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Cancer

Cancer is a condition where cells in a specific part of the body grow and reproduce uncontrollably. The cancerous cells can invade and destroy surrounding healthy tissue, including organs. Cancer sometimes begins in one part of the body before spreading to other areas. This process is known as metastasis.

Introductory resources

1 in 2 people will develop some form of cancer during their lifetime. In the UK, the four most common types of cancer are described below.

Breast Cancer

Breast cancer is cancer that starts in the breast tissue. Breast cancer is the most common cancer in the UK population.

In the UK, there are around 56,000 new cases of breast cancer in women every year, and 400 new cases in men. 18% of breast cancers were in women under 50, and 24% of breast cancers occurred in women over 75.

Breast Cancer Symptoms

The first symptom of breast cancer that most women notice is a lump or an area of thickened tissue in their breast tissue.

The NHS advises the public to contact their GP practice if they notice any of the following:

  • a new lump or area of thickened tissue in either breast that was not there before
  • a change in the size or shape of one or both breasts
  • a discharge of fluid from either of your nipples
  • a lump or swelling in either of your armpits
  • dimpling on the skin of your breasts
  • a rash on or around your nipple
  • a change in the appearance of your nipple, such as becoming sunken into your breast.

It’s estimated that 25% of breast cancers are preventable through lifestyle changes. Breast Cancer UK have resources on their website to inform women of the current evidence on these.

The treatment needed depends on the type of breast cancer as well as the person’s health. Treatments include surgery, chemotherapy, hormone therapy, and radiotherapy.

Breast Cancer Screening

The NHS Breast Screening Programme invites all women from the age of 50 to 70 for screening every 3 years. This means that some people may not have their first screening mammogram until they are 52 or 53 years. In some parts of England, the screening programme has been inviting women from 47 to 73 years old as part of a trial.

Above the age of 70, self-referral for screening is available every 3 years without automatic invites.

Below the age of  50, the risk of breast cancer is generally very low. Mammograms are more difficult to read in younger women because their breast tissue is denser. So the patterns on the mammogram don’t show up as well. There is little evidence to show that regular mammograms for women below the screening age would reduce deaths from breast cancer.

Breast screening is also available for some trans or non-binary people.

Education Resources

  • Breast Cancer Screening Course: This course describes the NHS Breast Screening Programme in all four United Kingdom countries and the importance of the role of primary care. Using case scenarios and reflection of your own practice, you will learn about the advantages and limitations of breast screening, barriers to engagement and explore ways in which you can maximise patient engagement. This course has been developed in partnership with NHS Cancer Screening Programmes, and is free after registration with RCGP. It takes approx. 30 minutes to complete.

*Please note that all Gateway C courses require registration which is free to any NHS health care professional.

Bowel Cancer

Bowel (colorectal) cancer is a cancer that starts in the colon and rectum.

Around 43,000 people are diagnosed with bowel cancer in the UK each year. It is the 4th most common cancer in the UK. Both men and women can get bowel cancer, and it is more common in older people.

Risk factors include:

  • older age
  • genetics and family history
  • medical history such as familial adenomatous polyposis (FAP), Lynch syndrome, ulcerative colitis and Crohn’s disease
  • diet and lifestyle factors.

Cancer can less commonly occur in other parts of the bowel, anus and small bowel. Treatment depends on the location of the tumour and the stage of cancer.

Bowel Cancer Screening

The screening programmes send a bowel cancer testing kit every 2 years to people eligible to take part. You need to be registered with a GP to receive a screening invitation.

There are separate bowel screening programmes for the different countries in the UK, find out more here.

This video explaining how to do the bowel screening test can be shared with patients.

Training/Education Modules

  • Faecal Immunochemical Test (FIT) Gateway C: This course aims to increase health practitioner’s understanding of the use of FIT as a screening tool, and support practitioners in using FIT appropriately in symptomatic patients, to aid decision making in relation to referral on a suspected cancer pathway. It is supported by Cancer Research UK, Bowel Cancer UK, and is accredited by RCGP. It is free and requires registration with Gateway C, and takes approx. 1 hours to complete.
  • Colorectal Cancer Early Diagnosis Gateway C: This course aims to support the early diagnosis of colorectal cancer, and is accredited by RCGP. It is free and requires registration with Gateway C, and takes approx. 1 hours to complete.

Lung Cancer

Lung cancer is cancer that starts in the trachea, the main bronchus or the lung tissue.

Around 49,200 people are diagnosed with lung cancer every year in the UK, and early diagnosis improves outcomes.

There are usually no signs or symptoms in the early stages of lung cancer. Symptoms of lung cancer include:

  • a persistent cough
  • haemoptysis
  • persistent breathlessness
  • unexplained fatigue and weight loss
  • pain on breathing or coughing.

Modules

  • Lung Cancer Early Diagnosis Gateway C: This course aims to support early diagnosis of lung cancer, and includes a number of topic areas, each containing activities to challenge and keep you thinking. The course is accredited by RCGP and includes an interactive video consultation, activities, and resources covering finger clubbing, haemoptysis, thrombocytosis, chest X-rays and NICE guidelines. It is free and requires registration with Gateway C, and takes approx. 1 hours to complete.

Prostate Cancer

Prostate cancer is the most common cancer in men in the UK. It usually develops slowly, so there may be no signs for many years.

Symptoms of prostate cancer do not usually appear unless the tumour grows near the urethra or grows in size in order to press on the urethra.

When this happens, men may notice:

  • frequency or urgency
  • hesitancy or need to strain to pass urine
  • dribbling after finishing passing urine
  • a feeling that their bladder has not fully emptied

These are all also symptoms of benign prostate enlargement.

If prostate cancer grows out of the prostate (locally advanced prostate cancer) or spreads to other parts of the body (advanced prostate cancer), it can cause other symptoms, including:

  • back pain, hip pain or pelvis pain
  • problems getting or keeping an erection
  • blood in the urine or semen
  • unexplained weight loss.

Modules

  • Prostate Cancer Early Diagnosis Gateway C: This course aims to support the early diagnosis of prostate cancer, including how to manage patients with prostate cancer symptoms and consider PSA testing in asymptomatic patients. It is free and requires registration with Gateway C, and takes approx. 1 hours to complete.

General – Cancer and Primary Care Nursing

Cancer Care Reviews

  1. South West London Macmillan Primary Care Nursing Project education resources. Includes videos focussing on cancer care reviews and a series of podcasts:
    The value of good cancer care reviews, and the role that nurses play in delivering them
    How to carry out an effective Cancer Care Review.
  2. Macmillan’s Resources
    Cancer Care review – this page provides a range of resources to support best practice in carrying out cancer care reviews.
    Practice Nurse – a range of resources to support practices nurses proving care to people living with or at risk of cancer.

Consequences of Treatment and late effects

  1. Consequences of Cancer and Treatment. Aimed at: GPs, Practice Nurses, GPs in training, Health care Assistants and Physician Associates.
    Course description: The toolkit provides resources and information for primary care professionals to identify and manage the consequences of cancer treatment, and support patients to live well after a cancer diagnosis. It is designed to be used by any general practice in the UK, and is appropriate for everyone who provides or commissions services for people living with and beyond cancer.
    Developed by: Macmillan Cancer Support and Clinical Innovation and Research Centre
    Tumour site: All
    Free/Cost: Free
    Duration: Various
    Accreditation: Royal College of General Practitioners
    CPD Points: Early Diagnosis/Personalised Cancer Care: Personalised Care.
  2. Symptom of the month by Guys Cancer Academy. A series of free education sessions covering the latest research in symptom management as well as patient-led presentations on their experiences and stories. Symptoms include fatigue, chemotherapy induced peripheral neuropathy, anxiety, nausea and vomiting, cancer related thrombosis, cancer elated constipation and diarrhoea and more. No registration needed, free to access, varying on demand video recordings. No CPD points.
  3. Sexual Health and Wellbeing and Cancer. Video recordings from a study day hosted by the Guys Cancer academy, includes:
    – Talking about sex with cancer patients and their partners
    – Patient experience of chemotherapy on body image
    – Fertility needs of people with cancer
    – Patient experiences.
    No registration, videos can be watched on demand. No CPD points.
  4.  Fear of Cancer recurrence. Gateway C (part of a longer module on colorectal cancer but can be accessed as a stand-alone activity). Time required: 30 minutes. Short course which explains the fear of cancer recurrence and how to support someone to manage this. The activity:
    – Explores the reasons for fear of recurrence of cancer
    – Discusses the management of patient anxiety
    – Examines the skills necessary to support patients.
  5. Managing Physical Effects. Gateway C in collaboration with Macmillan Cancer Support and North Central London Cancer Alliance. Accredited by the Royal College of GPs. This short course covers common physical effects of cancer treatments – peripheral neuropathy, lymphoedema, cardiac and bone health. Time to complete 60 minutes.

Screening and Prevention – All

  1. Introduction to Population Screening. An overview of health screening as it’s applied to large populations of people and how national screening programmes are implemented in the NHS. Aimed at: GPs, Practice Nurses, GPs in training, Health care Assistants and Physician Associates.
    The module covers:
    – what population screening is
    – roles and responsibilities (covering the UK National Screening Committee, Public Health England, the Department of Health and Social Care, and the NHS)
    – the balance of benefits and harms in screening and why personal informed choice is so important
    – important concepts (for example, the difference between screening and diagnosis, and the meaning of terms like ‘positive predictive value’, ‘false negatives’ and ‘specificity’)
    – personal experiences of screening.
    Developed by: Health Education England
    Tumour site: Bowel, Breast and Cervical
    Free/Cost: Free
    Duration: Various
    Accreditation: N/A
    CPD Points: N/A
    Early Diagnosis/Personalised Cancer Care: Early Diagnosis
  1. Very Brief Intervention Training – Smoking. This 30-minute module will provide you with the knowledge and skills needed so that you can feel confident in delivering very brief advice (VBA+). While this training module features general practice the principles of, and skills to deliver, VBA+ apply to any clinical or community setting. Very Brief Advice on Smoking (VBA+).
  2. Good Practice Screening Guide: breast, cervical and bowel by Healthy London Partnership highlights areas of good practice in primary care. It will help practices to support screening participation in their populations, including those who often find services hard to reach. It will increase the number of cancers prevented and detected earlier, thus improving survival and reducing mortality from cancer.
  3. Health professional | Cancer Research UK – comprehensive resources for professionals. Keep up to date with the latest statistics, evidence and information on diagnosing, treating and preventing cancer. You can also find professional tools and early diagnosis campaigns and activities that can support your work.
  4. Cervical Screening in Trans Men and Non-binary People with a Cervix – RM Partners – a best practice guide for primary care developed with primary care clinical experts in collaboration with those with lived experience. Developed for RM Partners Cancer Alliance and West London ICS’s but a resource that could be used nationally.

Non-academic Cancer Training programmes

  1. Macmillan has a wide range of tools and resources for health and social care professionals who support people living with or at risk of cancer. Here are some useful links:
    Learning and communications hub – join to attend their free training and events.
    Resources for practice nurses – a collection of useful tools and information. Here you can also find out more about their Practice Nurse Programme – a continuous professional development course for Registered Practice Nurses to enable you to enhance your knowledge and skills in cancer care.
    Explore Programme for Primary Care – this programme designed to meet the development needs of staff who wish to increase their knowledge of cancer care and to enhance their knowledge, skills and professional confidence. It provides foundation knowledge to registered healthcare professionals in primary care. Aimed at all healthcare professionals.
  2. Cancer Nursing Careers programme. A collaboration between RM Partners, University of Stirling, University of Huddersfield and Heath education England available on E learning for health. Free, requires registration with ELFH. This programme has been developed to provide cancer-specific learning opportunities for registered nurses who provide care to people affected by cancer (PABC) in non-specialist cancer settings including primary, secondary and community services. All nurses, regardless of practice setting, are likely to have contact with PABC and, to enhance their practice, should have an understanding of cancer and its treatment, education in the basic principles and practice of cancer care, skills in assessing the cancer care needs of patients and families, and training in communication skills.
  3. Cancer in the Community. The Royal Marsden School in collaboration with Health Education England South London has designed an e-learning programme to provide an overview of the key issues in cancer care and to raise awareness of them. The programme aims to ensure knowledge for community-based workers related to the key aspects of cancer and its treatment becomes embedded into their daily activities, and aims to inspire them to support clients before, during and after cancer is diagnosed. A number of national guidance and policy documents have highlighted a need to develop cancer services and education. Approximately 1.8 million people in England are currently living with a diagnosis of cancer; this number is increasing by over 3% each year and the total figure will rise to over 4 million by 2030. Evidence shows that many cancer survivors have unmet needs particularly at the end of treatment, whilst others are struggling with consequences that could be either avoided or managed. Some progress has been made in addressing these needs but more needs to be done. One recommendation from the All Party Parliamentary Group on Cancer (APPGC) is that GPs and community staff need more education and support to help them in identifying warning signs and symptoms of cancer, to facilitate earlier diagnosis; manage patients on treatment and be able to support patients living with or after treatment for cancer.
    The four e-learning sessions in this programme cover the following topics:
    – Cancer Prevention and Screening (40 minutes)
    – Cancer Diagnosis and Staging (50 minutes)
    – Cancer Treatments (50 minutes)
    – Living With and Beyond Cancer (50 minutes).
    The modules can be completed as open access without an ELFH log in. Registration with ELFH is free, and if logged in the learner will receive a record of learning and certificate.

Thank you to Transforming Cancer Services Team for London and Wessex Cancer Nursing Across Boundaries Project Team for their collaboration in compiling these resources.

 

Important Risk Factors for Cancer

People with Type 2 diabetes have a higher risk of developing breast, endometrial and bowel cancers. In the UK, cancer is now the most common cause of death among people with diabetes. Despite this, people with diabetes are less likely to participate in cancer screening which can improve survival from cancer. Health Care professionals are generally unaware of this association.

Based on research by Professor Laura Ashley, an intervention has been developed for practice nurses to highlight cancer screening at the annual diabetes review.  This is a key step in addressing this issue and this training resource will equip you in understanding and sharing this important information.

Access the training resource (video).