Pancreatic cancer

Pancreatic Cancer is the quickest killing cancer in the UK, with one in four people dying within a month and three in four within one year of diagnosis. Pancreatic cancer has rapid disease progression and people experience nutritional, physical and psychological deterioration rapidly following a diagnosis, therefore, delays to diagnosis and treatment can lead to people quickly becoming inoperable or too unwell to tolerate treatment.

Pancreatic Cancer is the deadliest common cancer, with 6.5% five-year survival in England (2015-19). This represents over 9,000 cases and over 8,000 deaths every year in England and rates are rising. Pancreatic adenocarcinoma has the lowest early stage diagnosis of all common cancers, with 6 times higher one-year survival at early stage compared with people diagnosed at stage four.

People with pancreatic cancer are likely to experience multiple appointments before referral, often re-attending with the same symptoms and ultimately, 44% are diagnosed thorough emergency presentation.

What can we do as GPs?

Be aware of the symptoms of Pancreatic cancer which can be vague and overlap with other cancers. NICE NG12 guidance advises 2ww referral for people aged 40 years and over with jaundice. NICE advises urgent imaging (ultrasound or CT scan) 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.

CT scan is the investigation of choice as ultrasound misses a number of pancreatic cancers. Many GPs across Wessex don’t have direct access to CT scanning. Many people with these persistent symptoms will meet the referral criteria to the Rapid Investigation Service.

Earlier Diagnosis does make a difference to patient experience and survival.

Being aware of family history - People with a first degree relative with pancreatic cancer have a 60 - 70% increased risk of pancreatic cancer. Peutz-Jegher syndrome, Familial atypical multiple mole melanoma syndrome, Lynch syndrome, BRCA2 and BRCA1 are all associated with increased risk of pancreatic cancer.

What else can GPs do?

Pancreatic Enzyme Replacement Therapy (PERT) is indicated for all patients with pancreatic cancer to help prevent rapid physical deterioration. This in turn may affect fitness for cancer treatment. Only 50% of people with pancreatic cancer receive PERT, despite being included in the NG85 pancreatic cancer guidelines. An online healthcare professional course about PERT is available.

More is being understood about optimal treatment particularly for locally advanced pancreatic cancer in the absence of metastases with potentially exciting trials which may start to impact on survival.

Please click here for 10 top tips for primary care from Macmillan Cancer Support and Pancreatic Cancer UK. 

PSA testing position statement and CRUK suspected prostate cancer guide

In light of Movember this month, we thought it was good opportunity to remind primary care about the Wessex position statement on testing for prostate cancer. This was produced by the Wessex Cancer Alliance primary care leads, in conjunction with urology specialists, to help provide clarity on the use of PSA testing.

CRUK have recently published a helpful Recognition and referral of suspected prostate cancer guide, which includes information on the PSA test and what health professionals can do to support the timely referral of suspected prostate cancer.

Cancer in children

Cancer in children accounts for less than 1% of all new cancer cases in the UK, yet it is the leading medical cause of death in 1 - 9 year olds. While it may be regarded as an uncommon presentation in primary care, it is important that it is considered in a differential diagnosis in a child presenting with unexplained symptoms.

Around 1800 children are diagnosed with cancer in the UK every year. Earlier diagnosis improves outcomes and long-term survival has increased significantly with 72% of children diagnosed with cancer now surviving for at least 20 years.

Symptoms can be extremely vague, for example leukaemia (the most common cancer in children under 15) can present with tiredness, bruising, nose bleeds, recurrent infection, or bone pain.

What can we do as GPs?

• Be alert for CANCER - Concern, Anorexia, Number of attendances, Complexion (pallor), Exhaustion, Recurrent pyrexia
• Routinely review any children seen three times about the same symptoms

• Be particularly alert to cancer signs and symptoms in children with certain genetic disorders; for example, Down Syndrome is associated with increased risk of leukaemia
• Be aware of how brain tumours present at different stages of childhood - see information from Headsmart
• Safety net when seeing children

The UK Children's Cancer and Leukaemia Group (CCLG) have published a supporting resource for children's NICE NG12 guideline CCLG_referral_guidance_April_2021_(Web).pdf. This provides additional advice on the urgency for referral - immediately, or within 48 hours or via the 2 week wait route. A summary is also available.

Please remember that across Wessex, local paediatricians are happy to be contacted for advice if cancer is suspected, to offer guidance on specific cases. The paediatric 2WW forms are for transfer of information only and if cancer is suspected in a child then the clinician should contact the on-call paediatrician to discuss and refer.

ARRS toolkit

Wessex Cancer Alliance (WCA) has produced a toolkit to help primary care understand the potential and opportunities to employ and develop existing roles who are part of the ARRS to:

1) Support the delivery of cancer priorities within the Network Contract DES

2) Support achievement of Quality Outcome Framework (QoF) Indicators

3) Provide opportunities to support personalised care planning throughout the cancer pathway

This toolkit provides links to education, tools, patient information and promotional material and asset mapping to support and assist ARRS postholders to develop their cancer knowledge and skills. It also provides recruitment and supervision resources to aid employers.

In addition, WCA will support with development of new innovative cancer specific roles and/or cancer patient pathway improvement within Primary Care Networks in the Wessex region. In particular, we are providing a lot of support to employ Cancer Care Coordinators across the region.

The toolkit can be accessed here.

If you would like to meet individually or attend the webinar on the 13^th December 2022 to learn more about the toolkit and how it can be used by your staff, clinical director and management team please contact: mary.edwards8@nhs.net

Quality Improvement Project - cervical cancer screening

We have produced an off-the-shelf project step-through to help you achieve the screening part of the Network Contract DES for cervical screening. This covers general increasing uptake and also for people with learning disabilities.

A similar document for bowel screening can be found here.

Prioritising blood tests in primary care for 2WW patients

It is very important that blood tests for patients referred on a 2WW / Urgent Suspected Cancer pathway are prioritised in primary care to prevent delays.

The Dorset Cancer Partnership have created a short survey to establish the current processes within practices/PCNs regarding the arrangement of blood tests necessary for an Urgent Suspected Cancer Referral/2WW referral. We would be grateful if you could complete this survey and share widely across your PCNs to enable us to gather this information across Wessex.

The survey for Dorset practices/PCNs can be found here.

The survey for HIOW practices/PCNs can be found here.

New Macmillan Cancer Awareness video in different languages

Macmillan have produced a new Cancer Awareness video in a number of different languages. These can all be found on the Cancer Matters Wessex website.