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. It represented 15% of all new cancer cases in 2017 and is the most common cancer in women, globally.

In UK women, around 54,700 new cases of breast cancer were diagnosed in 2017. In men, there were around 390 new cases in 2017.

17% of breast cancers were in women under 50, between 2015-2017.

24% of breast cancers occurred in women over 75 between 2015-2017.

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
  • 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.

 Education resources:

  •  Breast cancer Screening. 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. Free after registration with RCGP. Time to complete: 30 minutes.

*Please note that all Gateway C require registration which is free to any NHS health care professional: www.gatewayc.org.uk/register.

Bowel Cancer

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

Around 42,300 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. 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 location of tumour and staging.

Training/Education modules:

  1. Faecal Immunochemical Test (FIT) Gateway C – FIT for screening, and symptomatic. Supported by Cancer Research UK, Bowel Cancer UK and accredited by RCGP. Time to complete 2 hours. Free, need to register with Gateway C. This course aims to increase health practitioner’s understanding of the use of FIT as a screening tool; support practitioner’s in using FIT appropriately in symptomatic patients, to aid decision making in relation to referral on a suspected cancer pathway.
  1. Colorectal Cancer – early diagnosis. Gateway C. Time to complete 2 hours. Free (need to register with Gateway C.) Accredited by RCGP. This course aims to support the early diagnosis of colorectal cancer.
  2. Colorectal Cancer – long-term complications. Gateway C. Free (need to register). Accredited by RCGP. Time to complete 2 hours. This course aims to provide information on supporting patients living with the late effects of cancer treatment. It focuses on late effects commonly experienced following treatment from colorectal cancer: peripheral neuropathy, altered bowel function, impotence and also fear of recurrence.

Lung Cancer

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

Around 47,000 people are diagnosed with lung cancer condition every year in the UK. 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:

  1. Lung Cancer – Early Diagnosis. Gateway C Free, need to register. Time to complete- 2 hours. Accredited by RCGP. This course aims to support early diagnosis of lung cancer. There are a number of topic areas, each containing activities to challenge and keep you thinking. The course includes an interactive video consultation and activities and resources covering finger clubbing, haemoptysis, thrombocytosis, chest x-rays and NICE guidelines.
  2. Lung Cancer – end-of-life care. Gateway C, free but need to register. Consists of three courses, each takes 1 hour to complete, total 3 hours. These three courses aim to support health professionals who are working with patients approaching the end of their life, and their families.
    We explore aspects of care related to the end stages of cancer through the case study of a lung cancer patient, but all three sections have broad applicability to end-of-life care for other patients.

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:

  1.  Prostate Cancer- responding to a PSA screening request. Gateway C supported by Cancer research UK. Accredited by RCGP. It takes one hour to complete. Free, need to register with Gateway C. This course aims to support health practitioners to have conversations regarding the pros and cons of PSA testing with asymptomatic patients. Additionally, it covers awareness of prostate cancer symptoms, patients who are at most risk, investigations and how to interpret them.
  2. Symptomatic Prostate Cancer. Gateway C, accredited by RCGP. It takes one hour to complete. Free, need to register with Gateway C. This course aims to support health practitioners in raising awareness of patients who are most at risk of developing prostate cancer and to identify ways in which it can present.  It also includes interpreting investigations and clinical decision making regarding referring patients and referral pathways.
  3. Metastatic Prostate cancer. Gateway C, accredited by RCGP. Time to complete one hour. Free, registration with Gateway C required. This course aims to support health practitioners assess patients for risk of advanced prostate cancer, discuss raised PSA levels and make clinical decisions around referral with a patient with comorbidities and diminished capacity. Additionally, it covers awareness of prostate cancer symptoms, patients who are at most risk, investigations and how to interpret them.

 

General – Cancer and primary care nursing

Cancer Care Reviews

  1. SWL 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+)

Non-academic Cancer Training programmes

  1. Macmillan Explore Programme for Primary Care. This programme has been 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.
    Tumour site: All
    Free/Cost: Free
    Duration: Complete over a 3-6-month period
    Accreditation: Y
    CPD Points: 26
    Early Diagnosis/Personalised Cancer Care: Both
  2. Macmillan Practice Nurse Programme. A continuous professional development course for Registered Practice Nurses to enable you to enhance your knowledge and skills in cancer care. This is a free blended learning programme that was launched on the 28th June 2021. The programme incorporates e-learning, self-directed learning and virtual face to face facilitated sessions. We estimate that it will take between 20-25 hours in total to complete over a 12-week period. A certificate of achievement will be awarded upon completion of the course.
    Contact:  serviceopssupport@macmillan.org.uk.
  3. 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.
  4. 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.