Diagnosis & Treatment planning

Diagnosis and Treatment Planning

Diagnosis

What tests are available to diagnose these cancers?

Currently in England, an endoscopy remains the best available investigative technique. This is a short and simple procedure carried out in a hospital setting by trained experts. A thin cable with a camera and sample tool on the end is inserted down the throat and into the stomach. A mild sedative or anaesthetic throat spray helps to reduce any discomfort. The procedure takes less than an hour to complete.

A relatively new technique called the ‘Cyto-sponge’ has been adopted in Scotland as a preliminary test that GPs are able to conduct within their practices. However, it has yet to be rolled out in England and Wales. This is a simple test where a small sponge-tablet is swallowed and retrieved back up the gullet via a thin thread, then sent to a lab for analysis.

A multi-cancer blood test is currently under development and maybe available by 2024.

What tests are available for related benign conditions like achalasia and pathological gastro-oesophageal reflux?

A range of test are available including:

Gastroscopy (more formally OesophagoGastroDuoedenscopy – OGD) the main technique for investigating these other conditions to detect Achalasia (if the bottom of the oesophagus is very narrow or tight, and food or saliva may be found sitting around the area of the oesophagus) or the presence of hiatus hernia, oesophagitis or gastritis. It also helps to rule out other causes of dysphagia.
Barium swallow test can also provide useful information. This is a test where you will be asked to drink some liquid barium while X-ray images are obtained. It may show a narrowing at the bottom of the oesophagus, described as bird’s beak or rat’s tail appearance or help to evaluate oesophageal dysmotility (problems with the oesophageal contractions that help food to be moved from the mouth to the stomach).
Oesophageal pH and manometry can also be used. Oesophageal manometry involves passing a narrow tube through the nose into the oesophagus to measure pressure changes during swallowing to help clarify true/pathological reflux and exclude diagnosis of achalasia.
Gastric emptying studies: which can be used to evaluate for gastroparesis (occasionally required to inform of surgical prospects.

When will I know for sure that I have cancer?

Only after having had a test that has been properly examined by trained experts will you know conclusively what your diagnosis is. Pathology samples, or cells taken from the oesophagus or stomach, usually take up to 10 working days to analyse. Results of a test should be discussed by prior written appointment, face to face with the Consultant Oncologist or Surgeon assigned to your case.

How do I cope with a cancer diagnosis?

A cancer diagnosis will always be a big shock for anyone, and inevitably loved ones and friends involved. Initially it leaves us feeling stunned - like hitting a brick wall, understandably fearing the absolute worst. It may take anything up to a week for the initial shock to subside, to be replaced by a series of very natural reactions – often denial “this can’t be happening to me”, or anger “why is this happening to me” and sometimes sadly depression, “I feel helpless – what’s going to happen to my family?”. Unfortunately, it is an emotional rollercoaster period for everyone involved.

But be completely assured, your natural ability to cope with a diagnosis will take over; a sense of survival and determination to get better, to understand more about the cancer and what can be done to beat it, are thoughts and actions you will instinctively act upon.

And also be very assured that medical teams within the NHS are well rehearsed and practiced at saving people’s lives. They are an incredible force for our wellbeing. You will receive the very best possible treatment available within the NHS. As good as anywhere in the world.

So, in summary, here are a few simple tips to help cope with an oesophageal cancer diagnosis:

Right from the off, try to remain calm and keep a sense of positivity; these are cancers that can be treated and managed effectively, so think about what can be done to beat it.
Look for support, share your news with your closest family first – talking is a great way to release pressure and lessen anxiety. It’s good to talk with friends too if you feel ready for it.
Don’t be tempted to delve into the internet for answers before you are clear about your own circumstances. Have detailed discussions with your lead clinician/consultant first. The internet can be misleading and cause unnecessary anxiety. We at OOSO have been through these cancers ourselves. We know how important it is to listen to our doctors first.
Be assured that modern treatments work very well and aren’t as difficult to cope with as they used to be.
Call us at OOSO if you would like to chat with folk who have been through all the treatment. We are here to lean on.

Staging and Treatment Planning

What happens after a cancer diagnosis?

To recap, the normal process is for a GP to initially refer their patient to the appropriate team at a local hospital. They will carry out investigative tests and inform the patient of the results.

After spotting the initial symptoms and signs of oesophageal or stomach cancer and diagnosing the cancer your clinical team can plan your treatment pathway, which depending on the type, location and stage of cancer may involve a combination of options/elements.

The patient will be assigned to a Lead or Consultant Oncologist, who will coordinate all necessary appointments. If cancer is diagnosed, then a treatment plan will be discussed with you.

At this stage, your GP and/or your clinical team should ensure you understand all the treatment options available to you, so you can make an informed decision about whether and how to proceed.

These treatment options and plans can include chemotherapy, radiotherapy, surgery and other interventions like gastric stents.

If a surgical option is recommended as part of the plan, you will also be assigned to a Consultant Surgeon to oversee surgical stages of the treatment plan.

Treatment

If the cancer is at an early stage, the main treatment option is surgery to remove the affected part of the oesophagus or stomach. For very early-stage cancers, it may be possible to remove just the abnormal areas in the lining of the oesophagus or stomach using an endoscopy (tube) placed down the throat.

Patients may also have chemotherapy (using drugs to destroy cancer cells) and/or radiotherapy (using radiation to destroy cancer cells) before or after surgery.

Certain types of early-stage oesophageal cancer may be suitable for treatment with only chemoradiotherapy (without surgery).

However, these treatments place a great deal of strain on the body, so patients who are frail or very unwell may decide, together with their doctors, that this treatment is not suitable.

If surgery is not suitable because the cancer is very advanced or a patient is too unwell for treatment, they may receive therapies which aim to reduce the impact of symptoms, extend and improve quality of life but do not neccessarily cure the cancer.

Such therapies include endoscopic stenting (where a tube, known as a stent, is placed into the oesophagus to keep blocked parts of the oesophagus open, which helps the patient to swallow); chemotherapy or radiotherapy; and best supportive care (no treatment beyond the immediate relief of symptoms).

It is comforting to share the emotional burden of care with family and friends, or a trained counsellor. Trained counsellors can offer objective, impartial advice and support that family members may find hard to give. Resignation and acceptance are big steps to make, but ultimately help with one’s peace of mind and quality of life towards the end.

Helping yourself through treatment stages

Follow the instructions and advice of your clinicians. Make sure you take all the tablets prescribed and attend every infusion appointment. If you feel unwell, contact the chemotherapy and or radiotherapy teams – they will advise and help you.

Stay determined and focussed on completing as much of the treatment plan as you possibly can. It can be quite challenging, but you can do it. Don’t feel disappointed if there are ‘hiccups’ throughout the treatment plan; for example, if you are told there are delays for infusions or tablets need changing for whatever reason. It’s rare for everything to run perfectly, but clinicians and nurses are excellent and do everything they can to help you through treatment without problems.

Ideally, be as fit and active as you can before treatment starts, and during treatment if you feel able to do light exercise and get outdoors for fresh air. But don’t ‘overdo it’, it is important to rest each day too, especially after infusions. There’s an important balance between keeping active and resting when you need to.

Some patients find they can continue working throughout treatment, which gives some indication that the effects are tolerable and normal life can continue. In my case, I was able to take time off work, which I found extremely beneficial on the days I needed to rest.

Keeping active is not only good for the body, but also excellent therapy for the mind. Having good mental health is so important throughout this whole experience – keeping fit, active and or just busy, with family and friends supporting you is an incredibly important part of feeling good, despite the circumstances, and getting well again.