GP - The Presentation of Cancer in the Primary Care Setting

Question 1

what can you do to prevent cancer

Answer 1

• Tobacco
• Food
• Immunisation
• Exercise
• Environment

Question 2

What does a low haemoglobin mean

Answer 2

• this can mean that they have a gastrointestinal tumour

Question 3

What can allow us to have early detection

Answer 3

• Awareness
• Health care seeking
• Screening
• Access

Question 4

How can you prevent cancer

Answer 4

• 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

Question 5

What are the 3 commonest routes for patients first presentation

Answer 5

• GP surgery = 68%
• A and E = 7%
• Screening = 6%

Question 6

How do patients with cancer present in primary care?

Answer 6

• 1. With suspicious symptoms / “red flags”
• 2. Via screening
• 3. Incidental Finding

Question 7

Why is screening valuable and why can it be a problem

Answer 7

• 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

Question 8

what are the 4 most common cancers

Answer 8

• Breast - 15%
• Prostate- 13%
• Lung – 13% - deaths is significantly higher – less treatable and more rapidly evolving
• Bowel – 12%

Question 9

what criteria is used to decide if you need to screen or not

Answer 9

The Wilson criteria

Question 10

What is the Wilson criteria

Answer 10

• 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

Question 11

What is the 9 criteria for the Wilson criteria of screening

Answer 11

1. the condition should be an important health problem
2. the natural history of the condition should be understood
3. there should be a recognisable latent or early symptomatic stage
4. there should be a test that is easy to perform and interpret, acceptable, accurate, reliable, sensitive and specific
5. there should be an accepted treatment recognised for the disease
6. treatment should be more effective if started early
7. there should be a policy on who should be treated
8. diagnosis and treatment should be cost-effective
9. case-finding should be a continuous process

Question 12

Why to patients not attend screening

Answer 12

Fear
Too Busy
Feel well/self-perceived low risk 
Prior negative experience eg pain/false positives
Embarrassment
Language Barriers, Transient Populations

Question 13

what are the nationally used screening test and how do you test them

Answer 13

• 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.

Question 14

What two cancers do not have nationally used screening and why

Answer 14

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

Question 15

What three things can be used to increase screening

Answer 15

• Improve acess
• Improve uptake
• Reduce fear

Question 16

what are the red flags

Answer 16

• 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

Question 17

where do you not want lumps to be

Answer 17

• throat
• mouth
• neck

Question 18

what can cause anaemia

Answer 18

• cancer (gastrointestinal)
• reproductive age - mensuration
• diet - less likely in the UK

Question 19

why is infection a sign of cancer

Answer 19

• 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

Question 20

what does painful jaundice mean

Answer 20

Painful jaudince - head of the pancreas - pancreatic cancer

- can also get itching before jaundice as well

Question 21

Where can you have unexpected bleeding for

Answer 21

• PU – peri urethra
• PV – per vagina
• PR – per rectum

Question 22

What is the third presentation rule

Answer 22

• this is when someone comes back to you three times, this is the time to start investigating and not send them away

Question 23

What is safety netting

Answer 23

• 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

Question 24

What does NICE urgent referral do

Answer 24

• Organised by site, symptom, investigation
• Covers child, young adult and adult
• Standardises terms e.g. very urgent and urgent
• referred within 2 weeks

Question 25

What happens in incidental findings

Answer 25

• Investigating something else
• Picked up on examination for something else
• Think about high risk groups-poor immunity, post-partum and elderly

Question 26

What is the role of the GP in the cancer treatment

Answer 26

• support for family and patient

Question 27

What is the role of the GP in the cancer treatment

Answer 27

• 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