Tests

Ultrasound imaging uses high frequency sound waves, passed from a probe into the body. The probe picks up the sound waves as they bounce back of the tissue and a computer processes images based on the results. The ultrasound waves are painless, inaudible and do not require any anaesthetic or a drip to be placed. The probe can also measure the flow in blood vessels (Doppler)

Indications

Ultrasound allows the doctor to visualise the internal organs, blood vessels and the body wall. It is usually recommended to help diagnose

• Abdominal abnormalities such as tumours, infections, cysts (fluid-filled sac-like structures). In general, ultrasound scans of the bowel are less reliable, in adults.
• Gallstones in the gallbladder and bile ducts
• Liver disease and inflammation of the pancreas
• Problems of the pelvic organs
• Abdominal and groin hernia
• Ultrasound is also used to guide procedures such as biopsy and surgery.

Pre-procedural Preparation

You will be asked to remove clothing covering the area to be scanned. If you are undergoing an upper abdominal or gallbladder scan, you will be asked not to eat for a few hours before the test, so that bowel gas does not obscure the pictures.

Procedure

Ultrasound is usually done by a radiology technologist.

• You will lie on a bed next to the technician.
• The ultrasound probe, which is the size of a paintbrush, is pressed onto the area of interest.
• You may be asked to breathe, hold your breath, cough or stand during the test.
• The entire procedure takes about 10 to 20 minutes.

Risks & Complications

Ultrasound scanning is very safe and can be performed at any time during pregnancy.

Computerized tomography (CT scan) or Computer Axial Tomography (CAT) scan is an imaging procedure that uses an X-ray machine connected to a computer. The scan creates cross-sectional images or slices of the internal structures of the body. Sometimes, a contrast material or dye may also be injected into your arm or any other part of your body for a better view of an area. The internal structures are easily visible on the CT scan with the help of the dye.

Indications

CT scan images allow the doctor to look at the inside of the body and is usually recommended to help diagnose various conditions including:

• Abdominal and intestinal abnormalities such as tumours, infections, cysts (fluid-filled sac-like structures), and bowel disease.
• Kidney and bladder stones, urinary tract blockage, or other urinary tract diseases.
• Liver diseases and inflammation of the pancreas
• Problems of the pelvic organs
• Enlarged adrenal glands
• CT scan is also used to guide procedures such as biopsy, radiation therapy and surgery.

Pre-procedural Preparation

You will be asked to remove any jewellery or metal fastenings that are in the area to be scanned. The scan may require a contrast dye or substance that improves the picture of certain tissues or blood vessels. This material may be swallowed, given as an enema or injected into the blood stream, depending on the part of your body that is to be scanned. If you are undergoing an abdominal scan, you will be asked not to eat for six hours before the test.

Procedure

A CT Scan is usually done by a radiology technologist.

• You will lie on a table that is attached to the CT scanner.
• The table will slide into a large donut-shaped machine which takes images while moving around your body. Each rotation will yield several thin sliced images of your body.
• You may be asked to breathe or hold your breath during the chest and abdomen scanning. You should lie still during the procedure as this increases the clarity of the images.
• The CT scan technologist will watch you through a window during the procedure. You can communicate with the technologist through an intercom.
• You should inform the technologist if you experience any problems during the scan. The entire procedure takes about 30 to 60 minutes.

Post-Procedural Care

You can return to your normal routine after the procedure. If a contrast dye was used, you will be instructed to drink plenty of fluids to flush out the dye from the body. In some cases, you may have to wait for an hour to make sure you feel okay after the scan.

Nursing mothers should wait for 24 hours after a scan using a contrast dye before resuming breastfeeding.

Risks & Complications

As with any procedure, a CT scan involves minor risks and complications.

• Doctors do not generally recommend CT Scans without a good medical reason as there is far more X-ray exposure than is involved in ordinary X-rays. There must be a diagnostic benefit to performing a CT scan, for the risk of x-ray expose to be justified.
• Pregnant women should not have a CT scan as there is a small risk that X-rays may cause abnormality to the unborn child.
• The contrast dye used in CT Scans often contains iodine, which can cause allergic reaction in some patients.
• Also, the dye may cause some kidney damage to people who already have kidney problems.

MRI or magnetic resonance imaging scan is an imaging test that creates pictures of internal body structures (bones and soft tissues) with the help of magnetic fields and radio waves.

The MRI can also be combined with other imaging techniques to provide a more definitive diagnosis. The scan is often used to clarify findings from previous X-rays or CT scans.

Indications

MRI scans provide information on a variety of conditions and procedures and to assess function of the internal organs such as:

• Brain and spinal cord abnormalities
• Prostate, liver and breast abnormalities
• Function and structure of the heart
• Joint problems
• Blood flow through blood vessels
• Tumour detection and help in staging (tumour size, severity and spread)

Procedure

Before the procedure, you will be asked to remove any metallic devices such as hearing aids, hairpins, removable dental work or other objects that may interfere with the procedure. You may be provided with ear plugs or music to block the strong noises from the MRI scan. You may be sedated if required.

The MRI machine consists of a large strong magnet and a table that moves into the opening of the scanner. During the procedure, you will be asked to lie on the table, which will be advanced into the scanner. The machine creates a magnetic field that creates loud noises. In some cases, a contrast dye may be injected through your arm to provide a clearer view of the scan. A radio wave antenna directs signals to the body and receives them back to create images by a computer attached to the scanner. You need to keep very still throughout the scan as movement may blur the resulting images. The entire procedure may take up to an hour to complete.

If you were not sedated, you may resume your usual activities immediately after the MRI. If you have been given a sedative, you will need to arrange for a relative or friend to take you home after the scan.

Advantages & Disadvantages

Advantages of MRI include:

• Does not use radiation
• Is non-invasive
• Can take images of any part of the body from almost any direction and orientation
• Produces better images of soft-tissue structures compared to other imaging techniques
• Can differentiate between tissues based on their biochemical properties such as water, fat, iron
• Can scan large regions of the body

Disadvantages of MRI Include:

• Certain patients who get nervous in small spaces (claustrophobic) may not be able to have an MRI.
• Elderly or ill patients may find it difficult to cooperate, which may result in blurred images.
• MRI cannot be done on patients with implanted medical devices such as aneurysm clips in the brain, heart pacemakers and cochlear (inner ear) implants
• MRI is an expensive procedure

Risks & Complications

Since an MRI scan is a non-invasive test, it is a very safe procedure. However, there is a very small risk of an allergic reaction to the contrast dye or sedation medicine if used. Any metal or electronic devices in your body are a safety threat and you should not undergo an MRI in those circumstances. Before your MRI test, make sure you notify your doctor and the MRI technologist if you:

• Have any health conditions, such as kidney or liver problems that may prevent you from having an MRI using contrast material
• Are pregnant as the effects of magnetic fields on the baby are not yet known

Positron emission tomography scan, also called PET scan or PET imaging, is a highly specialized nuclear imaging test that uses small amounts of radioactive substances to produce powerful images of the body’s biological function. PET scan is non-invasive and usually painless.

Procedure

PET scan uses a special camera and a radioactive chemical tracer to view organs in the body. The radionuclides used in PET scans are chemical substances such as glucose, carbon, or oxygen used naturally by the organ or tissue during its metabolic process.

During the test, the tracer liquid is put into a drip (intravenous, or IV) in your arm. The tracer may also be swallowed or inhaled depending on what part is being imaged. The tracer moves through your body, where much of it collects in a specific organ or tissue. The tracer gives off tiny positively charged particles called positrons. The camera records the positrons and turns the recording into pictures on a computer.

Indications

PET scans may be performed to:

• Detect certain types of cancer
• Determine if cancer has spread to other parts of the body
• Assess the effectiveness of cancer treatments

Procedure

Before the Procedure

• Notify the radiologist or technician of any medications you are taking and if you are allergic to or sensitive to contrast dye, iodine, or seafood.
• Fasting for a certain period prior to the procedure is required, usually for at least four hours.
• Notify your physician if you are pregnant or breastfeeding.

During the Procedure

You will be positioned on an examination table. An IV line will be inserted into your arm if needed. The radiotracer will then be injected into your vein, swallowed or inhaled depending on the imaging needed.

You may have to drink a contrast liquid that helps the radiologist interpret the imaging results. The radiotracer takes about 30 to 60 minutes to concentrate in the organs. During this time, you will be asked to lie still and not talk.

After 30-60 minutes, you will be moved into the scanner for imaging.

Post-Operative Care

You will be instructed to drink plenty of fluids and empty your bladder frequently for 24 to 48 hours after the test to help flush the remaining radionuclide from your body.

If you notice any pain, redness, and/or swelling at the IV site, you should notify your physician.

Advantages & Disadvantages

• PET scans provide information about both structure and function of the tissues.
• It helps detect some cancers or areas of spread which have not been identified by other imaging studies such as a CT or MRI.
• Since it provides information on cellular activity, it helps in the early detection of disease.

Risks & complications

• The amount of the radionuclide used for the procedure is small enough that there is no need for precautions against radioactive exposure.
• The injection of the radionuclide may cause some slight discomfort.
• Allergic reactions to the radionuclide are rare, but may occur.

An endoscope is a long, thin, flexible tube with a tiny video camera and light attached on its end. Endoscopy is a procedure used to diagnose and treat problems of the digestive system. It is usually indicated for patients having trouble with swallowing, having persistent isolated nausea or vomiting, chronic anaemia and/or iron deficiency anaemia, acute gastrointestinal bleeding and gastroesophageal reflux.

Traditionally, physicians refer patients to a GI endoscopist to evaluate necessity for endoscopy. Open access endoscopy is when a patient is referred to have a routine gastrointestinal endoscopic evaluation without consulting with a specialist doctor first. To qualify, you need to have few or no medical problems. The common procedures that are performed on an open access basis are colonoscopy, where the scope is introduced through the anus to view the colon or large intestine, and gastroscopy, where the scope is introduced through the mouth to view the oesophagus, stomach and small intestine.

Although open access endoscopy is becoming more common, it may be associated with certain drawbacks such as poorly informed patients and inappropriate or unnecessary referrals. However, it can be used safely when patient safety, transfer of information and medical complexities are properly addressed.

Colonoscopy is a procedure used to view large intestine (colon and rectum) using an instrument called colonoscope (a flexible tube with a small camera and lens attached). The procedure can detect inflamed tissue, ulcers, and abnormal growths. It is used to diagnose early signs of colorectal cancer, bowel disorders, abdominal pain, muscle spasms, inflamed tissue, ulcers, anal bleeding, and non-dietary weight loss.

The procedure is done under general anaesthesia. The colonoscope is inserted into the rectum which gently moves up through the colon until it reaches the cecum (junction of small and large intestine). Colonoscopy provides an instant diagnosis of many conditions of the colon and is more sensitive than X-ray.

The colonoscope is then withdrawn very slowly as the camera shows pictures of the colon and rectum onto a large screen. Polyps or growths can also be removed by colonoscopy which can be sent later for detection of cancer.

Instructions for colonoscopy

Your physician may provide you written instructions and will be communicate verbally on how to get prepared for the colonoscopy procedure. The process is called bowel prep.

Gastrointestinal (GI) tract should be devoid of solid food or opaque liquid to improve the chances of the whole colon being visualised. Please follow the links to information sheets on bowel preparation for a morning or afternoon colonoscopy.

Certain medications such as aspirin, Plavix, warfarin or other blood thinning medications, may cause bleeding if polyps are removed at your colonoscopy. However, these medications are sometimes essential and should not be stopped unless instructed by your doctor. Iron medications produce a dark black stool, and this makes the view inside the bowel less clear.

A laxative or an enema may be required the night before a colonoscopy. Laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed in pill form or as a powder dissolved in water.

Driving, operating heavy machinery or signing legal documents should not be performed for 24 hours after colonoscopy, due to the sedative medications used.

Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic tool that enables your physician to diagnose and treat problems of the liver, gallbladder, bile ducts and pancreas. ERCP combines X-rays and endoscopy, which includes the use of a long, thin, flexible tube with a tiny video camera and light on the end to carefully examine the inside of the upper digestive system.

ERCP is usually indicated to diagnose and treat conditions of the bile or pancreatic duct which include blockage or narrowing of the ducts due to gallstones, tumours, infection, valves that don’t open properly, scarring, accumulation of tissue debris and fluid, or inflammation of the pancreas. ERCP is also considered for obtaining a biopsy.

ERCP is performed on an outpatient basis under heavy sedation or general anaesthesia. You are placed on an X-ray table, on your back or side. Your doctor inserts the endoscope through your mouth, down into the stomach and into the upper part of the small intestine (duodenum). Once the endoscope reaches the orifice of pancreas and bile ducts, a thin tube called a catheter will be inserted through the endoscope and a dye is injected into the ducts. X-ray images are taken to diagnose any problem related to the ducts. When a problem is detected, your doctor may choose to treat your condition immediately by:

• Opening narrowed duct regions with an inflatable balloon, and placing stents (plastic or metal tubes) to keep the duct open
• Enlarging a narrowed or hardened sphincter muscle (regulating the flow of bile and digestive juices into the small intestine) using an electrically heated wire that is passed through the endoscope

As with any procedure, ERCP may involve certain risks and complications which include pancreatitis (inflammation of the pancreas), infection, bleeding and tissue damage.

Ultrasound imaging uses high frequency sound waves, passed from a probe into the body. The probe picks up the sound waves as they bounce back of the tissue and a computer processes images based on the results. The probe can also measure the flow in blood vessels (Doppler). The closer the probe is to the tissues, the clearer the images.

Indications

Endoscopic Ultrasound allows the doctor to visualise specific internal organs and blood vessels of the upper gastrointestinal tract.

It is usually recommended to help diagnose or stage

• Abdominal abnormalities such as tumours, infections, cysts (fluid-filled sac-like structures).
• Gallstones in the gallbladder and bile ducts
• Liver disease and inflammation of the pancreas
• Biopsy of the lymph nodes
• Biopsy of the pancreas
• Drain cysts of the pancreas.

Pre-procedural Preparation

You will be asked to remove clothing covering the area to be scanned. If you are undergoing an upper abdominal or gallbladder scan, you will be asked not to eat for a few hours before the test, so that bowel gas does not obscure the pictures.

Procedure

Ultrasound is usually done by a radiology technologist.

• You will lie on a bed next to the technician.
• The ultrasound probe, which is the size of a paintbrush, is pressed onto the area of interest.
• You may be asked to breathe, hold your breath, cough or stand during the test.
• The entire procedure takes about 10 to 20 minutes.

Risks & Complications

Ultrasound scanning is very safe and can be performed at any time during pregnancy.

What is an MDT?

An MDT is weekly meeting by a hospitals doctors and nurses, who are involved in the care of patients with cancer. There are many MDTs who specialize in different types of cancer. A specialist Upper GI cancer MDT includes surgeons, gastroenterologists, radiologists (interpret images), pathologists (interpret biopsies), medical oncologists (chemotherapy), radiation oncologists (radiation therapy), specialist nurses and dieticians.

How does an MDT work?

At the MDT, your lead clinician (the doctor who has performed your tests to date) presents your diagnosis and any issues regarding your conditions. The tests you have had done are analysed by the relevant doctors. Treatment plans are formulated on the best evidence available.

Can I attend the MDT?

Patients are not able to attend the MDT due to privacy issues of the other patients being discussed. Multiple patients are discussed in the limited time that all doctors can be present in the same room. The language of the meeting is ‘medical jargon’ which it may be difficult to understand.

How can I be sure that my personal views & concerns are Considered?

Your lead clinician is your advocate in this meeting. It is important that your doctor knows concerns, views and preferences about treatment before the meeting if possible.

How can I find out about the MDT Discussion?

Your points of contact are your lead clinician and the MDT specialist nurse. The discussions of the MDT are recorded and documented in your medical record. You will receive a telephone call from your clinician regarding the MDT recommendations and how to move forward. A letter communicating the MDT discussions is sent to your GP

What type of recommendations would an MDT Suggest?

A good MDT discussion leads to recommendations of treatment or further tests.  If a further test is required, the reason why this may make a difference will be explained.  It may be that a further MDT discussion will be needed with the results. 

Treatment recommendations are not final and take the form of

“Mr. or Mrs. X should see an oncologist to discuss the benefit of chemotherapy” rather than “Mr. or Mrs. X should have chemotherapy”

Who makes the final decision of my Treatment?

Ultimately all decisions on your treatment are made by you. Your doctors of the MDT are there to guide you. You may want a second opinion if you are unhappy with the recommendations. You may also find that your GP (who is the doctor who often knows you best), close friends or family members may be extremely valuable in aiding your decision.