Oesophagus Cancer (Upper GI)

Oesophageal cancer (also called cancer of the gullet or food pipe) affects over 7500 people in the UK each year. We provide excellent, compassionate and timely cancer care using the latest techniques.

If you visit us for investigation, diagnosis and possible treatment you can expect:

• Support - every step of the way - Every patient benefits from the support of our clinical nurse specialists. The nurses stay with you throughout your treatment journey – from your first clinic appointment to aftercare.
• Regional cancer experts - Dr Howard Smart and Dr Sanchoy Sarkar are regional experts in the management of gullet disease – including cancer.
• Specialist techniques - We train health professionals to use endoscopes to investigate oesophageal cancer. This speeds up diagnosis for our patients. We perform over 14,000 endoscopic procedures a year. We also use the latest technology to diagnose pre-cancerous changes and early cancers of the gullet.
• Access to the latest treatments - Our clinical trials programme makes new treatments available to patients – often giving them a better outcome. We aim to have a trial option open to patients at each step of the treatment path. And that’s not all. As a university hospital, we lead research into oesophageal cancer diagnosis, treatment and prevention. We regularly publish research papers that help in the fight against cancer.
• Collaborative working - We work closely with the Liverpool Heart and Chest Hospital and the Clatterbridge Cancer Centre. This means our patients benefit from the combined expertise of leading hospitals in the region.

Oesophagus Cancer diagnosis

The oesophagus (gullet) is shaped like a tube and connects the throat to the stomach. It moves food towards the stomach once it is swallowed. Gullet cancer is abnormal tissue in the gullet which has the potential to spread to other places in the body.

The causes of gullet cancer

The exact cause is unknown, but it is more common in people who’ve had heartburn (acid reflux) for a long time. Long-term heartburn may lead to a change in the lining of gullet. This is called Barrett’s oesophagus and may develop into cancer if left untreated for a long time. We closely monitor patients with Barrett’s oesophagus to make sure there are no changes. Another type of gullet cancer (squamous cell cancer) is more common in smokers and people who drink a lot of alcohol.

Symptoms of gullet cancer

Gullet cancer is often diagnosed late because it does not cause many symptoms at an early stage. The major symptom is difficulty swallowing. This can be a strange sensation or pain in the chest just after swallowing, or a feeling of food getting stuck in the chest. Other symptoms include:

• weight loss
• new or increased heart burn/indigestion
• food coming back up after swallowing
• vomiting
• Heartburn and indigestion are very common. A vast majority of the people with these symptoms do not have cancer of the oesophagus.

Your GP will refer you to the hospital for an urgent gastroscopy if your symptoms suggest gullet cancer. We will see you within two weeks.

A gastroscopy is a thin tube that’s passed through the mouth and into the gullet and stomach. The tube has a camera on the end which allows the specialist to see inside the gullet and stomach. The procedure takes a few minutes. There will be no need to stay overnight.

Confiming the diagnosis: biospy

A biopsy is the only way to tell for certain that tissue is cancerous. During the gastroscopy, small pieces of tissue are taken from any abnormal areas in the gullet or stomach. This is then examined under a microscope by a tissue expert (pathologist).

Confirming the diagnosis: CT scan

This helps the doctor find out about the extent (spread) of cancer if diagnosed. It’s done within 7-10 days of your first clinic appointment - by which time the biopsy result is also available. You’ll need to have some blood tests prior to CT scan.

Getting support: your key-worker (upper GI specialist nurse)

If cancer is diagnosed, you’ll see a specialist nurse immediately after the gastroscopy. The specialist nurse has lots of knowledge and experience of patients with gullet and stomach cancers. This nurse is your key-worker and will stay in close contact throughout your treatment. You’ll be contacted by telephone and will also meet the nurse in the clinic. This will give you a chance to be updated about the progress of your investigations and also ask questions. The key-worker will also speak to your family members, but no specific information about your treatment will be given out without your consent. Your key-worker might change depending on the type of treatment you receive.

Test result

These can take seven to ten days. Once the results of your biopsy and CT scan are available, you’ll be seen in the gastroenterology clinic, usually by the specialist nurse. The results are explained and your questions answered. Your symptoms will also be addressed.

MDT (multi disciplinary team) is a group of cancer experts who meet every Wednesday to discuss the most appropriate treatment options for you.

The results of your tests are reviewed and the most appropriate treatment option for you is discussed. The final decision is made after discussion with you, usually at your next clinic visit.

Further tests

If the cancer has not spread beyond your gullet on the CT scan - and you are fit enough to have an operation – you’ll get further tests. This is to rule out any cancer spread that’s not been picked-up by CT scan. We do this in three ways:

• Endoscopic ultrasound (EUS): this is an ultrasound scan done from the inside of the gullet. The technique is the same as for gastroscopy and is performed by a consultant gastroenterologist.
• Positron Emission Tomography CT scan (PET-CT): this is used to detect the spread of cancer to the bones and also small spread elsewhere not picked up by CT scan.
• Bronchoscopy: this is to ensure that the wind pipe is not affected by cancer. A very thin tube with camera at its tip is passed into your wind pipe.

Patients who require these tests are re-discussed at the MDT. All of the tests are usually completed within four weeks from when the cancer was first suspected.

Oesophagus Cancer treatment

We will start your cancer treatment as soon as possible. The type of treatment you’ll receive depends on the type of cancer, the extent of cancer and your background health. Different treatment options are discussed with you in detail. Your preferences are taken into account. Of course, you have the final say in whatever treatment you receive.

• Surgery (operation): You’ll be offered surgery if the cancer has not spread and you’re otherwise fit. The section of the gullet with cancer is removed and the remaining section is joined to stomach. In some cases, the upper part of the stomach is also removed. You’ll need a few more tests will will be performed before surgery. The operation is done at the Liverpool Heart and Chest Hospital. Most patients undergoing surgery will receive pre-surgery chemotherapy to shrink the cancer and reduce the chance of cancer coming back after surgery
• Radiotherapy (x-ray treatment): radiotherapy is suitable for some patients. It uses radiation to shrink cancer cells. This is a painless procedure and you'll need a few sessions. The treatment is done at the Clatterbridge Cancer Centre. Treatment level and intensity will vary from patient to patient.
• Chemotherapy: Some patients are given chemotherapy. It uses anti-cancer drugs to kill cancer cells or prevent their growth. It can be given as injections or in the form of tablets. Again, this is under supervision of an oncologist at the Clatterbridge Cancer Centre.
• Combination treatment: Some patients are given a combination of chemotherapy, radiotherapy and surgery. All of these treatments have side-effects, which will be discussed with you prior to treatment.

Helping you swallow

A stent is a small piece of metal that expands to keep the gullet open. It allows you to swallow more comfortably. The procedure is done by performing a gastroscopy and using x-rays to put the stent in the gullet. You won’t have to stay overnight for this procedure.

Palliative care

If the cancer is very advanced - or you’re not fit for treatment - you’ll be offered palliative care. It involves the control of symptoms and improving the general sense of well-being. We have an excellent palliative care team at the hospital.

Clinical Trials

You may be asked to take part in a clinical trial. Clinical trials help us learn more about the best way to treat specific conditions. Learn more about the Clinical Research Unit by visiting the website here

Members of the MDT include:

• a clinical nurse specialist (your key-worker)
• consultant gastroenterologists
• a gullet surgeon
• an x-ray specialist
• a gastrointestinal pathologist
• a cancer specialist (oncologist)
• a palliative care expert

Contact Details for the Cancer Team : 0151 706 2000

Visit the Marie Curie website here

Visit the MacMillan Cancer website here 

Visit the Cancer Research UK website here

Visit the NHS Choices - Cancer website here

We are teaming up with Macmillan, Liverpool Wellbeing Enterprise and the Clinical Commissioning Group to look at how better we can provide our cancer patients to make sure you are as happy as you can be and that you're doing all the things you want to do following your diagnosis.

For more details, contact your Community Wellbeing Officer today on 0151 237 2670, email info@wellbeingenterprises.co.uk, drop in to the Macmillan support and information service on the ground floor in the Linda McCartney Centre.

Download the leaflet here.