Download Oesophago-Gastric Cancer. -Time to Collaboration

Oesophageal Cancer.
-improving outcomes.
Anil Kaul
Consultant General and Upper GI Surgery
St Helens and Knowsley Teaching Hospitals NHS
Trust
How big is the problem
• Oesophageal and Gastric cancer - 13500 patients
affected each year in the UK
• Fifth most common malignancy
• Fourth most common cause of death
• Oesophageal (numbers are rising)
• Gastric (numbers are decreasing)
• OG Junction ( numbers are rising)
Oesophageal cancer
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13th most common cancer in the UK
Total cases
Males
Females
8332
5582 (67%)
2750 (35%)
• Higher incidence in the northwest
• Expected number about 110 cases in 2 years
• Actual numbers about 190 cases in 2 years
Risk factors
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Age >55
Male
Deprivation
Tobacco
Alcohol
Obesity
H Pylori
Reflux
Symptoms
SIGN 2006 ;NICE 2004
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Dysphagia
Odynophagia
Persistent dyspepsia.
Loss of Appetite
Loss of weight
Vomiting
GI Blood Loss, Anaemia, Malaena, Haematemesis
Be clear on cancer campaign
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heartburn most days for 3 weeks or more.
indigestion on and off for 3 weeks or more
food feels like it’s sticking in your throat when you swallow
losing weight for no obvious reason
Trapped wind and frequent burping
Feeling full very quickly when eating
Feeling bloated after eating
Nausea or vomiting
• Stomach pain
How do I reduce my chances of getting this
cancer ?
• Stop smoking
• Look after yourself, If you’re overweight, you
should lose weight
• Eat healthily, Try to get your 5 A DAY
• Cut back on drinking alcohol
Investigations
• For Diagnosis
• Endoscopy
• Barium Swallow and Meal
• For Staging
• CT/ EUS/PET
• Staging Laparoscopy
Treatment Options
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Curative
Surgery
Chemotherapy
Radiotherapy
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Palliative
Chemotherapy
Radiotherapy
Stent
Outcomes
• Oesophageal
• Overall 5 year survival 7 % (AUGIS 2012)
• Gastric
• Overall 5 year survival 13% (AUGIS 2012)
The need for action
• In St Helens and Knowsley the incidence is higher
than national average
• Patients are diagnosed at a later stage in the disease
• Overall outcome compared to the national average is
poor
NAEDI
National Awareness and early Diagnosis Initiative
• 950 deaths from Oesophago gastric cancer can be
avoided each year (CRUK) if our results were as good
as Europe
• Main Factor Identified is delay in diagnosis
Results
• Results of curative Treatments are similar to the rest
of the UK and Europe
• Cancer Research UK / DOH has identified late
presentation as the main reason for poor outcome
Bottom line
• Prevention
• Early diagnosis
• Curative treatment
Early Diagnosis is the key
• Who diagnoses them
• GP
• AED
• Other specialties
63.3 %
16.4%
17.3%
• GP suspected cancer 68.8%
• Overall only 45.6 % diagnosed because GP suspected
cancer
So what’s the cause of delay
• Patient related
»Ignorance
»Fear
»Access to services
• Primary Care related
»? Support / ? resource
• Secondary care
»Inefficient System
iVan
Way forward- Collaboration
- MCCN – “How to save an extra 424 lives ….. Catching cancer
earlier”
• Primary Care ownership of this issue
• Partnership working with Public Health and
Secondary Care.
NAEDI
National Awareness and early Diagnosis Initiative
• Achieve Early Presentation
• Optimise Clinical Practice
• Improve GP Access to Diagnostic test
• Research Evaluate and Monitor