STEP 3: Diagnosis, staging and treatment planning
Diagnosis and staging
An expert histopathologist should review the biopsy material from the endoscopy before the MDM.
Staging for oesophageal cancer may involve:
- CT scan of the neck, thorax, abdomen and pelvis
- endoscopic ultrasound
- PET scan
- endoscopic resection.
Staging for oesophagogastric junction cancer may involve:
- CT scan of the neck, thorax, abdomen and pelvis
- endoscopic ultrasound
- staging laparoscopy
- PET scan
- endoscopic resection.
Staging for gastric cancer may involve:
- CT scan of the neck, thorax, abdomen and pelvis
- endoscopic resection
- staging laparoscopy.
Genetic testing
Environmental factors are important in causing gastric cancer; inherited factors (i.e. genes) usually play a minor role.
Occasionally gastric cancers are due to an inherited cancer predisposition.
Treatment planning
Discuss all newly diagnosed patients at an MDM within 4 weeks of GP referral.
Research and clinical trials
Consider enrolment where available and appropriate. Search for a trial.
Communication
The lead clinician’s (1) responsibilities include:
- discussing a timeframe for diagnosis and treatment options with the patient and/or carer
- explaining the role of the multidisciplinary team in treatment planning and ongoing care
- encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
- providing appropriate information and referral to support services as required
- communicating with the patient’s GP about the diagnosis, treatment plan and recommendations from MDMs.
1: Lead clinician – the clinician who is responsible for managing patient care.
The lead clinician may change over time depending on the stage of the care pathway and where care is being provided.
Checklist
Timeframe
Staging work-up needs to be complete for presentation at the MDM within 2 weeks of diagnosis and within 4 weeks of GP referral.