Introduction Around 1 in 7 oesophago-gastric cancers (OGC) diagnosed via emergency admissions have advanced disease – being less suitable for curative therapy – highlighting the need for better surveillance.  NICE guidelines on OGC screening recommend that patients with upper gastrointestinal (GI) symptoms with low haemoglobin (Hb) or thrombocytosis be considered for non-urgent endoscopy – while iron deficiency anaemia warrants urgent endoscopy to look for lower GI cancers.  Low Hb, low MCV, thrombocytosis and leucocytosis have been suggested as being independently associated with OGC. 
Method This retrospective observational cohort study analysed haematological profiles (prior to histological diagnosis) of 590 patients with OGC over 3 calendar years (2014–2016). WHO guidelines were used to define anaemia [Hb <130 g/L (males) and <120 g/L (females)] – and further stratification was done based on severity [mild (>110 g/L), moderate (80–110 g/L) and severe (<80 g/L)]. We further sub-analysed patterns based on sex, age, tumour location and severity of anaemia.
Results Of the 590 patients, 285 (48%) were anaemic, of which 221 (37%) were normocytic, 51 (9%) were microcytic and 13 (2%) were macrocytic. Among 390 male patients, 194 (50%) were anaemic, of which 148 (38%) were normocytic and 38 (10%) were microcytic. Among 200 female patients, 91 (46%) were anaemic, of which 73 (37%) were normocytic and 13 (7%) were microcytic. Among 392 patients with oesophageal cancers, 123 (31%) were normocytic and 25 (6%) were microcytic. Among 198 patients with gastric cancers, 98 (49%) were normocytic and 26 (13%) were microcytic. There was a higher ratio of normocytosis to microcytosis seen in mild anaemia, when compared to moderate and severe anaemia. Leucocytosis and thrombocytosis were seen in 16% and 13% of all OGC patients respectively; more prevalent than microcytosis seen in only 9% of all patients.
Conclusion The higher prevalence of pre-diagnosis normocytic anaemia in OGC highlights the importance of prompt evaluation of any type of anaemia in patients suspicious of OGC – without focusing on low MCV or ferritin levels. Normocytic anaemia should be considered sufficient to trigger urgent investigations for OGC in patients with upper GI symptoms.
. Healthcare Quality Improvement Partnership (HQIP). National Oesophago-Gastric Cancer Audit 2016. NHS Digital; 2016.
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. Stapley S, Peters T, Neal R, Rose P, Walter F, Hamilton W. The risk of oesophago-gastric cancer in symptomatic patients in primary care: a large case-control study using electronic records. Br J Cancer. 2013Jan 15;108(1):25–31.
Disclosure of Interest None Declared
- haematological profile
- microcytic anaemia
- normocytic anaemia
- oesophago-gastric cancer
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