Establish intent of treatment

• Curative
• Anti-cancer therapy to improve quality of life and/or longevity without expectation of cure
• Symptom palliation.

Treatment options

Given the poor prognosis of this cancer at present, for many patients, treatment is often given with palliative rather than curative intent. Early specialist palliative care may be required.

Endoscopic treatments are suitable for high-grade dysplasia and selected cases of early cancer.

Surgery

Surgical resection offers the best long-term survival chance in patients with locally advanced oesophageal or gastric cancer.

Palliative oesophageal resection for metastatic cancer is not recommended.

Radiation therapy may be indicated for oesophageal or oesophagogastric junction cancer as part of:

• neoadjuvant therapy before surgery
• definitive chemoradiation (unresectable locally advanced disease)
• symptom palliation.

Radiation therapy may be indicated for gastric cancer as part of:

• postoperative care in combination with chemotherapy in selected patients who have undergone a gastrectomy for locally advanced gastric cancer
• symptom palliation before or after chemotherapy.

Systemic therapy may be indicated for:

• locally advanced disease (pre- or postoperatively or as primary treatment)
• inoperable locally advanced oesophageal or gastro-oesophageal cancer.

Palliative care

Review by a specialist palliative care team is essential. Early referral to palliative care can improve quality of life and in some cases may prolong survival. Referral should be based on need, not prognosis.

For more, visit the Palliative Care Australia website.

Communication

The lead clinician and team’s responsibilities include:

• discussing treatment options with the patient and/or carer including the intent of treatment as well as risks and benefits
• discussing advance care planning with the patient and/or carer where appropriate
• helping patients to find appropriate support for exercise programs where appropriate to improve treatment outcomes.

Checklist

Timeframe

Begin treatment within 2 weeks of the MDM.