Cancer

Question 1

Hi Dr what are the four most common cancers

Answer 1

Breast cancer lung cancer bowel cancer and prostate cancer in that order

Question 2

Hi Dr what is the most common cancer for women

Answer 2

Breast cancer

Question 3

Hi Dr what is the most common cancer for men in the UK

Answer 3

Prostate cancer

Question 4

Apart from breast cancer BRCA1 and BRCA2 increase the risk of which other cancer

Answer 4

Ovarian

Question 5

Hi Dr I have just seen a 40-year-old woman who told me that her mum and her older sister but had breast cancer what should I do

Answer 5

Referred her to Rapid Access breast clinic because she has two first degree relatives who have had breast cancer

Question 6

Hi Dr I have just seen a Jewish lady who says her mother had breast cancer at age 40 even though she only has the one first degree relative with breast cancer do I still need to refer her to a genetic clinic

Answer 6

Yes in the Jewish population they just need to have one first or second degree relative with breast cancer to be referred

Question 7

Hi Dr I’m trying to remember which cancers in the UK are screened for I know breast is definitely one of them and cervix of course but what is the other one

Answer 7

Bowel cancer

Question 8

Hi Dr I have just seen a 40-year-old patients who has been worried about when she needs to go and get screen for breast cancer when are women in the UK typically screened for breast cancer

Answer 8

50 to 70 every 3 years

Question 9

Hi Dr I was just chatting to a medical student who was wondering if screening for breast cancer has actually had an overall benefit what should I tell him

Answer 9

Of 2000 attendees for ten years one life will be saved

Question 10

Hi Dr I recently turned 60 and was told that I would need to be screened for bowel cancer how do you check?

Answer 10

Faecal occult blood testing

Question 11

Hi Dr I have just seen a female patients who turned 62 she was wondering how often you screen patients for bowel cancer

Answer 11

We screen patients from age 60 every two years up until age 74 so long as they consent

Question 12

Hi Dr I have just received the results back from a 70 year old patient of mine which showed abnormalities in his faecal occult blood testing what investigation do I need to follow up with

Answer 12

Ok so you should offer the patient colonoscopy

Question 13

Hi Dr I heard that beetle occult blood testing hypersensitivity of around 60% what does that actually mean in basic English

Answer 13

Of the patients who receive an abnormal result 60% will actually have bowel cancer otherwise known as true positives

Question 14

Hi Dr I was just having a disagreement with a medical student as to which screening test for bowel cancer is more effective between faecal occult blood testing and faecal immunofluorescence testing who is right

Answer 14

The medical student is right because faecal immunofluorescence testing is more sensitive than faecal occult blood and will most likely replace it

Question 15

Ok so Dr I am old fashioned I used to do the faecal occult blood testing but I hear that there is a newer method which is more sensitive how should I instruct the patient

Answer 15

Faecal immunofluorescence testing the patient is given a brush that is attached to the lid of a pot

Question 16

Hi Dr I know that screening for bowel cancer typically starts when we are 60 but I have heard there is another technique being rolled out to everyone in the UK when they reach the age of 55 can you tell me what this is

Answer 16

One off flexible sigmoidoscopy to identify and remove polyps in the bowel

Question 17

Hi Dr just going back to cervical screening for a minute if the woman has a borderline or low grade cytology result what is the next line investigation

Answer 17

Test for HPV

Question 18

And Dr if the woman’s cervical screen is low grade and she’s positive for HPV what will be the next most appropriate thing to do

Answer 18

Refer her for colposcopy

Question 19

Hi Dr I know that there has been some debate in regards to how helpful all these screening tests are for bowel cervical and breast cancer.
Surely we are picking up the majority of people with cancer no?

Answer 19

actually only 10% which is quite low

Question 20

Hi Dr I have just seen a 34 year old female who has complained of a breast lump that she cannot explain. on examination it is non tender and there are no associated skin changes or discharge and no retraction of the nipple do I still need to refer her to the Rapid access breast clinic

Answer 20

Yes because she is aged over 30 and has an unexplained lump nice recommend an urgent referral

Question 21

Hi Dr I’ve just seen a 60 year old lady who has left nipple discharge. I wanted to rule out breast cancer so I carried out an examination which was normal all apart from the discharge. There was no lump no pain no skin changes. Do I still need to refer her to the breast clinic urgently

Answer 21

according to Nice guidance Yes because she is aged 50 and over with unilateral nipple symptoms

Question 22

Hi Dr I have just seen a 40 year old lady with a lump in her left axilla. I want to rule out breast cancer so I carried out an examination and found nothing else apart from this lump. There are no skin changes on inspection on palpation there are no lumps or Tenderness. Do I still need to refer her urgently to the Rapid Access breast clinic

Answer 22

According to Nice guidance yes because she is over 30 and has an unexplained lump in her axilla

Question 23

Hi Dr I have just seen a patient who has been complaining of rectal bleeding alongside vague abdominal discomfort for the last 6 months. Is there any condition I need to definitely rule out?

Answer 23

Yes colorectal cancer

Question 24

Hi Dr apart from anaemia which symptom carries the highest risk of colorectal cancer

Answer 24

Fresh colorectal bleed the risk is about 2 to 5%

Question 25

Hi Dr I’ve just seen a 45 year old gentleman who has been complaining of diarrhoea. Is this a high risk factor for colorectal cancer?

Answer 25

No the risk is about 1.1% in patients over 40

Question 26

Hi Dr I couldn’t remember initially when he came in but actually this patient has been coming in repeatedly over this year complaining of diarrhoea, does this increase his risk for colorectal cancer if we exclude other differentials

Answer 26

Yes even though the risk is low at 1.1% it increases for every attendance

Question 27

Hi Dr I have heard that diagnosing cancer for GPS can be quite tricky especially bowel cancer. What is the problem with using and constipation as a symptom of bowel cancer?

Answer 27

25% of colorectal cancers have constipation however 5 to 10% of the normal population have constipation anyway which means that the risk is about 0.4% based solely on constipation as a symptom

Question 28

Hi Dr I have just finished doing an abdominal examination of a 40 year old gentleman who complained of having an anal mass. Does this warrant an urgent referral?

Answer 28

Yes

Question 29

Hi Dr just a simple question when we talk about urgent referrals to clinics like the Rapid Access breast clinic or for colonoscopy in the case of bowel cancer how long do patients actually have to wait for

Answer 29

Up to two weeks maximum

Question 30

Hi Dr I’ve just seen a 75 year old gentleman who says that over the last 6 months he has noticed he has lost the considerable amount of weight. He said it was not intentional. Roughly what is the risk that who has bowel cancer

Answer 30

Around 10% of patients presenting with this symptom over the age of 70

Question 31

Hi Dr when is the minimum age that we start to become more worried about a diagnosis of bowel cancer in patients who present with abdominal problems such as anaemia weight loss and constipation

Answer 31

From 40 onwards

Question 32

Hi Dr I have just seen a 42 year old gentleman who has been complaining of unexplained weight loss with abdominal pain for the last six months
Does this warrant an urgent referral?

Answer 32

Yes as he is aged over 40 and has unexplained weight loss and abdominal pain

Question 33

Hi Dr I was just seeing a 55 year old gentleman who has come in complaining of unexplained rectal bleeding. I have finished doing an abdominal examination and a PR examination and am discussing management. Where should I send him

Answer 33

Urgent referral to the hospital

Question 34

Hi Dr I’ve just seen a 65 year old gentleman with iron deficiency anaemia and his fecal occult blood test is positive for blood does this warrant a referral

Answer 34

Yes

Question 35

Hi Dr I’ve just seen 65 year old lady who is anemic does this warrant an urgent referral to the hospital for suspected bowel cancer

Answer 35

Yes

Question 36

Hi Dr I can’t remember which cancers in the UK are screened for can you tell me if lung cancer is screened for

Answer 36

No bowel breast and cervical cancer are the only cancers in the UK that are screened for

Question 37

Hi Dr I have heard that the prognosis for lung cancer is relatively poor but I don’t understand why can you tell me

Answer 37

Patients with lung cancer typically present late and the condition itself progresses quite rapidly so when you put these two factors together that is why

Question 38

Hi Dr I’ve Just Seen A 43 year old female who has an extensive smoking history and has been complaining more recently that she’s been coughing up blood. What should I do next

Answer 38

urgent chest X-ray then urgent referral for suspected lung cancer as you meet nice recommendations of being aged 40 and presenting with one symptom from cough fatigue chest pain weight loss appetite loss shortness of breath because of her smoking history

Question 39

Hi Dr I have just been a 45 year old gentleman who was complaining of shortness of breath and cough which investigation do I need to carry out he doesn’t smoke

Answer 39

Urgent chest x-ray for suspected lung cancer as he meets the nice criteria of being aged over 40 and having cough and SOB

Question 40

Hi Dr I’ve just seen a 47 year old lady who is complaining of chest pain with weight loss. I have already carried out the basic bedside tests and the ECG has ruled out cardiac problems. I want to rule out lung cancer just in case which investigations should I carry out

Answer 40

An urgent chest x-ray as the patient meets the criteria of being aged over 40s and presenting with two symptoms from the list of six which includes cough fatigue shortness of breath chest pain weight loss and appetite loss

Question 41

Hi Dr I have just seen a 50 year old gentleman he’s complaining of appetite loss and fatigue. Even though he isn’t presenting with any respiratory problems do I still need to rule out a diagnosis of lung cancer.

Answer 41

Yes you need to arrange for an urgent chest x-ray as nice recommends that patients who are aged 40 and have two or more of the following 6 symptoms cough fatigue shortness of breath chest pain weight loss and appetite loss be investigated

Question 42

Hi Dr I was doing some reading and realise that there are lots of signs that a patient can present with that me worry you and prompt an urgent chest x-ray aside from cough fatigue shortness of breath weight loss appetite loss and chest pain. Can you tell me any other signs that may prompt an urgent chest x-ray in a patient over 40

Answer 42

Yeah if you do a respiratory examination and you discover finger clubbing or any abnormal lymph nodes in a patient over 40 then this may prompt urgent chest x-ray as well

Question 43

Hi Dr I have a strong suspicion that a 50 year old gentleman with an extensive smoking history presenting with cough shortness of breath and weight loss with examination findings of cervical lymphadenopathy has lung cancer however his chest x-ray has come back negative which investigation can I do as a follow up

Answer 43

You can do a CT chest which is how the diagnosis of lung cancer is confirmed anyway

Question 44

Hi Dr I have just finished taking history from a 35 year old gentleman complaining of erectile dysfunction. I did a urine dip which tested positive for blood in the urine and I am concerned that even though he is quite young he may have prostate cancer. Can I go onto do a PSA

Answer 44

So long as you feel confident you have ruled out a urinary infection and carried out a digital rectal examination then yes

Question 45

Hi Dr what kind of symptoms may a patient that has a brain cancer present with.

Answer 45

As the tumour grows it will put pressure on certain regions of the brain and then you may see a picture similar to stroke searches progressive numbness or weakness
You may see a picture similar to acute head trauma such as vomiting seizure and headache