This protocol should ony be used to refer patients with no suspicion of cancer.
If there is a suspicion of cancer, the patient should be referred using the guidelines and protocols in the Lanarkshire Cancer Referral Centre
Tag: gastric
Gastrointestinal (Upper) Cancer, Surgeon Template
This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.
Presenting Complaint
Main Presenting Complaint: [Text – 98 character maximum]
Reason for Referral: [Text]
World Health Organisation Performance Scale
Using the following as a guide, please select the most appropriate answer to describe the patients general health:
Options:
- Asymptomatic
- Symptomatic but completely ambulatory
- Symptomatic, <50% in bed during the day
- Symptomatic, >50% in bed, but not bedbound
- Bedbound
Priority: Urgent Suspicion of Cancer
Date of Onset: [Date]
Will the patient accept any site for treatment:
- Yes
- No
Symptoms and Investigations
Symptoms
Unexplained weight loss:
- Yes (If Yes, please provide brief details)
- No
Unexplained iron deficiency anemia:
- Yes (If Yes, please provide brief details)
- No
Family history of oesophago-gastric cancer in more than two first degree relatives:
- Yes (If Yes, please provide brief details)
- No
Family history of familial adenomatous polyposis in any first degree relative:
- Yes (If Yes, please provide brief details)
- No
Barrett’s oesophagus:
- Yes (If Yes, please provide brief details)
- No
Pernicious anaemia:
- Yes (If Yes, please provide brief details)
- No
Gastric surgery over 20 years ago:
- Yes (If Yes, please provide brief details)
- No
Known dysplasia, atrophic gastritis, intestinal metaplasia:
- Yes (If Yes, please provide brief details)
- No
Upper abdominal epigastric mass:
- Yes (If Yes, please provide brief details)
- No
Iron deficiency anaemias:
- Yes (If Yes, please provide brief details)
- No
Clincal Examination
Jaundice:
- Yes (If Yes, please provide brief details)
- No
Upper abdominal mass:
- Yes (If Yes, please provide brief details)
- No
Investigations
FBC and ESR sent:
- Yes
- No
LFT, U&E sent:
- Yes
- No
Previous endoscopy done:
- Yes
- No
Gastrointestinal (Upper) Cancer, Endoscopy Template
This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.
Presenting Complaint
Main Presenting Complaint: [Text – 98 character maximum]
Reason for Referral: [Text]
World Health Organisation Performance Scale
Using the following as a guide, please select the most appropriate answer to describe the patients general health:
Options:
- Asymptomatic
- Symptomatic but completely ambulatory
- Symptomatic, <50% in bed during the day
- Symptomatic, >50% in bed, but not bedbound
- Bedbound
Priority: Urgent Suspicion of Cancer
Date of Onset: [Date]
Will the patient accept any site for treatment:
- Yes
- No
Symptoms and Investigations
Symptoms
Unexplained weight loss:
- Yes (If Yes, please provide brief details)
- No
Unexplained iron deficiency anemia:
- Yes (If Yes, please provide brief details)
- No
Family history of oesophago-gastric cancer in more than two first degree relatives:
- Yes (If Yes, please provide brief details)
- No
Family history of familial adenomatous polyposis in any first degree relative:
- Yes (If Yes, please provide brief details)
- No
Barrett’s oesophagus:
- Yes (If Yes, please provide brief details)
- No
Pernicious anaemia:
- Yes (If Yes, please provide brief details)
- No
Gastric surgery over 20 years ago:
- Yes (If Yes, please provide brief details)
- No
Known dysplasia, atrophic gastritis, intestinal metaplasia:
- Yes (If Yes, please provide brief details)
- No
Upper abdominal epigastric mass:
- Yes (If Yes, please provide brief details)
- No
Iron deficiency anaemias:
- Yes (If Yes, please provide brief details)
- No
Clincal Examination
Jaundice:
- Yes (If Yes, please provide brief details)
- No
Upper abdominal mass:
- Yes (If Yes, please provide brief details)
- No
Investigations
FBC and ESR sent:
- Yes
- No
LFT, U&E sent:
- Yes
- No
Previous endoscopy done:
- Yes
- No
Gastrointestinal (Upper) Cancer Endoscopy
Oesophago-gastric, hepatobiliary and pancreatic cancers
Approximately 3,000 people are diagnosed with a primary oesophago-gastric, hepatobiliary or pancreatic cancer in Scotland every year.
Common symptoms of oesophago-gastric cancer include weight loss, dysphagia, heartburn or pain, vomiting and anaemia. Common symptoms of hepatobiliary or pancreatic cancer include jaundice, abdominal mass, epigastric pain and weight loss. The risk of developing an oesophago-gastric cancer is higher in patients of East Asian origin and a higher suspicion of risk should be used in these patients.
An abdominal examination and appropriate blood tests (for example, full blood count, ferritin, urea and electrolytes test [U&Es] and liver function tests [LFTs]) should be performed on all patients with symptoms suggestive of these cancers. These findings can facilitate triage in secondary care. Referral should not be influenced by Helicobacter pylori (H pylori) status. Proton pump inhibitors should be avoided if possible prior to investigation. H2 antagonists may be used for symptomatic relief.
All patients with high-risk features should be referred to a team specialising in the management of oesophago-gastric, hepatobiliary or pancreatic cancers, depending on local arrangements.
Urgent suspicion of cancer referral
Oesophago-gastric cancer
Dysphagia (interference of the swallowing mechanism that occurs within 5 seconds of the swallowing process) or odynophagia (pain on swallowing) at any age.
New onset upper gastrointestinal pain or discomfort in people over 55 years.
New or worsening upper gastrointestinal pain or discomfort combined with one or more of the following features:
- unexplained weight loss
- unexplained iron deficiency anaemia
Persistent vomiting more than 4 weeks.
Upper gastrointestinal pain or discomfort combined with at least one of the following risk factors:
- family history of oesophago-gastric cancer in more than two first-degree relatives
- family history of familial adenomatous polyposis in any first-degree relative
- Barrett’s oesophagus
- pernicious anaemia
- gastric surgery over 20 years ago
- known dysplasia, atrophic gastritis or intestinal metaplasia
Hepatobiliary and pancreatic cancer
Features of hepatobiliary or pancreatic cancer can be vague and non-specific, and may include:
- unexplained obstructive jaundice
- upper abdominal or epigastric mass
- unexplained back pain (consider other cancer causes such as malignant spinal cord compression)
- unexplained weight loss
- any suspicious abnormality, in the hepatobiliary tract, found on imaging (such as biliary dilatation or pancreatic/liver lesion)
Primary care management
Dyspepsia under 55 years without accompanying symptoms or risk factors should be managed according to local or national guidelines.
Good Practice Points
There should be a low threshold for considering investigation (perhaps with discussion about appropriate imaging with a radiologist) or routine referral for patients presenting with:
- late onset diabetes in a weight-losing patient
- non responsive dyspepsia following initial test and treat
- post prandial pain or early satiety
- new onset irritable bowel syndrome symptoms in middle age
- steatorrhoea or fat malabsorption
Reference:
Scottish Referral Guidelines for Suspected Cancer. Scottish Government, August 2014
SIGN Guideline 87 – Management of oesophageal and gastric cancer
Clinical Lead Mr Hakim BenYounes, Chief of Medical Services, NHS Lanarkshire
Review Date March 2017
Gastro Intestinal (Upper) Cancer Endoscopy dictation template