1. Clinical T1 Cancers S Wahed OG NSSG Audit Day 6 November 2013

2. RVI N = 30; resections only Oesophageal (12) Gastric (18) Weight loss23 Epigastric discomfort28 Vomiting24 Odynophagia10 Nausea12 Reflux32 Difficult swallowing23 Barrett’s surveillance100 Anaemia02

3. 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

4. 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

5. RVI - Gastric EMR 1 Neoadj 3 (node positive) TG 7 STG 9 Merindino 2

6. 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

7. JCUH N = 20; includes non-resections May 2012 – April 2013 OesophagealGastric 2WW71 Barrett’s80

8. 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

9. JCUH - Oesophageal Resections – 3 pT1 N0 AC – 1 HGD EMR – 3 HGD – 1 T1 N0 AC

10. JCUH - Gastric N = 3 Median age 70 – range 60-80 M:F 2:1 Gastric – Surgery 2 1 lap, 1 open – Polypectomy 1

11. JCUH - Gastric Resections – pT1b N0 – HGD Polypectomy – AC

12. 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

13. Acknowledgements Helen Jaretzke & Angela Tate Helen Wescott