oesophageal cancer. -improving outcomes. anil kaul consultant general and upper gi surgery st helens...
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Oesophageal Cancer.-improving outcomes.
Anil Kaul
Consultant General and Upper GI SurgerySt Helens and Knowsley Teaching Hospitals NHS Trust
How big is the problem
• Oesophageal and Gastric cancer - 13500 patients affected each year in the UK
• Fifth most common malignancy• Fourth most common cause of death
• Oesophageal (numbers are rising)• Gastric (numbers are decreasing)• OG Junction ( numbers are rising)
Oesophageal cancer
• 13th most common cancer in the UK• Total cases 8332• Males 5582 (67%)• Females 2750 (35%)
• Higher incidence in the northwest• Expected number about 110 cases in 2 years• Actual numbers about 190 cases in 2 years
Symptoms SIGN 2006 ;NICE 2004
• Dysphagia• Odynophagia• Persistent dyspepsia.• Loss of Appetite• Loss of weight• Vomiting• GI Blood Loss, Anaemia, Malaena, Haematemesis
Be clear on cancer campaign
• heartburn most days for 3 weeks or more. • indigestion on and off for 3 weeks or more • food feels like it’s sticking in your throat when you swallow • losing weight for no obvious reason • Trapped wind and frequent burping • Feeling full very quickly when eating • Feeling bloated after eating • Nausea or vomiting
• Stomach pain
How do I reduce my chances of getting this cancer ?
• Stop smoking
• Look after yourself, If you’re overweight, you
should lose weight
• Eat healthily, Try to get your 5 A DAY
• Cut back on drinking alcohol
Investigations
• For Diagnosis• Endoscopy• Barium Swallow and Meal
• For Staging• CT/ EUS/PET• Staging Laparoscopy
Treatment Options
• Curative• Surgery• Chemotherapy• Radiotherapy
• Palliative• Chemotherapy• Radiotherapy• Stent
Outcomes
• Oesophageal• Overall 5 year survival 7 % (AUGIS 2012)
• Gastric• Overall 5 year survival 13% (AUGIS 2012)
The need for action
• In St Helens and Knowsley the incidence is higher
than national average
• Patients are diagnosed at a later stage in the disease
• Overall outcome compared to the national average is
poor
NAEDI National Awareness and early Diagnosis Initiative
• 950 deaths from Oesophago gastric cancer can be avoided each year (CRUK) if our results were as good as Europe
• Main Factor Identified is delay in diagnosis
Results
• Results of curative Treatments are similar to the rest of the UK and Europe
• Cancer Research UK / DOH has identified late presentation as the main reason for poor outcome
Early Diagnosis is the key
• Who diagnoses them
• GP 63.3 %• AED 16.4%• Other specialties 17.3%
• GP suspected cancer 68.8%
• Overall only 45.6 % diagnosed because GP suspected cancer
So what’s the cause of delay
• Patient related» Ignorance iVan»Fear»Access to services
• Primary Care related»? Support / ? resource
• Secondary care» Inefficient System
Way forward- Collaboration - MCCN – “How to save an extra 424 lives ….. Catching cancer
earlier”
• Primary Care ownership of this issue
• Partnership working with Public Health and Secondary Care.
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