We have developed a suite of resources for secondary care clinicians, highlighting some key areas that you may come across that could indicate cancer. These resources are aimed at F1 & 2s, emergency department clinicians.
5 minutes to save a life: Could this be Cancer?
Alliance GPs are developing a series of bitesize education videos to outline some of the key red flag signs and symptoms to look out for in patients. Click on the headings below to find out more.
Survival is strongly linked to stage at diagnosis.
For colon cancer 5 year survival:
- stage 1 cancer is 90%
- stage 4 cancer is 10%
Most emergency diagnoses are stage 4
In the UK there are screening programmes for bowel, breast and cervical cancer. Lung cancer screening is currently being rolled out across the country.
The majority of cancers diagnosed through screening are stage 1
If unexplained and new, the chance of a cancer diagnosis that year is 7.8% (11.6% of males, 6.2% of females). If a second blood test shows platelet count to be the same or higher, 18.1% of males and 10.1% of females will have a 1-year cancer incidence.
LEGO-C (lung, endometrial, gastric, oesophageal, colorectal) is a helpful acronym to remember the cancers that are linked to thrombocytosis.
Watch the video to find out more.
SCREENING (asymptomatic population) – Positive result if ≥120 µg
SYMPTOMATIC – Positive result if ≥10 µg
It is recommended that you use FIT even in patients with obvious rectal bleeding to look for a cancer from higher up in the colon (avoid blood when testing).
Do not rely on a negative bowel screening test in a patient with symptoms
Test for ovarian cancer in any woman aged 50 or over who has experienced symptoms within the last 12 months that suggest irritable bowel syndrome (IBS).
IBS rarely presents for the first time in women of this age.
Be aware Ca125 can also be raised with other cancers including lung and pancreatic
Ca125 can miss over 23% of ovarian cancers
Chest X-Ray can miss 25% lung cancers
Be aware of lung cancers in never-smokers. If this were a separate entity it would be the 7th most common UK cancer.
Lung cancer can present with vague symptoms including appetite loss, weight loss and fatigue.
Still consider investigations for people with signs and symptoms of cancer even if they don’t meet the fast-track referral age criteria.
Smoking causes around 54,300 cases of cancer every year in the UK. Smoking is linked to at least 16 different types of cancer.
Obesity and being overweight cause around 22,800 cases of cancer every year in the UK.
Alcohol is estimated to cause 11,900 cancer cases in the UK. The largest number of cases are breast cancer.
Ask – Establish and record smoking status: “Do you smoke?/Are you still smoking?
Advise how to stop: a simple statement advising that “the best way to stop is with a combination of behavioural support and treatment, which can significantly increase the chance of successfully stopping”.
Act – Offer support and treatment: “When you are ready, just make an appointment with [x] who is great!”
Sources
- Survival | Bowel cancer | Cancer Research UK
- Clinical relevance of thrombocytosis in primary care: a prospective cohort study of cancer incidence using English electronic medical records and cancer registry data – PubMed
- Overview | Suspected cancer: recognition and referral | Guidance | NICE
- Using the faecal immunochemical test in patients with rectal bleeding: evidence from the NICE FIT study – Hicks – 2021 – Colorectal Disease
- Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review – PubMed
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4868732/
- Sensitivity of chest X-ray for detecting lung cancer in people presenting with symptoms: a systematic review | British Journal of General Practice
- Lung cancer in never smokers: Tumor immunology and challenges for immunotherapy – PMC
- The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015 | British Journal of Cancer