Oesophageal and Gastric Tumours
We seperate oesophageal and gastric “lumps” into causes that are benign and malignant.
Oesophageal and gastric benign lesions can be either left alone or surgically excised by keyhole or open techniques if you are symptomatic. Unfortunately a large number of oesophageal and gastric masses are cancerous. There are two common types of cancers in the oesophagus - adenocarcinoma and squamous cell carcinoma. Gastric cancers are typically adenocarcinoma with specific subtypes such as signet ring tumours. There are also uncommon tumours such as gastrointestinal stromal tumours (GISTs) that also sometimes diagnosed and these have a slightly different pathway.
Modern treatment for all tumours is what we term “multidisciplinary.” Many different medical, nursing and allied health specialities are involved as we assess, treat and care for you. Treatable cancers are often found when they are locally advanced. These are still treatable depending on several factors.
What type of cancer is this?
We pick up oesophageal and gastric cancers either “accidentally” or when you have symptoms such as difficulty swallowing, reflux, blood loss, obstruction or weight loss.
We establish the exact diagnosis by taking tissue usually with a gastroscopy and examining this under a microscope. This is a pathology slide of a biopsy taken of an adenocarcinoma of the oesophagus. When you receive this diagnosis, it can be an enormous shock. Your endoscopist or GP should then refer you urgently to a specialist.
If you wish, Jonathan will often see a new cancer referral within the week.
How bad is it?
This is really what you want to know. Is the cancer early, locally advanced or has it spread into the liver or lungs? The reason for early referral is that it will often take several weeks for us to work out the “staging” of the cancer. This needs to be done with precision. We use scans, endoscopic ultrasounds and sometimes minor surgery to work out the stage.
It is important to then double-check all of the investigations and to ensure that we are treating you with the best available evidence. I present your story and investigations to the Upper GI Multidisciplinary Meeting at Sir Charles Gairdner Hospital, one of the two State Comprehensive Cancer Centres in WA.
This objective assessment is important to ensure nothing has been overlooked. Think about this as a “tumour board” of experienced specialists in surgery, medical oncology, radiation oncology, gastroenterology, pathology, radiology and other disciplines. A consensus decision based on the best evidence is then made.
How can we beat this cancer?
Treating this tumour involves three things.
The medical management: treatment hinges on the three pillars of surgery, chemotherapy and radiotherapy. The exact combination depends on what type of tumour you have and the stage of tumour. Jonathan will advise you on the treatment options following the “tumour board” meeting.
Nutritional management: often by the time this tumour has been picked up, you have become malnourished. Making sure you are well nourished is crucial and our dietetics team become heavily involved in your care
Physical fitness: No matter what your treatment ends up, it is like preparing for a marathon. Brisk walking is a simple way to prepare. We will also enrol you in a surgical gym for surgical preparation.