Gastro-Oesophageal Cancer

Gastro-oesophageal cancer develops due to abnormal growth and multiplication of the cells lining the inner layer of the stomach or oesophagus. The cancer first spreads to adjacent lymph nodes but in latter stages, it may spread via the blood stream to other organs such as the liver, bones and lungs. Most cancers are adenocarcinomas and these develop in the glandular cells that line the stomach wall or lower oesophagus. There are other rarer cancers of the oesophagus and stomach, which include squamous-cell cancers of the oesophagus and gastro-intestinal stromal tumours (GIST) that develop in the connective tissue of the stomach or oesophagus.

Risk factors include:

• Increasing age
• Cigarette smoking
• Family history
• Obesity
• Infection with helicobacter pylori which may predispose to stomach cancer
• Change in the lining of the lower oesophagus (barretts oesophagus) may predispose to lower oesophageal cancer.

Symptoms

• Indigestion or heartburn
• Bloating
• Pain
• Dysphagia – difficulty swallowing
• Weight loss
• Anaemia and lethargy

Diagnosis

• Endoscopy – this is an examination of the inside of the stomach and oesophagus. Biopsies may be taken to confirm the diagnosis.
• Blood tests
• CT scan – this may help to stage the tumour to establish if there is spread of the cancer
• PET scan – this is a specialised scan looking for spread of the cancer and may be indicated for oesophageal cancer if your doctor feels this is necessary.
• Endoscopic ultrasound – this may be indicated to show if the tumour has spread through the wall of the stomach or oesophagus.
• Laparoscopy may be indicated to look for spread of the cancer.

Treatment

Treatment is usually provided by a team of health professionals, which may include surgeons, medical oncologists, radiotherapists, gastroenterologists and a range of allied health personnel (multidisciplinary team).

Treatment depends on the stage of the cancer and may include:

• Chemotherapy – this may be given before or after surgery for gastro-oesophageal cancer.
• Radiotherapy – may be indicated.
• Surgery – there are different types of surgery depending on the site of the cancer. Surgical procedures are major procedures and should be done by surgeons experienced in this type of surgery. These include:

1. Subtotal gastrectomy: this is where part of the stomach is removed. This is usually done via an abdominal incision and involves removal of the surrounding lymph nodes. In some cases this may be able to be done with laparoscopic surgery.
2. Total gastrectomy: this is where all of the stomach and surrounding lymph nodes are removed. Occasionally, other organs such as the spleen need to be removed as well.
3. Oesophago-gastrectomy: this is a very major operation involving removal of the lower oesophagus and the top part of the stomach with the surrounding lymph nodes. It is done via an incision in the chest and the abdomen although there are indications for minimally invasive techniques. The stomach is fashioned into a tube and joined to the upper oesophagus in the chest.