Upper gastrointestinal cancer (UGI)
Upper gastrointestinal (UGI) cancer is a primary cancer of the oesophagus (gullet), stomach, duodenum and small bowel. This also covers GISTs (gastrointestinal stromal tumours).
Hepato-bilary (HPB) is also included involving the pancreas, liver, bile duct and/or gall bladder.
Further information about UGI and HPB cancers can be found on the Macmillan, Pancreatic Cancer charity or British Liver Trust websites.
At Barts Health, the care of patients with UGI/HPB cancer is provided at Whipps Cross, Newham and The Royal London hospitals. Appointments and treatment can take place at each of these locations.
If you are having tests or undergoing treatment for UGI/HPB cancer, you will be given the contact number for a specialist nurse who will support you throughout your treatment.
Your doctor may need to do a series of tests to find out more about the cancer. You may need to undergo one or more of the following investigations:
A gastroscopy is a procedure where a thin, flexible tube called an endoscope is used to look inside the oesophagus (gullet), stomach and first part of the small intestine (duodenum).
Liver ultrasound scan
These scans listed below build up a picture of the inside of your body by taking a series of images
CT (computerised tomography) scan
MRI (magnetic resonance imaging) scan
PET scan (positron emission tomography)
You may need several blood tests to assess your general health. The specific blood test for UGI/HPB cancer is called CEA, CA 19-9 (tumour marker).
Prior to curative surgery for oesophageal or gastric cancers you will need to undergo a staging laparoscopy. This is a key hole procedure done under a general anaesthetic and involves looking into the abdomen through tiny cuts. This allows the surgeon to look at the cancer and whether it has spread to other organs such as the liver and the surrounding lymph nodes.
It may take up a couple of weeks to complete these investigations. Should you have any concerns during this time please contact your clinical nurse specialist.
Further information about all cancer investigations can be found on the Macmillan, Pancreatic Cancer charity and British Liver Trust websites.
Your treatment options
The upper gastrointestinal/hepato-biliary cancer team at Barts Health have multidisciplinary team meetings (MDTs). This is where a group of health professionals with expert knowledge in upper gastrointestinal/hepato-biliary cancer manage your investigations and treatment.
You do not attend the meeting but a member of the team, usually your specialist nurse, will tell you about the results of the meeting. You may be given a choice of treatment options, which your specialist will discuss with you. If you don't understand what you've been told, let the staff know so they can explain again.
Before you have any treatment, you will need to give permission (consent). Further information about types of treatment used for treating upper gastrointestinal/hepato-biliary is available on the Macmillan, Pancreatic Cancer charity,or British Liver Trust websites.
The upper gastrointestinal/hepato-biliary clinics for patients under the care of The Royal London Hospital and Newham Hospital are held at The Royal London Hospital on Tuesday mornings.
The clinics at Whipps Cross are scheduled on different days each week. You will be informed of your clinic date and time in advance.
The medical oncology clinics are held at St Bartholomew’s Hospital all day Monday and Tuesday afternoon for follow up clinics and Wednesday afternoon for new patients.
The clinical oncology clinics are held at St Bartholomew’s Hospital Monday afternoon for new patients and Thursday afternoon for follow-up clinics.
You will see your specialist doctor in the clinic after the multidisciplinary team has met. Your doctor might talk to you about your diagnosis and treatment plan. You can also talk to them about any concerns you may have.
It may be a good idea to take someone with you to your clinic appointment. You may also find it useful to have a list of questions ready to make sure you get the information you need.
Your care team
The upper gastrointestinal/hepato-biliary cancer team at Barts Health includes the following staff:
A specialist doctor who is trained in operating on upper gastrointestinal/hepato-biliary cancers.
A doctor trained in diagnosing and treating cancer patients with chemotherapy .
A doctor trained in diagnosing and treating cancer patients with ra diotherapy.
A doctor who is expert in interpreting x -rays and scans. They may also perform biopsies (taking tissue samples) with the aid of imaging techniques.
A doctor who looks at tissue samples under a microscope to search for cancer cells.
Clinical Nurse Specialist (CNS)
An experienced cancer nurse who acts as your key worker. They will give you advice and support as you go through investigations and treatment and support you through your care pathway.
Member of the palliative care team
The palliative care team specialises in relieving pain and other symptoms, including psychological difficulties caused by cancer.
Multi-disciplinary team co-ordinator
The co-ordinator provides administrative support to the upper gastrointestinal/hepato-biliary cancer team and aims to ease the pathway from referral to treatment.
The upper gastrointestinal/hepato-biliary cancer team are a group of experts and will work with you to conduct and provide the best care plan possible.
If you have any concerns, please talk to the team who will be considerate of your decisions and wishes.
Information for professionals
Sources of referrals to the UGI/HPB teams are as follows:
The two week wait pathway from a GP
Inpatient referrals via the MDT co-ordinator
Tertiary referrals from other NHS organisations