1. Vicki Newport RGN BSc Midwifery BSc Advanced Nurse Primary Care
Queen’s Nurse
Macmillan Lead Improvement Nurse in London Cancer

2. Present Situation
Late detection of cancer diagnosis in A&E is still a problem – 23% patients in London diagnosed.
Poor one year survival late diagnosis.
Poor coverage and uptake of screening programmes in London- on average about 69%
Poor professional and patient awareness early cancer symptoms.

3. My role… Nurse Improvement Lead, London Cancer
To improve the outcomes of early cancer diagnosis and awareness of cancer symptoms.
To enhanced the capability of practice nurses in quality improvement in Primary Care ie safety netting/audit.

7. Cervical Screening Leaflets

8. Why do we over cervical screening?
Cervical Smear
Why do we over cervical screening?

9. Introduction 
.A cervical screening test (previously known as a smear test) is a method of detecting abnormal cells on the cervix- the entrance to the vagina.
Detecting and removing abnormal cervical cells can prevent cervical cancer.
Cervical screening is not a test for cancer; it is a test to check the health of the cells of the cervix.
Around 1 in 20 women the test will show some abnormal changes in the cells of the cervix.
Most changes will not lead to cervical cancer and the cells may go back to normal on their own but the abnormal cells need to be removed so that they cannot become cancerous.

10. What do you tell the patient?
The cervical screening test usually takes a few minutes.. An instrument called a speculum will be gently inserted into your vagina to hold the walls of your vagina open so that your cervix is visible. A small soft brush will be used to take some cells from the surface of your cervix.
The sample of cervical cells will then be sent to a laboratory and examined under a microscope to see whether there are any abnormal cells.
Some women may find the procedure a bit uncomfortable or embarrassing, but for most women it is not painful.
If the test picks up abnormalities in the cells in your cervix, it may be recommended that you have treatment to remove them, or further tests in a few months to see if they return to normal on their own.

11. What early cancer symptoms am I looking out for?
Usually no symptoms with abnormal cervical cells and sometimes there are no symptoms with early stage cervical cancer.
Recognised symptoms associated with cervical cancer.
Abnormal bleeding: during or after sexual intercourse, or between periods
Post menopausal bleeding, if you are not on HRT or have stopped it for six weeks
Unusual and/or unpleasant vaginal discharge
Discomfort or pain during sex
Lower back pain

12. Preventing cervical cancer  There is no single way to completely prevent cervical cancer, but there are a number of things that can help reduce your risk.
Safer sex- Most cases of cervical cancer are linked to an infection with certain types of human papillomavirus (HPV). HPV can be spread through unprotected sex, so using a condom can help reduce your risk of developing the infection.
Cervical screening- Regular cervical screening is the best way to identify abnormal changes in the cells of the cervix at an early stage.
Women aged 25 to 49 years old are invited for smear tests every three years. Women aged 50 to 64 years old are invited every five years.
Smoking- offer and refer for smoking cessation advice.

13. NHS Cervical Screening Programme

14. Top 10 cancer killers Lung Colorectal Breast Prostate Oesophageal
Pancreatic
Stomach
Non-Hodgkin’s lymphoma
Ovarian
Leukaemia
NOTES FOR PRESENTERS
SLIDE FOR ALL
Rationale for this guideline (Refer to full guideline Section 1.2)
Improving care for people with cancer is a key aim for NHS; includes reduction in mortality by 20% in people under 75 years by 2010 compared to baseline.
National Audit Report on cancer services in England shows that patients tended to have more advanced cancer at time of diagnosis compared to other countries. Older people and those from more deprived areas more likely to be diagnosed with cancer at a more advanced stage.
Therefore early referral important. For example, delays of 3 to 6 months between the onset of symptoms and diagnosis are associated with worse survival rates in breast cancer. In a study of time between presentation and treatment of six common cancers in general practice, the median number of days between presentation of the 1st symptom and initiation of referral was 0 days for breast, 28 days for large bowel, 31 days for lung, 84 days for oesophageal, 20 days for prostate and 66 days for stomach cancer.

15. Gynaecological cancer
NOTES FOR PRESENTERS
SLIDE FOR CLINICIANS
Ask participants to refer to Pg 13 in QRG
NICE ADDITIONS TO DH 2000 GUIDELINE
No lower age limit in cases of post-menopausal bleeding
Tamoxifen as a risk factor in endometrial cancer
Symptoms of ovarian cancer
Indications for full pelvic examination
Advice that smear is not needed if cancer is suspected
Ultrasound for checking abdominal or pelvic mass not obviously uterine fibroids, or of GI or urological origin
Urgent referral to specialist team if urgent ultrasound not available 13

16. Quality Improvement
NHS strives to provide safe and good quality health care; improve patient experience, tackle effectiveness and update practice in the light of evidence from research.
Patient safety is identified in the NMC Code (Nursing and Midwifery Council 2008) and the RCN Principles of Nursing Practice (RCN 2010a) as an essential part of nursing care.
Principle C states: "Nurses and nursing staff manage risk, are vigilant about risk, and help to keep everyone safe in the places they receive health care" (RCN 2010b, Principle C).

17. Breast Screening

19. Breast symptoms to look out for
A lump or thickening in an area of the breast
A change in the size or shape of a breast
Dimpling of the skin
A change in the shape of your nipple
A blood stained discharge from the nipple
A rash on a nipple or surrounding area
A swelling or lump in your armpit

20. Health Promotion Physical exercise Smoking Alcohol Diet
Lifestyle- being aware- any noted changes

23. Macmillan Cancer Support

24. NHS Cervical Screening Programme- useful links
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