The oesophagus ("gullet") is the organ that connects the mouth/throat to the stomach. It transports food and can be affected by a variety of conditions including cancer. There are two main types of oesophageal cancer: squamous cell cancer and oesophageal adenocarcinoma. The latter is more common in Western societies these days. The treatment is complex and requires an experienced multidisciplinary team. Organ-sparing cancer treatments are often possible, but at times radical surgery involving operating in both the abdomen (belly) and chest is required. If this is the case, then often patients need to undergo preoperative chemotherapy and sometimes radiation treatment. Most often the surgical treatment of cancer of the oesophagus can be performing minimally-invasively or as a hybrid-procedure (parts open, parts minimally invasive). 

Stomach cancer can affect parts of the stomach (upper, middle, lower) or the whole stomach ("linitis plastica"). Depending on it's location, and the extent of disease organ-sparing approaches, but also radical surgery can be required. Similar to oesophageal cancer, if radical surgery is required, then frequently patients need to have a period of chemotherapy prior to surgery. Most often surgery can be performed minimally invasively greatly enhancing the recovery process. 

Pancreas cancer is a highly aggressive and complicated disease. It's treatment involves gastroenterologists, surgeons, oncologists, and radiation-oncologists as well as importantly allied health professionals such as dieticians. There are many different tumours/cancers that affect the pancreas and depending on what type you are affected by the treatments can vary quite substantially. For "classic" pancreas cancer (pancreatic ductal adenocarcinoma, PDAC), however, the treatment is often multidisciplinary consisting of chemotherapy + surgery +/- radiation-therapy. If the cancer involves the head of the pancreas, patients will frequently need to undergo the so-called "Whipple's procedure", where the head of pancreas, surrounding bowel, bile ducts, gallbladder and sometimes part of the stomach are removed and then reconstructed using patients' own tissues. Sometimes, the removal and reconstruction of the essential small bowel/liver vessels (portal vein/super mesenteric vein/artery, hepatic & coeliac artery) is required. This can only be performed in highly-specialised Units by surgeons with experience in the radical removal of abdominal vessels and their reconstruction. For more information on this I strongly recommend all patients view the excellent resources on the Cancer Council Australia Website and also the fantastic information put together by St Joseph's Hospital in Toronto, Canada - www.whipplepathway.ca. 

Liver cancer surgery may be required for tumours that either arise in the liver itself or because of metastases (seedlings) from other organs such as bowel cancer. Surgery for liver cancers can be fairly limited, often being performed minimally invasively, but can also range to extensive open surgery, requiring complex reconstructions of the blood vessels of the liver and its bile ducts. The treatment for liver cancers should only occur in highly specialised Units with experience in managing not just the cancer but often underlying liver disease that may predispose the patient to cancer formation (such as liver cirrhosis). Often, liver tumours also require a multidisciplinary approach, and sometimes procedures are required to make the liver grow prior to attempting surgery ("multistaged resections"). At St George Hospital we have an extensive track-record in managing patients with complex liver conditions and many of the treatments that are required to manage these challenging conditions were pioneered at our institution. 

Fibrolamellar Carcinoma (previously known as Fibrolamellar Hepatocellular Carcinoma) is an extremely rare cancer of the liver that occurs in children and young adults with no underlying liver disease such as cirrhosis. Virtually all cancers harbour a mutation resulting in the DNAJB1-PRKACA fusion gene which drives this cancer formation and propagation. Traditionally it was thought that FLC is a "surgical disease" meaning that there were previously no effective systemic chemotherapy options available. However, this has now changed and there are a variety of newer combination treatments showing promise for this devastating condition. Frequently, therefore, a combination of surgery + chemotherapy +/- radiotherapy +/- interventional radiological treatments are required to keep the disease controlled. Fibrolamellar carcinoma IS NOT the same has hepatocellular carcinoma and requires completely different treatments as most traditional HCC treatments are not effective in this disease.

Overall the clinical experience in managing this condition is very limited and many clinician's will only see 1 or 2 cases over their whole career. However, I work very closely with the FibroFighters Foundation as well as Dr Paul Kent of the Rush Medical Centre in Chicago who now manage the world's largest cohort of patient's suffering from this disease. We collaborate for both clinical and research purposes. Through this collaboration I have partnered with many patients and their doctor's across Australia to help have their cases discussed at our weekly International Fibrolamellar Tumour Board, hereby ensuring that our local, Australian patients, can be offered the most update and cutting-edge treatments for this very rare condition.

Whilst overall fairly rare, tumours of the bile duct or gallbladder can also occur requiring surgery. Depending on the location as well as extent, removal of the gallbladder with part of the liver, extensive liver resections, removal of the bile duct and pancreas (with a Whipple's procedure) or even both (liver + pancreas surgery) may be required. These tumours can frequently present diagnostic challenges and thus the experience of your team in managing these tumours is essential to ensure successful outcomes. 

I treat a variety of other cancers, that may affect other parts of the body, in particular abdominal organs. At St George Hospital we also specialise in the treatment of so-called neuroendocrine tumours and GISTs (gastrointestinal stromal tumours), which may sometimes require extensive abdominal procedures to help achieve disease control and/or cure. This may at times require so-called multi-visceral resections (removal of multiple organs), which can result in substantial impacts for patients and thus patient suitability needs to be very carefully assessed by your multidisciplinary team. For diseases that spread to the lining of the belly (peritoneum) we often perform procedures in conjunction with the St George Peritonectomy Unit, an internationally leading institution for peritoneal surface oncology.