Should I see a stomach cancer specialist?

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 treatment (such as antacids or antibiotics). If GPs referred everyone who came to see them to a specialist immediately, the system would get jammed and people needing urgent appointments wouldn't be able to get them.

The National Institute for Health and Clinical Excellence (NICE) have produced guidelines for GPs to help them decide which patients need to see a specialist urgently.

While reading these guidelines, it is important to remember that

• 90 out of every 100 people diagnosed with stomach cancer (90%) are over the age of 55
• The chance of a person with indigestion who is under 55 having stomach cancer is one in a million

The guidelines for stomach cancer have 3 options for GPs - a definite need for urgent referral to a stomach cancer specialist or for an endoscopy, situations where the GP can use their judgement about whether you need an urgent referral or not, and immediate referral to a specialist.

According to the NICE referral guidelines, you should ideally get an appointment within 2 weeks for an urgent referral. 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. The NICE guidelines recommend that anyone with newly diagnosed indigestion should have a blood test to check for anaemia.

Your GP may suggest you have an urgent test called an endoscopy if you are over 55 years old, with indigestion (dyspepsia) that has come on fairly recently and cannot be relieved by indigestion treatment. An endoscopy is a test where a doctor puts a tube down your throat and into the stomach. The tube has a camera at one end, and an eye piece at the other. So the doctor can have a close look inside your throat and stomach, and can take tissue samples (biopsies) if necessary.

If you have the following symptoms at any age, your GP can decide to send you to a specialist straight away, or send you for an urgent endoscopy first. If you have indigestion and

• Chronic bleeding from the stomach
• Difficulty swallowing
• Weight loss (when you are not trying to lose weight)
• Being sick repeatedly
• A low red blood cell count with a low level of iron in your blood (iron deficiency anaemia)
• A swelling or lump the GP can feel in your stomach area
• A barium meal X-ray result that shows a possible stomach cancer

Your GP should send you to a stomach cancer specialist immediately if you have

• Unexplained upper abdominal pain and weight loss
• A swelling or lump your doctor can feel in your upper abdomen (stomach area)
• Yellowing of the skin and eyes caused by a blockage to the bile duct (obstructive jaundice)
• Difficulty swallowing, with food sticking in your throat (called dysphagia)

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

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

Your GP will make a decision after examining you and taking all your medical history into account.

Your doctor may also consider an urgent referral if you have unexplained worsening of indigestion and had surgery for a peptic ulcer more than 20 years ago. This is because people who had past surgery for peptic ulcer are known to have a higher risk of stomach cancer than other people.

People who have conditions that cause cell changes to the lining of the stomach or intestine are also at higher risk of stomach cancer. These conditions are called atrophic gastritis, dysplasia or intestinal metaplasia. If you have worsening indigestion and have had any of these conditions, your doctor may refer you urgently to a specialist.

If you are concerned that your GP is not taking your symptoms as seriously as you think they 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.

Do bear in mind that this type of cancer is much more common in older people than it is in younger people. It is also important to know that indigestion is a very common symptom amongst the general population. Having this symptom alone should not worry you. But if it is combined with weight loss, anaemia or being sick then your GP should refer you to a specialist.

Difficulty swallowing is not a common symptom amongst the general population. Anyone with swallowing problems should be referred for further investigations.