Gastrointestinal cancers

What are gastrointestinal cancers?

Gastrointestinal cancers are cancers that develop anywhere along your digestive system, the long pathway that runs from your mouth to your anus. This includes cancers of the oesophagus (gullet), stomach, liver, pancreas, bowel and other digestive organs.

What are the symptoms of gastrointestinal cancers?

Symptoms depend on which part of your digestive system is affected, and they often don't appear until a tumour is more advanced.

Cancer of the oesophagus can cause difficulty swallowing, cancers of the liver or pancreas often cause abdominal pain, and bowel (colorectal) cancer typically changes your bowel habits or causes bleeding.

Stomach cancer is one of the more common types, and its symptoms can be easy to miss because they're similar to less serious conditions, such as stomach ulcers or acid reflux.

• heartburn or acid reflux
• problems swallowing
• feeling or being sick
• indigestion, including burping a lot
• feeling full very quickly when eating
• loss of appetite, or losing weight without trying to
• a lump or pain at the top of your abdomen
• feeling tired or having no energy.

What are the causes of gastrointestinal cancers and who is at risk?

Gastrointestinal cancers are generally more likely to develop in men, and your risk increases with age. Smoking, drinking alcohol and an unhealthy diet have all been linked to these cancers, and a small percentage are inherited.

Certain underlying conditions raise the risk of specific gastrointestinal cancers. These include long-term gastro-oesophageal reflux disease for cancer of the oesophagus, Helicobacter pylori infection for stomach cancer, and long-term hepatitis B or C infection or cirrhosis (long-term liver scarring) for liver cancer.

For stomach cancer specifically, your risk is higher if you're over 50, male, or have a long-term H pylori infection, severe long-term acid reflux, gastritis, or a condition called pernicious anaemia.

Having a close relative who's had stomach cancer also raises your risk, as does smoking, being overweight, a diet high in salt, and working with certain chemicals, such as in the rubber or coal industries.

Are there different types of gastrointestinal cancer?

There are several main types of gastrointestinal cancer, named after the organ they start in:

• oesophageal cancer
• stomach (gastric) caner
• pancreatic caner
• small bowel cancer (including the duodenum, the first part of your small intestine)
• gallbladder and bile duct cancer
• liver cancer
• colorectal (bowel) cancer.

Together, cancers of the oesophagus, stomach, pancreas, duodenum, gallbladder, bile ducts and liver make up around 11% of all cancers diagnosed in the UK.

Colorectal cancer is the most common and most treatable of these, and stomach cancer is also common, most often starting in the glandular cells lining the stomach (called adenocarcinoma).

Rarer types include gastrointestinal stromal tumours, neuroendocrine tumours, and anal cancer.

How are gastrointestinal cancers diagnosed?

If your doctor suspects a gastrointestinal cancer, you may be offered:

• an endoscopy (a thin, flexible tube with a camera, passed down your throat to examine your oesophagus, stomach or bowel)
• a colonoscopy (a similar test for your bowel)
• blood tests
• imaging scans such as an ultrasound, CT or MRI scan.

A biopsy, where a small tissue sample is taken and checked under a microscope, is usually needed to confirm a diagnosis.

For suspected stomach cancer, this usually means a gastroscopy: a specialist passes a thin, flexible tube with a camera through your mouth and into your stomach to look for problems and take a biopsy if needed. The test takes around 10 to 15 minutes, shouldn't be painful, though it can feel uncomfortable, and you can usually have a local anaesthetic spray or sedation to help you relax.

You should get your results within 2 weeks. If cancer is confirmed, you'll usually need further tests, such as more scans or a small operation called a laparoscopy, to find out the size of the cancer and whether it has spread.

How are gastrointestinal cancers treated?

Treatment depends on the type, size and location of the cancer, whether it has spread, and your general health.

When a tumour is easy to reach, surgery to remove it may be all that's needed. When it's harder to reach, or removing it would badly affect how your digestive system works, chemotherapy, radiotherapy or targeted therapy may be used first, or instead.

• Surgery: This is to remove the tumour along with some surrounding tissue – the remaining healthy parts of the organ can sometimes be reconnected
• Chemotherapy: This uses medicine to kill cancer cells, before or after surgery, or as the main treatment if surgery isn't possible
• Radiotherapy: This uses high-energy rays to kill cancer cells, often alongside chemotherapy
• Targeted therapy and immunotherapy: Drugs that target cancer cells directly or help your immune system fight them
• Transplant: In some cases of liver cancer, this may be an option.

If your cancer is advanced and can't be cured, treatment aims to control it, ease your symptoms, and help you live longer and more comfortably. A palliative care or symptom control team, who focus on comfort and quality of life, can support you and your family through this.

When should I see a doctor?

See a GP if you notice a change that isn't normal for you, especially problems swallowing, a lump in your abdomen, unexplained weight loss, or digestive symptoms that don't improve after 3 weeks of your usual treatment. These symptoms are common and usually caused by something other than cancer, but it's important to get them checked, because cancer found early is more treatable.

Get advice from NHS 111 urgently if you've been being sick for more than 2 days, or if you have symptoms you're worried about and aren't sure where to get help.