GP - The Presentation of Cancer in the Primary Care Setting Flashcards
what can you do to prevent cancer
- Tobacco
- Food
- Immunisation
- Exercise
- Environment
What does a low haemoglobin mean
- this can mean that they have a gastrointestinal tumour
What can allow us to have early detection
- Awareness
- Health care seeking
- Screening
- Access
How can you prevent cancer
- Air pollution – urban and indoor, smoke, cooking fuels
- HPV vaccine
- Smoke free
- Healthy weight
- Eat fruit and veg
- SunSmart
- Eat less processed and red meat
- Active
- Eat less salt
What are the 3 commonest routes for patients first presentation
- GP surgery = 68%
- A and E = 7%
- Screening = 6%
How do patients with cancer present in primary care?
- With suspicious symptoms / “red flags”
- Via screening
- Incidental Finding
Why is screening valuable and why can it be a problem
- Much more likely to survive after 3 years if the cancer is detected in screening
- does enhance detection but whether overall it enhances life expectancy for example they are very sensitive but they could have presented a year later and it would still be treatable
what are the 4 most common cancers
- Breast - 15%
- Prostate- 13%
- Lung – 13% - deaths is significantly higher – less treatable and more rapidly evolving
- Bowel – 12%
what criteria is used to decide if you need to screen or not
The Wilson criteria
What is the Wilson criteria
- List of 9 criteria of the sort of things you should think about if you think you should screen for something, if they don’t meet all 9 criteria then don’t do screening because it will be too expensive or you wont be able to tell the difference
What is the 9 criteria for the Wilson criteria of screening
- the condition should be an important health problem
- the natural history of the condition should be understood
- there should be a recognisable latent or early symptomatic stage
- there should be a test that is easy to perform and interpret, acceptable, accurate, reliable, sensitive and specific
- there should be an accepted treatment recognised for the disease
- treatment should be more effective if started early
- there should be a policy on who should be treated
- diagnosis and treatment should be cost-effective
- case-finding should be a continuous process
Why to patients not attend screening
Fear Too Busy Feel well/self-perceived low risk Prior negative experience eg pain/false positives Embarrassment Language Barriers, Transient Populations
what are the nationally used screening test and how do you test them
- retinoblastoma = Newborn and 6 week check for red reflex
- Bowel Cancer = scope at 55yrs and faecal occult blood(FOB)/ (FiT) faecal immunoflurence test 60-74 = 2 yearly
- Cervical cancer = tested in 25-49 = 3 yearly, tested in 50-64 = 5 yearly
- Breast cancer = 50-70 3 yearly and pilots to extend.
What two cancers do not have nationally used screening and why
Prostate = PSA does not fulfil the Wilson criteria therefore it is not a national testing
Ovarian = CA125 – does not fufil the wilsons criteria therefore it is not a national testing
What three things can be used to increase screening
- Improve acess
- Improve uptake
- Reduce fear
what are the red flags
- weight loss
- lumps - anywhere, primary and secondary
- symptoms of anaemia and or infection
- unexpected bleeding
- changes - voice, stamina/SOB; moles; back pain, swallowing, bowels, complexion
- Generally unwell
- Not quite right
- Third presentation rule
where do you not want lumps to be
- throat
- mouth
- neck
what can cause anaemia
- cancer (gastrointestinal)
- reproductive age - mensuration
- diet - less likely in the UK
why is infection a sign of cancer
- In those under 5 they experience 4-5 infections a year but need to be aware if they do not get repaired from infection
- 2 chest infections in a smoker
what does painful jaundice mean
Painful jaudince - head of the pancreas - pancreatic cancer
- can also get itching before jaundice as well
Where can you have unexpected bleeding for
- PU – peri urethra
- PV – per vagina
- PR – per rectum
What is the third presentation rule
- this is when someone comes back to you three times, this is the time to start investigating and not send them away
What is safety netting
- Don’t know what it is
- Come back in 4 weeks
- If XYZ happen then they come back immediately
- Patietns present in early stages when not sure what the problem is
What does NICE urgent referral do
- Organised by site, symptom, investigation
- Covers child, young adult and adult
- Standardises terms e.g. very urgent and urgent
- referred within 2 weeks
What happens in incidental findings
- Investigating something else
- Picked up on examination for something else
- Think about high risk groups-poor immunity, post-partum and elderly
What is the role of the GP in the cancer treatment
- support for family and patient
What is the role of the GP in the cancer treatment
- New cases of Cancer discussed formally.
- Cancer Register as part of QOF
- Acute illnesses/treatment of side effects of Rx
- Some medications, dressings
- Support of patient and families
- Post treatment-Cancer Survival & Palliative
