Excerpt

Oesophago-gastric cancer presents patients, carers and healthcare professionals alike with a range of difficult management decisions. Those affected by the disease often undergo a complex investigative pathway as a prelude to a variety of treatments with wide ranging short- and long-term effects that require continued support throughout the initial period of care and beyond. We hope that this document will provide helpful and appropriate guidance to both patients and professionals alike on the diagnosis and subsequent management of early and locally advanced oesophago-gastric cancers.

It has been impossible to cover every aspect of the patient pathway but instead as a group we have concentrated on those areas where it was felt uncertainty or variation in practice currently exists. As such the guideline is not intended as an exhaustive textbook on the management of oesophago-gastric cancer. The guideline sets out recommendations that will hopefully be helpful and informative in decision-making and management of a variety of situations but cannot be a substitute for clinical judgement in a specific case. We were aided and supported in our goal by a diverse and engaged Guideline Committee and are grateful for all the hard work, commitment and common sense demonstrated by them throughout the two-year process. Their complementary skills and perspectives have inspired this guideline. We would also like to thank the staff at the National Guideline Alliance for their considerable support during the development of this guideline.

Contents

• 1. Introduction
  • 1.1. Foreword
  • 1.2. Epidemiology and current management
• 2. Guideline Summary
  • 2.1. Committee membership and National Guideline Alliance (NGA) staff
  • 2.2. Recommendations
  • 2.3. Research Recommendations
  • 2.4. Other versions of this guideline
  • 2.5. Schedule for updating this guideline
• 3. Development of the guideline
  • 3.1. What is a NICE guideline?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
  • 3.4. What this guideline covers
  • 3.5. What this guideline does not cover
  • 3.6. Relationship between the guideline and other NICE guidance
• 4. Guideline development methodology
  • 4.1. Developing the review questions and protocols
  • 4.2. Searching for evidence
  • 4.3. Reviewing research evidence
  • 4.4. Method of combining clinical studies
  • 4.5. Appraising the quality of evidence
  • 4.6. Evidence of cost effectiveness
  • 4.7. Developing recommendations
• 5. Information and support
  • 5.1. Radical treatment
  • 5.2. Palliative management
• 6. Organisation of services
  • 6.1. Multidisciplinary teams
  • 6.2. Surgical services
• 7. Assessment after diagnosis
  • 7.1. Staging investigations
  • 7.2. HER2 testing in adenocarcinoma
• 8. Radical treatment
  • 8.1. T1N0 oesophageal cancer
  • 8.2. Surgical treatment of oesophageal cancer
  • 8.3. Lymph node dissection in oesophageal and gastric cancer
  • 8.4. Localised oesophageal and gastro-oesophageal junctional adenocarcinoma
  • 8.5. Gastric Cancer
  • 8.6. Squamous cell carcinoma of the oesophagus
• 9. Palliative management
  • 9.1. Non-metastatic oesophageal cancer not suitable for surgery
  • 9.2. First-line palliative chemotherapy
  • 9.3. Second-line palliative chemotherapy
  • 9.4. Luminal obstruction
• 10. Nutritional support
  • 10.1. Curative treatment
  • 10.2. Palliative care
• 11. Follow-up
  • 11.1. Routine follow-up
  • 11.2. Recommendations
  • 11.3. Research recommendations
• 12. References
• 13. Glossary and Abbreviations
• 14. Appendices
  • Appendix A. Scope
  • Appendix B. Stakeholders
  • Appendix C. Declarations of Interest
  • Appendix D. Review protocols
  • Appendix E. Search strategies
  • Appendix F. Evidence tables
  • Appendix G. GRADE Profiles
  • Appendix H. Forest plots
  • Appendix I. Cost-effectiveness analyses
  • Appendix J. Excluded studies
  • Appendix K. Included studies
  • Appendix L. Health economic evidence review
  • Appendix M. Network meta-analysis of second line palliative chemotherapy for locally advanced and metastatic disease

V3.0 Final

Developed by the National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists

Disclaimer

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.

Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.

NICE guidelines cover health and care in England. Decisions on how they apply in other UK countries are made by ministers in the Welsh Government, Scottish Government, and Northern Ireland Executive. All NICE guidance is subject to regular review and may be updated or withdrawn.