Should I see an oesophageal cancer specialist?
This page tells you about the guidelines that GPs have to help them decide who needs to see a specialist for suspected oesophageal cancer and how soon. You can find information about
Should I see an oesophageal cancer specialist?
It can be very difficult for GPs to decide who may have a suspected cancer and who has something much less serious. But some particular symptoms require urgent attention. The National Institute for Health and Clinical Excellence (NICE) says that the following symptoms need an urgent referral to a specialist, ideally within two weeks.
- Indigestion (dyspepsia) at any age, in combination with any of the following symptoms – weight loss, being sick, a low red blood cell count (anaemia) caused by coughing up blood, difficulty swallowing (called dysphagia), a swelling or lump in your upper abdomen, or a barium meal result that suggests you could have oesophageal cancer
- Indigestion without other symptoms in anyone aged 55 or over, that has come on recently and that your GP can't explain
- Difficulty in swallowing, at any age
- Unexplained abdominal pain and weight loss, with or without back pain, at any age
- A lump in your upper abdomen, at any age
Your GP should refer you to a specialist if you don't have indigestion but do have other symptoms such as being sick continuously, weight loss or anaemia that your doctor can't explain.
If you have symptoms and do not think your GP is taking them seriously enough, you could print out this page and take it to your appointment.
You can view and print the quick guides for all the pages in the About oesophageal cancer section.
There were about 7,650 cases of oesophageal cancer diagnosed in the UK in 2004. Just under 3 out of every 100 cancers diagnosed is an oesophageal cancer (2.8%). It is more common in men than women and, as with most cancers, is more common in older people. There are very few cases in people under the age of 40.
It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to simple treatments. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and those needing urgent appointments wouldn't be able to get them.
There are particular symptoms that mean your GP should refer you to a specialist straight away. NICE (the National Institute for Health and Clinical Excellence) have produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. These NICE guidelines on referrals for oesophageal cancer were revised in 2005. While reading these guidelines, it is important to remember that
- Indigestion is a very common complaint, and is usually not serious
- Oesophageal cancer is more common in older people - less than 1 case in 100 is diagnosed in someone under 40. Only 11 cases in every 100 are diagnosed in people in their 50s.
According to Department of Health guidelines, you should ideally get an appointment within 2 weeks for an urgent referral. You may need urgent referral for an endoscopy or to see an oesophageal cancer specialist if you have
- Indigestion (dyspepsia) at any age, in combination with any of the following symptoms - weight loss, being sick, a low red blood cell count (anaemia) caused by coughing up blood, difficulty swallowing (called dysphagia), a swelling or lump in your upper abdomen, or a barium meal result that suggests you could have oesophageal cancer
- Indigestion without other symptoms in anyone aged 55 or over, that has come on recently and that your GP can't explain
- Difficulty in swallowing, at any age
- Unexplained abdominal pain and weight loss, with or without back pain, at any age
- A lump in your upper abdomen, at any age
If you don't have indigestion but have the following symptoms, your GP should consider the possibility of oesophageal cancer and might make an urgent referral
- Being sick continuously, and losing weight
- Weight loss or anaemia that your doctor can't explain
If you are referred for an urgent endoscopy your doctor will temporarily stop any drugs you are on for indigestion. Ideally you should be off these for at least two weeks before the test. Your GP might also arrange for you to have a blood test to check for anaemia. The NICE guidelines recommend that anyone with newly diagnosed indigestion should have a blood test to check for anaemia.
Your doctor may urgently refer you to a specialist if you have indigestion that is getting worse, along with
- Cell changes in the tissue lining of your gullet (oesophagus)
- Barrett's oesophagus
- Surgery for a peptic ulcer more than 20 years ago
There is more information about the possible risks factors and symptoms of cancer of the oesophagus in this section of CancerHelp UK.
You wil be looked after by a ‘multi-disciplinary team’ (MDT). This is a team of health professionals who work together to decide on the best way to care for you.
The specialist MDT is likely to include the following health professionals
- Surgeons (they will be specialists in surgery for the foodpipe and stomach)
- Cancer specialist doctors (oncologists)
- Radiotherapy doctors (radiotherapists)
- Clinical nurse specialists
- Dieticians (to help with nutritional issues)
- Palliative care specialists, for help with controlling symptoms
The MDTs might also include other professionals such as physiotherapists and occupational therapists.
You will have a ‘key worker’ who will be your main point of contact with the MDT. This is usually the clinical nurse specialist.
If you are concerned that your GP is not taking your symptoms as seriously as you think he or she should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.
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