In recent years the incidence of diseases like oesophageal or gastric cancer are on the increase. Thanks to the stresses and strains of modern life – in some cases unhealthy diets, an overabundance of processed foods and excessive levels of alcohol can contribute to the development of cancer, however, in many cases no obvious causes are ever determined.
As with most cancers, if they’re diagnosed at an early stage, they’re more likely to be treatable and – in many cases – curable.
The problem is, however, that these two types of cancer tend to be more gradual than others since their symptoms often resemble those of less serious and often simply annoying medical conditions such as heartburn, indigestion, difficulty swallowing and even plain hiccupping. For some people symptoms don’t begin to appear until the cancer is more advanced.
We’re all familiar with the Gaviscon adverts, aren’t we? The firemen putting out the fire with their hoses and everything returning to normal? Anyone watching those adverts thinks, ‘Yes, I get heartburn. That will do nicely thanks….’ A couple of spoons of an anti-heartburn medication and you’re good to go….
Think that way?
Certainly heartburn and indigestion are now common occurrences – and increasingly so – thanks to acidic foods, fatty meals, fizzy drinks and excess alcohol, but, unfortunately, heartburn and other ‘annoying’ medical issues can be a sign that there’s much more wrong than first meets the eye.
First, let’s look at the science…
Although it’s called ‘heartburn’, heartburn doesn’t actually have anything to do with the heart. In fact, it’s not even located over the heart, but behind the breastbone. In most cases it’s caused by acid reflux, which involves the acid in the stomach travelling back up the oesophagus (your gullet), causing a burning sensation in the oesophagus.
Put simply, at the point where your oesophagus meets your stomach, there is a muscle valve called the oesophageal sphincter, which ensures that your food passes in one direction from your gullet to your stomach. As soon as you eat something, this sphincter opens up to let food pass into your stomach. For the rest of the time, however, it should remain closed so that the contents of your stomach don’t come back up again.
If this sphincter – or valve if you like – isn’t working properly, then the contents of your stomach are regurgitated or brought back up into your oesophagus, causing acid reflux and heartburn. Over a period of time the acid can cause inflammation in your gullet, leading to pain.
Unfortunately, this pain can range from the benign to the much more serious. When heartburn becomes almost permanent and is accompanied by other related symptoms, it is then referred to as gastro-oesophageal reflux disease (GORD).
At this stage it may also be accompanied by symptoms such as:
- Regurgitation of food
- Pain with swallowing
- Frequent heartburn
- Difficulty swallowing
- Unexpected weight loss
- Coughing during a meal
While in some people the acid reflux may not even cause burning, but may simply cause a dull pain in the centre of the chest, in others the pain in the chest can become so acute that it can be mistaken for a heart attack.
Difficulty in swallowing (dysphagia)
And then there’s the difficulty in swallowing….
In many people this feels as if they’re swallowing over a lump in their throat. The condition is actually called globus or dysphagia and, while it can be accompanied by pain, in most people it is painless. Again, this symptom is often attributed to the extreme form of acid reflux – gastro-oesophageal reflux disease (GORD) – but it can also be caused by oesophageal motor disorders, inflammatory issues such as tonsillitis and chronic sinusitis.
Some people with dysphagia will experience problems swallowing certain foods or liquids, while others will be unable to swallow at all.
Other signs of dysphagia, which may accompany the swallowing difficulties include:
- Coughing or choking when eating or drinking
- Persistent drooling of saliva
- Being unable to chew food properly
- Bringing food back up
- Experiencing the sensation that food is ‘stuck’ in the throat or chest
While dysphagia can be caused by another health condition, such as a condition that affects the nervous system, such as a stroke or head injury, and can also be linked to – and caused by GORD – there is also the chance that it is being caused by a mouth cancer or oesophageal cancer.
You may be surprised by this one, but hiccups may occur when an oesophageal tumour invades the phrenic nerve or diaphragm. When these structures are irritated, they cause repeated contractions of the diaphragm, hence the hiccups!
While hiccupping is a normal occurrence, is familiar to most people and usually terminates on its own, it should be investigated if it lasts longer than a month or so, when it is much less common. In the central nervous system, the upper spinal cord, brain stem and hypothalamus can all be involved in the production of hiccups and all signs can be transmitted to the diaphragm. Gastrointestinal causes of hiccups therefore include GORD, oesophageal cancer and hiatus hernia.
If hiccupping lasts longer than two days and is linked to other issues, such as heartburn or trouble swallowing (see below) then, you should consult your GP for further examination.
When the symptoms are more serious
So, how do you tell the difference between everyday, benign conditions such as heartburn, indigestion, hiccups and dysphagia, and more serious illnesses, such as oesophageal or gastric cancer?
Well, the first thing that you can do is take a good look at your symptoms before seeking medical advice.
When it comes to indigestion and heartburn, you’ll probably experience the following:
- Heartburn, particularly after eating
- Feeling full and bloated
- Feeling sick
- Belching and passing wind
- Bringing up food or experiencing bitter-tasting fluids in your mouth
If, however, you experience sensations such as stomach ache, or back pain, then you need to have these investigated, since these are not symptoms of indigestion or heartburn. You may simply be constipated, but the symptoms definitely need to be looked into.
If you are suffering the symptoms of dysphagia, or if your hiccupping lasts longer than 48 hours and is accompanied by either of the previous conditions, you should always seek medical opinion. Early investigation can help to rule out more serious conditions, but your GP can assess you and refer you on for further tests, if required.
The OG Cancer NI Catch It Early campaign, funded by the National Lottery and OG Cancer, strives not only to increase the awareness of the signs of oesophageal-gastric cancers in the public but also throughout the medical and caring professions.
For further information follow #OGCancerNI, call 07568 157450 or make an appointment to see your local GP today.
Update on Implementation of Mental Health Action Plan
A progress update on the implementation of the Northern Ireland Mental Health Action Plan has been published.
The Action Plan was first published in May 2020 and contains 38 actions which will improve mental health services going forward. It also includes a plan on dealing with the mental health response to the Covid-19 crisis.
Commenting on the update, Health Minister Robin Swann said: “It is now 12 months since I published the Mental Health Action Plan and I felt it was important to provide an update on this work at this key juncture.
“I am pleased to report substantial progress has been made against the actions contained in the Action Plan. This is a considerable achievement, particularly given the additional, significant pressures related to Covid-19 and the challenges encountered by all those working to support people with mental ill health during this period.”
The progress update highlights key achievements including:
- The creation of a Mental Health Champion;
- Approval of the business case and securing of £4.7m funding for the development of a specialist perinatal mental health community service model;
- The establishment of the CAMHS and Forensic Mental Health Managed Care Networks; and
- The launch of a Mental Health Innovation Fund.
A number of reviews of key services were also commissioned as part of the Mental Health Action Plan including a review of: crisis services; transitions from CAMHS to Adult Mental Health Services; eating disorder services; personality disorder services; low secure in-patient services; and rehabilitation services. The outworking of these reviews will help inform future strategic policy and service delivery.
Minister Swann continued: “The progress that has been made is due in no small part to the drive and dedication of so many people working tirelessly to improve services and to ensure that mental health is given the priority and profile it deserves.
“However, challenges remain and much still needs to be done. The Action Plan was always intended as a short term measure to kick start the reform of mental health services.”
One of the key actions set out in the Mental Health Action Plan was to develop a new, ten year Mental Health Strategy for Northern Ireland.
Concluding Minister Swann said: “The Strategy is my Department’s long term strategic plan to address the pressure on mental health inpatient beds, to meet the increased needs created by the pandemic, and to put mental health on an even footing with physical health. I also hope it will bring us in line with mental health provision in other parts of the UK, and indeed, once fully implemented, ensure Northern Ireland has a world class mental health system to be proud of.”
The draft Mental Health Strategy 2021-31 was issued for public consultation in December 2020. It is intended to publish the final Strategy this summer alongside a funding plan, which sets out the resource requirements to implement the Strategy.
The Rainbow Project Welcome Introduction of Fair Project on Blood Donations
The Northern Ireland Blood Transfusion Service (NIBTS) will soon be starting to assess donor eligibility on a person-by-person basis for declared lifestyle choices; instead of applying across-the-board restrictions which have previously excluded potential donors. Using a donor’s individual experiences to determine whether that person is eligible to donate makes the process fairer for all donors and means more people will be able to give blood than ever before.
It also means all donors will be asked the same questions – regardless of gender or sexual orientation.
These changes to the way UK blood services assess the risk of transfusion transmitted infections incorporate the key recommendations of the 2020 FAIR (For the Assessment of Individualised Risk) Report. The recommendations were designed by epidemiology, sexual health and infectious disease experts to make sure we keep the blood supply safe while making blood donation fairer and more accessible to all. NIBTS are working in collaboration with Rainbow Project to ensure all those eligible to donate blood can do so safely.
The new FAIR risk assessment will be implemented in England, Scotland and Wales will come into effect on 14th June 2021, while in Northern Ireland the change won’t come into effect until September 2021.
Best Available Medical Evidence
Speaking about the change, Director of The Rainbow Project John O’Doherty said: “We welcome the implementation of the Fair Report and the new rules surrounding blood donations. These changes mean a large number of people who have never been able to donate blood will be eligible to do so. We would like to thank the Health Minister, Robin Swann, for ensuring that decisions related to blood donations are based wholly on the best available medical evidence and that policies are implemented on a UK wide basis.
“This is an issue we have been campaigning on for over 10 years including the implementation of an individualised risk assessment. During that time, we have been clear that donating blood is not a right, but a civic responsibility on all of us who are eligible to do so. The focus of The Rainbow Project will now turn to encouraging all those people who are now eligible to register as blood donors. Security and sustainability in our blood supply is a continued pressure across our health service – and while vocal and visible support for the NHS during the pandemic is to be welcomed – one of the most effective ways we can support our NHS is through donating blood.
“While we are disappointed that Northern Ireland will not be implementing the new assessment at the same time as the rest of the UK, we understand the reasons behind this and welcome the ongoing communication from the Northern Ireland Blood Transfusion Service and their commitment to ensuring staff are trained on the use of the new assessment process. The COVID 19 pandemic has had a huge impact on all aspects of our health service. Rather than spending the next 3 months condemning the Blood Transfusion Service, we will be directing our resources towards supporting the implementation of the new system and encouraging all those who are eligible to donate blood.