Bladder cancer

There are around 10,300 new bladder cancer cases in the UK every year. It is more common in men but is more likely to be diagnosed at a later stage in women.

The below infographic highlights the key things to remember about this cancer - Think BLADDER. 

Further information on bladder cancer presentation can be found in this information sheet.

Blood cancer

Background :More than 30,000 patients are diagnosed with blood cancer (leukaemia, myeloma, lymphoma) in the UK every year. 28% are diagnosed via emergency admission which is significantly higher than other cancers which is important as only 40% of these patients survive for 3 years or more by comparison with 77% 3 year survival for patients diagnosed via primary care.

Blood cancers are also one of the more common cancers in children and young people.

Presentation: Symptoms are frequently vague and nonspecific including- unexplained weight loss, unexplained bruising/ bleeding, petechiae, lymphadenopathy, shortness of breath, night sweats, persistent/ recurrent/severe infections, unexplained fever, pruritus, bone/ joint/ abdominal pain, tiredness and pallor.

These symptoms can easily be ignored by patients and initially put down to other causes by clinicians.

Management: young people and children with petechiae or Hepatosplenomegally need immediate specialist assessment.

Urgent blood tests are indicated in primary care as advised by NICE.

New NICE FIT Guidance

NICE have published new guidance on the use of FIT in patients with symptoms of bowel cancer, and the NG12 referral guidelines for suspected lower GI cancers have also been updated.

1. In line with existing Wessex guidance, NICE recommends the use of FIT to guide referral for people with symptoms suggestive of colorectal cancer.
2. Patients should be referred if they have a FIT result of 10ug/g or higher.
3. People with a rectal mass, unexplained anal mass or ulceration do not need to be offered FIT before a referral is considered.
4. People who are unable or unwilling to complete a FIT should be supported but referral should not be delayed if there is strong clinical concern.

The guidance notes that although a FIT result of 10ug/g should be used as a guide, GPs must be able to refer people regardless of FIT result if they think it is necessary and where symptoms persist.

For more details on the Wessex colorectal pathway and FIT please see our dedicated Symptomatic FIT website page, which includes advice on safety netting in primary care and the FIT<10 safety netting pathway available to Wessex practices. Please see also details of the Gateway C webinars on FIT below in the Education section.

If you have any questions or concerns about the guidance on FIT please contact us at england.wessexcanceralliance@nhs.net and one of our team will be in touch.

Upcoming ‘Help Us, Help You’ cancer campaigns: Reducing cancer barriers and Lung Cancer Symptoms

On Monday 4 September, NHS England is re-launching the ‘Reducing cancer barriers' phase of the ‘Help Us, Help You’ campaign. The aim of the campaign is to encourage people who are experiencing potential signs of cancer to contact their GP practice to help increase earlier diagnosis and improve outcomes.​ The campaign will run from 4 September until 15 October.

On Monday 18 September, NHS England is re-launching the lung cancer symptoms phase of the ‘Help Us, Help You’ campaign. The aim of the campaign is to increase knowledge of the key symptom of lung cancer – a cough that lasts for three weeks or more – and encourage those who experience this symptom to contact their GP practice.​ The campaign will run from 18 September until 22 October.

A toolkit and resources for both campaigns can be downloaded free of charge from: Campaign Resource Centre​.

Rapid Investigation Service (RIS)

What is the Rapid Investigation Service?

This is a Wessex-wide virtual service set up in 2020, which aims to swiftly investigate patients with non-specific symptoms who do not meet site-specific two week wait referral criteria. The aim is to detect cancers more quickly. Historically these patients have often had a convoluted and delayed path to cancer diagnosis.

The referral criteria include:

• new significant unexplained weight loss
• new unexplained constitutional symptoms
• new unexplained, abdominal pain for four weeks or more
• new unexplained or progressive pain, e.g. bone pain
• new unexplained raised platelet count in patients over 40 years
• referrer, intuition of cancer diagnosis

A number of mandatory filter tests need to have been done and the results received in primary care prior to referral.

Please see the FAQ document. The referral form has recently been updated (see below for further details).

New Wessex-wide 2WW Referral Form Rapid Investigation Service (RIS)

The current Suspected Cancer Non-Specific Symptoms RIS 2WW Referral form has been updated.

The new form has had some small changes made, designed to make the form completion quicker and simpler for GPs.

The form has been available on GP clinical systems since Monday 31^st July and is also available in our dedicated 2WW form section, on our website.

To give feedback on the new form, or for any queries please contact us using the details at the end of this bulletin.

We also ask that you forward this information onto your colleagues and the relevant teams through your existing communication routes.

ARRS Surveys

The Additional Roles Reimbursement Scheme Cancer Toolkit (available here) has been live on the Wessex Cancer Alliance website for nearly a year. We are now evaluating the toolkit and would appreciate responses to a short survey from anyone working in an ARRS post, this includes Cancer Care coordinators, Social Prescribers, Paramedics, FCP MSK Physios, GP Assistants, Occupational Therapists and Dietitians that have used the toolkit (Survey 1) and from employers and supervisors of ARRS (Survey 2), this includes non-clinical and clinical cancer leads, PCN managers, practice managers, education leads that have used or promoted the toolkit. This survey will take less than 5 mins to complete.

Survey 1 - ARRS Postholder:

https://forms.office.com/e/ERsj9B0LgrS

Survey 2 - ARRS employer:

https://forms.office.com/e/KD4aexU1dv

HPV vaccination podcast

The HPV vaccination prevents a range of cancers – listen to our podcast to find out more about the key changes coming to this vaccination programme.

Below are a few key points.

From September there are some changes to the HPV programme:

• People under 25 with no underlying medical conditions will only require 1 dose – if a young person has already had one vaccine dose they do not need another one.

• Men who have sex with men aged between 25-45 years should have 2 doses, (this programme is delivered via sexual health clinics)

• Those in an eligible group that are immunosuppressed, living with HIV or on antiretroviral therapy (at the time of vaccination) will still require 3 doses.

All women and people with a cervix aged 25-64 years still need to be encouraged to attend for their routine cervical screening when due.

Useful resources:

Universal programme leaflets and information: HPV vaccination programme - GOV.UK (www.gov.uk)

Changes from September 2023 letter: HPV vaccination programme: changes from September 2023 letter - GOV.UK (www.gov.uk)

GP contract changes 2023/24: NHS England » Changes to the GP Contract in 2023/24

Patient Group Directions South East: NHS England — South East » South East Patient Group Direction downloads

Patient Group Directions South West: NHS England — South West » Patient Group Directions (PGDs)

Jo’s trust: Human papillomavirus (HPV) | Jo's Cervical Cancer Trust (jostrust.org.uk)