Cancer Care Pathway for Oesophageal Cancer

FACTS

  • Oesophageal cancer is uncommon

  • Makes up 1.4% of cancer cases in men and 0.8% in women in Australia

  • 1587 were diagnosed with Oesophageal cancer in 2020

SYMPTOMS

  • Unexplained weight loss

  • Difficulty swallowing

  • Food or fluids getting stuck in your throat

  • Episodes of choking

  • Vomiting blood

  • New or worse heartburn and reflux

What is Oesophageal Cancer?

Oesophageal cancer refers to a malignant tumour found in the oesophagus, more commonly known as your food pipe.

The oesophagus is essential in your digestion and nutrition as it connects the mouth to the stomach. The oesophagus is lined with muscle which allows you to push your food down to your stomach. An oesophageal tumour may be found at various points within the oeosphagus, but it is most commonly found at the lower end– where the stomach and oesophagus meet. This is called the Gastro-Oesophageal Junction.

There are two types of cancers found in the oesophagus, you may hear your surgeon refer to either of the following:

  • Adenocarcinoma

  • Squamous cell carcinoma

The type of cancer will determine the treatment decision. The oesophagus has a number of layers, and the above cancer types are the medical terms used when discussing your cancer. They refer to the specific layers of the oesophagus and the cells affected by your cancer. If you’d like to learn more– ask your Surgeon or Cancer Nurse Coordinator to explain this to you in more detail.

In order to diagnose your cancer, read on to learn about the various tests and procedures that you may undertake prior to diagnosis.

Diagnosis: What to Expect

  • Gastroscopy

    A gastroscopy is a minor procedure where a small flexible camera is inserted down your oesophagus and into your stomach. At this time, they may take a biopsy, to confirm if it is malignant or benign. This procedure involves a light anaesthetic/sedation and you will go home the same day.

  • Endoscopic Ultrasound (EUS)

    Like the gastroscopy, an EUS involves a small flexible camera that is inserted down the oesophagus, however this camera also has a ultrasound probe at the tip allowing the doctor to see all the layers of the stomach. This will show whether the cancer has spread beyond the stomach. They will also take a biopsy during this procedure.

  • CT Scan

    A CT Scan stands for “Computerized tomography” which will use x-ray beams to get pictures inside your body. This will take multiple x-rays and compile them, making it different from single x-ray image. This will help the doctors identify the location of cancer. This may, or may not, require you to ingest “contrast” which is a medical dye. This can help to make the images clearer and easier to see the tumour. This is a non-invasive scan, but will require you to lie still on a table for approximately 10-30minutes.

  • PET/CT Scan

    A PET scan stands for “positron emission tomography”. This is not always used in gastric cancer, more commonly for oesophageal cancer. This scan can be done at the same time as the CT Scan. A PET scan is a method of identifying very small cancer cells that are not detectable through other imaging. You will receive a glucose solutionthrough an IV line. After waiting for 30-90 minutes (so that the solutionon can spread throughout the body) you will then have the scan. The solutionon collects in all cells, but particularly in cancer cells as they use more energy.

  • Laparoscopy

    A laparoscopy is a diagnostic procedure that will require you to undergo a general anaesthetic. This is a minimally invasive procedure where “Ports” (thin tubes) are inserted, using small cuts (5 - 12 mm into the belly button and abdomen. The abdomen is inflated with gas and the surgeon is able to visually inspect the surrounding organs and, in some cases, the tumour itself. They will also take more biopsies of the surrounding tissue to determine if there are any cancer cells present.

Multidisciplinary Meeting

After your investigations have been completed, your case will be discussed at a multidisciplinary meeting (MDM). This meeting is made up of surgeons, oncologists, radiologists, pathologists and the allied health team to collaboratively discuss your diagnosis and determine the best individualised treatment pathway for your disease. Your cancer will be staged by what is referred to as the “TNM” Staging System. Once this has been determined, you will meet with your surgeon again. This will take you through to the treatment phase of your journey.

Treatment Team

  • Surgeon

    At this appointment, you will meet with the surgeon, fellow or registrar to discuss your diagnosis and treatment options. If this includes surgery, the surgeon will talk you through the operation, risks and benefits so that you can make informed decisions.

  • Cancer Nurse Coordinator

    Your meeting with the cancer nurse may coincide with any of the above appointments depending on your treatment. Here, you will be provided with contact details for a central contact at the hospital, educational resources and you will have the opportunity to ask any questions you have about your care.

  • Medical/Radiation Oncologist

    If your treatment involves pre-operative chemotherapy (known as neoadjuvant treatment), you will meet the medical oncologist. At this point, you may also meet the radiation oncologist. The oncologists work collaboratively with the surgeons to ensure you are receiving the best care possible.

  • Anaesthetist

    Will assess your fitness for surgery and talk you through the medications and pain relief administered during the surgery.

  • Dietitian

    Some of you will be referred to a dietitian at the time of diagnosis. This will give you an opportunity to optimise your nutrition prior to treatment and allow ongoing support both in and out of the hospital.

  • Physiotherapist

    Will guide you in enhancing your physical fitness for pre-habilitation before surgery and in mobilising and keeping active after surgery

  • Psych-Oncologist

    Will review mental health issues related with your cancer diagnosis.

Please Note: If you are having surgery, you will also meet a number of people involved in your “Pre-Surgery” planning and assessment. Your Cancer Nurse Coordinator will take you through this in more detail during your appointment.

 

Resources