If you have had an endoscopy that confirms or raises the concern that you might have a cancer you are likely to need several more investigations. The aim of these investigations is to determine what the extent of the disease is (stage) and what possible treatments are available.  You may also meet a specialist nurse who will act as a point of contact whilst you have your investigations. As well as having the endoscopy you may need the following tests. Every effort will be made to try and ensure that these are performed as swiftly as possible.

Below is a list of the investigations that may be carried out. Click on each tab to read more about them.

A CT scan is a test that uses X rays to obtain detailed pictures of the inside of your body. The CT scan takes places in the radiology department of the hospital. The appointment can take up to an hour to complete.

The CT scanner is a machine which is shaped like a polo mint. For most scans a special dye is required to obtain detailed pictures of the bowel. You may be asked to drink the dye and/or have the dye injected into your body via small thin tube (cannula) which is placed in your arm prior to the test. At the time of injection of the dye you may experience the following:

– Feel flushed
– A metallic taste in your mouth
– Feel the need to pass urine

You will be asked to lie down on the table which will then slide forward and backward through the hole of the scanner. At the time of the scan you may experience a noise from the scanner. You may be asked to hold your breath at times during the test. The scan takes 10-15 minutes to complete.

Once the test is completed, you will be observed for 30 minutes to ensure that you have had no reaction to the dye. The cannula is then removed and you will be able to go home.

Further details about the CT scan can be found here: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/tests/ct-scan

A CT PET scan combines two scanning modalities. A CT scan uses X rays to obtain detail pictures of the body. A PET scan uses a mildly radioactive drug which is used to highlight areas of the body which are more metabolically active than normal. The PET CT scan takes places in the radiology department.
Prior to the scan, you need to be starved for 4-6 hours beforehand. No strenuous activity should be performed for 24 hours before the scan.

The CT PET scanner is a machine which is shaped like a polo mint. A small thin tube (cannula) is placed in your arm prior to the test. A mildly radioactive liquid called a radioactive tracer is placed via the cannula into the bloodstream. This is done an hour before the test. You will be advised to rest during this hour and allow the tracer to spread though the body.

The radiographer will take you to the scanning room and place you on the scanning table. You will be asked to lie down on the table which will then slide forward and backward through the hole of the scanner. At the time of the scan you may experience a noise from the scanner. You may be asked to hold your breath at times during the test. The scan takes 10-15 minutes to complete.

Once the test is completed, you will be observed for 30 minutes to ensure that you have had no reaction to the dye. The cannula is then removed and you will be able to go home.

Further details about the CT PET scan can be found here: https://www.cancerresearchuk.org/about-cancer/cancer-in-general/tests/pet-ct-scan

An endoscopic ultrasound is a test which involves the use of specialised ultrasound probe which is attached to an endoscope. The test is very much like an endoscopy, and you may have an endoscopy immediately beforehand. The ultrasound probe is used to obtain detailed pictures of the wall of and the structures surrounding the oesophagus and stomach.

The test is similar to an upper gastrointestinal endoscopy. You will be asked to be starved 6 hours prior to the test.

You will be consented for the procedure by the endoscopist and then be brought in to the endoscopy room. A small thin tube (cannula) is placed in your arm. An anaesthetic spray may be applied to numb the back of the throat. You will be asked to lie on your left side on the trolley. A mouth guard is placed in your mouth. A sedative is given to help you relax. The endoscope with the ultrasound probe attached is placed into your mouth and is then placed into the gullet. The endoscopist will then obtain detailed pictures of the wall of the gullet and surrounding structures. The test will take 15-20 minutes to complete.

Following completion of the test, you will be taken to the recovery. Once recovered from the sedative and the local anaesthetic you will be discharged home

A staging laparoscopy is keyhole surgery which is performed under general anaesthetic and in most cases is a day case procedure. It is used to directly inspect the organs inside the abdomen. It is also used to obtain tissue and fluid samples within the abdomen.

A small 1 cm cut is placed underneath your bellybutton under a general anaesthetic. Carbon dioxide gas is placed into abdomen to expand the space. Usually two further 0.5cm cuts are placed in the upper part of the abdomen. A laparoscope is placed into the abdomen to obtain detailed pictures of the internal organs. Approximately 200mls of saline is placed into the abdomen. The fluid is then sucked out and sent for analysis.

The incisions are closed usually with absorbable stitches. Once recovered from the general anaesthetic you will be discharged home. In most cases it is completed as a daycase procedure. The results from the test take approximately a week to return.

During your visit to the pre-assessment clinic we may ask you to part take in an assessment called a Cardiopulmonary Exercise Test — in short CPET. This test will help us to measure how fit you are and how your heart, lungs and muscles work together and in response to physical exercise. This can be used to give information on how your body might cope with the stresses of a large operation.  

First we connect you to heart, blood pressure and breathing monitors. Then we ask you to pedal an exercise bike very slowly while you breathe in and out through a mask which is connected to a machine which monitors your breathing. The effort needed to cycle is very gentle and is gradually increased until the test is complete. The whole test takes 20 to 30 minutes, and a qualified person will carefully monitor your condition throughout the test.  If you feel at any time that the test is too much or you wish to stop we will do so. We will, however, encourage you to exercise to the best of your ability.

You should not be worried about your level of fitness before the test as this is a very safe and easy test to perform and complete. Importantly, certain conditions may exclude you from participation in this test. We will let you know if you are not a suitable candidate. This test may also be repeated in some patients following completion of chemotherapy. This will allow us to reassess your fitness after chemotherapy and monitor your progress before surgery.

Looking After Yourself

It is very important you fully understand the extent of this surgery and the importance of your involvement in your recovery process. Even before you are admitted to hospital we would like you to think about how well you are likely to recover from your surgery. You can improve your recovery after surgery by optimising your health before you are admitted and by understanding the process of your recovery and what you can do to help the doctors and nurses during your post-operative period.

Clinical research has shown the best way of caring for you after your surgery. We have put all this research together to ensure we care for you in the best possible way. This is called an Enhanced Recovery after Surgery (ERAS) Pathway. However, none of this will be possible without your hard work and motivation. The best recovery will be a result of team work – you, the doctors, nurses, physiotherapists, dietitians and specialist nurses.

To optimise your recovery period you will be given instructions individual to your needs on nutrition, exercise and drinking/smoking.