Cancer

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Cancer

Cancer has never had a higher profile. The media loves stories about it, whether it is the latest success story (usually only so far trialled in rats), or the dire story of how a cancer was missed. To make it worse media doctors seem to want to peddle the latest 'screening' tests without any thought as to how effective they might be. We are often left in the middle trying to do the best for our patients, which sometimes means not doing the obvious! This chapter will help, guaranteed!

This chapter summarises the latest evidence for a number of cancers, however,
Prostate cancer is covered in the Men's Health chapter
Breast cancer is covered in the Online Handbook (Women's Health chapter)
Melanoma is covered in the Online Handbook (Dermatology chapter)
Aspirin for cancer prevention is discussed in the Cardiovascular Disease chapter.

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  Managing bone metastases
This clinical review in the BMJ helpfully addresses some of the problems caused by bony metastases. I have summarised the key points here.
  SIGN guidelines on cancer pain
This is a guideline to help grandmothers suck eggs! You will be familiar with most of the recommendations in this guideline from SIGN; however, the really useful section is a chart summarising how to convert from one opioid to another.
  Red flags and cancer diagnosis: do they help
I'm fed up with hearing politicians banging on about how much better GPs ought to be at diagnosing cancer. They make it sound so easy. What with those fantastic national guidelines on who to refer under the two week wait scheme, how could we ever get it wrong?
  Serum tumour markers
There is always a risk in medicine that we treat the test result rather than the patient. I think that is especially true with tumour markers; we may be falsely reassured or unnecessarily alarmed. So when should we consider doing them and how do we interpret the result?
  Advanced care planning
This chapter summarises the latest evidence for advanced care planning, and the latest evidence for a number of cancers. Melanoma, breast and prostate cancers are covered in the Dermatology, Women's Health and Men's Health chapters, respectively.
  Colorectal cancer
Colorectal cancer is the second most common cancer in Europe. Detected early, the 5-year survival rate is 90% but in those diagnosed with widespread cancer it is less than 10%. This gives a great incentive for early diagnosis in primary care but this is not always easy.
  Oesophogeal cancer
Oesophageal cancer is the eighth most common cancer; its incidence is increasing and the prognosis following diagnosis has hardly changed in 20 years.
  Soft tissue sarcoma
Rare, making up less than 1% of malignancy in adults but 10% in children. Average GP will see 1 case in 24 years. Prognosis is often poor and diagnosis delayed.
  Oxygen therapy in palliative care
In terminal care refractory dyspnoea can be a common and difficult symptom to treat. Currently oxygen is considered an appropriate treatment for this condition. One-third of Canada's oxygen budget is spent on palliative provision.
  Confidence in GPs after a diagnosis of cancer
This small Danish cohort study asked 766 patients to rate their confidence with their GP after a diagnosis of cancer. The study compared changes in confidence when there had been a doctormediated delay in diagnosis (defined as =14d delay before referral made) and no delay.
  Cancer in adults who had cancer as children
Children who survive cancer are known to be more at risk of subsequent cancer with some studies demonstrating a 3–6 fold higher risk. No study, however, has looked long term at the risks for these patients into middle age and beyond, until now.
  Endometrial cancer
This BMJ Clinical Review provides a useful summary of endometrial cancer, the fourth most common cancer in women.
  Ovarian cancer
Ovarian cancer is notoriously difficult to diagnose and is frequently diagnosed at a late stage. However, it is not a silent killer. How best can we work out when to suspect it and what investigations should we do?