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Early diagnosis RATs for primary care
UK Risk Assessment Tools
QCancer
Qcancer men
Qcancer women
UK Early diagnosis programmes
UK NCAT
Macmillan - early diagnosis
US: National Cancer Institute
PDQ® (Physician Data Query) is NCI's cancer database of peer-reviewed, regularly updated evidence-based, referenced summaries
Women
Breast
Ovarian
Endometrial screening
Endometrial
Cervical
Men
Prostate prevention
Prostate screening
Testicular screening
Penile
Other cancers
Colorectal screening
Colon
Rectal
Liver cancer screening
Lung - non small cell
Lung
Risk factors
Smoking in cancer care
UK: NICE
Implementation tools for primary care
Cancers - recent evidence
Breast
Prostate cancer
Colorectal cancer
Ovarian
Lung
British National Formulary
Malignant disease and immunosuppression
Cancer research UK
Statistics UK
Statistics World
Mortality UK
Cancer deaths UK
Deaths - selected cancers
Projections
Projected mortality UK
Projections by cancer type
Cancer
Articles are complemented with links to external websites. These enable instant access to the current evidence base. They include:
- Links to the US National Cancer Institute's database of peer-reviewed, regularly updated evidence-based summaries
- Links to the results of pre-defined search requests made to PubMed
- Links to the results of pre-defined search requests made to 'NHS Evidence', the database of evidence provided by the UK's National Institute for Health and Care Excellence
CPD: Links to online CPD on select external websites appear with some articles.
Major articles on cancer

Diagnosis and management of oesophageal cancer
22 Feb 2018
Oesophageal cancer commonly presents with dysphagia or odynophagia and can be associated with weight loss and vomiting. Referral for urgent endoscopy should always be considered in the presence of dysphagia regardless of previous history or medication. NICE recommends urgent referral (within 2 weeks) for direct access for upper GI endoscopy in patients with dysphagia and those aged 55 years or over with weight loss and any of the following: upper abdominal pain, reflux, or dyspepsia.

Prompt investigation improves outcomes for kidney cancer
22 Feb 2018
Renal cell carcinoma should be suspected in the presence of: localising symptoms such as flank pain, a loin mass or haematuria; constitutional upset including weight loss, pyrexia and/or night sweats; or unexplained test results. Smoking, obesity and hypertension are common risk factors and all three demonstrate a dose-response relationship with the relative risk of renal cell carcinoma.

Improving detection of non-melanoma skin cancer
05 Aug 2015
Basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) are clinically and pathologically distinct and both are locally invasive. However, while BCCs rarely metastasise, SCCs have the potential to do so especially when they arise on the ears or lips. Patients with one non-melanoma skin cancer (NMSC) have a higher risk of developing another NMSC and of malignant melanoma.

New developments in metastatic prostate cancer therapy
23 Apr 2015
Advanced prostate cancer remains an incurable and lethal disease. Innovation continues to provide new hope for patients with advanced disease, with improved survival while maintaining quality of life. As patients live longer with increasing treatment options, education of all healthcare professionals involved in their care is crucial in ensuring holistic care for this complex disease.

Early diagnosis pivotal to survival in lung cancer
24 Nov 2014
Lung cancer is the most common cause of cancer death, both in the UK and worldwide. There has been little change in survival over the past 20 years, with increasing evidence that there are disparities in outcomes between the UK and other comparable healthcare systems. It has been postulated that this is due to an excess of early deaths, delays in diagnosis are thought to contribute to this problem. A recent study showed that 30% of patients with lung cancer die within the first 90 days and they have seen their GP on average five times in the four months before diagnosis, suggesting there may be opportunities to diagnose these patients earlier in the disease process. The challenge GPs face is to identify and refer those at risk as early as possible and to maintain a high index of suspicion if symptoms persist. [With external links to current evidence base]

GPs could play key role in prostate cancer survivorship programmes
24 Nov 2014
More than 80% of men diagnosed with prostate cancer can expect to survive for at least five years. Up to 87% of men with prostate cancer may have unmet supportive care needs. Patients regularly cite psychological and sexual issues as the most significant. Poor functional outcomes after treatment such as incontinence and erectile dysfunction have a major impact on quality of life. The key elements of a survivorship programme are: education, intervention, surveillance and co-ordination of care. Interventions which may improve immediate care include: structured holistic needs assessment and care planning, treatment summaries and cancer care reviews, patient education and support events and advice about, and access to, physical activity schemes. [With external links to the evidence base]

Early endoscopy improves survival in gastric cancer
25 Jul 2014
Gastric cancer often presents late and the mortality ratio remains one of the highest compared with more common cancers. Early diagnosis improves survival in this potentially curable cancer. Dysphagia, weight loss and age over 55 are significant predictors of cancer. All patients presenting with dyspepsia and either alarm features or known conditions that increase the risk of gastric cancer should be referred for urgent endoscopy. Given that the majority of gastric cancer cases occur in people over 55, urgent endoscopy is also recommended in patients in this age group with new uncomplicated dyspepsia prior to treatment, even without alarm symptoms or if the symptoms respond to treatment. [With external links to current evidence base]

GPs have key role in managing men with testicular cancer
22 Apr 2014
Testicular cancer accounts for 1% of all malignancies in males. However, it is the most frequently occurring solid tumour in men between the ages of 15 and 34 years. Testicular tumours have excellent cure rates, even in those with metastases, as they are extremely sensitive to chemotherapy and radiotherapy. Early diagnosis is, however, very important as treatment is more successful and less intensive, and long-term health consequences can be minimised. [With external links to current evidence and summaries]

Optimising the management of early prostate cancer
22 Apr 2014
A suspicion of a diagnosis of prostate cancer is usually based on either induration or nodularity of the prostate on digital rectal examination or, more commonly, a rise in serum prostate specific antigen (PSA) level. The usual cut-off point for PSA is taken as 4 ng/ml, but in men below 65 a value of more than 2.5 ng/ml should raise suspicion. The Gleason grading of any cancer identified is an important part of the decision-making process concerning the need for active treatment, as opposed to surveillance alone. Gleason pattern 6 cancers are regarded as low risk, Gleason 7 intermediate risk and 8-10 high risk. [With external links to the current evidence base]

Detecting ovarian disorders in primary care
20 Mar 2014
Ovarian cysts occur more often in premenopausal than postmenopausal women. Most of these cysts will be benign, with the risk of malignancy increasing with age. Symptoms which may be suggestive of a malignant ovarian cyst, particularly in the over 50 age group, include: weight loss, persistent abdominal distension or bloating, early satiety, pelvic or abdominal pain and increased urinary urgency and frequency. [With external links to the current evidence base]

Prompt diagnosis key in bladder cancer
22 Jan 2014
Bladder cancer is the most frequently diagnosed cancer involving the urinary tract. Delayed diagnosis is associated with high-grade muscle invasive disease which has the potential to progress rapidly, metastasise and is often fatal. Haematuria which is typically intermittent, frank, painless and at times present throughout micturition is the classical and most common presentation of bladder cancer. However, irritative symptoms such as dysuria, urgency, urge incontinence and frequency as well as obstructive symptoms i.e. feeling of incomplete voiding, intermittent stream and straining can also be experienced. [With external links to the current evidence base]

Improving the detection and treatment of liver cancer
25 Jul 2013
Liver cancer is the sixth most common cancer worldwide. Over the past decade survival in liver cancer has been steadily improving as a result of developments in surgery, transplantation and the introduction of a number of novel local, ablative and molecular targeted therapies. [With external links to current evidence and summaries]

GPs have key role in early detection of melanoma
24 Jun 2013
Lesions which have a high index of suspicion for melanoma should not be removed in primary care. Patients should be referred urgently to secondary care with a history recording the duration of the lesion, change in size, colour, shape and symptoms. [With external links to current evidence and summaries]

Early diagnosis improves survival in colorectal cancer
26 Jul 2012
Colorectal cancer is the second most common cause of death from cancer in the UK. The UK has one of the lowest survival rates for colorectal cancer in Europe. Collaborative work from cancer registries across Europe has indicated that early symptom recognition and early diagnosis are important factors in improving survival. GPs play an important role in recognising symptoms and supporting patients through the investigation and ongoing management of their disease. [With external links to current evidence and summaries]

Is there a link between BPH and prostate cancer?
25 Apr 2012
GPs are playing an increasing role in managing both prostate cancer and benign prostatic hyperplasia (BPH). More than 70% of men over 70 years are affected by BPH, and prostate cancer is the most common cancer in men in the UK. GPs play an important part in the initial management of men presenting with lower urinary tract symptoms and in addressing concerns regarding prostate cancer and the significance of the patient’s symptoms. While there is no proven causal link between prostate cancer and BPH, associations have been found. BPH may increase the chance of an incidental prostate cancer being diagnosed through PSA testing and other investigations. [With external links to current evidence and summaries]

Postmenopausal bleeding should be referred urgently
21 Mar 2012
All women with postmenopausal bleeding should be referred urgently. Endometrial cancer is present in approximately 10% of cases. First-line investigation is a transvaginal ultrasound scan. A normal TVUS is reassuring, and if examination is normal further investigation is not required, providing the bleeding has stopped. There is no evidence to indicate whether different patterns of postmenopausal bleeding such as one-off bleeding or more frequent bleeds are more likely to be associated with malignancy. [With external links to current evidence and summaries]

Improving outcomes in lung cancer patients
23 Nov 2011
Lung cancer is the leading cause of cancer mortality in the UK resulting in more than 33,500 deaths in 2008, 4,000 more than for bowel and breast cancer combined. Five-year survival figures are poor but have recently improved from around 5% to 7.5% in men and 8.5% in women.There is evidence of marked variation in the standard of care in England. It has recently been shown that if patients are first referred to a thoracic surgical centre, rather than a hospital that does not have thoracic surgeons on site, they are 51% more likely to have a resection. There are similar findings for other active treatments. By reducing this variation there is scope for marked improvement in outcomes, possibly to levels seen in other countries such as Australia, Canada, Sweden and Norway where five-year survival rates are approximately double. Thus there is a need to encourage lung cancer teams to select patients correctly so that the best treatment can be offered. Improving diagnosis, staging and fitness assessment was a major focus in the recently updated NICE guideline on diagnosis and treatment of lung cancer, published in April 2011. [With external links to current evidence and summaries]

Diagnosing and managing pancreatic cancer
07 Aug 2011
Adenocarcinoma of the pancreas is one of the top ten leading causes of cancer deaths and in the UK approximately 8,000 people are diagnosed with the disease each year. The incidence is similar in men and women and rises with age. Rates increase significantly in people aged 45 years and over and around three-quarters of patients diagnosed with pancreatic cancer are over the age of 65. Treatment options include resectional surgery, which is the only chance of cure from the disease; and palliative stenting, chemotherapy and radiotherapy. Overall, the long-term prognosis of the disease is poor with a one-year survival rate of approximately 10-20%. For non-metastatic disease, median survival is six to ten months, although for those with metastatic disease at presentation median survival is only three to six months. Both one- and five-year survival rates for pancreatic cancer in the UK are lower than the European average. Despite improvements in imaging, surgical techniques and chemotherapy, overall survival has not improved appreciably in the past few decades. [With external links to current evidence and summaries]

Improving early detection of ovarian cancer
22 Jun 2011
Ovarian cancer is the fifth most common cancer in women. The incidence has increased over the past 20-25 years, particularly in the 65 and over age group. The outcome for women with ovarian cancer is generally poor, with an overall five-year survival rate of less than 35%. The survival rates for women with ovarian cancer in the UK are significantly lower than the European average. Despite recommendations, published by NICE in 2005, on referral of patients with suspected cancer, the majority of women diagnosed with ovarian cancer are not electively referred via the ovarian cancer two-week pathway. They are often referred to the wrong specialty or present as emergencies. NICE has now published a clinical guideline on the diagnosis and initial management of ovarian cancer. [With external links to current evidence and summaries]
Editorials

MP-MRI could improve the diagnosis of prostate cancer
22 Feb 2017
Multi-parametric magnetic resonance imaging (MP-MRI) could play an important role in triaging men with a raised PSA for prostate biopsy and improve the detection of clinically significant prostate cancer, findings from a UK study suggest.

Active monitoring vs treatment for localised prostate cancer
24 Oct 2016
No significant difference in prostate cancer mortality was seen in men with localised prostate cancer who underwent active monitoring compared with surgery or radiotherapy at ten years’ follow-up in ProtecT, a large UK trial. However, both surgery and radiotherapy were associated with lower rates of metastasis and disease progression. ProtecT seems to support the use of active monitoring/surveillance in low-risk patients, but this does not mean that it is a sensible option for all men newly diagnosed with prostate cancer. Most men in ProtecT had low Gleason grade, low-risk disease and the findings must not be used to push men with more aggressive disease away from active treatment.

DRE has vital role in early detection of prostate cancer
22 Jan 2015
Digital rectal examination is important, not just for reducing concern in men with urinary symptoms, large prostates and borderline PSA levels, but also because it is recognised that a significant number of men have clinically significant prostate cancer despite a normal PSA. [With external links to the evidence base]

Obesity, metformin and prostate cancer risk
15 Dec 2014
A total of 104 global studies were reviewed, examining nearly 10 million (9,855,000) men and 191,000 cases of prostate cancer. The analysis concluded that being overweight or obese significantly increases the risk of advanced prostate cancer. The link between obesity and advanced prostate cancer is important for primary care. In order to maximise the benefit from PSA testing of asymptomatic men, we should be trying to target higher-risk men and should now think of adding obesity to that list. [With external links to the evidence base]

Collaborative care effective in cancer patients with depression
23 Oct 2014
Integrated collaborative care substantially improves outcomes for cancer patients with major depression, a UK study has found. GPs have an important role in recognising depression in cancer patients and should bear in mind the high prevalence of depression when carrying out QOF cancer reviews. This study suggests that treatment is unlikely to be effective unless it incorporates some form of enhanced care. GPs may not have access to collaborative care but can provide case management and liaise with local oncology teams.

HPV vaccination uptake lowest in young women at greatest risk
22 Apr 2014
Teenage girls most at risk of cervical cancer are least likely to be offered HPV vaccination and, those who are, less likely to complete the course, a cross-sectional study of sexual health service users has found. [With external links to current evidence and summaries]

Are 5-ARIs suitable for prevention of prostate cancer?
23 Oct 2013
As with the original Prostate Cancer Prevention Trial, the use of a 5-ARI, in this case finasteride, was seen to reduce the incidence of prostate cancer by about a third. Although high-grade cancer was more common in the 5-ARI group, after 18 years of follow-up there was no significant difference in rates of prostate cancer specific survival or overall survival between the two groups. Prescription of finasteride or dutasteride as a chemopreventive agent against prostate cancer cannot be justified on the available evidence. [With external links to current evidence and summaries]

PSA in men in their 40s predicts risk of prostate cancer death
23 Sep 2013
For many men, three lifetime PSA tests (mid to late 40s, early 50s and at age 60 years) would be sufficient screening to identify the small number of men developing clinically significant prostate cancer, allowing resources to be concentrated on those at higher risk, a study in the BMJ concludes. The European Association of Urology recommends that all men aged 40-45 years should be offered a baseline PSA to ‘initiate a risk-adapted follow-up approach with the purpose of reducing prostate cancer mortality and the incidence of advanced and metastatic cancer’.
PSA at 60 may predict risk of death from prostate cancer
20 Oct 2010
The debate on PSA screening to detect prostate cancer is ongoing. Two large studies published in 2009 gave an unclear message. The European ERSPC trial showed a significant reduction in prostate cancer mortality as a result of screening but with a significant risk of overtreatment in order to save lives (48 additional patients requiring treatment for each life saved). The American PLCO study showed no benefit from screening, but has been criticised for the large amount of PSA testing outside the study in the control arm, contaminating the results and potentially diluting any benefit.A meta-analysis incorporating these two studies and four other randomised controlled trials (a total of 387,286 men), published in the BMJ, has examined the overall evidence for PSA screening. [With external links to current evidence and summaries]
Photoguide

Skin malignancy
25 Jul 2014
• Acanthosis nigricans • Morphoeic basal cell carcinoma • Primary cutaneous anaplastic large cell lymphoma • Amelanotic melanoma • Dermatofibrosarcoma protuberans • Squamous cell carcinoma [With external links to current evidence and summaries]
Clinical reviews
Does vasectomy increase the risk of prostate cancer?
23 Sep 2014
Vasectomy may be associated with a small increase in absolute risk of prostate cancer, the findings from a large cohort study in the United States suggest. A cohort of 49,405 men taking part in the Health Professionals Follow-Up Study, run by Harvard University, was followed up from 1986 to 2010. During this period 12,321 men (25%) had vasectomies. [With external links to the current evidence base]
Do CT scans in childhood raise cancer risk?
25 Jul 2013
Undergoing CT scans during childhood is associated with a small but significant risk of developing cancer, a large data linkage study from Australia has found. The absolute excess incidence rate for all cancers combined was 9.38 per 100,000 person-years at risk after nearly ten years’ follow-up.
Functional outcomes after surgery vs radiotherapy for localised prostate cancer
21 Mar 2013
Although short-to medium-term functional outcomes favoured radiotherapy over surgery in terms of sexual and urinary function in localised prostate cancer, by 15 years follow-up there were no differences in functional outcomes between the two treatment groups, in the PCOS. [With external links to current evidence and summaries]
Identifying risk factors for endometrial cancer
21 Feb 2013
Obesity, polyps and a history of non-familial colorectal cancer appear to increase the risk of endometrial cancer in women with previous normal endometrial biopsy findings, a case-control study from the US has found.
Cryptorchidism raises risk of testicular cancer later on
28 Jan 2013
Boys with isolated cryptorchidism have a three-fold increased risk of developing testicular cancer later in life, a meta-analysis published in Archives of Disease in Childhood has found.
Intermittent ADT an option for advanced prostate cancer
31 Oct 2012
Compared with continuous treatment intermittent androgen deprivation therapy (ADT) can improve patients’ quality of life and does not adversely affect survival, a study in the NEJM concludes. [With external links to current evidence and summaries]