1. Common cancers and NICE
Muhammad Matin GPST3

2. Referral Timelines referenced in the NICE guideline
Immediate:
Within a few hours, or even more quickly if necessary
Very urgent:
To happen within 48 hours
Urgent:
National target for urgent referrals (currently 2 weeks)
Non-urgent:
All other referrals

3. The Twenty Most Common Cancers: 2014
Number of New Cases, UK

4. The 20 Most Common Causes of Cancer Death in 2014
Number of Deaths per Year, All Ages, UK

5. Urological cancers – few statistics
1. Prostate cancer:
Over 41,000 new cases each year in the UK.
A full-time GP will usually diagnose one new person with prostate cancer each year.
Five-year survival is approximately 80%.
2. Bladder cancer
Over 10,000 new cases each year in the UK,
A full time GP is likely to diagnose approximately 1 person with bladder cancer every 3-5 years.
Almost three-quarters of new cases are in males.
Five year survival is approximately 55%.

6. Urological cancers – few statistics
3. Renal cancer
over 10,000 new cases are diagnosed each year in the UK.
60% of new diagnoses are in males.
Five year survival is over 55%.
4. Testicular cancer
over 2,000 new testicular cancers are diagnosed each year in the UK.
A full-time GP will usually diagnose one new person with testicular cancer during their career.
The peak age of onset is years, although it can occur in older males. It is the commonest cancer in males between 16 and 24 years.
Five year survival is almost 100%.

7. Suspected prostate cancer
2WW referrals: Refer
If their prostate feels malignant on digital rectal examination (new NICE recommendation for 2015)
If their PSA levels are above the age-specific reference range (new NICE recommendation for 2015). PSA : 345, 50, 60, 70
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 or
Visible haematuria (new NICE recommendation for 2015)

8. Suspected bladder cancer
2WW referrals: Refer
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 NICE recommendation for 2015).
Consider non-urgent referral for bladder cancer in people aged 60 and over with recurrent or persistent unexplained urinary tract infection (new NICE recommendation for 2015).

9. Suspected testicular cancer
2WW referrals: Consider - a non-painful enlargement or change in shape or texture of the testis (new NICE recommendation for 2015).
Consider a direct access ultrasound scan for testicular cancer in men with unexplained or persistent testicular symptoms (new NICE recommendation for 2015).

10. Suspected penile cancer
2WW referrals : Consider
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 NICE recommendation for 2015).
unexplained or persistent symptoms affecting the foreskin or glans (new NICE recommendation for 2015).

11. Lower GI cancer - statistics
Colorectal cancer
Around 40,000 new cases each year in the UK,
Up to a quarter of these following screening. Screening in Uk, in scotland
A full time GP is likely to diagnose approximately 1 person with colorectal cancer every year.
Five year survival is approximately 60%
Anal cancer
Just over 1,000 new anal cancers are diagnosed each year in the UK.
Anal cancer occurs in both sexes, though nearly two-thirds occur in women.
Five-year survival is around 60%.

12. Colorectal cancers - referral
2WW referrals: Refer
They are aged 40 and over with unexplained weight loss and abdominal pain or
They are aged 50 and over with unexplained rectal bleeding (50/PR bleed) or
They are aged 60 and over with Iron-deficiency anaemia or Changes in their bowel habit
Tests show occult blood in their faeces (new NICE recommendation for 2015).
2WW referrals: Consider
A rectal or abdominal mass (new NICE recommendation for 2015).
Under 50 with rectal bleeding and Abdominal pain/Change in bowel habit/Weight loss/Iron-deficiency anaemia (new NICE recommendation for 2015).

13. Suspected anal cancer
Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for anal cancer in people with an unexplained anal mass or unexplained anal ulceration (new NICE recommendation for 2015).

14. Gastrointestinal tract (upper) cancers - statistics
Oesophageal cancer : over 8,000 new cases each year. Five year survival is approximately 15%. 
Pancreatic cancer: nearly 9,000 new pancreatic cancers are diagnosed each year in the UK. Five year survival is less than 5%.
Stomach cancer - over 7,000 new stomach cancers are diagnosed each year in the UK. Five year survival is approximately 20%.
Gallbladder cancer - around 700 new gallbladder cancers are diagnosed each year in the UK. It is seen in almost twice as many women as men.
Liver cancer - over 4,000 new primary liver cancers are diagnosed each year in the UK. A full time GP is likely to diagnose approximately 2-4 people with liver cancer in their whole career.

15. Suspected oesophageal/stomach cancer
2WW urgent direct access UGI endoscopy : Offer
With dysphagia or
Aged 55 and over with weight loss and any of the following:
Upper abdominal pain
Reflux
Dyspepsia (new NICE recommendation for 2015)
Consider non-urgent direct access UGI endoscopy:
People with haematemesis (new NICE recommendation for 2015).
Aged 55 or over with:
Treatment-resistant dyspepsia or
Upper abdominal pain with low haemoglobin levels or
Raised platelet count with either Nausea/Vomiting/Weight loss/Reflux/Dyspepsia/Upper abdominal pain, or
Nausea or vomiting with either Weight loss/Reflux/Dyspepsia/Upper abdominal pain (new NICE recommendation for 2015)

16. Suspected pancreatic cancer
2WW : Refer Aged 40 and over and have jaundice (new NICE recommendation for 2015).
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 NICE recommendation for 2015)

17. Other suspected upper GI cancers
Referral for suspected small intestinal cancer : No recommendations due to lack of evidence on investigations in primary care
Referral for suspected gall bladder cancer : Consider US in 2 weeks with an upper abdominal mass consistent with an enlarged gall bladder (new NICE recommendation for 2015).
Referral for suspected liver cancer : Consider US in 2 weeks with an upper abdominal mass consistent with an enlarged liver (new NICE recommendation for 2015).

18. Lung and pleural cancers – statistics
Lung cancers:
Over 43,000 new lung cancers are diagnosed each year in the UK.
A full time GP is likely to diagnose approximately 1 person with lung cancer each year.
Five year survival is below 10%.
Mesothelioma:
Over 2,500 new cases, though the incidence is increasing rapidly.

19. Lung and pleural cancers –referrals
2WW: Refer
Have chest X-ray findings that suggest lung cancer or
Are aged 40 and over with unexplained haemoptysis (new NICE recommendation for 2015).
Offer an urgent chest X ray (to be performed within 2 weeks) in people aged 40 and over if they have two or more of unexplained symptoms, or if they have ever smoked and have 1 or more of the unexplained symptoms:
Cough, fatigue, shortness of breath, chest pain, weight loss, appetite loss (new NICE recommendation for 2015)
Consider an urgent chest X-ray (to be performed within 2 weeks) 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 NICE recommendation for 2015).

20. Head and neck referrals
Referral for suspected laryngeal cancer : 2ww consider in people aged 45 and over with:
persistent unexplained hoarseness or
an unexplained lump in the neck (new NICE recommendation for 2015)  
Referral for suspected oral cancer : 2ww consider
unexplained ulceration in the oral cavity lasting for more than 3 weeks or
a persistent and unexplained lump in the neck(new NICE recommendation for 2015)
Consider an urgent referral to a dentist 2 ww
a lump on the lip or in the oral cavity or
a red or red and white patch in the oral cavity consistent with erythroplakia or
erythroleukoplakia (new NICE recommendation for 2015)

21. Head and neck referrals
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 or
a red or red and white patch in the oral cavity consistent with erythroplakia or
erythroleukoplakia (new NICE recommendation for 2015)
Referral for suspected thyroid cancer : 2ww consider for thyroid cancer in people with an unexplained thyroid lump (new NICE recommendation for 2015).

22. Any questions???