GPAtlas🧭 When to suspect
Upper gastrointestinal cancers – of the oesophagus, stomach, pancreas, liver and gallbladder – are among the less survivable cancers in the UK, chiefly because they present late.
Five-year survival ranges from around 7% for pancreatic cancer (the lowest of any common cancer) to roughly 15–20% for oesophageal and stomach cancer.
The biggest lever a GP holds is earlier diagnosis: outcomes improve markedly when disease is caught at an earlier stage.
The primary-care task is pattern recognition against age and symptom thresholds, then matching each pattern to the correct route:
• A suspected cancer pathway referral.
• An urgent direct-access scan.
• A non-urgent endoscopy.
A small number of features act as alarm symptoms that bypass all other criteria:
• Dysphagia at any age
• An upper abdominal mass
• Jaundice in someone aged 40 or over
| Cancer (5-yr survival) | Key presenting features | First-line action |
|---|---|---|
| Oesophageal (~15%) | • Dysphagia at any age • Or aged ≥ 55 with weight loss and any of upper abdominal pain, reflux, or dyspepsia |
Suspected cancer pathway referral (delivered as urgent upper gastrointestinal [GI] endoscopy) |
| Stomach (~20%) | • As for oesophageal • Or an upper abdominal mass consistent with stomach cancer |
Suspected cancer pathway referral (urgent endoscopy; mass → pathway referral) |
| Pancreatic (~7%, lowest of common cancers) | • Jaundice if aged 40 and over • Or aged 60 and over with weight loss and any of diarrhoea, back pain, abdominal pain, nausea, vomiting, constipation, or new-onset diabetes |
• Jaundice, aged 40 and over → suspected cancer pathway referral • Aged 60 and over with that symptom cluster → urgent direct-access CT (ultrasound if CT unavailable) |
| Gallbladder (> 10%, commoner in women) | Upper abdominal mass consistent with an enlarged gallbladder | Urgent direct-access ultrasound |
| Liver (~15%) | Upper abdominal mass consistent with an enlarged liver | Urgent direct-access ultrasound |
NICE updated the upper GI recommendations on 1 May 2025:
• Oesophageal and stomach symptoms carrying a 3% or greater probability of cancer now warrant a suspected cancer pathway referral rather than a GP-booked direct-access endoscopy.
• In practice the referral is still delivered as an urgent upper GI endoscopy.
• The suspected cancer pathway is governed by the Faster Diagnosis Standard – diagnosis or ruling-out within 28 days.
The 2026 amendments also recognise a non-specific-symptoms pathway for unexplained weight loss (aged 60 and over) or appetite loss where no single cancer is clearly indicated.
Raise suspicion further with:
• A history of smoking or excess alcohol
• Long-standing reflux or Barrett's oesophagus
• Obesity
• Helicobacter pylori infection
• Female sex – for gallbladder cancer
Source: NICE NG12 · Cancer Research UK
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