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Management of upper gastrointestinal cancers
  1. A Melville, freelance consultant1,
  2. A Eastwood, senior research fellow 2,
  3. E Morris, research assistant3,
  4. D Forman, professor3
  1. 1Melville Johnson, 1 Osmond Terrace, Porthmadog, Gwynedd LL49 9AN, UK
  2. 2NHS Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
  3. 3Cochrane Collaboration Review Group in Upper Gastrointestinal and Pancreatic Diseases, Cancer Epidemiology, School of Medicine, University of Leeds, Leeds LS2 9LN, UK
  1. Dr A Melville Arabella_Melville{at}

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This paper is an edited version of Effective Health Care volume 6 number 4 (December 2000), which deals with the management of cancers of the oesophagus, stomach and pancreas. It summarises systematic reviews undertaken to inform Improving Outcomes in Upper Gastro-intestinal Cancers.1 These publications form part of a series providing guidance on NHS services for patients with cancer, all of which are available at


Upper gastrointestinal (UGI) tumours caused 13.5% of all cancer deaths in England and Wales in 1997.2 Incidence and mortality rates are shown in table 1. Gastric (stomach) cancer is declining but adenocarcinomas of the oesophagus and the junction between the stomach and oesophagus are becoming more common in many countries (fig 1).36

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Table 1

UGI cancers: incidence rates, 7 survival rates, 8 9 and death rates 2

Figure 1

Trends in upper gastrointestinal cancer mortality, England and Wales.10

These cancers are often at an advanced stage at the time of diagnosis and over three quarters of patients in England and Wales die within a year. This mortality rate is worse than in many other developed countries, particularly for gastric cancer.89

Diagnosis and assessment

Many people with oesophageal or gastric cancer have indigestion, reflux, and pain or discomfort in the area of the chest or upper abdomen—symptoms generically described as dyspepsia. Dyspepsia prompts a substantial proportion of primary care consultations but fewer than 2% of these patients have cancer. The risk rises sharply in middle age, with incidence increasing from 1 per 100 000 people under the age of 40 to 155 per 100 000 over the age of 55.2

A large retrospective review suggested that only one person per million population under the age of 55 presenting with uncomplicated dyspepsia and no sinister symptoms (persistent vomiting, dysphagia, or weight loss) is likely …

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