No 31: Cancers of the stomach, oesophagus and pancreas
Almost one in 10 cancers strike the upper gastrointestinal (UGI) system (the stomach, oesophagus or pancreas). Most sufferers are elderly, although younger people are occasionally affected. Prognosis is generally poor - only about a quarter of UK patients survive a year after diagnosis. International studies show better survival rates elsewhere.
Early diagnosis is difficult. Typical symptoms - such as dyspepsia, nausea and stomach pains - are common to many other, less serious, complaints. Government guidelines stipulate patients should have investigations within two weeks if they show symptoms including jaundice, dysphagia (when foods sticks on swallowing), or dyspepsia, when combined with other warning signs such as weight loss or family history of UGI cancer. Anyone with suspected oesophageal or stomach cancer should have an endoscopy; ultrasound is best for suspected pancreatic cancer.
For stomach cancer, the UK's five-year survival rate of 12% is almost half the 21% European average. Later diagnosis and poorer hospital care seem to be key reasons. A major study of UGI cancer care in 29 hospitals in England and Wales found doctors who saw more patients had lower death rates.
The trend is confirmed in US studies. Surgery to remove the cancerous area is the main treatment when cancer is diagnosed early enough, but it is risky. Patients often die within one month. A large study has shown that chemotherapy before surgery for oesophageal cancer improves survival by 10% after two years.
Combining chemotherapy with surgery for stomach cancer has a slight benefit, according to analysis of several studies. Radiotherapy seems to help only a minority of patients with oesophageal cancer. For most people, palliative care to relieve symptoms is the main need. Inserting metal tubes can help swallowing.
What works? is based on reviews of the most up-to-date and reliable evidence available. It is written in collaboration with the NHS Centre for Reviews and Dissemination at York university (01904 433 634) and verified by experts. Details can be seen at CRD.