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.

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.