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National Oesophago-Gastric Cancer Audit

New Patient Registration sheet –

Patients with Oesophageal High Grade Glandular Dysplasia

Patient Details Surname:

NHS number:

Forename:

Postcode:

Sex: Male Female Not specified Not known Date of birth:

Initial Referral to Local Oesophago-gastric Team and Diagnostic Process

Source of referral

From surveillance service: Symptomatic referral Not known

Date of endoscopic biopsy in which HGD was first diagnosed:

Hospital where the first endoscopic biopsy was taken:

Was the original diagnosis of HGD confirmed by a second pathologist? Yes No Not known

Was a repeat biopsy taken to confirm the diagnosis of HGD? Yes No Not known

Did the repeat biopsy confirm the diagnosis of HGD? Yes No Not known

Was the second biopsy diagnosis of HGD confirmed by a second pathologist? Yes No Not known

Comorbidities? None Cardiovascular disease COPD / Asthma Chronic Renal Impairment

Liver Failure / Cirrhosis Diabetes Mental Illness

Cerebro / peripheral vascular disease Significant other

Endoscopic Report

At the initial endoscopy where a diagnosis of HGD was made:

- Were quadrantic biopsies taken every 2cm from the entire segment of Barrett’s?

Yes No Not known

- Were additional biopsies taken of any visible nodule?

1Yes No Not known

HGD appearance

Flat mucosa Nodular lesion Depressed lesion Not known

Barrett ’s Se gm ent

Present Absent Not known

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Endoscopic Report (Continued)

Leng th of Barrett’s Segm en t

Is the length of circumferential columnar lining recorded in the endoscopy report? Yes No

Length of Circumferential Columnar Lining (nearest 0.5 cm): C___.__ cm

Is the maximum length of columnar lining recorded in the endoscopy report? Yes No

Maximum length including tongues/islands of Columnar Lining (nearest 0.5 cm): M___.__ cm

HGD Lesion (based on pathology report)

Unifocal Multi-focal Not known

Planned Treatment

Hospital at which treatment plan made

Date treatment plan agreed

Was the treatment plan agreed at an MDT meeting? Yes No

Hospital where initial treatment was given

Date initial treatment was given

Initial treatment modality

Surveillance (follow up endoscopy) Radiofrequency ablation

Oesophagectomy Argon plasma coagulation

Photo dynamic therapy Multipolar electrocautery

Endoscopic Mucosal Resection (EMR) Laser therapy

Endoscopic Submucosal Dissection (ESD) Cryotherapy

Other No active treatment

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Use of surveillance or no active treatment as planned treatment

What was the reason for this treatment plan?

Patient choice

Patient unfit for endoscopic or surgical treatment

Lack of access to endoscopic treatment or surgery

Unknown

Use of surveillance

If plan was surveillance, when was the next surveillance endoscopy planned for?

≤3 months

4-6 months

7-12 months

>12 months

Not known

4

Use of Endoscopic Mucosal Resection (EMR) / Endoscopic Submucosal Dissection (ESD)

Date of EMR/ESD:

Was excision complete? Yes No Not Known

If yes, what was the ongoing plan?

Further endoscopic treatment of the remaining Barrett’s segment

Surveillance (follow up endoscopy) only

No further surveillance or treatment

Not Known

If no, what was the ongoing plan?

Further EMR/ESD

Further ablative endoscopic treatment e.g. RFA, APC

Refer for oesophagectomy

Surveillance (follow up endoscopy) only

No further surveillance or treatment

Not Known

Post-treatment Histology (pathology results based on EMR/ESD)

No high-grade dysplasia or carcinoma

High-grade dysplasia confirmed

Intramucosal carcinoma identified

Submucosal carcinoma or worse

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3 3 3

National Oesophago-Gastric Cancer Audit

New Patient Registration datasheet

Patients with Oesophageal Gastric Cancer

Patient Details Surname:

NHS number:

Forename:

Postcode:

Sex: Male Female Not specified Date of birth:

Initial Referral and Diagnosis Data

Source of referral: Direct from GP Barrett’s Surveillance Emergency admission

Open access endoscopy Other – initiated by consultant (outpatient episode) Not known

Priority of referral: Urgent 2-week wait Routine referral (GP referral only)

Date of first referral to local oesophago-gastric team for investigation:

Date of diagnosis:

Local cancer unit where cancer was diagnosed:

Diagnosis - Site

Oesophagus: Upper 1/

Middle

1/

Lower

1/

NB: cervical oesophageal tumours are NOT included in this audit

Gastro-Oesophageal Junction (adenocarcinomas only) Siewert classification:

1 2 3

Stomach: Fundus Body Antrum Pylorus

Diagnosis - Histology Invasive adenocarcinoma Squamous cell carcinoma

Adenosquamous carcinoma Small-cell carcinoma

Undifferentiated carcinoma Other epithelial carcinoma

NB: Non-epithelial tumours (GIST, sarcomas or melanomas) are NOT included in this audit

Staging investigations (please tick all that apply) None

CT scan

Endoscopic ultrasound (EUS)

Staging laparoscopy

PET / PET – CT scan

EUS Fine needle aspiration

Other investigation

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Pre – Treatment Stage Which TNM version do you use: TNM v6 TNM v7 TNM v8

T: 0 Tis 1 1a

N: 0 1

M: 0 1

1b 2

2

2a 2b 3

3

4

3a

4a

3b

4b x

x

x

ECOG (WHO) Performance Status

0 Carries out all normal activity without restriction

3 Limited self care, confined to bed or chair for >50% waking hours

1 Restricted but walks/does light work 4 Fully disabled, confined to bed/chair

2 Walks, full self care but no work. Up and about >50% of the time

Comorbidities (please tick all that apply) None

Cardiovascular disease

Chronic renal impairment

Cerebro/periph vascular

Other significant condition

Liver failure or cirrhosis Diabetes

Barrett’s oesophagus Mental illness

Chronic respiratory disease (including COPD/asthma)

Treatment Plan Date final care plan agreed:

Treatment intent:

Curative:

Non-curative (palliative) (ie. surgery, chemotherapy, radiotherapy, endoscopy)

No active treatment (supportive care) (ie. non -specific symptomatic treatments)

Details of planned treatment Curative modality Palliative modality

Surgery only Palliative surgery

Chemotherapy and surgery (any combination) Palliative oncology (unspecified)

Chemo-radiotherapy and surgery (any combination) Endoscopic palliation therapy

(Definitive) Radiotherapy only No active treatment (supportive care)

Definitive chemo - radiotherapy

Endoscopic mucosal resection

7

Reasons for palliative treatment (please tick all that apply) Patient declined treatment

Unfit, because of advanced stage cancer

Unfit, because significant co-morbidity

Unfit, because poor performance status

Not known

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National Oesophago-Gastric Cancer Audit

Postoperative Datasheet (Oesophageal Gastric Cancer and HGD Patients)

Patient details (for patient identification only) Surname

NHS number

Forename

Date of birth

Admission and Surgical Details (Main procedure only) Hospital name:

Date of admission: Date of operation:

Pre-operative intent of surgery: Palliative Curative

Fitness for Surgery (ASA grade): 1 2 3 4 5

Smoking: current smoker ex-smoker non-smoker (history unknown)

never smoked not known

Procedure Oesophageal Gastric

- Oesophagectomy: - Gastrectomy:

Left thoraco-abdominal approach Total Extended total

2 – Phase (Ivor-Lewis) Proximal Distal

3 – Phase (McKeown) Completion Merendino

Transhiatal Wedge/localised gastric resection

Bypass procedure / Jejunostomy only

Thoracotomy (Open & Shut) Laparotomy (Open and Shut)

Number of Surgeons involved in the original operation:

GMC Code for Surgeon Responsible for original operation:

GMC Code for additional Surgeon 1 involved in original operation:

GMC Code for additional Surgeon 2 involved in original operation:

GMC Code for additional Surgeon 3 involved in original operation:

9

Surgical Access (thoracic) – the approach used for the thoracic phase of the operation (if applicable)

Open operation Thoracoscopic converted to open

Thoracoscopic completed

Not applicable

Surgical Access (abdominal) – the approach used for the thoracic phase of the operation

Open operation Laparoscopic converted to open

Laparoscopic completed

Nodal Dissection

Oesophagectomy: None 1 – field 2 – field 3 – field

Gastrectomy: D0 (peri-gut resection) D1 D2 D3

Postoperative complications and course (please tick all that apply) None Respiratory:

Anastomotic leak Pneumonia

Chyle leak ARDS

Haemorrhage Pulmonary embolism

Cardiac complication Pleural effusion

Acute renal failure Wound infection

Other

Unplanned return to theatre? Yes No Death in hospital? Yes No

N Date of discharge or death:

Postoperative pathology and staging

Site of tumour:

Oesophagus: Upper 1/3 Middle

1/3 Lower

1/3

NB: cervical oesophageal tumours are NOT included in this audit

Gastro-Oesophageal Junction (adenocarcinomas only) Siewert classification:

1 2 3

Stomach: Fundus Body Antrum Pylorus

Histology:

Invasive Adenocarcinoma Squamous cell carcinoma

Adenosquamous carcinoma Small-cell carcinoma

Undifferentiated carcinoma Other epithelial carcinoma

Malignant Neoplasm Complete regression

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Proximal resection margin involved? Yes No

Distal resection margin involved? Yes No

Circumferential resection margin involved? (<1mm)

Number of lymph nodes examined:

Yes No N/A

Number of lymph nodes positive:

Postoperative stage

Which TNM version do you use: TNM v6 TNM v7 TNM v8

T: 0 Tis 1 1a 1b 2

N: 0 1 2

M: 0 1

Patient had neoadjuvant therapy prior to surgery:

2a 2b

Yes

3

3

No

4

3a

4a

3b

4b x

x

x

Enhanced recovery after surgery (ERAS) What best describes the surgical pathway that this patient followed? A protocolised enhanced recovery (ERAS) without daily documentation in medical notes?

A protocolised enhanced recovery (ERAS) with daily-documentation in medical notes?

A standard (non-ERAS) surgical pathway

Did the patient complete the ERAS pathway? Yes

No: but partial completion

No: non-completion

Unknown / not documented

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National Oesophago-Gastric Cancer Audit

Chemotherapy/Radiotherapy Datasheet (Oesophageal Gastric Cancer Patients) Please fill in this datasheet for every course of oncological treatment received by a patient with oesophago- gastric cancer. Most patients will only require one datasheet to be completed. For patients who have both neoadjuvant and adjuvant therapy, complete two separate datasheets.

Patient details (for patient identification only) Surname

NHS number

Forename

Date of birth

Hospital of treatment Hospital where oncology treatment took place

Treatment details Treatment intent:

Neoadjuvant Adjuvant Curative Palliative

Intended treatment modality:

Chemotherapy Radiotherapy Chemo-radiotherapy

Details of therapy Chemotherapy details (if applicable)

Date first cycle started:

Outcome of treatment:

Treatment completed as prescribed

Reason if incomplete

Patient died

Progressive disease during treatment

Acute chemotherapy toxicity

Technical or organisational problems

Patient choice (interrupted or stopped treatment)

On-going treatment

Not known

Radiotherapy details (if applicable)

Date first fraction started:

Outcome of treatment:

Treatment completed as prescribed

Reason if incomplete

Patient died

Progressive disease during treatment

Acute radiotherapy toxicity

Technical or organisational problems

Patient choice (interrupted or stopped treatment)

Not known

Post oncology fitness (for neoadjuvant therapy only)

Patient proceeded to planned curative surgery: Yes

No

Not applicable

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National Oesophago-Gastric Cancer Audit

Endoscopic / Radiological Palliative Therapy Datasheet (Oesophageal Gastric Cancer Patients) Please fill in this datasheet for every patient with oesophago-gastric cancer on the occasion of their FIRST

PALLIATIVE endoscopic / radiological therapeutic intervention.

Patient details (for patient identification only) Surname

NHS number

Forename

Date of birth

Treatment details Hospital name:

Date of endoscopic / radiological procedure:

Procedure details Type of procedure (tick all that apply)

Insertion of stent Laser therapy Argon plasma coagulation

Photodynamic therapy Gastrostomy Brachytherapy

Dilatation (Tick dilatation if it was the only procedure or if required to facilitate treatment)

Other

Is this procedure part of a planned course of multiple interventions? Yes No Not known

Anaesthesia: Sedation Local anaesthetic spray General anaesthesia

Sedation and local anaesthetic spray combined Not known

Details of stent procedure, if inserted Type of stent:

Plastic: expandable Metal: covered Metal: Anti-reflux Not known

Biodegradable Metal: uncovered Other

Method of stent placement:

Fluoroscopic control Endoscopic control Fluoroscopic & Endoscopic Not known

Immediate complications following stent insertion (tick all that apply)

No complication Postoperative stricture Perforation

Haemorrhage Other complications

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VERSION HISTORY

Version Date created Version description Author

1.0 06/12/2011 First draft based on First NOGCA O Groene / D Cromwell

1.1 15/12/2011 Revision after review/comparison with COSD O Groene / D Cromwell

1.2 26/01/2012 Integration of full data set O Groene / D Cromwell

1.3 05/02/2012 Review O Groene / D Cromwell

1.4 09/11/2012 Revision in line with new data collection system

1.5 09/04/2013 Amendment to Pre-treatment Histology

1.6 09/05/2013 Addition of surgeon level data items

2.0 19/08/2015 Updated HGD data items

2.1 29/09/2016 Content review and formatting C Brand

2.2 30/03/2017 Added ERAS items C Brand

2.3 18/01/2018 Added TNM 8 and content revision C Brand