GEM - cancer educational module

Cancer

• the GP role extends from primary prevention through early diagnosis of cancer to terminal care, and so for family doctors cancer needs to be seen as a patient journey in which they are involved at various stages (1)
• cancer is principally a disease of ageing, and in an ageing population it is becoming more common: 65 percent of all new cancers occur in people over 65 years. During 2000, 270,000 new cases of cancer were registered in the UK (1):
  • over half of these were form the breast, lung, colon and prostate
  • in 2002, cancer accounted for 26 percent of all mortality in the UK, 155,180 deaths - now greater than heart disease
  • of cancer deaths, lung cancer was responsible for 22 percent and is the biggest cause in both sexes
    • cigarette smoking is the single most important cause for lung cancer and may be linked to one-third of all cancer deaths
  • for patients under 65, cancer kills 37 percent; for women under 65 this figure rises to 47 percent
  • cancer is a clear concern for many patients who consult their doctor and it is, a concern driven by common life experience

With respect to the epidemiology of cancer:

• regarding aetiological risk factors for development lung cancer:
  • how does passive smoking affect risk of lung cancer?
  • which type of asbestos exposure is principally associated with risk of mesothelioma?
  • is nickel exposure associated with risk of lung cancer?
  • GPN reference
• regarding risk factors for development of breast cancer:
  • what is the lifetime risk of breast cancer associated BRCA1 gene?
    • GPN reference
    • what are the referral criteria from primary care regarding a family history of breast cancer?
      • GPN reference
  • how does HRT usage affect the risk of breast cancer development?
    • GPN reference
• regarding risk factors for development of ovarian cancer:
  • how does family history affect the risk of ovarian cancer?
    • GPN reference
  • how does the use of depot progestogen contraceptives affect ovarian cancer risk?
    • GPN reference
• regarding risk factors for development of colon cancer:
  • how does family polyposis coli affect risk of colon cancer?
    • GPN reference
  • how does age affect colon cancer risk?
    • GPN reference
• regarding risk factors for skin cancer?
  • what is Gorlin's syndrome
    • GPN reference
  • how does sunshine exposure affect risk of malignant melanoma
    • GPN reference
  • what are the risk factors for development of squamous cell carcinoma of the skin?
    • GPN reference

Clinical features of Cancer

• intermenstrual bleeding is the most common presentation of ovarian cancer? T/F
  • GPN reference
• a presentation of haemoptysis should not be a prompt for a CXR? T/F
  • GPN reference
• a first episode of postmenopausal bleeding can be observed? T/F
  • GPN reference
• what are the features of a pigmented lesion that are suggestive of a possible malignant melanoma?
  • GPN reference

Cancer screening:

• how effective is faecal occult blood screening for colon cancer screening?
  • GPN reference
• what are the age-specific ranges for prostate specific antigen as a screening test for prostate cancer?
  • GPN reference
• Ca-125 levels may be raised in ovarian cancer.What other conditions might result in a raised Ca-125 level?
  • GPN reference

Referral guidelines

• bowel cancer:
  • what period of time for a change to passing of loose motions/diarrhoea is suggested as criteria for a 2-week referral for a 62 year old man
  • in what circumstances is passing of bright red blood per rectum a criteria for a urgent (2-week referral)
  • GPN reference
• urological cancer:
  • at what age is the finding of microscopic haematuria a justification for urgent referral?
  • GPN reference
• upper gastrointestinal referral
  • there has been consolidation of the NICE dyspepsia and NICE upper gastrointestinal cancer guidance. How does this relate to the development of new-onset dyspepsia in a 55 year old man?
  • GPN reference
• brain cancer referral
  • what features associated with a headache are suggested as criteria for urgent referral?
  • GPN reference

Other useful sections on GPN relevant to the cancer curriculum of the nMRCGP include:

• lung cancer section GPN reference
• breast cancer section GPN reference
• ovarian cancer section GPN reference
• colon cancer section GPN reference
• malignant melanoma GPN reference
• squamous cell skin cancer GPN reference
• urgent referral for cancer section GPN reference

Reference:

1. Royal College of General Practitioners. Curriculum Statement 12 Care of people with Cancer and Palliative Care.