Upper GI and hepatobiliary cancer

DGRefHelp - NHS Dumfries & Galloway
NHS Dumfries and Galloway

Upper GI cancers (oesophagus, stomach, hepato-pancreato-biliary) often present with vague symptoms which are very common in non-cancer presentations in primary care. Identifying those patients to refer is therefore difficult based on individual 'red flag' symptoms. 

Dysphagia for gastro-oesophageal cancer and jaundice for pancreatic cancer are the only discriminatory symptoms (i.e. >3% positive predictive value)

Common symptoms are:

  • Dysphagia
  • Dyspepsia/reflux
  • Nausea/vomiting
  • Upper abdominal pain
  • Early satiety
  • Abdominal mass
  • Unintentional weight loss
  • Jaundice
  • Change in bowel habit
  • New onset diabetes at an older age

Note that iron deficiency anaemia is not one of the criteria for USoC referral for upper GI - see Colorectal cancer pathway.

Where there is a strong 'gut feeling' of malignancy but the patient does not fit the site specific criteria a referral to the Rapid Cancer Diagnostic Service may be appropriate.

Assessment

Assessment of patients with symptoms suggestive of upper GI cancer should include:

  • Abdominal examination
  • FBC to assess for anaemia
  • U&E, LFT
  • HbA1c

Refer urgent suspicion of cancer

Oesophago-gastric cancer

  • Persistent or progressive dysphagia (NOT a 'feeling of something stuck in throat')
  • Weight loss (5% or more of bodyweight or strong clinical suspicion) AND age 55 or over AND one of:
    • upper abdominal pain
    • early satiety
    • reflux
    • dyspepsia
    • nausea and/or vomiting

Refer via SCI-Gateway...General Surgery...Open Access UpperGI Endo

Hepato-pancreato-biliary cancer

  • Painless obstructive jaundice in a person aged 40 years or over
  • Weight loss (5% or more of bodyweight or strong clinical suspicion) AND age 55 or over AND one of:
    • change in bowel habit
    • back and/or abdominal pain
    • nausea and/or vomiting
    • new onset diabetes
  • Abdominal pain in a person 55 or over with any of:
    • nausea and/or vomiting
    • weight loss (5% or more of bodyweight or strong clinical suspicion)
    • constipation
  • Palpable upper abdominal or epigastric mass
  • Abnormality on imaging suspicious of HBP cancer

Refer via SCI-Gateway...General Surgery...General

 

Editorial Information

Last reviewed: 01/10/2025

Next review date: 01/10/2027

Approved By: National cancer pathway