Specialist Gastric and Oesophageal Cancer Surgery in Sydney

What is Oesophageal cancer?

 

• • Oesophageal cancer is cancer of the upper food pipe. The most common variant in the Western world is adenocarcinoma. It is the 8th most common cancer and the 6th leading cause of death from cancer worldwide.
  • Risk factors: Male gender, GORD, Barrett’s oesophagus, smoking, achalasia and obesity.
  • Barrett’s oesophagus (BE): If present needs lifelong surveillance and strict control of acid reflux. Patients with BE are 50 times more likely to develop cancer.

 

When to seek medical help?

 

• • The majority of patients are asymptomatic or have non-specific symptoms. Hence, conditions such as BE, which tend to be asymptomatic in over 50% of cases and at high risk for developing oesophageal cancer need attention.
  • Symptoms: Difficulty in swallowing, weight loss, loss of appetite, worsening acid reflux, painful swallowing, anaemia causing symptoms such as black stool and tiredness, and hoarse voice.

 

What is the management of Oesophageal cancer?

 

• • Confirmation of the diagnosis and staging of the cancer is the initial and vital step toward curative treatment.
  • Gastroscopy: This allows for confirmation of the diagnosis allowing surgeons to take a biopsy.
  • CT and PET scan: These are two different types of scans done after confirming the diagnosis which allows the surgeon to assess the degree of spread of cancer beyond the oesophagus if present.
  • Chemotherapy: This is the first line of treatment if cancer has not spread beyond the oesophagus in a suitable prior to surgery. Chemotherapy is typically given before and after the surgery.
  • Oesophagectomy: This is the operation of choice which involves excising 2/3rd of the oesophagus, fashioning the stomach into a tube and joining it to the cut end of the oesophagus. In selected cases, depending on the nutritional status of the patient, the operation involves inserting a feeding tube for supplemental feeds.

 

What to expect following the operation?

 

• • Typically, patients stay in intensive care for 1-2 days and then 7-10 days further on the ward providing that the recovery is uncomplicated.
  • Patients are discharged on a puree diet along with feeds via the feeding tube sometimes. The diet is monitored by the dietician who will gradually upgrade as appropriate.
  • Patients who recover well may receive more chemotherapy to further reduce the chances of cancer recurrence.
  • The overall recovery for most patients to feel near normal may take 6-12 months.
  • Patients commonly remain under close follow-up for many years in order to detect any recurrence.

 

What is Gastric cancer?

 

• • Gastric cancer is cancer of the stomach. The most common variant in the Western world is adenocarcinoma. It is the 5th most common cancer and the 4th leading cause of death from cancer worldwide. The other variant that is seen slightly less commonly is GIST (gastrointestinal stromal tumour)

 

• • Risk factors: male gender, obesity, alcohol, helicobacter pylori infection, certain familial conditions (e.g., CDH1 gene deficiency, Lynch syndrome and FAP) and preserved smoked or salted food products.

 

When to seek surgical help?

 

• • The majority of patients are asymptomatic, especially in the early stages.
  • Symptoms: weight loss, loss of appetite, fatigue (from anaemia), feeling full early, upper abdominal pain, vomiting blood and black stools.

 

What is the management of Gastric cancer?

 

• • Confirmation of the diagnosis and staging of the cancer is the initial and vital step toward curative treatment.
  • Gastroscopy: This allows for confirmation of the diagnosis allowing surgeons to take a biopsy.
  • CT scan: This allows the surgeon to assess the degree of spread of cancer beyond the stomach if present.
  • Staging laparoscopy: This is a small operation that involves putting a camera into the patient’s abdominal cavity which, similar to CT scan, allows the surgeon to assess the spread of cancer within the abdominal cavity prior to starting definitive treatment.
  • Chemotherapy: This is the first line of treatment if cancer has not spread beyond the stomach in a suitable prior to surgery. Chemotherapy is typically given before and after the surgery.
  • Gastrectomy: This is the operation of choice which involves excising the affected part of the stomach (sometimes the whole stomach). In selected cases, depending on the nutritional status of the patient, the operation involves inserting a feeding tube for supplemental feeds.

 

What to expect following the operation?

 

• • Typically, patients stay in the hospital for 7-10 days providing that the recovery is uncomplicated.
  • Patients are discharged on a puree diet along with feeds via the feeding tube sometimes. The diet is monitored by the dietician who would gradually upgrade as appropriate.
  • Patients who recover well receive more chemotherapy to further reduce the chances of cancer recurrence.
  • Patients commonly remain under close follow-up for many years in order to detect any recurrence.