What are the guidelines for managing patients with oesophageal cancer who present with weight loss and anorexia?

Management of patients with oesophageal cancer presenting with weight loss and anorexia involves a multidisciplinary approach focused on diagnosis, staging, treatment options, and supportive care.

First, patients presenting with weight loss and anorexia, especially if aged 55 and over with upper abdominal symptoms, should be referred urgently for direct access upper gastrointestinal endoscopy within 2 weeks to assess for oesophageal cancer ²,⁴.

Once oesophageal cancer is confirmed, staging investigations including whole-body CT and F-18 FDG PET-CT (except for T1a tumours) should be performed to determine suitability for radical treatment ¹.

For localized oesophageal cancer, treatment options include surgical resection (open or minimally invasive oesophagectomy) with consideration of lymph node dissection, or definitive chemoradiotherapy, with the choice made after multidisciplinary discussion and patient involvement ¹.

In patients with non-metastatic disease unsuitable for surgery, chemoradiotherapy or chemotherapy, local tumour treatments such as stenting or palliative radiotherapy, and best supportive care should be considered, with discussions about benefits and risks involving the patient and their family ¹.

For patients with advanced or metastatic disease, first-line palliative chemotherapy may be offered if performance status allows, and HER2 testing should be performed to guide targeted therapy options ¹.

Supportive care is critical for patients with weight loss and anorexia: referral to a specialist cancer dietitian and palliative care team is recommended to optimize nutritional status and symptom control ¹,⁶. Oral nutritional support should be considered early if dietary intake is insufficient to prevent further clinical deterioration and muscle loss ⁶.

Self-expanding stents may be offered to relieve dysphagia and improve oral intake in patients with luminal obstruction ¹.

All treatment decisions should be reviewed in a specialist multidisciplinary team meeting including oncologists, surgeons, and radiologists with expertise in oesophago-gastric cancer ¹.