Clinical T1 Cancers

S WahedOG NSSG Audit Day6 November 2013

RVI• N = 30; resections only

Oesophageal (12)

Gastric (18)

Weight loss 2 3Epigastric discomfort 2 8Vomiting 2 4Odynophagia 1 0Nausea 1 2Reflux 3 2Difficult swallowing 2 3Barrett’s surveillance 10 0Anaemia 0 2

RVI - Oesophagus

• N = 12 – 11 lower third, – 2 middle third

• Median age 63 – range 41 – 76

• M:F 8:4• All EUS• CT-PET 1• Bone scan 1

• EMR surgery 5• Surgery 7– Neoadj 1 (cT1 N1)

• All pT1 N0

RVI - Gastric• N =18 • Median age 71.5

– range 41-81 • M:F 11:7• Cardia 3• Fundus 1• Body 1• GC 3• LC 3• Antrum 2• Pylorus 1

• CT all– 5 N1

• EUS 12– 2 N1

• PET 1• Bone scan 2• Laparoscopy 5

– node positive on CT or EUS 4

RVI - Gastric

• EMR 1• Neoadj 3 (node

positive)• TG 7• STG 9• Merindino 2

RVI – Gastric Resections

• HGD• 11 x pT1 N0• 3 x pT2 N0• pT1 N1• pT2 N3 (neoadj)• pT3 N1 (?emergency

obstruction)

• ACA 16• Small cell

neuroendocrine 1• HGD 1

JCUH

• N = 20; includes non-resections• May 2012 – April 2013

Oesophageal Gastric

2WW 7 1

Barrett’s 8 0

JCUH - Oesophageal

• N = 17 • Median age 70 – range 52-98

• M:F 11:6

• EUS 2

• Surgery 4• EMR 4– +1 surgery– +1 CRT

• Chemorad 5– SCC 3, AC 1, HGD 1 (?)

• Pall DXT 1 SCC • BSC 2 • Refer 1

JCUH - Oesophageal

• Resections– 3 pT1 N0 AC– 1 HGD

• EMR– 3 HGD– 1 T1 N0 AC

JCUH - Gastric

• N = 3• Median age 70– range 60-80

• M:F 2:1

• Gastric– Surgery 2

• 1 lap, 1 open

– Polypectomy 1

JCUH - Gastric

• Resections– pT1b N0– HGD

• Polypectomy– AC

Conclusion

• Early cancers relatively small proportion of cases

• Early oesophageal cancers are picked up on Barrett’s surveillance

• Surgery is most common treatment modality• Histology appears to confirm accurate staging

Acknowledgements

• Helen Jaretzke & Angela Tate• Helen Wescott