Upper Gastrointestinal (GI) Cancers (Esophageal, Pancreatic, Stomach)

🔍 When to Suspect

Esophageal: dysphagia. Pancreatic: jaundice (age 40+), or weight loss plus other symptoms (age 60+). Stomach: upper abdominal mass, or weight loss plus upper abdominal pain (age 55+)

From the full topic in The Ocean Library: Upper Gastrointestinal (GI) Cancers (Esophageal, Pancreatic, Stomach)

🧭 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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