1.1.1 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for lung cancer if they:

  • have chest X-ray findings that suggest lung cancer or
  • are aged 40 and over with unexplained haemoptysis. [new 2015]
1.1.4 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for mesothelioma if they have chest X-ray findings that suggest mesothelioma. [new 2015]
1.1.2 Offer an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over if they have 2 or more of the following unexplained symptoms, or if they have ever smoked and have 1 or more of the following unexplained symptoms:
  • cough
  • fatigue
  • shortness of breath
  • chest pain
  • weight loss
  • appetite loss. [new 2015]
1.1.3 Consider an urgent chest X-ray (to be performed within 2 weeks) to assess for lung cancer in people aged 40 and over with any of the following:
  • persistent or recurrent chest infection
  • finger clubbing
  • supraclavicular lymphadenopathy or persistent cervical lymphadenopathy
  • chest signs consistent with lung cancer
  • thrombocytosis. [new 2015]
1.1.5 Offer an urgent chest X-ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over, if:
  • they have 2 or more of the following unexplained symptoms, or
  • they have 1 or more of the following unexplained symptoms and have ever smoked, or
  • they have 1 or more of the following unexplained symptoms and have been exposed to asbestos:
  • cough
  • fatigue
  • shortness of breath
  • chest pain
  • weight loss
  • appetite loss. [new 2015]
1.1.6 Consider an urgent chest X-ray (to be performed within 2 weeks) to assess for mesothelioma in people aged 40 and over with either:
  • finger clubbing or
  • chest signs compatible with pleural disease. [new 2015]
1.2.1 Offer urgent direct access upper gastrointestinal endoscopy (OGD - oesophagoduodenoscopy) (to be performed within 2 weeks) to assess for oesophageal cancer in people:
  • with dysphagia or
  • aged 55 and over with weight loss and any of the following:
  • upper abdominal pain
  • reflux
  • dyspepsia. [new 2015]
1.2.7 Offer urgent direct access upper gastrointestinal endoscopy (OGD - oesophagoduodenoscopy) (to be performed within 2 weeks) to assess for stomach cancer in people:
  • with dysphagia or
  • aged 55 and over with weight loss and any of the following:
  • upper abdominal pain
  • reflux
  • dyspepsia. [new 2015]

1.2.2 Consider non-urgent direct access upper gastrointestinal endoscopy (OGD - oesophagoduodenoscopy) to assess for oesophageal cancer in people with haematemesis. [new 2015]
1.2.3 Consider non-urgent direct access upper gastrointestinal endoscopy to assess for oesophageal cancer in people aged 55 or over with:

  • treatment-resistant dyspepsia or
  • upper abdominal pain with low haemoglobin levels or
  • raised platelet count with any of the following:
  • nausea
  • vomiting
  • weight loss
  • reflux
  • dyspepsia
  • upper abdominal pain, or
  • nausea or vomiting with any of the following:
  • weight loss
  • reflux
  • dyspepsia
  • upper abdominal pain. [new 2015]
1.2.8 Consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people with haematemesis. [new 2015]
1.2.9 Consider non-urgent direct access upper gastrointestinal endoscopy to assess for stomach cancer in people aged 55 or over with:
  • treatment-resistant dyspepsia or
  • upper abdominal pain with low haemoglobin levels or
  • raised platelet count with any of the following:
  • nausea
  • vomiting
  • weight loss
  • reflux
  • dyspepsia
  • upper abdominal pain, or
  • nausea or vomiting with any of the following:
  • weight loss
  • reflux
  • dyspepsia
  • upper abdominal pain. [new 2015]

1.2.4 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for pancreatic cancer if they are aged 40 and over and have jaundice.[new 2015]

1.2.5 Consider an urgent direct access CT scan (to be performed within 2 weeks), or an urgent ultrasound scan if CT is not available, to assess for pancreatic cancer in people aged 60 and over with weight loss and any of the following:
  • diarrhoea
  • back pain
  • abdominal pain
  • nausea
  • vomiting
  • constipation
  • new-onset diabetes.[new 2015]

1.2.6 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with an upper abdominal mass consistent with stomach cancer.

1.2.10 Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for gall bladder cancer in people with an upper abdominal mass consistent with an enlarged gall bladder.[new 2015]
1.2.11 Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for liver cancer in people with an upper abdominal mass consistent with an enlarged liver.[new 2015]

1.3.3 For people who have not returned a faecal sample or who have a FIT result below 10 micrograms of haemoglobin per gram of faeces:
  • safety netting processes should be in place
  • referral to an appropriate secondary care pathway should not be delayed if there is strong clinical concern of cancer because of ongoing unexplained symptoms (for example, abdominal mass). [2023]
1.3.5 Consider a suspected cancer pathway referral for colorectal cancer in adults with a rectal mass. [2015, amended 2023]

1.3.6 Consider a suspected cancer pathway referral for anal cancer in people with an unexplained anal mass or unexplained anal ulceration. [2015]
1.3.1 Offer quantitative faecal immunochemical testing (FIT) using HM-JACKarc or OC-Sensor to guide referral for suspected colorectal cancer in adults:
  • with an abdominal mass, or
  • with a change in bowel habit, or
  • iron-deficiency anaemia, or
  • aged 40 and over with unexplained weight loss and abdominal pain, or
  • aged under 50 with rectal bleeding and either of the following unexplained symptoms:
    • abdominal pain
    • weight loss, or
  • aged 50 and over with any of the following unexplained symptoms:
    • rectal bleeding
    • abdominal pain
    • weight loss, or
  • aged 60 and over with anaemia even in the absence of iron deficiency
FIT should be offered even if the person has previously had a negative FIT result through the NHS bowel cancer screening programme. People with a rectal mass, an unexplained anal mass or unexplained anal ulceration do not need to be offered FIT before referral is considered. [2023]

1.3.3 For people who have not returned a faecal sample or who have a FIT result below 10 micrograms of haemoglobin per gram of faeces:
  • safety netting processes should be in place
  • referral to an appropriate secondary care pathway should not be delayed if there is strong clinical concern of cancer because of ongoing unexplained symptoms (for example, abdominal mass). [2023]
1.4.1 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer if they are:
aged 30 and over and have an unexplained breast lump with or without pain or
aged 50 and over with any of the following symptoms in one nipple only:
  • discharge
  • retraction
  • other changes of concern.[new 2015]
1.4.2 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for breast cancer in people:
  • with skin changes that suggest breast cancer
  • aged 30 and over with an unexplained lump in the axilla.

1.4.3 Consider non-urgent referral in people aged under 30 with an unexplained breast lump with or without pain. See also recommendations 1.16.2 and 1.16.3 for information about seeking specialist advice.[new 2015]

1.5.1 Refer the woman urgently if physical examination identifies ascites and/or a pelvic or abdominal mass (which is not obviously uterine fibroids).[2011]
1.5.8 If the ultrasound suggests ovarian cancer, refer the woman urgently[1] for further investigation. [2011]

1.5.2 Carry out tests in primary care (see recommendations 1.5.6 to 1.5.9) if a woman (especially if 50 or over) reports having any of the following symptoms on a persistent or frequent basis, particularly more than 12 times per month:
  • persistent abdominal distension (women often refer to this as 'bloating')
  • feeling full (early satiety) and/or loss of appetite
  • pelvic or abdominal pain
  • increased urinary urgency and/or frequency. [2011]
1.5.3 Consider carrying out tests in primary care (see recommendations 1.5.6 to 1.5.9) if a woman reports unexplained weight loss, fatigue or changes in bowel habit. [2011]
1.5.4 Advise any woman who is not suspected of having ovarian cancer to return to her GP if her symptoms become more frequent and/or persistent. [2011]
1.5.5 Carry out appropriate tests for ovarian cancer (see recommendations 1.5.6 to 1.5.9) in any woman of 50 or over who has experienced symptoms within the last 12 months that suggest irritable bowel syndrome (IBS)[2], because IBS rarely presents for the first time in women of this age. [2011]
1.5.6 Measure serum CA125 in primary care in women with symptoms that suggest ovarian cancer (see recommendations 1.5.1 to 1.5.5). [2011]
1.5.7 If serum CA125 is 35 IU/ml or greater, arrange an ultrasound scan of the abdomen and pelvis. [2011]
1.5.9 For any woman who has normal serum CA125 (less than 35 IU/ml), or CA125 of 35 IU/ml or greater but a normal ultrasound:
  • assess her carefully for other clinical causes of her symptoms and investigate if appropriate
  • if no other clinical cause is apparent, advise her to return to her GP if her symptoms become more frequent and/or persistent. [2011]

1.5.10 Refer women using a suspected cancer pathway referral (for an appointment within 2 weeks) for endometrial cancer if they are aged 55 and over with post-menopausal bleeding (unexplained vaginal bleeding more than 12 months after menstruation has stopped because of the menopause).[new 2015]
1.5.11 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for endometrial cancer in women aged under 55 with post-menopausal bleeding.[new 2015]

1.5.12 Consider a direct access ultrasound scan to assess for endometrial cancer in women aged 55 and over with: unexplained symptoms of vaginal discharge who:
  • are presenting with these symptoms for the first time or
  • have thrombocytosis
  • report haematuria,or
visible haematuria and:
  • low haemoglobin levels
  • thrombocytosis or
  • high blood glucose levels.[new 2015]

1.5.13 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for women if, on examination, the appearance of their cervix is consistent with cervical cancer.[new 2015]

1.5.14 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for vulval cancer in women with an unexplained vulval lump, ulceration or bleeding.[new 2015]

1.5.15 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for vaginal cancer in women with an unexplained palpable mass in or at the entrance to the vagina.[new 2015]

1.6.1 Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their prostate feels malignant on digital rectal examination.[new 2015]
1.6.3 Refer men using a suspected cancer pathway referral (for an appointment within 2 weeks) for prostate cancer if their PSA levels are above the age-specific reference range.[new 2015]

1.6.2 Consider a prostate-specific antigen (PSA) test and digital rectal examination to assess for prostate cancer in men with:
  • any lower urinary tract symptoms, such as nocturia, urinary frequency, hesitancy, urgency or retention or
  • erectile dysfunction
  • visible haematuria.[new 2015]
1.6.4 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for bladder cancer if they are:
aged 45 and over and have:
  • unexplained visible haematuria without urinary tract infection or
  • visible haematuria that persists or recurs after successful treatment of urinary tract infection, or
aged 60 and over and have unexplained non-visible haematuria and either dysuria or a raised white cell count on a blood test.[new 2015]

1.6.5 Consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection.[new 2015]

1.6.6 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for renal cancer if they are aged 45 and over and have:
  • unexplained visible haematuria without urinary tract infection
  • visible haematuria that persists or recurs after successful treatment of urinary tract infection.[new 2015]

1.6.7 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for testicular cancer in men if they have a non-painful enlargement or change in shape or texture of the testis.[new 2015]

1.6.8 Consider a direct access ultrasound scan for testicular cancer in men with unexplained or persistent testicular symptoms.[new 2015]

1.6.9 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for penile cancer in men if they have either:
  • a penile mass or ulcerated lesion, where a sexually transmitted infection has been excluded as a cause, or
  • a persistent penile lesion after treatment for a sexually transmitted infection has been completed.[new 2015]
1.6.10 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for penile cancer in men with unexplained or persistent symptoms affecting the foreskin or glans.[new 2015]

1.7.1 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) for melanoma if they have a suspicious pigmented skin lesion with a weighted 7-point checklist score of 3 or more.[new 2015]
1.7.2 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if dermoscopy suggests melanoma of the skin.[new 2015]
1.7.3 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for melanoma in people with a pigmented or non-pigmented skin lesion that suggests nodular melanoma.[new 2015]
PLEASE NOTE: The dermoscopy 7 point checklist is not included in the NICE recommendations and has been included as an aid for those healthcare professionals who have had specialist dermoscopy training

1.7.4 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with a skin lesion that raises the suspicion of squamous cell carcinoma.[new 2015]

1.7.5 Consider routine referral for people if they have a skin lesion that raises the suspicion of a basal cell carcinoma.[new 2015]
1.7.7 Follow the NICE guidance on improving outcomes for people with skin tumours including melanoma: the management of low-risk basal cell carcinomas in the community (2010 update) for advice on who should excise suspected basal cell carcinomas. [new 2015]

1.7.6 Only consider a suspected cancer pathway referral (for an appointment within 2 weeks) for people with a skin lesion that raises the suspicion of a basal cell carcinoma if there is particular concern that a delay may have a significant impact, because of factors such as lesion site or size.[new 2015]
1.7.7 Follow the NICE guidance on improving outcomes for people with skin tumours including melanoma: the management of low-risk basal cell carcinomas in the community (2010 update) for advice on who should excise suspected basal cell carcinomas. [new 2015]

1.8.1 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with:
  • persistent unexplained hoarseness
  • an unexplained lump in the neck.[new 2015]
1.8.2 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for oral cancer in people with either:
  • unexplained ulceration in the oral cavity lasting for more than 3 weeks or
  • a persistent and unexplained lump in the neck.[new 2015]
1.8.3 Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
  • a lump on the lip or in the oral cavity
  • a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.[new 2015]
1.8.4 Consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) for oral cancer in people when assessed by a dentist as having either:
  • a lump on the lip or in the oral cavity consistent with oral cancer
  • a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.[new 2015]
1.8.3 Consider an urgent referral (for an appointment within 2 weeks) for assessment for possible oral cancer by a dentist in people who have either:
  • a lump on the lip or in the oral cavity
  • a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.[new 2015]
1.8.4 Consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) for oral cancer in people when assessed by a dentist as having either:
  • a lump on the lip or in the oral cavity consistent with oral cancer
  • a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia.[new 2015]

1.8.5 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump.[new 2015]

1.9.1 Consider an urgent direct access MRI scan of the brain (or CT scan if MRI is contraindicated) (to be performed within 2 weeks) to assess for brain or central nervous system cancer in adults with progressive, sub-acute loss of central neurological function.[new 2015]

1.9.2 Consider a very urgent referral (for an appointment within 48 hours) for suspected brain or central nervous system cancer in children and young people with newly abnormal cerebellar or other central neurological function.[new 2015]

1.10.1 Consider a very urgent full blood count (within 48 hours) to assess for leukaemia in adults with any of the following:
  • pallor
  • persistent fatigue
  • unexplained fever
  • unexplained persistent or recurrent infection
  • generalised lymphadenopathy
  • unexplained bruising
  • unexplained bleeding
  • unexplained petechiae
  • hepatosplenomegaly.[new 2015]

1.10.2 Refer children and young people for immediate specialist assessment for leukaemia if they have unexplained petechiae or hepatosplenomegaly.[new 2015]

1.10.3 Offer a very urgent full blood count (within 48 hours) to assess for leukaemia in children and young people with any of the following:
  • pallor
  • persistent fatigue
  • unexplained fever
  • unexplained persistent infection
  • generalised lymphadenopathy
  • persistent or unexplained bone pain
  • unexplained bruising
  • unexplained bleeding.[new 2015]

1.10.4 Offer a full blood count, blood tests for calcium and plasma viscosity or erythrocyte sedimentation rate to assess for myeloma in people aged 60 and over with persistent bone pain, particularly back pain, or unexplained fracture.[new 2015]

1.10.5 Offer very urgent protein electrophoresis and a Bence-Jones protein urine test (within 48 hours) to assess for myeloma in people aged 60 and over with hypercalcaemia or leukopenia and a presentation that is consistent with possible myeloma.[new 2015]
1.10.6 Consider very urgent protein electrophoresis and a Bence-Jones protein urine test (within 48 hours) to assess for myeloma if the plasma viscosity or erythrocyte sedimentation rate and presentation are consistent with possible myeloma.[new 2015]

1.10.7 Refer people using a suspected cancer pathway referral (for an appointment within 2 weeks) if the results of protein electrophoresis or a Bence‑Jones protein urine test suggest myeloma. [new 2015]

1.10.10 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for Hodgkin's lymphoma in adults presenting with unexplained lymphadenopathy. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus, weight loss or alcohol-induced lymph node pain.[new 2015]
1.10.8 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for non-Hodgkin's lymphoma in adults presenting with unexplained lymphadenopathy or splenomegaly. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss. [new 2015]

1.10.11 Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for Hodgkin's lymphoma in children and young people presenting with unexplained lymphadenopathy. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss.[new 2015]
1.10.9 Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for non-Hodgkin's lymphoma in children and young people presenting with unexplained lymphadenopathy or splenomegaly. When considering referral, take into account any associated symptoms, particularly fever, night sweats, shortness of breath, pruritus or weight loss. [new 2015]

1.11.1 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for adults if an X-ray suggests the possibility of bone sarcoma.[new 2015]

1.11.2 Consider a very urgent referral (for an appointment within 48 hours) for specialist assessment for children and young people if an X-ray suggests the possibility of bone sarcoma.[new 2015]

1.11.3 Consider a very urgent direct access X-ray (to be performed within 48 hours) to assess for bone sarcoma in children and young people with unexplained bone swelling or pain.[new 2015]

1.11.4 Consider an urgent direct access ultrasound scan (to be performed within 2 weeks) to assess for soft tissue sarcoma in adults with an unexplained lump that is increasing in size.[new 2015]

1.11.5 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for adults if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists.[new 2015]

1.11.6 Consider a very urgent direct access ultrasound scan (to be performed within 48 hours) to assess for soft tissue sarcoma in children and young people with an unexplained lump that is increasing in size.[new 2015]

1.11.7 Consider a very urgent referral (for an appointment within 48 hours) for children and young people if they have ultrasound scan findings that are suggestive of soft tissue sarcoma or if ultrasound findings are uncertain and clinical concern persists.[new 2015]

1.12.1 Consider very urgent referral (for an appointment within 48 hours) for specialist assessment for neuroblastoma in children with a palpable abdominal mass or unexplained enlarged abdominal organ.[new 2015]

1.12.2 Consider urgent referral (for an appointment within 2 weeks) for ophthalmological assessment for retinoblastoma in children with an absent red reflex.[new 2015]

1.12.3 Consider very urgent referral (for an appointment within 48 hours) for specialist assessment for Wilms' tumour in children with any of the following:
  • a palpable abdominal mass
  • an unexplained enlarged abdominal organ
  • unexplained visible haematuria.[new 2015]

Background and Risks for Lung Cancer

Background

  • 3rd most common cancer
  • 47% cases in women, 53% in men
  • 98% cases diagnosed >50y/o
  • Survival
    • earliest stage
      • 1 year - 88%
      • 5 years - 57%
    • latest stage
      • 1 year - 20%
      • 5 years - 3%
  • Screening
    • targeted lung health checks

Risks

  • Lifetime risk
    • men 8%
    • women 7%
  • 79% preventable
    • smoking
    • occupational
      • asbestos (6-8% cases)
      • silica (glass manufacturing) (0.02% cases)
      • diesel exhaust fumes (0.02% cases)
      • paint fumes (0.01% cases)
      • radon (0.01% cases)
      • mineral oils (metal/print work) (0.01% cases)
      • TCCD (pesticide & metal production) (0.01% cases)
    • air pollution
  • medical conditions
    • pneumonia (43-57% increased risk)
    • COPD
      • emphysema (104-144% increased risk)
      • chronic bronchitis (47-52% increased risk)
  • radiation
    • eg XRays, CT scan
    • residential radon
  • family history
    • sibling affected (82% increased risk)
    • parent affected (25-37% increased risk)

Education

Lung Cancer
Early Diagnosis
module

Background and Risks for Breast Cancer

Background

  • Most common cancer in the UK
  • 99% cases in women, 1% in men
  • 98% cases diagnosed in people ≥ 35
  • survival
    • earliest stage
      • 1 year - 100%
      • 5 year - 98%
    • latest stage
      • 1 year - 98%
      • 5 year - 26%
  • mammogram screening
    • 50 - 70 y/o every 3 years
    • optional > 70 y/o

Risks

  • lifetime risk for women 15%
  • 23% preventable
    • not breast feeding (5% cases)
    • obesity (8% cases)
    • alcohol (8% cases)
    • hormone replacement therapy (2% cases)
    • contraception tablets (1% cases)
    • poor physical fitness
  • family history: mother or sister affected - 2x increased risk (15% cases)
  • gene mutations (2% cases) eg BRCA 1 or 2

Education

Breast Cancer
Recurrence
module

Background and Risks for Bowel Cancer

Background

  • 4th most common cancer in the UK
  • 44% cases in women, 56% in men
  • 94% cases diagnosed in people > 50y/o
  • survival
    • earliest stage
      • 1 year - 98%
      • 5 year - 92%
    • latest stage
      • 1 year - 44%
      • 5 year - 10%
  • screening - home stool test (FIT)
    • 60-74 y/o every 2 years
    • optional > 75 y/o

Risks

  • lifetime risk
    • men 7%
    • women 6%
  • 54% preventable
    • diet
      • low fibre intake (28% cases)
      • high red/processed meat intake (13% cases)
    • alcohol (6% cases)
      • 2 units/day (4% increased risk)
      • 1.5-6 units/day (10-17% increased risk)
      • >6 units/day (33% increased risk)
    • obesity (11% cases)
    • smoking (7% cases)
  • medical conditions
    • inflammatory bowel disease (70% increased risk)
    • diabetes (22-30% increased risk)
  • family history: parent, sibling or child affected - 2x increased risk

Education

Lower GI Cancer
Early Diagnosis
module
Faecal
Immunochemical
Test

Background and Risks for Stomach Cancer

Background

  • 17th most common cancer
  • 33% cases in women, 67% in men
  • most common in black people, then white, then Asian people
  • 95% diagnosed in people >50 y/o
  • survival
    • earliest stage
      • 1 year - 89%
      • 5 years - 70 to 80%
    • latest stage
      • 1 year - 21%
      • 5 years - 5%

Risks

  • lifetime risk
    • men 1%
    • women <1%
  • 54% preventable
    • diet
      • low fruit and veg intake
      • high salt intake (68% increased risk)
      • pickled food (28% increased risk)
    • alcohol, 3+ units/day (13-21% increased risk)
    • smoking (15% cases)
    • obesity (6% cases)
  • medical conditions
    • infections
      • helicobacter pylori infection (41% cases)
      • Epstein Barr virus (9% cases)
    • type 1 diabetes (0.4% risk)
  • family history - 30% increased risk

Education

Stomach Cancer
Early Diagnosis
module

Background and Risks for Oesophageal Cancer

Background

  • 14th most common cancer
  • 31% cases in women, 69% in men
  • more common in white than black or Asian people
  • 92% diagnosed in people >55 y/o
  • survival
    • earliest stage
      • 1 year - 85%
      • 5 years - 53%
    • latest stage
      • 1 year - 21%
      • 5 years - 2%

Risks

  • lifetime risk
    • men 2%
    • women 1%
  • 59% preventable
    • alcohol (13 cases)
    • smoking (34% cases)
    • obesity (27% cases)
  • medical conditions
    • acid reflux
      • daily symptoms (7.4x increased risk)
      • symptoms > 20years (6.2x increased risk)
      • weekly symptoms (4.9 increased risk)
      • symptoms (2.8 increased risk)
    • Barrett's oesophagus (11x increased risk)


Education

Oesophageal Cancer
Early Diagnosis
module

Background and Risks for Liver Cancer

Background

  • 18th most common cancer
  • 92% diagnosed in people > 50y/o
  • 34% cases in women, 66% in men
  • survival
    • earliest stage
      • 1 year - 78%
      • 5 year - 50 to 70%
    • latest stage
      • 1 year - 20%
      • 5 year - data unavailable

Risks

  • lifetime risk
    • men 2%
    • women 1%
  • 49% cases preventable
    • infections (10% cases) eg hepatitis
    • smoking (20% cases)
    • alcohol (7% cases)
    • obesity (23% cases)
  • medical conditions
    • liver cirrhosis (8-55x increased risk)
    • primary biliary cholangitis (19x increased risk)
    • haemochromotosis (11x increased risk)
    • non-alcoholic fatty liver disease (4x increased risk)
    • HIV (5-6x increased risk)
    • gallstones (90% increased risk)
    • diabetes
      • type 1 (3x increased risk)
      • type 2 (66% increased risk)
  • family history (1.5x increased risk)

Background and Risks for Pancreatic Cancer

Background

  • 10th most common cancer
  • 96% diagnosed in people > 50y/o
  • 50% cases in women, 50% in men
  • more common in white and black people than Asian people
  • survival (all stages)
    • 1 year - 20%
    • 5 year - 5%
    • higher for pancreatic endocrine tumours

Risks

  • lifetime risk
    • men 2%
    • women 2%
  • 31% cases preventable
    • smoking (30% cases)
    • alcohol, ≥6 units/day  (70% cases)
    • obesity (10% cases)
  • medical conditions
    • chronic pancreatitis (3x increased risk)
    • gallstones (25% increased risk)
    • type 1 diabetes (34% increased risk)
  • genetic mutations
    • BRCA2 variants, increased risk in men relative to women
  • family history
    • parent, sibling or child affected by:
      • pancreatic cancer (62-78% increased risk)
      • prostate cancer (45% increased risk)

Education

Pancreatic Cancer
Early Diagnosis
module

Background and Risks for Testicular Cancer

Background

  • 18th most common cancer in men
  • 80% diagnosed in people between 20-50 y/o, highest incidence 30-34 y/o
  • more common in white than black or Asian people
  • survival
    • earliest stage
      • 1 year - 99 to 100%
      • 5 year - 99 to 100%
    • latest stage
      • 1 year - 82%
      • 5 year - data unavailable

Risks

  • lifetime risk
    • 0.5%
  • 0% cases preventable
    • not fully understood
  • family history
    • father affected (4-5x increased risk)
    • brother affected (8-9x increased risk)

Background and Risks for Renal Cancer

Background

  • 7th most common cancer
  • 38% diagnosed in women, 62% in men
  • more common in white than black or Asian people
  • 94% cases diagnosed in people >45 y/o
  • survival
    • earliest stage
      • 1 year - 96%
      • 5 year - 87%
    • latest stage
      • 1 year - 39%
      • 5 year - 12%

Risks

  • lifetime risk
    • men - 3%
    • women - 2%
  • 34% preventable
    • smoking (33% increased risk)
    • obesity (increasing risk with increasing BMI)
    • taking frequent painkillers
      • paracetamol (30% increased risk)
      • anti-inflammatories eg ibuprofen (38% increased risk)
  • medical conditions
    • kidney disease (2.3x increased risk if on dialysis)
    • kidney stones (41% increased risk)
    • high blood pressure (67% increased risk)
    • type 1 diabetes (30% increased risk)
  • family history
    • parent, sibling or child affected (2.2-2.6% increased risk)

Background and Risks for Bladder Cancer

Background

  • 11th most common cancer
  • 27% diagnosed in women, 73% in men
  • more common in white than black or Asian people
  • 95% cases diagnosed in people >55 y/o
  • survival
    • earliest stage
      • 1 year - 95%
      • 5 year - 79%
    • latest stage
      • 1 year - 36%
      • 5 year - data unavailable

Risks

  • lifetime risk
    • men - 2%
    • women - 0.8%
  • 49% preventable
    • smoking (45% cases) current smokers at 2-4x increased risk
    • workplace exposures (6% cases)
      • aromatic amines (dyes, rubber, textiles) (1% cases) eg hairdressers
      • polycyclic aromatic hydrocarbons (fossil fuel combustion) eg drivers, mechanics, miners
      • paint eg decorators (1% cases)
    • taking frequent painkillers ionising radiation exposure (2% cases) eg XRays, CT scans, radiotherapy
  • family history
    • parent, sibling or child affected (1.8x increased risk)

Background and Risks for Prostate Cancer

Background

  • 2nd most common cancer
  • more common in black, then white then Asian men
  • 99% cases diagnosed in men>50 y/o
  • survival
    • earliest stage
      • 1 year - 100%
      • 5 year - 100%
    • latest stage
      • 1 year - 88%
      • 5 year - 49%
  • PSA blood test

Risks

  • lifetime risk 18%
  • ?% preventable (evidence unclear) obesity linked to more advanced prostate cancer
  • genetic mutations (5-15% cases) eg BRCA 2 gene - 5x increased risk
  • black skin - 75% more likely to develop prostate cancer and twice as likely to die from it
  • family history
    • brother affected (2.9-3.3x increased risk)
    • father affected (2.1-2.4x increased risk)
    • grandfather, uncle or nephew affected (1.9x increased risk)

Education

Prostate Cancer
Early Diagnosis
module

Background and Risks for Ovarian Cancer

Background

  • 16th most common cancer in women
  • more common in white than black or Asian women
  • 88% cases diagnosed in women>45 y/o
  • survival
    • earliest stage
      • 1 year - 98%
      • 5 year - 93%
    • latest stage
      • 1 year - 54%
      • 5 year - 13%

Risks

  • lifetime risk 2%
  • 11% preventable
    • obesity (7% cases)
    • HRT (4% cases)
    • workplace exposures (<1% cases)< li>
    • smoking (<1% cases)< li>
  • genetic mutations (5-15% cases) eg BRCA genes 1 or 2
  • family history (3% cases) mother or sister affected (2.7-3.5x increased risk)

Education

Ovarian Cancer
Early Diagnosis
module

Background and Risks for Endometrial Cancer

Background

  • 13th most common cancer in women
  • 94% cases diagnosed in women >45 y/o
  • survival
    • earliest stage
      • 1 year - 99%
      • 5 year - 92%
    • latest stage
      • 1 year - 47%
      • 5 year - 15%

Risks

  • lifetime risk 3%
  • 34% preventable
    • obesity (34% cases)
    • HRT (4% cases)
      • oestrogen only (2.3x increased risk)
      • oestrogen - progesterone (22% reduced risk)
    • workplace exposures (<1% cases)
    • smoking (<1% cases)
  • genetic mutations (5-15% cases) eg BRCA genes 1 or 2
  • reproductive factors
    • not having children (35-42% increased risk)
    • age giving birth to first child - <25 y/o = 44% increased risk compared to >40 y/o
    • age at menopause - if 50-54 y/o, at 22-35% increased risk compared to 45 y/o
    • contraceptive pill (26-43% reduced risk)
  • medical conditions
    • polycystic ovarian syndrome (2.8x increased risk)
    • diabetes (40-81% increased risk)
  • family history (3% cases) mother or sister affected (2.7-3.5x increased risk)

Background and Risks for Cervical Cancer

Background

  • 21st most common cancer
  • more common in white and black than in Asian women
  • 98% cases diagnosed in women >25 y/o, highest rate of diagnosis 30-35 y/o
  • survival
    • earliest stage
      • 1 year - 96%
      • 5 year - 88%
    • latest stage
      • 1 year - 50%
      • 5 year - 16%
  • screening
    • 25-49 y/o every 3 years
    • 49-64 y/o every 5 years
  • vaccination
    • since 2008
    • 12-13 y/o
    • protects against 2 strains of Human Papilloma Virus (HPV)

Risks

  • lifetime risk <1%
  • 99.8% preventable
    • HPV (99.8% cases - see vaccination)
    • smoking (46% increased risk)
  • sexual/reproductive factors
    • >5 sexual partners - 3x risk compared to 1 partner
    • oral contraceptives for 5+ years (2x increased risk)
  • family history - mother, sister or daughter affected (74-80% increased risk)

Education

Cervical Cancer
Early Diagnosis
module

Background and Risks for Melanoma

Background

  • 5th most common cancer
  • 49% cases in women, 51% in men
  • more common in white than black or Asian people
  • 99% cases diagnosed >25y/o
  • Survival
    • earliest stage
      • 1 year - 100%
      • 5 year - 100%
    • latest stage
      • 1 year - 53%
      • 5 year - 25%

Risks

  • Lifetime risk
    • men 3%
    • women 2%
  • 86% preventable
    • ultraviolet radiation (86% cases)
      • sunburn every 2 years (3x increased risk)
      • sunbed (16-25% increased risk with 1 use)
      • intermittent sun exposure worse than all-year exposure
    • obesity (men only)
  • skin, hair and eye colour
    • red or blonde hair (3x increased risk compared to dark hair)
    • blue, green or hazel eyes (51-57% increased risk to dark eye colour)
    • the more pale the skin, the higher the risk
  • moles
    • large/unusually shaped (4-10x increased risk)
    • high numbers (100+) (7x increased risk compared to 0-15 moles)
  • freckles (2x increased risk)
  • medical conditions
    • HIV (50% increased risk)
    • inflammatory bowel disease
      • Crohn's (80% increased risk)
      • ulcerative colitis (23% increased risk)
  • occupational exposure eg airline pilots and cabin crew (2.2x increased risk)
  • family history
    • extra increase in risk if >1 parent, sibling or child affected
    • extra increase in risk if affected relative <30y o at diagnosis< li>

Education

Skin Cancer
Early Diagnosis
module

Background and Risks for Brain Cancer

Background

  • 9th most common cancer
  • 51% cases in women, 49% in men
  • more common in white than black or Asian people
  • 90% cases diagnosed >30y/o
  • Survival (all stages)
    • 1 year - 40%
    • 5 year - 11%

Risks

  • Lifetime risk
    • men 2%
    • women 1%
  • 2% preventable - obesity (2% cases)
  • radiation
    • 1-2 CT scans during childhood - 3x increased risk of brain tumour
    • radiotherapy for childhood cancer - 14x risk of glioma
  • family history
    • parent with CNS tumour - 70% increased risk of any CNS tumour
    • parent with CNS tumour - 2x increased chance of any CNS tumour
    • parent or child with glioma - 70% increased risk of glioma
    • sibling with glioma - 2.2-2.6x increased risk of glioma
    • parent or sibling with meningioma - 130% increased risk of meningioma

Education

Brain Tumour
Early Diagnosis
module

Background and Risks for Leukaemia

Background

  • 12th most common cancer
  • 40% cases in women, 60% in men
  • 87% cases diagnosed >45y/o
  • Survival data unavailable

Risks

  • Lifetime risk
    • men 2%
    • women 1%
  • 12% preventable
    • smoking (3% cases)
    • radiation (9% cases)
    • air pollution
  • workplace exposure - benzene (petrochemicals)
  • genetic conditions
    • Down's syndrome
    • Fanconi anaemia
    • ataxia telangiectasia
    • Bloom syndrome
  • medical conditions
    • HIV (3x increased risk
    • myelodysplastic syndromes
    • polycythaemia rubra vera
    • rheumatoid arthritis
    • autoimmune haemolytic anaemia
    • ulcerative colitis
  • family history - parent or sibling affected (6-9x increased risk)

Education

Chronic Leukaemia
Early Diagnosis
module
Acute Leukaemia
Early Diagnosis
module

Background and Risks for Lymphoma

Background

  • 6th most common cancer
  • 45% cases in women, 55% in men
  • 92% cases diagnosed >45y/o
  • Survival data unavailable

Risks

  • Lifetime risk
    • men 3%
    • women 2%
  • 12% preventable - occupational exposures
    • pesticide exposure (22-40% increased risk)
    • trichloroethylene (refrigeration, cleaning products)
  • infection
    • helicobacter pylori infection (2% cases)
    • hepatitis B (1% cases)
    • hepatitis C (2-3x increased risk)
    • HIV (11x increased risk)
    • glandular fever (26% increased risk)
  • medical conditions
    • Sjogrens syndrome (14-19x increased risk)
    • systemic lupus erythematous (SLE) (5-7x increased risk)
    • coeliac disease (2.6-4.4x increased risk)
    • rheumatoid arthritis (2.3x increased risk)
    • systemic sclerosis/scleroderma (2.7x increased risk)
    • psoriasis (40% increased risk)
  • family history - increased risk if parent, sibling or child affected

Education

Lymphoma
Early Diagnosis
module

Background and Risks for Sarcoma - Bone

Background

  • not in UK top 20 most common cancers
  • 49% cases in women, 51% in men
  • All ages affected, peaks at 10-20y/o and 65+y/o
  • survival
    • all stages
      • 1 year - 83%
      • 5 year - 62%

Risks

  • ionising radiation
  • medical conditions
    • Previous retinoblastoma (124-145x increased risk)
    • Neurofibromatosis type 1 (122x increased risk)
  • family history
    • parent with Hx of
      • colorectal cancer (2x increased risk)
      • Liver cancer (4x increased risk in children)
    • mother with Hx of
      • Endocrine gland cancer (3.6x increased risk)
      • Melanoma (3x increased risk)
      • Breast cancer (1.7 increased risk; 5x increased risk in children if mother <45y o at diagnosis)< li>

Education

Sarcoma
Early Diagnosis
module

Background and Risks for Sarcoma - Soft Tissue

Background

  • not in UK top 20 most common cancers
  • 48% cases in women, 52% in men
  • 79% diagnosed >40y/o
  • survival
    • all stages
      • 1 year - 75%
      • 5 year - 53%

Risks

  • Polychlorphenols (wood preservative)
  • ionising radiation
  • medical conditions
    • Previous retinoblastoma (124-145x increased risk)
    • Neurofibromatosis type 1 (122x increased risk)

Education

Sarcoma
Early Diagnosis
module

Background and Risks for Thyroid Cancer

Background

  • 20th most common cancer in the UK
  • 72% cases in women, 28% in men
  • Age at peak diagnostic incidence 45-49y/o.
  • Commoner in women during reproductive years
  • survival
    • earliest stage
      • 1 year - 99.5%
    • latest stage
      • 1 year - 88.2%
    • all stages
      • 1 year - 91.4%
      • 5 year - 87.4%

Risks

  • obesity
  • Benign thyroid disease
    • goitre
    • Hashimoto’s
    • nodules/adenomas
  • Medical conditions
    • acromegaly
    • SLE
    • past HX cancer
      • non-Hodgkin’s lymphoma
      • breast
      • oesophageal
      • testicular
  • radiation
  • Genetic, eg RET mutations, which cause multiple endocrine neoplasia (MEN1 & MEN2)

Background and Risks for Myeloma

Background

  • 19th most common cancer
  • 43% diagnosed in women, 57% in men
  • more common in black than white or Asian people
  • 95% cases diagnosed in people >50 y/o
  • survival
    • earliest stage
      • 1 year - 96%
      • 5 year - data unavailable
    • latest stage
      • 1 year - data unavailable
      • 5 year - data unavailable

Risks

  • lifetime risk
    • men - 1%
    • women - <1%< li>
  • 14% preventable - obesity (14% cases)
  • medical conditions
    • pernicious anaemia (50% increased risk)
    • MGUS (67% increased risk)
  • family history
    • parent, sibling or child affected (2.3% increased risk)

Education

Myeloma
Early Diagnosis
module

Background and Risks for Head/Neck Cancer

Background

  • 8th most common cancer
  • 31% cases in women, 69% in men
  • 95% cases diagnosed >45y/o
  • includes multiple sites
    • nasal & paranasal sinus
    • mouth & oropharyngeal
    • laryngeal
    • salivary gland
    • tonsil
    • nasopharyngeal
    • throat
    • tongue
  • Survival (laryngeal cancer only)
    • earliest stage
      • 1 year - 99%
      • 5 year - 89%
    • latest stage
      • 1 year - 64%
      • 5 year - data unavailable

Risks

  • Lifetime risk
    • laryngeal cancer
      • men <1%< li>
      • women <1%< li>
    • oral cancer
      • men 2%
      • women <1%< li>
  • 46-88% preventable
    • smoking (17-64% increased risk)
    • alcohol (28-38% increased risk)
    • sexual contact (oral and oropharyngeal cancers)
      • high numbers of sexual partners
      • young age at first sexual contact
    • diet
      • low fruit and veg intake (48% increased risk of laryngeal cancer)
      • high processed meat and fat intake
      • salted fish (2.5x increased risk)
  • occupational exposure - wood dust (10% cases nasopharyngeal cancer) eg furniture and plywood workers
  • organ transplant
  • infections
    • HIV (50-172% increased risk of laryngeal cancer)
    • human papilloma virus (5.4% increased risk of laryngeal cancer)
    • helicobacter pylori (2x increased risk of laryngeal cancer
  • medical conditions
    • systemic lupus erythematous (4x increased risk)
    • previous head and neck cancer (12-16x increased risk)
    • dental conditions
      • gum disease (2.6x increased risk) the more teeth lost the higher the risk
      • wearing dentures (42% increased risk of oral cancer) higher risk if dentures don't fit well
  • family history - 70% increased risk

Background and Risks for Head/Neck Cancer

Background

  • 8th most common cancer
  • 31% cases in women, 69% in men
  • 95% cases diagnosed >45y/o
  • includes multiple sites
    • nasal & paranasal sinus
    • mouth & oropharyngeal
    • laryngeal
    • salivary gland
    • tonsil
    • nasopharyngeal
    • throat
    • tongue
  • Survival (laryngeal cancer only)
    • earliest stage
      • 1 year - 99%
      • 5 year - 89%
    • latest stage
      • 1 year - 64%
      • 5 year - data unavailable

Risks

  • Lifetime risk
    • laryngeal cancer
      • men <1%< li>
      • women <1%< li>
    • oral cancer
      • men 2%
      • women <1%< li>
  • 46-88% preventable
    • smoking (17-64% increased risk)
    • alcohol (28-38% increased risk)
    • sexual contact (oral and oropharyngeal cancers)
      • high numbers of sexual partners
      • young age at first sexual contact
    • diet
      • low fruit and veg intake (48% increased risk of laryngeal cancer)
      • high processed meat and fat intake
      • salted fish (2.5x increased risk)
  • occupational exposure - wood dust (10% cases nasopharyngeal cancer) eg furniture and plywood workers
  • organ transplant
  • infections
    • HIV (50-172% increased risk of laryngeal cancer)
    • human papilloma virus (5.4% increased risk of laryngeal cancer)
    • helicobacter pylori (2x increased risk of laryngeal cancer
  • medical conditions
    • systemic lupus erythematous (4x increased risk)
    • previous head and neck cancer (12-16x increased risk)
    • dental conditions
      • gum disease (2.6x increased risk) the more teeth lost the higher the risk
      • wearing dentures (42% increased risk of oral cancer) higher risk if dentures don't fit well
  • family history - 70% increased risk

7 Point Checklists

Pigmented lesion 7 point checklist
2WW referral if >= 3 points
Major features
(2 points)		 Minor features
(1 point)
Change in size Diam > 7mm
Irregular shape Inflammation
Irregular colour Oozing
Change in sensation

7 Point Checklists

Dermoscopy lesion 7 point checklist
2WW referral if >= 3 points
Major features
(2 points)		 Minor features
(1 point)
Atypical pigment network Irregular streaks
Blue-whiteish veil Irregular pigmentation
Atypical vascular pattern Irregular dots/globules
Regression structures

HCP documents

For patients with a family history of pancreatic
cancer or pancreatitis


HCP Information Sheet v2 HCP Referral Sheet v2

Click on links to download

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