1. Oesophageal Cancer. -improving outcomes. Anil Kaul Consultant General and Upper GI Surgery St Helens and Knowsley Teaching Hospitals NHS Trust

2. 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)

3. Oesophageal cancer 13 th 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

6. Risk factors Age >55 Male Deprivation Tobacco Alcohol Obesity H Pylori Reflux

7. Symptoms SIGN 2006 ;NICE 2004 Dysphagia Odynophagia Persistent dyspepsia. Loss of Appetite Loss of weight Vomiting GI Blood Loss, Anaemia, Malaena, Haematemesis

8. 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

9. 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

10. Investigations For Diagnosis Endoscopy Barium Swallow and Meal For Staging CT/ EUS/PET Staging Laparoscopy

11. Treatment Options Curative Surgery Chemotherapy Radiotherapy Palliative Chemotherapy Radiotherapy Stent

12. Outcomes Oesophageal Overall 5 year survival 7 % (AUGIS 2012) Gastric Overall 5 year survival 13% (AUGIS 2012)

13. 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

14. 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

15. 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

16. Bottom line Prevention Early diagnosis Curative treatment

17. Early Diagnosis is the key Who diagnoses them GP63.3 % AED16.4% Other specialties17.3% GP suspected cancer 68.8% Overall only 45.6 % diagnosed because GP suspected cancer

18. So what’s the cause of delay Patient related » Ignorance iVan » Fear » Access to services Primary Care related » ? Support / ? resource Secondary care » Inefficient System

20. 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.

21. NAEDI National Awareness and early Diagnosis Initiative Achieve Early Presentation Optimise Clinical Practice Improve GP Access to Diagnostic test Research Evaluate and Monitor