CANCER

Disease in which there is progressive multiplication of cells (neoplasia) under conditions where this would not normally occur. When a malignant tumour forms, its cells are invasive, lose their differentiation and orientation, and disperse to parts of the body distant from the initial growth (metastasise). Cancer’s natural course is fatal. In most cancers, early detection and treatment increase the chance of survival.

Cancer types

There are more than 200 different types of cancer, but in the UK four of them - breast, lung, large bowel (colorectal) and prostate - account for 53% of all new cases. In men, prostate is the most common cancer (24%), followed by lung (15%) and bowel (15%). In women, breast is the most common cancer (31%), followed by bowel (12%) and lung (11%). Incidence of thyroid and liver cancer have shown the fastest increases in both males and females over the past decade, and incidence of melanoma skin cancer, kidney cancer, Hodgkin lymphoma, and head and neck cancers have also incresed markedly. 

Cancer occurrence

Cancer occurs predominantly in older people, but around 1 in 10 cases occur in adults aged 25–49 years in the UK, among whom the most common cancers diagnosed are breast, malignant melanoma, bowel and cervix. Cancer is rare in children (but see Cancer in children and young people).

Cancer screening

Each UK country has a nationally co-ordinated screening programmes for bowel (not NI), breast and cervical cancer.

Role of healthcare professionals

Continuing education Education must be ongoing, and related to improving and maintaining clinical skills, to enable identification of cancer at an early stage.

Referral Be aware of the latest NICE guidance on referral for suspected cancer; use this in conjunction with guidance on specific cancer services. The advice takes into account the latest evidence and research findings.

Be familiar with typical presenting features of cancer, alert to unusual symptom patterns, and ensure urgent referral under the 2-week rule if cancer is a possibility. In children, be sensitive to parental concerns. Request further clinical advice if a child’s condition is not progressing as expected. See Cancer in children and young people. 

See also Bowel cancer; Lung cancer; breast, cervical, ovarian cancer (in Women’s health); prostate, testicular cancer (in Men’s health)

Depending on local arrangements, referrals should be made to the local specialist team for the particular cancer. If cancer is suspected, the wait for a referral appointment should not exceed 2 weeks. When a patient is referred, offer support and consider cultural issues. Follow current advice on breaking bad news.

Investigations Referral of patients with suspected cancer should not be delayed pending investigation in primary care

Cancer treatments include surgery, radiotherapy and chemotherapy. Adverse effects of therapy include immunosuppression, and hence susceptibility to infection, and more specific problems such as sore mouth and eating problems with radiotherapy to the head and neck, and hair loss with chemotherapy. Patients will see specialist staff but may appreciate additional support and help with accessing resources.