Oesophago-gastric, Hepatobiliary and Pancreatic Cancers
Urgent suspicion of cancer referral
Oesophago-gastric cancer:
- Dysphagia (interference of the swallowing mechanism that occurs within five seconds of the swallowing process) or unexplained odynophagia (pain on swallowing) at any age
- Unexplained weight loss, particularly >55 years, combined with one or more of the following features:
- new or worsening upper abdominal pain or discomfort
- unexplained iron deficiency anaemia
- reflux symptoms
- dyspepsia resistant to treatment
- vomiting
- New vomiting persisting for more than two weeks
Hepatobiliary and pancreatic cancer:
- Painless obstructive jaundice
- Unexplained weight loss, particularly >55 years, combined with one or more of the following features:
- upper abdominal or epigastric mass
- new onset diabetes
- any suspicious abnormality, in the hepatobiliary tract, found on imaging (such as biliary dilatation or pancreatic/liver lesion)
- new onset, unexplained back pain (consider other cancer causes including myeloma or malignant spinal cord compression)
- ongoing GI symptoms despite negative endoscopic investigations
There is emerging evidence that thrombocytosis is a risk marker for underlying cancer, including gastric and oesophageal. Remember “LEGO-C”.
Oesophago-gastric cancer
Good practice points
Consider routine referral for people presenting with new upper gastrointestinal pain or discomfort combined with any of the following risk factors:
- family history of oesophago-gastric cancer in a first-degree relative
- Barrett’s oesophagus
- pernicious anaemia
- previous gastric surgery
- achalasia (dysfunction of the oesophageal muscle)
- known dysplasia, atrophic gastritis or intestinal metaplasia
Primary care management
Dyspepsia without accompanying symptoms or risk factors should be managed according to local or national guidelines
Hepatobiliary and pancreatic cancer
Good practice points
Consider seeking advice in people presenting with new onset GI symptoms with known chronic liver disease.