STEP 2: Presentation, initial investigations and referral

Signs and symptoms

  • Dysphagia (difficulty swallowing)
  • Persistent epigastric pain/dyspepsia
  • Pain on swallowing
  • Food bolus obstruction
  • Unexplained weight loss or anorexia
  • Haematemesis (vomiting blood) or melena
  • Early satiety
  • Unexplained nausea/abdominal bloating or anaemia.

Symptoms (red flag) requiring urgent consultation

  • New onset or rapidly progressive dysphagia
  • Progressive/new epigastric pain persisting for more than 2 weeks.

General practitioner investigations

The patient’s GP should take a thorough medical history to check for any risk factors and symptoms (e.g. bleeding or dysphagia) that suggest upper gastrointestinal (GI) cancer.

Immediately refer all patients with significant (red flag) symptoms for an endoscopy.


Where there is a confirmed diagnosis or high level of suspicion, patients should see an upper GI surgeon with expertise in oesophagogastric cancer who is an active participant in an upper GI cancer multidisciplinary team within 2 weeks of GP referral.

The specialist may need to urgently refer the patient to allied health practitioners (particularly a dietitian) before a multidisciplinary meeting (MDM).

Referral options

At the referral stage, the patient’s GP or other referring doctor should advise the patient about their options for referral, waiting periods, expertise, if there are likely to be out-of-pocket costs and the range of services available. This will enable patients to make an informed choice of specialist and health service.


The GP’s responsibilities include:

  • explaining to the patient and/or carer who they are being referred to and why
  • supporting the patient and/or carer while waiting for specialist appointments
  • informing the patient and/or carer that they can contact Cancer Council on 13 11 20.



Patients with concerning (red flag) symptoms of oesophagogastric cancer should see their GP within 2 weeks.

If oesophagogastric cancer is suspected, refer patients to a specialist for an endoscopy within 2 weeks of GP referral.