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Upper gastrointestinal cancers

Cancer types

Upper gastrointestinal cancers include oesophageal cancer, stomach cancer, small bowel cancer, pancreatic cancer, liver cancer and cancers of the biliary system.

Accurate investigation and staging is central to the appropriate management of patients with upper gastrointestinal cancers.

What symptoms might need an urgent Upper GI referral:

  • Problems swallowing food/liquids or medication (dysphagia)
  • Increased or new persistent reflux/dyspepsia (indigestion/heartburn)
  • Decline in appetite
  • Unintentional weight loss
  • Vomiting of blood (haematemesis)
  • Passing black stool (malaena)
  • Nausea or vomiting
  • Feel full quickly (early satiety)
  • Abdominal/epigastric pain
  • Yellow colour to skin or white of eye (jaundice)
  • Change of colour of urine (becoming dark)
  • Change in colour of stool (becoming pale/chalky)
  • Abdominal pain/bloating

Upper GI Diagnostics

There are a number of investigations which you may or may not require. These will be decided upon by a specialist doctor or nurse.

Sometimes it is necessary to have more than one test in order to get an accurate diagnosis. Some of these investigations may have already been carried out at your first appointment.

Following any of these investigations, you may be contacted by the hospital asking you to attend for further tests for clarification of your diagnosis. This is so that your doctor has the full range of results available to discuss with you at your outpatient appointment.

Gastroscopy (OGD)

A gastroscopy (OGD) is a procedure where a long flexible telescope (gastroscope), about the thickness of your index finger, with a bright light at its tip, is carefully passed through your mouth. This allows the doctor to look directly at the lining of your food pipe (oesophagus), stomach and small bowel (duodenum). A video camera on the gastroscope transmits pictures of the inside of the digestive tract to a monitor, so that the doctor can look for any abnormalities. The doctor may take a biopsy. This is a sample of the lining of the digestive tract which can be looked at under a microscope. A small piece of tissue is removed painlessly through the scope, using tiny biopsy forceps.

Depending on your symptoms, you may have an OGD prior to having an outpatient appointment. This pathway is known as ‘straight to test’.

Further information about the Endoscopy Department, including patient information leaflets is available – Endoscopy

Computer Tomography (CT) scan

A Computerised Tomography or CT scan takes a series of pictures of any part of your body using x-rays to produce images that show cross-sections or slices of your body. A Radiographer (a University-trained health professional who works in Radiology to produce diagnostic images using a variety of different modalities) will perform your scan and may be assisted by an RDA (Radiology Department assistant). The data produced from the scanner is processed by a powerful computer to create the images and can be viewed on a screen to show very detailed images of the inside of your body.

Depending on your symptoms, you may have a CT scan prior to having an outpatient appointment. This pathway is known as ‘straight to test’.

Further information about the Radiology Department, including patient information leaflets, is available – Radiology

Magnetic Resonance Imaging (MRI) scan

A Magnetic Resonance Imaging (MRI) scanner uses a magnetic field and radio waves to build up pictures of parts of the body by picking up signals sent out by water molecules. An MRI Scan can produce two or three dimensional images of what is going on inside a patient’s body. MRI images are so precise that doctors can often get as much information from the MRI as they would from looking directly at the tissue.

Depending on your symptoms, you may have an MRI scan prior to having an outpatient appointment. This pathway is known as ‘straight to test’.

For further information about the Radiology Department, including patient information leaflets, is available – Radiology

Ultrasound scan

An ultrasound scan uses sound waves to build up a picture of internal organs. It can show changes in different organs and helps doctors to know if a lump or abnormal area is cancer or not.

Doctors sometimes use an ultrasound scan when they are doing a biopsy (removing a small piece of tissue). The scan helps to guide them to the exact area.

A small device called an ultrasound probe is used. The probe gives off sound waves that bounce off different parts of the body and make “echoes”. The echoes are converted into a picture by a computer.

Depending on your symptoms, you may have an ultrasound scan prior to having an outpatient appointment. This pathway is known as ‘straight to test’.

For further information about the Radiology Department, including patient information leaflets, is available – Radiology

Endoscopic Ultrasound (EUS) scan

An Endoscopic Ultrasound Scan procedure allows the endoscopist to look clearly at your oesophagus (gullet), stomach, pancreas and bile ducts, depending on your underlying condition. The scan uses high frequency sound waves transmitted through the tip of an endoscope. The endoscope (a flexible tube with a small camera at the tip) is passed down the oesophagus and into the stomach and duodenum. A scan of the surrounding structures can then be carried. Although you may have had other scans done, EUS is a very accurate technique, which may identify information which cannot be seen on conventional scanning. This test usually takes about 30 to 40 minutes.

Depending on your symptoms, EUS is carried out at either the Royal Sussex County Hospital in Brighton or the Royal Surrey County Hospital in Guildford.