OGC audit 2015: more dysplasia patients should undergo pioneering treatment

Published: 17 Dec 2015

A quarter of patients who are found to have abnormal cells in their food pipe are not undergoing pioneering treatment which could prevent them from developing cancer,  the National Oesophago-Gastric Cancer Audit (NOGCA) warns in its 2015 Annual Report.

Read the full report

Today’s publication also finds that:

  • The proportion of patients diagnosed with O-G cancer after an emergency admission has decreased since 2010, from 15.3 percent to 13.6 percent. Patients diagnosed as a result of an emergency are less likely to be able to have curative treatment, so this is a positive development
  • The proportion of patients offered curative treatment has increased from 36 percent to 38 percent, but the figure varied from 33 percent to 45 percent across regional networks
  • The 90-day postoperative mortality rate for both oesophagectomy and gastrectomy has fallen to 4.3 percent and 4.2 percent respectively from 5.7 percent and 6.9 percent in 2010

High-grade dysplasia (HGD) is a condition in which cells in the lining of the food pipe or oesophagus, become severely abnormal*.  These cell changes can lead to oesophageal cancer – if left untreated, around 1 in 20 patients with HGD develop this type of cancer each year.

In the past, the main treatment for patients with HGD was surgery to remove the oesophagus, but only relatively fit people could be considered for this major operation.  New medical procedures have been developed for treating HGD which involve using an endoscope – a long, thin, flexible tube that has a light source and a video camera at one end – to either remove or destroy the abnormal cells.  These treatments can be offered to a wider mix of patients and stop the cancer from developing.  They can also be performed as a day case. The British Society of Gastroenterology recommends that patients with HGD are considered for this type of treatment instead of simply being monitored to see if their condition deteriorates.

Dr Stuart Riley, the consultant gastroenterologist, clinical lead of the Audit and member of the British Society of Gastroenterology (BSG), said: “We know that endoscopic treatment can prevent patients with abnormal cells (or HGD) from developing cancer of the food pipe, or oesophagus. It is a well-established treatment with clear outcomes which is why it is concerning that a quarter of patients diagnosed with HGD in England and Wales are only having their condition monitored. “It is vital that steps are taken by clinicians, commissioners and NHS hospitals to make sure that patients across the country have access to these newer endoscopic treatments so we can reduce the number of people with HGD developing oesophageal cancer each year.”

The Audit is commissioned by HQIP as part of the National Clinical Audit and Patients Outcome Programme and collects data on patients diagnosed with HGD as well as oesophageal and stomach cancers in NHS hospitals in England and Wales.

Every year around 15,000 people are diagnosed with cancer of the food pipe (oesophagus) or stomach (gastric).  It is the fourth most common cause of cancer deaths in England and Wales.

However, people are often diagnosed with advanced disease and the five-year survival rate for patients diagnosed with oesophageal or gastric (O-G) cancer is approximately 15 percent.  Catching the condition early is vital to improving people’s survival rates.

The Audit is carried out by a partnership between the Association of Upper Gastro-Intestinal Surgeons, the British Society of Gastroenterology, the Royal College of Radiologists, the Health and Social Care Information Centre, and the Royal College of Surgeons of England. The 2015 Annual Report describes the management of 930 patients diagnosed with HGD in the two years between April 2012 and March 2014.