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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
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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
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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:
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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