Stomach and Gullet Cancer

Stomach and gullet cancer is medically known as oesophago-gastric (OG) cancer . Oesophageal cancer is cancer of the gullet and gastric cancer is cancer of the stomach.

Treatment of this cancer is a service provided by a Multi Disciplinary Team (MDT) of specialists in oesophago-gastric cancer who work in the Belfast City Hospital to diagnose and treat Oesophago Gastric cancer patients.

The oesophago-gastric Cancer MDT meets weekly in the Belfast City Hospital to agree upon your treatment plan.

This team of specialists consists of:

  • Gastroenterologists
  • Specialist surgeons
  • Clinical Oncologists
  • Medical Oncologists
  • Histopathologists
  • Radiologists
  • Pathologists
  • Clinical Nurse Specialists (CNSs)
  • Palliative Care Team
  • Dieticians
  • Administration staff

Please note that this section details services provided to adult patients of the Belfast Trust. Please follow the link for information on Children’s Cancers.


  • Types
    Types of Oseophageal Cancer

    Cancer of the oesophagus (gullet) can occur anywhere along the length of the oesophagus. There are two main types of oesophageal cancer and they require different approaches to treatment:

    • Squamous Cell Carcinoma
    • Adenocarcinoma

    Squamous Cell Cancers occur more commonly in the upper and middle regions. Adenocarcinoma is becoming more common and tends to occur at the lower end including the junction where the oesophagus joins the stomach.

    There are also rarer types of cancer of the oesophagus including soft tissue sarcomas such as Gastrointestinal Stromal Tumours (GISTs). The tests and treatments for these rarer types of cancer are different from those used to treat common OG cancers.

    For more information on the different types of osephageal cancer, please follow this link.

    Symptoms of Oseophageal Cancer

    There are a number of signs and symptoms that may indicate oesophageal cancer including:

    • Difficulty swallowing (Dysphagia)
    • Pain when swallowing
    • Weight loss
    • Vomiting (being sick) or bringing food back up that hasn’t yet entered the stomach (regurgitation)
    • Pain or discomfort behind the breastbone or in the back
    • Indigestion or heartburn that doesn’t go away
    • A cough
    • Hoarseness – this happens when there is pressure on the nerve that supplies the voice box

    These symptoms can be caused by conditions other than cancer but if they have not gone away after a couple of weeks, the patient should contact their GP.

    Types of Gastric Cancer

    Adenocarcinoma is the most common type of Gastric (Stomach) Cancer. It affects the cells of the stomach lining.

    There are a number of rarer types of cancer that can occur in the stomach. The tests and treatments for these are different from those mentioned in this website.

    These include:

    • Soft tissue sarcomas: Common Gastrointestinal Stromal Tumours (GISTS).
    • Lymphomas: this affects the lymphoid tissue
    • Carcinoid tumours

    For more information on the different types of gastric cancer

    Symptoms of Gastric Cancer

    There are a number of symptoms that may indicate Gastric (stomach) cancer including:

    • Heartburn or indigestion that doesn’t go away
    • Burping a lot
    • Loss of appetite
    • Difficulty swallowing
    • Weight loss
    • Feeling bloated during and after eating
    • Feeling sick (nausea) or being sick (vomiting)
    • Blood in the stools (bowel motion) or black stools
    • Tiredness (fatigue) or feeling short of breath due to anaemia (a reduced number of red blood cells in the blood)
  • Referral

    If a GP suspects a patient of having oesophago-gastric cancer, they will refer the patient to Belfast City Hospital or the Royal Victoria Hospital. Patients will be contacted regarding an appointment.

  • Investigations and diagnosis

    This usually begins with your GP, who will ask you about the symptoms you are experiencing and your general health before examining you. Your GP may also take some blood tests.

    Your GP may arrange for you to have an urgent gastroscopy (commonly called an endoscopy) at your local hospital.

    An endoscopy involves an examination to look inside the upper digestive tract using a flexible tube with a tiny camera attached which passes through the oesophagus (food pipe) and stomach. Samples (biopsies) may be taken of any abnormal looking areas.

    Some patients are sent for a barium swallow or barium meal following their endoscopy if they require further investigations. This investigation involves drinking a white chalky liquid which helps show up the oesophagus and stomach on a series of x-rays. However very few people have this test.

    When tests are complete, the patient will receive a clinic appointment to discuss the results with their local hospital team. At this appointment, patients will find out if they have cancer. If a cancer is confirmed and a patient lives outside the Belfast Health and Social Care Trust catchment area, they may be referred to the Specialist Oesophago-gastric Multi-disciplinary team in the Belfast Trust. In some situations they may be treated at their local hospital.

    Further Tests

    If these tests confirm oesophageal or gastric cancer, the patient may require further tests to find out if the cancer has spread to other parts of the body. This is known as staging cancer. The patient may also have some tests arranged to assess general fitness.

    These tests will include:

  • Multi-disciplinary team

    The Oesophago-gastric Cancer Multi Disciplinary Team (MDT) consists of a well established group of experts with a specialist interest in the diagnosis and treatment of patients with cancer of the oesophagus (gullet) and/or the gastric (stomach).

    The results of the tests are discussed at the Oesophago-gastric Cancer MDT meeting which takes place every Friday morning in the Belfast City Hospital. Detailed discussions between all the relevant specialists take place, looking at all the available results for patients to ensure that the best treatment plan is agreed. A record of this discussion will be sent to the patient’s GP.

    All tests are usually completed within four weeks from when the cancer was first suspected. Once a decision has been made at the MDT and this has been discussed with the patient, they will receive an appointment to see a specialist from the Oesophago-gastric team to discuss further treatment.

  • There are a number of treatments available for oesephago-gastric cancer. Patients may receive just one type of treatment or a combination of treatments depending on their circumstances. Patients must give their consent before they undergo any type of treatment. Treatments include:

    • Surgery
    • Chemotherapy
    • Radiotherapy
    • Other Treatments
    • Specialist Palliative Care
    Surgery

    For some patients with oesophageal or gastric cancer, surgery may be an appropriate treatment. Surgery to remove the cancer is a major operation and it will take a number of months to recover from the surgery.

    Oesophageal Cancer

    Surgery

    If a patient’s cancer is diagnosed at an early stage, an operation may be all that is needed to cure it. The majority of patients will require chemotherapy before and sometimes after surgery. The type of operation a patient will have depends on the size of the tumour and where it is located in the oesophagus.

    An oesophagectomy involves removal of part or most of the oesophagus and part of the stomach. This is dependent on the size and position of the tumour. Following the removal of the tumour, the stomach is reshaped and pulled up into the chest and joined to the oesophagus. Please follow the link for further information on how surgery is used to treat oesophageal cancer.

    Recovery

    The recovery time from surgery for oesophago-gastric cancer varies with each patient. Most patients requiring 6 months to year to make a full recovery. The Oesophageal Patients Association NI provides a useful information leaflet on life after a oesophagectomy

    Other Treatments
    Endoscopic Mucosol Resection (EMR)

    This type of treatment is a surgical procedure to remove the cancerous tissues of the digestive tract. An EMR is performed with a long narrow tube consisting of a light, video camera and other instruments. During endoscopic mucosal resection of the upper digestive tract, the tube (endoscope) is passed down the throat to reach an abnormality in the oesophagus, stomach or upper part of the small intestine (duodenum). This treatment is common for patients with oesophageal cancer.

    More information on Endoscopic Mucosol Resection and other types of treatment

    Gastric Cancer

    Surgery

    Patients may undergo a partial gastrectomy or a total gastrectomy as part of their treatment for stomach cancer.

    Partial gastrectomy

    This procedure involves the removal of part of the stomach. If a patient has cancer in an area close to where the stomach meets the gullet, they may need part of their gullet removed as well.

    Total gastrectomy

    This procedure involves the removal of the whole stomach. During a total gastrectomy, the surgeon connects the gullet to the small intestine. This ensures patients still have a working digestive system.

    Diagrams and more information on surgery to treat gastric cancer.

    Recovery

    The recovery time from surgery for oesophago-gastric cancer varies with each patient. Most patients requiring 6 months to year to make a full recovery.

    Information on Eating after stomach surgery.

  • Symptom Control

    Oesophageal Cancer

    Relieving Difficulty in Swallowing

    If patients have a difficulty swallowing their doctor may suggest treatment to help relieve this. This may include some chemotherapy or short course of radiotherapy. There are a number of other treatments a patient could be offered to relieve a blockage in the gullet or stomach or to improve symptoms. However these procedures won’t cure the cancer.

    Stenting

    A wire mesh tube (stent) is inserted into the oesophagus using endoscopy guidance. The stent helps to keep the oesophagus or stomach open which should help the patient eat more comfortably. For more information on stents, please follow this link.

    Laser Treatment

    This is usually used for treatment of oesophageal cancer and involves the use of a powerful beam to identify and remove the cancer tumour that has been causing the obstruction.

    This procedure is usually completed with general anaesthetic and involves an endoscopy. This treatment removes enough of the cancerous tumour to allow food to pass down the oesophagus and may need to be repeated several times for swallowing to return to normal.

    More information on laser treatments follow this link.

    Information on relieving difficulty swallowing

  • Follow Up

    As part of patient cancer review following cancer treatment, the patient will be asked to return to the hospital to see one of the Oesophago-Gastric Cancer Team. The frequency of these review appointments will differ for each patient. The review appointments allow the team to assess a patients progress following treatment. The check-ups are also a good opportunity to discuss with your doctor any problems or worries you may have.

    Follow up appointments will take place at outpatients in one of the three hospitals of the Belfast Trust; Belfast City Hospital, Royal Victoria Hospital or the Mater Hospital or at the hospital where the patient was first seen.

    If a patient notices any new symptoms, or they have any worries, they should contact the Oesophago-Gastric Clinical Nurse Specialist, their Consultant or their local GP to discuss the symptoms as they may need additional treatment or rehabilitation services such as a dietician or physiotherapy services.

  • Useful links

    A list of supportive websites relating to Oesophageal and Gastric Cancer have been provided below for you, your family and friends to read additional information.

    Please click on the links below for more information: