these symptoms, go to your doctor and ask them to arrange an endoscopy (camera test) to rule out cancer as a cause.

What are the causes of upper GI cancer?

The short answer is that we don't know. There is lots of research being undertaken to try and understand why people get upper GI cancer. What we do know is that no two cancers are the same and that there is not one single cause for it.

Who is most at risk?

Different cancers have different risk factors. Developing adenocarcinoma is associated with the following risk factors:

• Obesity (being overweight)
• Chronic acid reflux
• Barrett's oesophagus
• Bacterial (helicobacter pylori) infections (stomach cancer only)

Squamous cell carcinoma is linked with the following risk factors:

• Smoking
• Drinking alcohol to excess
• A persistently low immune system due to medications such as steroids

A very small proportion of upper GI cancers can be inherited. If a patient develops cancer at a young age (less than 50 years of age), it is important for first degree relatives to speak to their doctor as genetic testing may be needed.

What treatments are available for upper GI cancer? 

There are two areas of treatment: curative and palliative treatment.

Curative treatment aims to remove all traces of cancer. However, this is only suitable for about one in three patients with upper GI cancer. Most patients are diagnosed with metastatic disease (meaning the cancer has spread) and the only treatments available are palliative, meaning that they aim to slow the growth of the cancer or relieve symptoms but don't expect to eradicate the disease.

Curative treatments

The main curative treatment is surgery. Our team often perform this surgery using keyhole (laparoscopic) techniques which results in less pain and a quicker short-term. The location of the cancer will determine what operation is required. Oesophageal (food-pipe or gullet) cancer will usually require surgery to remove most of the oesophagus and half of the stomach. If the cancer is in the stomach, then either all or part of the stomach must be removed. We always talk to the patient in detail about this. Surgery of this kind is life-altering and has short and long-term effects on nutrition and quality of life, which can take up to a year to fully recover from.

The success of surgery in removing cancer is improved by adding other treatments such as chemotherapy and radiotherapy. Patients are always discussed in a meeting with other specialists to see whether this is appropriate for them. We are proud to be able to offer this specialised multi-disciplinary team service at The Alexandra Hospital.

Palliative treatments

Treatment for metastatic cancer aims to slow down the progression of cancer and prolong the life of the patient. This usually involves chemotherapy. There is a lot of interest in this area of upper GI cancer, and patients are often asked to take part in new treatment research.

Symptoms such as difficulty swallowing are often treated with a stent. A stent is a short, lightweight tube which opens the GI tract where it has narrowed because of the cancer. It allows food and drink to pass the by the cancer, helping to improve some of the symptoms of difficulty swallowing or vomiting.