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Oesophago gastric cancer the disease and the challenges Muntzer - - PowerPoint PPT Presentation
Oesophago gastric cancer the disease and the challenges Muntzer - - PowerPoint PPT Presentation
Oesophago gastric cancer the disease and the challenges Muntzer Mughal Oesophago gastric cancer How common is it? What causes it? What are the symptoms? How is it treated? Recent advances in: Detection
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Oesophago‐gastric cancer
How common is it?
What causes it?
What are the symptoms?
How is it treated?
Recent advances in:
- Detection
- Treatment
The future
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10 20 30 40 50 Western Africa Northern Africa Micronesia Melanesia South Central Asia Eastern Africa Northern America Southern Africa South-Eastern Asia Australia/New Western Asia Northern Europe Western Europe Middle Africa Caribbean Central America Southern Europe World South America Polynesia Eastern Europe Eastern Asia Rate per 100,000 population
Males Females
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5 10 15 20 25 30
Western Africa Middle Africa Northern Africa Central America Micro/Polynesia Western Asia South-Eastern Asia Southern Europe Australia/New Zealand Northern America Eastern Europe Melanesia Caribbean South America Western Europe Northern Europe South Central Asia Japan Eastern Africa Southern Africa China
Rate per 100,000 population Males Females
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Stomach
7th commonest cancer
8200 new cases a year
6000 deaths a year Oesophagus
9th commonest cancer
7640 new cases a year
7400 deaths a year
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Scotland Northern North West Trent Anglia Wales N Thames S Thames N Ireland 2 4 6 8 10 12 14 16 18 20 per 1 0 0 ,0 0 0 population Oesophagus Stomach
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9th commonest cancer in the U.K
Commonly diagnosed at a late stage
- UK
20% presenting as emergency
- Japan
50% diagnosed early
5-year survival
- Japan
41%
- Europe
10%
- UK
9%
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Lifestyle
- Alcohol
- Smoking
Diet
- Salty/pickled food
Obesity
Barrett’s oesophagus
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Diet
- salty/pickled food
Lifestyle
- Alcohol
- Smoking
Infection
- Helicobacter pylori
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2 4 6 8 10 12 14 16 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 Year of diagnosis Rate per 100,000 population males females persons
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5 10 15 20 25 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Year of diagnosis Rate per 100,000 population
males females persons
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O‐G cancer symptoms
Indigestion that won’t go away
Difficulty with swallowing
Weight loss
Jaundice
But even the earliest SYMPTOMS
- ften associated with advanced
cancer
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6,137,325 examinations between 1968 – 1998
6394 cancers detected (0.104%)
Disease stage:
- I
72.5%
- II
10.3%
- III
11.2%
- IV
6%
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Primary prevention
- Public awareness –
- besity, alcohol & smoking
Early diagnosis
- Public awareness
- Easier access to endoscopy
Surveillance & screening of high risk groups
- Barrett’s
Better treatment
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GP
Disease free No or subtle symptoms Dysphagia, heartburn
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Acceptability and accuracy of a non-endoscopic screening test for Barrett's oesophagus in primary care: cohort study.
Kadri SR et al
- BMJ. 2010 Sep 10;341:c4372. doi: 10.1136/bmj.c4372
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Extent of the disease
Scans
Inspection of abdominal cavity General level of fitness Tailoring to the individual
Palliative if advanced
Curative if localised
- Surgery ±
chemotherapy/radiotherapy
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Stomach
Usually removal of whole stomach with lymph glands Oesophagus
Removal of major part of oesophagus & part
- f stomach
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Most patients in 60s and 70s
Some have other medical problems
Operations are long & complex
Oesophagectomy involves opening the abdomen and the chest
Therefore, potentially high morbidity and mortality
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Gastrectomy
6 weeks off work, 6‐9 months to get back to ‘normal’
Smaller meals, difficulty regaining weight
Oesophagectomy
12 weeks off work, 12 months to get back to normal
Smaller meals, difficulty regaining weight
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1987 - 1991 1997 - 2000
Mortality after surgery 10% 5% 1-year survival 47% 62% 5-year survival 20% 31%
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Better ‘mapping’ (staging) of the disease
Better tailoring of treatment
- Multidisciplinary Team approach
Better surgery & after‐care
Endoscopic treatment of early disease
Key‐hole surgery!
Specialisation & centralisation
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World‐class UGI gastroenterology service
- Endoscopic treatment of early tumours
- Interventional techniques – laser, stenting
- Research
Excellent oncology services
Strong surgical service
- 387 cases discussed and 82 resections since Feb
2011 with 1 death
- Expertise for complex and re‐operative surgery
O‐G Cancer MDT at UCLH
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Covering population of 3.5 M
Appointment of O‐G Pathway Board Directors
- David Khoo
(Queens Hospital in Romford)
- Muntzer
Mughal
Programme to improve outcomes:
- Earlier diagnosis
- Smoother pathway through staging to treatment
- Fewer centres for surgery
- More enrolment of patients into trials
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Regional surgical centre
1.5 million population base
>600 cancers a year
>100 operations a year
6 experienced surgeons
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10 miles
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