Upper GI Cancer Q&A

Mr Bilal AlkhaffafDr Bilal Al-Khaffaf is one of our top general surgeons at BMI The Alexandra Hospital.

He treats a variety of general disorders and specialises in gastroenterology and cancer care. Find out more about gastroenterology.

Here we ask him about upper GI cancer, the causes, symptoms and treatments.

Dr Bilal Al-Khaffaf
Upper gastrointestinal (GI) cancer is an abnormal ‘life-threatening’ growth which occurs either in the food pipe (also known as the oesophagus or gullet) or the stomach. The commonest type of cancer in the United Kingdom is ‘adenocarcinoma’, however other types of cancer such as ‘squamous cell carcinoma’, ‘gastro-intestinal stromal tumour’ (GIST) and lymphoma of the stomach are also seen.

Dr Bilal Al-Khaffaf
The commonest symptoms include difficulty or pain on swallowing, persistent heartburn or acid reflux, unexplained weight loss and tiredness due to a low blood count (anaemia). Sometimes dark stool can be caused by bleeding from a tumour in the upper GI tract.

Because these symptoms are ‘non-specific’, meaning that they can be due to a wide variety of mostly benign conditions, they are often ignored or over-looked. As a consequence, the majority of patients who come to us with a diagnosis of upper GI cancer are at a stage where they cannot be cured. So, if you or anybody you know has these symptoms, go to your doctor and ask them to arrange an endoscopy (camera test) to rule out cancer as a cause.

Dr Bilal Al-Khaffaf
The short answer is ‘we don’t know’. There is lots of research being undertaken to try and understand why people get upper GI cancer. What we do know is that no two cancers are the same and that there is not one single cause for it.

Dr Bilal Al-Khaffaf
Different cancers have different risk factors. Developing ‘adenocarcinoma’ is associated with the following risk factors: 

  • Obesity (being overweight) 
  • Chronic acid reflux
  • Barrett’s oesophagus 
  • Bacterial (Helicobacter Pylori) infections (stomach cancer only)

Squamous cell carcinoma is linked with the following risk factors: 

  • Smoking 
  • Alcohol excess 
  • A persistently low immune system due to medications such as steroids

A very small proportion of upper GI cancers can be inherited. If a patient develops cancer at a young age (less than 50 years of age), it is important for first degree relatives to speak to their doctor as genetic testing may be needed.

Dr Bilal Al-Khaffaf
There are two areas of treatment; curative and palliative treatment. Curative treatment aims to remove all traces of cancer; however, this is only suitable for about 1 in 3 patients with upper GI cancer. Most patients are diagnosed with metastatic disease (cancer spread) and the only (palliative) treatments available aim to slow the growth of the cancer or relieve symptoms.

Curative treatments

The main curative treatment is surgery. Our team often perform this surgery using keyhole (laparoscopic) techniques which results in less pain and a quicker short-term. The location of the cancer will determine what operation is required. Oesophageal (food-pipe or gullet) cancer will usually require surgery to remove most of the oesophagus and half of the stomach. If the cancer is in the stomach, then either all or part of the stomach must be removed. We always talk to the patient in detail about this. Surgery of this kind is ‘life-altering’ and has short and long-term effects on nutrition and quality of life which can take up to a year to fully recover from.

The success of surgery in removing cancer is improved by adding other treatments such as chemotherapy and radiotherapy. Patients are always discussed in a meeting with other specialists to see whether this is appropriate for them. We are proud to be able to offer this specialised multi-disciplinary team service at the BMI Alexandra Hospital.

Palliative treatments

Treatment for metastatic cancer aims to slow down the progression of cancer and prolong the life of the patient. This usually involves chemotherapy. There is a lot of interest in this area of upper GI cancer, and patients are often asked to take part in new treatment research.

Symptoms such as difficulty swallowing are often treated with a ‘stent’. A stent is a short, lightweight tube which opens the GI tract where it has narrowed because of the cancer. It allows food and drink to pass the by the cancer, helping to improve some of the symptoms of difficulty swallowing or vomiting.

Dr Bilal Al-Khaffaf
I knew very early on in my training that I wanted to be a surgeon. I was inspired by some extremely dedicated, passionate, and caring consultants (including my father) who showed me that whilst being a good surgeon necessitates skill, patience and problem-solving under pressure, it is as much about developing a relationship with your patient based on trust and clear communication.

Dr Bilal Al-Khaffaf
I have had two highlights to date. I was very proud to be awarded a prestigious research award from the National Institute of Health Research to fund an international study which puts patients at the centre of future research. The study aims to ensure that when we look at new treatments for stomach cancer, we take into account outcomes which are important to patients and not just what is important to healthcare professionals.

The other highlight has been playing a pivotal role in developing keyhole surgery for the treatment of oesophageal and stomach cancer in Manchester. This has involved travelling to South Korea, the United States and the Netherlands to learn cutting edge techniques. Keyhole surgery means that patients no longer need to have operations that involve large incisions which has the main benefit of a quicker short-term recovery after surgery and less pain.

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