Non-Iron deficient anaemia (i.e. Low Haemoglobin and Normal ferritin) is associated with a very low pick rate of oesophageal or gastric malignancy.
Iron deficient anaemia (i.e. Low haemoglobin and Low ferritin and/or Low MCV) should be referred via the iron deficiency anaemia 2 week wait pathway (via the Colorectal Cancer 2 week wait pathway) unless associated with dysphagia.
Dysphagia (particularly progressive and of short duration) is the symptom with the highest positive predictive value for the identification of OG cancers.
Upper GI endoscopy (OGD) is the investigation of choice in patients with alarm symptoms suggestive of oesophago-gastric cancer and can be performed safely even in higher risk patients. A barium swallow requires the patient to stand upright for the duration of the procedure and is often impossible in poorly mobile patients.
The overall mortality for oesophageal cancer is poor with 75% unsuitable for curative treatment at presentation. Early tumours in contrast have a 5 year survival of up to 60%.
Stomach cancer risk is 2-10 times higher in people with a family history of the disease: 1-3% of stomach cancers are linked to inherited stomach cancer predisposition syndromes. Stomach cancer risk is higher in people with BRCA2 mutation in their family.
Barrett's oesophagus is the biggest risk factor for developing oesophageal adenocarcinoma. Surveillance is controversial but smoking cessation and moderating alcohol intake is always worthwhile.
Patients with jaundice should have an urgent ultrasound.
The tumour marker CA 19-9 is not recommended as a screening test and should only be measured in the presence of a proven pancreatic or biliary lesion or liver metastases of unknown primary.
Urgent 2ww referral should be considered for patients with:
Persistent upper abdominal pain with weight loss
New onset of dyspepsia/reflux which recurs after stopping Proton Pump Inhibitors (over 50s)