Bowel cancer in younger people

Who cannot have been moved by the bravery of Dame Deborah James who is moving towards the end of her 6 year journey with bowel cancer at the age of 40.

Bowel cancer is the 4^th most common cancer in the UK with survival closely linked to stage at diagnosis. Although most bowel cancers present in patients over the age of 50, every year in the UK more than 2,600 younger people are diagnosed. Sadly awareness remains low in this group amongst both patients and clinicians with 4 in 10 experiencing delays in referral and later stage diagnosis.

What can we do as GPs?

• Be aware of red flag symptoms including rectal bleeding, unexplained weight loss, abdominal pain / diarrhoea at night
• Ask about family history of cancer / bowel cancer
• Don’t exclude cancer due to age
• Ensure our patients with inflammatory bowel disease attend their screening colonoscopies

What guidance do we have to help us?

NICE NG12

• Refer to colorectal via 2 week wait patients aged 40 and over with unexplained weight loss and abdominal pain
• Refer patients with a positive FIT test
• Consider 2 week wait colorectal referral for patients < 50 year with rectal bleeding and any of unexplained abdominal pain or change in bowels or unexplained weight loss or unexplained iron deficiency anaemia

NICE DG30

Offer FIT testing to patients < 60 years with changes in bowel habit or unexplained iron deficiency anaemia

Useful resources

• WCA FIT webinar (March 2022)
• Gateway C courses -  'FIT' and 'Colorectal Cancer – Early Diagnosis'
• Bowel Cancer UK symptom diary
• Clinical decision support tools

Skin Cancer

Skin cancer is the most common cancer in the UK. Many skin cancers are preventable and linked to sun exposure.

Despite growing awareness, the incidence of skin cancer is increasing - 42% increase in non-melanoma skin cancers and 32% increase in malignant melanoma in the past decade. Getting sunburnt just once every two years can triple your risk of melanoma.

Ten-year survival rates for all types of skin cancers are high however this does depend on early recognition by patients and clinicians. Sadly there are more than 2300 deaths from melanoma annually in the UK. Gateway C has produced a new education module Skin Cancer – Early Diagnosis. This excellent resource provides a timely update on educating our immunosuppressed patients about their increased risk of skin cancer and how computer/phone apps can be used to monitor moles.

See also: NICE Guidelines for suspected cancer which details the 7-point checklist for melanoma.

The Rapid Investigation Service non-specific symptoms (NSS) pathway

The Rapid Investigation Service has been fully operational for over a year now, with 73% of practices in Wessex having referred one or more patient. Feedback has been very positive so far and the team are committed to improving patient experience.  The referral form has recently been updated, and further information is available in the updated FAQs and Year 1 newsletter.

The RIS team have capacity to take more referrals and they are always happy to answer any questions regarding a new or existing patient. Email : Wessexrds.admin@nhs.net Phone: 0300 123 1385

Cancer Care Reviews - survey and mentoring offer

Please complete this short survey to help us understand current practice in relation to Cancer Care Reviews (CCRs). The survey will help you reflect on any support needs and tell us how we can help.

As part of our support package we are now offering mentorship for practice nurses to deliver CCRs and will be providing training to other team members in future.

About the Practice Nurse mentorship offer

Pam Kay, Cancer Care Practice Nurse in Southampton and Right By You Wessex team member, is offering bespoke mentoring to Practice Nurses in Wessex who would like to better understand the needs of people living with cancer. This will include the delivery of effective cancer care reviews and improved liaison with secondary care to support the timely sharing of information and improve patient experience. If you are interested in taking up this free offer of mentorship, please contact pamkay@nhs.net.

Expressions of interest for breast awareness project

Wessex Cancer Alliance are piloting a new initiative to promote breast self-awareness and examination at routine cervical screening appointments. Funding will be provided through a Local Improvement Project and participating practices will also be supplied with a box of resources including awareness raising materials for patients, staff badges, training pack and FAQs.

Expressions of interest are now being accepted. For more information please see here or contact Tamzen.Hogben@nhs.net.

Cancer prevention poster

4 in 10 cancer cases in the UK can be prevented. Cancer Research UK (CRUK) have produced a poster highlighting factors that can increase the risk of cancer.

This is a useful resource for health care professionals and can be downloaded or printed for display.

There is also an infographic for patients on the ‘7 ways to cut your cancer risk’, which could be added to practice web pages and social media.

An easy read leaflet 'Cutting your risk' is also available.