For GPs

Upper Gastro-Intestinal Cancer

Cancer of the upper gastro-intestinal (UGI) tract (oesophagus and stomach) affects about 3500 Australians every year. These cancers occur when cells growing in the lining of the oesophagus and stomach grow rapidly and out of control forming a tumour. The cancerous cell can invade through the wall of these organs into surrounding tissues and also spread to neighbouring lymph gland and distant organs such as the liver, lungs, abdominal cavity and bones. These secondary tumours are called metastases.

The UGI tract starts in the neck and goes through the chest into the upper abdomen and thus is a long organ. Consequently tumours arising at different sites can cause different problems depending on if they occur at the start, middle, or end of the UGI tract. They also require and respond to different treatments.

UGI cancer in the neck or chest can present early with symptoms but some stomach cancers can present very late. UGI cancers that have spread to many lymph glands or others organs are seldom curable and have a grave prognosis.

    • What Are the Causes of UGI Cancer?

      The exact cause is not known, however just getting older increases your risk of developing UGI cancer. There are lifestyle factors such as cigarette smoking, alcohol consumption, high fat and low fibre diet and a lack of exercise that are thought to increase the incidence of UGI cancer. People who have longstanding regurgitation and reflux are prone to develop cancer of the lower oesophagus.

    • What Are the Symptoms of UGI Cancer?

      The most common symptoms of UGI cancer is dysphagia or difficulty in swallowing. This may be accompanied by weight loss, regurgitation and heartburn. Vomiting blood can occur with advanced disease. Other symptoms are chest pain, cough, abdominal pain or swelling.

        • What Are the Treatments for UGI Cancer?

          The available treatments for UGI cancer depend on the stage at which the cancer has been diagnosed, as well as the general health of the individual. If the cancer is diagnosed very early then surgery may be all that is required.

          If however the cancer is more advanced, initial chemotherapy (drug treatment) and sometimes radiation therapy may be required in addition to surgery. Chemotherapy also has the ability to delay or prevent the spread of cancer to other organs. of the cancer.

          Radiation therapy is used very commonly in combination with chemotherapy as definitive treatment for upper oesophageal cancer where surgery is both difficult and morbid. Combined chemotherapy and radiation therapy is often used for cancers in the middle and lower oesophagus before surgery is performed to improve the chance of the tumour being completely removed by the surgeon.

          Radiation therapy is also the treatment of choice for incurable patients who have difficulty with swallowing. If the radiation therapy fails to relieve the swallowing problem, insertion of a stent or a wire tube may be required. Radiation therapy in also useful in advanced UGI cancers where bleeding is a problem.

        • What Are the Side Effects of Radiation Therapy?

          The side effects of radiation therapy are confined to the area being treated. In the neck or chest the most common side effect is oesophagitis or inflammation of the oesophagus which can occur with three or more weeks of radiation therapy.

          It is easily managed with local anaesthetic liquids, soluble paracetamol or eve liquid morphine. It resolves about 2 weeks after the radiation is completed. Other side effects that occur in the chest are cough, breathing problems and slight skin burns which all can be treated and resolve after therapy.

          In the lower chest and abdomen nausea and vomiting can occur. This side effect can be prevented with anti-emetic drugs given before therapy. Almost all patients having radiation therapy complain of fatigue of some degree which can last for several months after therapy.

          Patients should be encouraged to exercise within moderate limits but also rest where necessary during therapy.

      How Do I Enquire About Radiation Therapy with My Healthcare Professional?

      The best person to discuss radiation therapy with for bowel cancer is a Radiation Oncologist. You can ask your Surgeon or General Practitioner for a referral to a Radiation Oncologist for a discussion about whether radiation therapy is a suitable treatment for you.

      Visit ‘For GPs and other Health Professionals’ and ‘Talking to your doctor’ sections for further information.

      Find your closest radiation oncology Treatment Centre