Should I see an oesophageal cancer specialist?

There are about 8,100 cases of oesophageal cancer diagnosed in the UK each year. Just under 3 out of every 100 cancers diagnosed (3%) is an oesophageal cancer. It is more common in men than women and, as with most cancers, is more common in older people. There are very few cases in people under the age of 40.

It can be very difficult for GPs to decide who may have a suspected cancer and who may have something much more minor that will go away on its own. With many symptoms, it is perfectly right that your GP should ask you to wait to see if they get better or respond to simple treatments. If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and those needing urgent appointments wouldn't be able to get them.

NICE (the National Institute for Health and Clinical Excellence) and the Scottish Government have produced guidelines for GPs to help them decide which patients need to be seen urgently by a specialist. While reading these guidelines, it is important to remember that

• Indigestion is a very common complaint, and is usually not serious
• Oesophageal cancer is more common in older people - less than 1 case in 100 is diagnosed in someone under 40. Only 11 cases in every 100 are diagnosed in people in their 50s.

According to Department of Health guidelines, you should ideally get an appointment within 2 weeks for an urgent referral. You may need urgent referral for an endoscopy or to see an oesophageal cancer specialist if you have

• Indigestion (dyspepsia) at any age, in combination with any of the following symptoms - weight loss, being sick, chronic bleeding from the food pipe or stomach, a low red blood cell count (anaemia), difficulty swallowing (called dysphagia), a swelling or lump in your upper abdomen, or a barium meal result that suggests you could have oesophageal cancer
• Indigestion without other symptoms in anyone aged 55 or over, that has come on recently and that your GP can't explain
• Difficulty in swallowing, at any age
• Unexplained abdominal pain and weight loss, with or without back pain, at any age
• A lump in your upper abdomen, at any age

If you don't have indigestion but have the following symptoms, your GP should consider the possibility of oesophageal cancer and might make an urgent referral for further tests

• Being sick continuously, and losing weight
• Weight loss or anaemia that your doctor can't explain

If you are referred for an urgent endoscopy your doctor will temporarily stop any drugs you are on for indigestion. Ideally you should be off these for at least two weeks before the test. Your GP might also arrange for you to have a blood test to check for anaemia.

Your doctor may urgently refer you to a specialist if you have indigestion that is getting worse and you have an increased risk of oesophageal cancer. For example, you have

• Cell changes in the tissue lining of your food pipe (oesophagus)
• Barrett's oesophagus

There is more information about the possible risks factors and symptoms of cancer of the oesophagus in this section.

You will be looked after by a multi disciplinary team (MDT). This is a team of health professionals who work together to decide on the best way to care for you.

The specialist MDT is likely to include the following health professionals

• Surgeons (they will be specialists in surgery for the food pipe and stomach)
• Cancer specialist doctors (medical oncologists)
• Radiotherapy doctors (clinical oncologists)
• Clinical nurse specialists
• Dieticians (to help with nutritional issues)
• Radiologists (specialises in taking and reading scans and X-rays)
• Palliative care specialists, for help with controlling symptoms

The MDTs might also include other professionals such as physiotherapists and occupational therapists.

You may have a key worker who will be your main point of contact with the MDT. This is usually the clinical nurse specialist.

If you are concerned that your GP is not taking your symptoms as seriously as you think he or she should, you could print this page and take it along to an appointment. Ask your GP to talk it through with you and then you may be able to decide together whether you need to see a specialist and if so, how soon.