On the 6th February 2020, the new GP contract was released which specifically included the early diagnosis of cancer. We are particularly excited to see new funding streams opened up to primary care to support this endeavour. This is now the first time primary care will receive sustainable funding to support early cancer diagnosis!


As of last week, 9 people in the UK had been diagnosed with the novel coronavirus, COVID-19. Current guidance from Public Health England states that it is possible that novel coronavirus may cause mild to moderate illness, in addition to pneumonia or severe acute respiratory infection, so patients could potentially present to primary care. For the vast majority of the population, contracting the coronavirus infection will lead to flu-like symptoms and the majority of patients will most likely survive, very similar to the majority of people who get the flu. However, like with the flu it is highly likely that people with suppressed immune systems are at a particularity high risk for severe disease and complications.

Click the link below to read more about guidance for NHS clinicians and what to advise your immunocompromised patients.


Sofia, a 66yr old female, presents to you with a 4 week history of vaginal discharge. The discharge is clear in colour, non-odorous, and does not cause her any discomfort. She denies any abdominal pain or vaginal bleeding. Sofia was seen by one of your colleagues a couple of weeks ago and a high vaginal swab and STI screen was taken. The results of these tests were normal. You also note that your colleague has documented a normal speculum and bi-manual examination.

She has come back into your surgery today for the results of her swab. She also mentions to you that she has seen some blood in her urine over the last couple of days. Sofia denies any dysuria, suprapubic pain, or increase in frequency. She has no systemic symptoms such as fever, weight loss or appetite loss.

The patient has a history of depression and has been taking Citalopram 20mg for the last 18 months. On examination her observations are all normal and her abdomen is soft and non-tender. A urine sample finds blood +++, but no leukocytes or nitrites.

What would you do next?

  1. Prescribe antibiotics and give safety-netting advice
  2. Send an MSU and review with the results
  3. Consider an abdominal/pelvic ultrasound scan
  4. Consider an abdominal/pelvic CT scan
  5. Refer the patient via the urology 2-week-wait pathway

How the Danish Beat the January Blues with Hygge

When the Christmas festivities come to an end, the emotional toll of the holidays isn’t always over, especially for people living with cancer. This time of year can leave many people feeling low or a bit let down. Several factors are thought to contribute to the January blues and these are often only exacerbated by the health anxieties often felt by people with cancer, not to mention the side effects of cancer treatment often including fatigue and lethargy. The Danish practice of hygge encourages a positive state of mind and encompasses several key elements such as creating a cosy, safe environment and switching off to spend time with loved ones.

Breast Lumps in Pregnancy

” The GP agreed there was a definite lump but I was told because I was under the age of 30 and pregnant, I won’t be referred as it’s likely to be changes to the breast experienced during pregnancy. If it was still there in 4 weeks I should return and they would consider referring me. However, it didn’t sit right to wait another 4 weeks. I think I waited 2 weeks in the end and called my surgery. The second doctor said she would send a standard referral which could take 4-6 weeks. Thankfully the next day I received a phone call from the hospital who booked my appointment for me just 3 days later. Luckily it has been caught nice and early and I am so hopeful! My cancer journey starts now and I don’t know what exactly it will look like, but had it not been for CoppaFeel! I wouldn’t have ever known to check my boobs. I’m very much looking forward to welcoming my baby girl and planning a pretty epic 30th birthday next year!”

Every year roughly 200 women in the UK are diagnosed with breast cancer whilst pregnant. Pregnant women diagnosed with breast cancer are more likely to be diagnosed at a late stage than women who are diagnosed in the general population.


Olga, a 52 year old woman, presents to you with a 3 month history of intermittent lower abdominal pain and bloating. This is the first time Olga has ever experienced this combination of symptoms. She has not noted a pattern to her symptoms and denies any relation to meals, or consumption of particular food. Olga denies any other abdominal or bowel related symptoms, including PR bleeding, and is otherwise feeling well. She has not lost any weight and denies having fevers. She went through the menopause at 50 years old and denies any gynaecological symptoms, including post menopausal bleeding. Olga has no significant past medical history or family history, has never smoked and rarely drinks alcohol.

On examination, her abdomen is not distended and is soft and non tender. Nil masses or organomegaly are felt. Speculum and bi-manual examination is normal. Observations are all normal and her weight is stable.

What would you do next?

  1. Ask the patient to keep a symptom diary and review in 4 weeks
  2. Order a routine set of blood tests, including CA125
  3. Order an urgent CA125 and FIT test
  4. Order a routine abdominal ultrasound scan
  5. Refer the patient via the Gynaecology 2 week wait pathway


For people living with cancer, the typically joyful Christmas period can be a particularly exhausting time. There are several factors that many may not even consider that can make Christmas a difficult time of year for people affected by cancer.

Click the link below to find some top tips to share with your cancer patients and their loved ones about coping with cancer at Christmas


Target Ovarian Cancer, one of our fantastic charity supporters, recognise how difficult this time of year can be for women with ovarian cancer and their families and friends. The charity offer a free e-learning module, developed in partnership with RCGP, for GPs as well as a range of downloadable resources.

Click below to read more about the support Target Ovarian Cancer are offering this Christmas and to access the e-module and resources

Cases corner – 65yr old man with mouth ulcer

Peter, a 65yr old man presents to you with a 4 week history of an ulcer on the inside of his left cheek. He reports he first noticed the ulcer when he was brushing his teeth but the area is painless. He cannot remember any trauma to this area and he does not think it has changed in size. He is otherwise well and denies any other symptoms. Peter is an ex-smoker with a total exposure of 12 pack-years.

On examination there is a small circular ulcerated lesion that is white in colour on the inside of his left cheek. You do not find any other lesions within his oral cavity and you note he has poor dentition. There is no cervical lymphadenopathy and his weight is stable.

What would you do next?

  1. Adopt a watch and wait strategy and reassess in 2 weeks
  2. Make a routine referral to the Maxillofacial team
  3. Advise the patient to see his dentist
  4. Advise the patient to use over the counter choline salicylate gel and return if no improvement
  5. Refer on a 2 week wait head and neck pathway for suspected oral cancer


Black men are approximately twice as likely to get prostate cancer than white men in England. Black and Asian females, aged 65 years and over, are at a higher risk of cervical cancer compared to white females. It is vitally important that the experiences of cancer in BAME groups is properly understood. Yet, this understanding is hindered by lacking data relating to these communities.

Click the link below to find out more about inequalities surrounding race and cancer and the role of GPs in reducing these inequalities

Pancreatic Cancer Awareness Month

This Pancreatic Cancer Awareness Month, Pancreatic Cancer Action (PCA) are on a mission to increase awareness of the pancreas, what it does and pancreatic cancer.A recent survey PCA conducted found that 74% of people couldn’t name one symptom of pancreatic cancer. Survival statistics for pancreatic cancer have not changed markedly in nearly 50 years, with less than 7% surviving 5 years.

Click below to read more about the message Pancreatic Cancer Action would like to share with GPs and for access to their CPD accredited e-learning module!


Yolanda, a 39yr old woman, presents to you with a 6 week history of a lump in her left axilla. She reports she first noticed this when in the shower but assumed it was due to an ingrown hair. Yolanda reports the lump is painless, has not changed in size and she denies any discharge from the lump. She has not noticed any change to either of her breasts and is otherwise feeling well. She denies any fevers or weight loss. Yolanda has no significant past medical history or family history, has never smoked and rarely drinks alcohol.

On examination, there is a 1.5cm lesion that is hard and non-mobile in her left axilla. The area is not tender on palpation with no overlying erythema. Nil of note is found when examining the right axilla. A breast examination finds diffuse nodularity of both left and right breast, but no discrete lesion is found. There is no cervical or inguinal lymphadenopathy. Her observations are all normal.

What do you do next?

  1. Adopt a watch and wait response and review the lesion in 4 weeks
  2. Order a routine ultrasound scan
  3. Order an urgent ultrasound scan
  4. Order an urgent ultrasound scan and blood tests (including full blood count)
  5. Refer the patient via a breast 2 week wait pathway

Are any of your patients using IQOS devices?

The IQOS website states they “offer a choice of better alternatives to smoking”. Unlike e-cigarettes, IQOS devices contain tobacco. However, the devices only heat the tobacco, rather than burning the substance like in traditional cigarettes. In theory, this reduces exposure to cancer-causing toxicants.

Click the link below to find out whether the increasingly popular IQOS devices are safer than cigarettes, whether they can help adults quit smoking and more!

Anthony Nolan supporting GPs to diagnosis blood cancers earlier

Blood Cancer Awareness Month has recently come to an end and Anthony Nolan have been, and continue to support GPs to reduce the number of times a patient visits them with haematological symptoms before a blood test is undertaken. Ultimately, supporting the early diagnosis of blood cancer.

The charity are also working to emphasize the important role of primary care post-transplant and the need for GPs to partner with the local transplant centre for optimal patient care.

Click below to read more about the message Anthony Nolan would like to share with GPs!

Cases corner – 24 YEAR OLD WITH BRUISING

Olivia, a 24 year old woman, presents to you with a 4 week history of excessive bruising. She first noticed a couple of bruises on her right leg, but could not remember a specific injury that caused them. Since then she has also noted some bruising on her left arm after a person with a large rucksack bumped into her on the tube and an unexplained bruise on her left ankle. Olivia denies any other symptoms and is otherwise feeling well. She does not drink alcohol, lives on her own and does not have a partner. Her last consultation was 14 months ago when she presented with symptoms of otitis externa.

On examination observations are normal, there is no organomegaly or lymphadenopathy. Olivia has various bruises of different sizes and age on her limbs.

What do you do next?

  1. Reassure the patient but offer safety net advice
  2. Order a routine set of bloods including FBC, U+Es, LFTs and clotting screen
  3. Order an urgent FBC (within 48hrs)
  4. Arrange for immediate admission under the haematologists
  5. Refer the patient via the Haematology 2 week wait pathway


Hundreds of people have come down with a mysterious lung illness believed to be linked to vaping. It has been reported that up to 6 people have died from the illness in the US. As a result, the CDC have recommended that the usage of e-cigarettes be stopped immediately.

What are the symptoms of the mystery lung illness? What is believed to be the cause? Is vaping killing people in the UK? What should doctors be recommending?

Click the link below to find out the answers to these questions and more!


The Oesophageal Patients Association (OPA), one of our latest charity supporters, is an independent charity formed by former oesophageal cancer patients. The group finds tremendous reassurance through sharing experiences.

Click below to read more about the OPA and don’t forget to signpost your patients to their amazing support and resources through the tool!


Tom, a 28 year old man, presents to you after his partner asked him to come in to be seen. He assures you he personally hasn’t notice anything, but his partner thinks that one testicle may be bigger than the other. He is not sure for how long as they only noticed it last week. He’s not sure but thinks it’s always been like that. You take a detailed history but he has no other symptoms, past medical history or family history of note. On examination, you note that the left testicle is bigger than the right, and the shape is slightly differently although still smooth. There is no swelling, tenderness or localised lymphadenopathy.

What do you do next?

  1. Reassure Tom that there are no sinister features on examination, the fact he doesn’t have any symptoms is reassuring and give him safety netting advice
  2. Refer Tom for an ultrasound of the testis
  3. Organise a routine referral to Urology
  4. Organise an urgent 2-week-wait urology referral


A study reported that frequent masturbation by men in their 20s was associated with an increased risk of developing prostate cancer, but that it lowered the risk for men in their 50s. This finding was linked to high levels of male sex hormones potentially increasing the risk of prostate cancer.

Several studies have investigated this question with varying outcomes.


John, a 58 year old man, presents to you worried about a mole on his back. It hasn’t bothered him before, and only noticed it because his wife saw it and asked him to get it looked at. He doesn’t know if it’s grown or changed in size; he responds with ‘Maybe it has.’ It’s not itchy and it’s never bled.

He reports his father had skin cancer when he was alive which was small cell carcinoma (of the nose). He has lived in the UK most of his life and worked on a building site. He has paid very little attention to his skin and seldom wears any skin protection. He doesn’t smoke. He mentions that he has a couple of other moles, so if you have time to check them out too.

You examine the patient: he has a pale complexion and you see the lesion here (there are no signs of bleeding/oozing or surrounding skin changes):

What would you do next?

  1. Reassure the patient that it is very unlikely to be sinister and review for changes in 4 weeks
  2. Refer on a non-urgent skin pathway for a suspected basal cell carcinoma
  3. Refer on a 2-week-wait skin pathway for suspected squamous cell carcinoma
  4. Refer on a 2-week-wait skin pathway for suspected melanoma


It is estimated that cervical cancer kills 2 people every day in England. It is predicted that if all eligible women attended their smear test, 83% of cervical cancer cases could be prevented. 

It has been 10 years since reality TV star, Jade Goody, lost her life to cervical cancer. Following her death, the number of women who attended their cervical screening increased by half a million. However, the Jade Goody effect now appears to have waned, as attendance reaches a 20-year low.

Click the link below to read more about the impact Jade Goody’s death had on cancer prevention and what is now being done to rebuild the effect.


“The last thing GPs want is to alarm patient unnecessarily by suggesting that they could have cancer, so having access to something constructive like a symptoms diary to record things in a standard way could help us to unravel what’s going on, and ultimately, save precious time in getting patients the care they need.”


Jane is 44-year-old women who attends with a 1-week history of dysuria. This is her fourth presentation in the last 8 months with lower urinary tracts symptoms. With each episode a urine sample was sent for microscopy and culture – which came back positive for a simple bacterial infection. She has previously completed three courses of antibiotics which resolved her symptoms. Subsequent MSUs have been negative in between episodes. She is afebrile and does not have any systemic symptoms. She is asymptomatic between episodes. You organise a urine dip which is positive for nitrites only. Examination and observations are unremarkable. There is no past medical history, drug history or family history of note.

What should you do next?

  1. Send the urine to the lab and prescribe a short course of antibiotics for a lower urinary tract infection
  2. Send the urine to the lab and book a follow-up with the patient to treat following review of results
  3. Send the urine to the lab, prescribe antibiotics and organise urgent bloods including a full blood count
  4. Send the urine to the lab, prescribe antibiotics and refer the patient under a 2-week-wait haematological referral

Cannabis – Does it Cure Cancer?

Several studies have assessed the potential role of THC and CBD, the two main cannabinoids found in the cannabis plant, in the treatment of cancer. Varying results have been reported and several questions remain unanswered. With the rising popularity of CBD oil, click the link below to read more about current findings and the potential role of cannabis in cancer treatment.


Around 15% of ovarian cancers are caused by inherited genetic faults, known as BRCA1 and BRCA2. 7 in 10 people have never heard of the BRCA gene mutations. This in turn means that many people are unaware of their cancer risk and therefore denied the opportunity to take potentially life-saving preventative measures.

Ovarian Cancer Action, The Eve Appeal, Ovacome and BRCA Umbrella have joined together in a new campaign to increase both patient and GP awareness of hereditary cancer.Click the link below to read more and find details about how to request a physical copy of the BRCA awareness poster for your practice.


David, a 38 year old man, presents to you with a 4 week history of change in bowel habit. He previously opened his bowels once a day, with normal soft brown stools. Now he opens them anywhere between once and four times a day. He denies any change in colour, or the presence of blood or mucous. The consistency now ranges between normal stool to liquid. He denies any appetite loss, nausea, vomiting, abdominal pain, weight loss or any other symptoms. He has not changed his diet and has had no recent travel history. He has no significant past medical history and does not take any regular medication. His observations and examination are unremarkable.

What should you do next?

  1. Ask the patient to keep a food diary and to review in 2 weeks
  2. Investigate for inflammatory bowel disease with blood tests and a faecal calprotectin
  3. Request a routine stool test for MC&S
  4. Request a faecal immunochemical test (FIT)
  5. Refer the patient using a routine lower GI referral
  6. Refer the patient via a 2-week-wait lower GI pathway

Pride matters – even in cancer

Current evidence suggests that cancer screening coverage is lower in lesbian, gay, bisexual and transgender (LGBT) communities. Pride offers an important opportunity to raise awareness of the inequities in cancer which exist among the LGBT community.

Click the link below to read more about screening coverage and receiving a cancer diagnosis within the LGBT community!

Raising awareness of ‘Red Flag’ symptoms this Sarcoma Awareness Month

The Bone Cancer Research Trust is the leading charity dedicated to fighting primary bone cancer. This Sarcoma Awareness Month they aim to increase awareness of the ‘red flag’ symptoms of primary bone cancer among GPs.

Click the link below to access an awareness pack for your practice, leaflets and a video of patients sharing their own experiences!


Jenny,a 29 year old woman, presents with a 5 month history of bleeding during sexual intercourse. She denies any inter-menstrual bleeding or pain with intercourse. She has never experienced this before. She has a long term partner and uses barrier contraception only. Her menses are regular and her last smear was 2 years ago which was negative for any abnormal cells. She denies any discharge, abdominal pain or urinary symptoms.

You examine her and note an inflamed and erythematous cervix, but no lesions/masses with no bleeding on examination. You take a swab.

What should you do next?

  1. Reassure Jenny that she has a cervical ectropion which is very common and to call her to relay the swab results
  2. Advise Jenny that although her cervix is inflamed, given the normal smear, she is very unlikely to have cervical cancer
  3. Refer Jenny for a trans-vagina ultrasound scan
  4. Organise a 2-week-wait gynaecology appointment for further evaluation for cervical cancer


Myeloma is the 3rd most common blood cancer with around 5,700 new cases diagnosed every year in the UK. Myeloma patients experience some of the longest delays to diagnosis of all cancer patients. Early diagnosis, via GP referral, is associated with improved one-year survival compared to emergency admissions.

Click the link below to find out about Myeloma UK’s Early Diagnosis Programme and how you, as a GP, can support this!

What is Immunotherapy & Why is the New CAR-T Therapy so Revolutionary?

As I am sure you have seen in the news this week, adults with lymphoma have been successfully treated with a new form of CAR-T therapy at King’s College Hospital. Clinical trials have found 40% of patients had all signs of their otherwise untreatable, terminal lymphoma, eliminated from their body after 15 months of treatment.

Click the link below to find out more about immunotherapy and the revolutionary new CAR-T therapy.


James, a 54 year old man, presented to you with a 2 day history of an acutely painful left calf. He denied any preceding symptoms, injuries, immobility or any chest symptoms. He is usually fit and well. You screened for any risk factors for a thrombosis but find nothing. He is a non-smoker, not on any medication, and has no relevant family history. You referred to ambulatory care for a same day appointment for a query DVT (Deep Vein Thrombosis).

The following week, the same patient presents for a review. He had a left leg DVT confirmed and had been started on rivaroxaban by the hospital and discharged. James asks you why he got the DVT?

What should you do next?

  1. Reassure James that DVTs are common and he is on the best treatment
  2. Safety-net James and advise that if he develops any further symptoms to come back and see you
  3. Refer James to haematology for further evaluation
  4. Conduct a thorough assessment to find an underlying cause for the DVT


A 5 year old girl named Jane presents with Mum who is very worried about Jane. For the past year she often gets tired, likes to sleep a lot and is a very fussy eater. Mum reports that since being a baby it has been very hard to get Jane to put any weight on. She reports no pain or weight loss. She was born at term and up to date with her immunisations with no relevant past medical history or family history.

Alan, a 46 year old man who works as a carpenter, presents to you with a three week history of hoarseness. He denies any cough or infective symptoms. He is a non-smoker and reports heavy drinking. He denies any respiratory symptoms. You ask about a sore throat or any pain and he only reports discomfort with no pain. He denies any difficult swallowing or gastrointestinal symptoms. His weight is stable and he has no symptoms of fatigue or appetite loss.

He came in one month ago and saw colleague for a ‘health check up.’ At the time he was asymptomatic and routine bloods were organised which were unremarkable. He has no past medical history to note and does not take any medication. You conduct an examination of the oropharynx which is unremarkable, with no cervical lymphadenopathy.

What should you do next?

  1. Reassure the patient that it is likely self-limiting but to come back if it persists for more than 4 weeks
  2. Refer the patient for a full blood count
  3. Refer the patient for a chest x-ray
  4. Refer the patient for a 2-week-wait suspected cancer referral


“It was back in the summer of 2017. I had a bit of a cough and also felt tight chested. Given the time of year, I just presumed it was pollen related. However, when my cough got worse and I started experiencing breathlessness, which is very unusual for me. I returned to my doctors and asked for a chest x-ray, and subsequent CT scan. It was then that I received my diagnosis – stage 4 lung cancer.”


A 2017 study found smoking among adults in the UK to be the lowest since records began in the 1940s. Despite this, 7.4 million adults in the UK still smoke and with approximately 50% of smokers predicted to die prematurely, there remains 3.7 million associated premature deaths in the UK.

Cases corner – 5 year old with concerned parent

A 5 year old girl named Jane presents with Mum who is very worried about Jane. For the past year she often gets tired, likes to sleep a lot and is a very fussy eater. Mum reports that since being a baby it has been very hard to get Jane to put any weight on. She reports no pain or weight loss. She was born at term and up to date with her immunisations with no relevant past medical history or family history.

You look at her growth charts and she has been on the 35th centile since she was born and has remained within that range. There is no evidence of weight loss and examination of all systems are unremarkable. She seems playful today and well kept.

There are no concerns regarding the social welfare of Jane. You scan the notes and see this is Mums third visit with Jane. Previous GPs have referred to the health visitor and dietician. Mum reports no improvement and is clearly very anxious. You probe her and she admits she is worried of underlying leukaemia.

What should you do next?

  1. Reassure Mum that Jane has no signs for concern and give clear instructions for safety netting when to bring Jane back
  2. Organise a blood test for Jane
  3. Refer Jane for a routine paediatric referral
  4. Consider referring Jane along a suspected cancer referral pathway


Oesophageal cancer is the 7th most common cause of cancer death in the UK.

Around 70% of oesophageal cancer cases are adenocarcinoma, where there is a strong association with persistent heartburn and dysplastic Barrett’s Oesophagus. This is where a past history of apparently resolved  persistent heartburn can be relevant.

Action Against Heartburn is a campaign by 18 charities with an interest in promoting the earlier diagnosis of oesophageal cancer. One main target is the regular customers of over-the-counter heartburn remedies such as Gaviscon.

C the Signs – Double award winners

We are delighted to tell you that C the Signs has won two awards in the last month!

We are extremely proud to have won the Mayor of London’s MedTech Business award in recognition of our collaborative working with the NHS. This award highlights how C the Signs brings together clinicians, charities and patients.

It was also an honour to have been recognised by Amazon for the secure state of the art infrastructure behind the C the Signs Tool.


Mr L, a 52 year old man, presents to you ”not feeling well”. He can’t articulate what he means but describes mild nausea. He denies any other symptoms including abdominal pain, change in bowel habit, rectal bleeding or difficulty swallowing. He says that he weighed himself this morning as his clothes were much looser and he has lost about 10kg over the last 3 months or so. His examination is unremarkable.

What should you do next?

  1. Do not refer the patient, but offer safety-netting
  2. Perform a non-urgent upper GI endoscopy
  3. Perform a CT of the abdomen within 2 weeks
  4. Perform a FIT test
  5. Refer the patient via a 2-week-wait pathway


When diagnosed at stage 1, 90% of people with bowel cancer will survive for at least five years. This is compared to a survival rate of less than 10% when diagnosed at stage 4. Bowel cancer screening reduces bowel cancer mortality by detecting the disease in early (often pre-symptomatic) stages. A guaiac-based faecal occult blood test (gFOBT) has always been the type of bowel cancer screening used in the UK. However, the gFOBT is now being replaced by a Faecal Immunochemical Test (FIT).


“You have cancer.” Friday 13th May 2011 at 11am my life fell apart. Three words that changed my life forever. A treatment plan was currently being discussed with me, but I couldn’t stop thinking “I am going to die”. Every piece of information I was given during this appointment went over my head and my mind had gone blank with shock.

Cases corner – 30 year old with change in bowel habit

Jane, a 30 year old women, presents with an 8 month history of change in bowel habit and abdominal pain. She describes the abdominal pain as a constant, dull ache with no localising features. Her bowels go from regular, to constipated to loose. She denies any rectal bleeding, weight loss, nausea or vomiting. She reports no dietary changes and has kept a food diary for you to review. Her periods are regular. She has no past medical history to note, is a non-smoker and has no relevant family history. You conduct an abdominal examination and a pelvic examination which is unremarkable. She is up to date with her smear tests.

What should you do next?

  1. Organise an abdominal and pelvic ultrasound
  2. Organise a coeliac screen, inflammatory markers and a full blood count
  3. Order a Ca125
  4. Order a Faecal Immunochemistry Test (FIT)
  5. Diagnose her with Irritable bowel Syndrome


Every year, over 46,000 people will be told they have lung cancer. Just over a third will then get to live for a year or more.

Late diagnosis plays a significant part in this; around three quarters are diagnosed in the late stages when curative-intent treatment is no longer possible.

So, we need to diagnose earlier. Simple. If only it was that easy.


Have you ever had a patient ask, ‘How do I get to all of my appointments whilst living with the side effects of cancer treatment?’ or ‘Can I still drive with my brain tumour?’

We work collaboratively with numerous cancer charities to empower GPs to answer these questions quickly and confidently. There is no need to reinvent the wheel, as they say. Rather than us spending time creating our own support resources for patients, we collaborate with existing charities to raise awareness of the fantastic support already available. In the same vane, our tool prevents GPs from spending valuable consultation time searching for answers or appropriate patient support, by quickly directing them to relevant resources.

Cases corner – 7 year old with unsteadiness

A 7 year old boy named James presents with his mum after falling at school. You ask him what happened, and he reports that he felt unsteady and think he tripped. He did not experience any other symptoms. He is currently asymptomatic and feels well in himself. There was no loss of consciousness or head injury. James has had an unremarkable birth history, with no past medical history of note.

You conduct a cardiovascular examination which is unremarkable. A neurological examination, demonstrates an ataxic and unsteady, which his mum confirms is new. There are no other deficits or dysfunction.

What should you do next?

  1. Organise a routine referral to the paediatric team for further evaluation
  2. Reassure Mum and advise her to bring him back for review in 2 weeks with adequate safety netting
  3. Organise an urgent referral to the paediatric team (within 48 hours)
  4. Refer the child to accident and emergency


Despite more men that women dying from cancer in the UK in 2016, it is predicted cancer prevalence among women will increase six times faster than in men over the next 20 years.

Public campaigns have raised awareness of the lifestyle choices which can impact cancer risk, yet it is less clear from these campaigns that these choices are affecting women significantly more so than men. This articles hopes to highlight this disparity in honour of International Women’s Day.

Shining a light on – Target Ovarian Cancer

1 in 5 women in England are too ill to be treated by the time they receive their ovarian cancer diagnosis.

Delays, which include women not knowing the symptoms, gaps in GP knowledge and delays in getting the right diagnostic tests all contribute to these women being too ill by the time they are diagnosed to withstand the invasive surgery and chemotherapy needed to treat ovarian cancer.

At the moment these delays risk leaving many women facing no option other than palliative or end of life care.

Cases corner – 56 year old with vaginal discharge

Mrs P, a 56 year old woman, presents to you with a 1 month history of vaginal discharge. She reports no evidence of blood, pruritus, dysuria or dyspareunia She is up to date with her smear tests. She denies any other symptoms. Her last menstrual period was 4 years ago. She has a BMI of 30. You conduct an examination which is unremarkable. She has never experience vaginal discharge before.

What should you do next?

  1. Reassure and ask her to come back if she develops any new symptoms
  2. Advise over the counter clotrimazole and to come back if there is no improvement in 2 weeks
  3. Send swabs to rule out an infection
  4. Refer patient for a trans-vaginal ultrasound Scan

C the Signs – An NHS England case study

It is an honour to be featured as a Case Study of good practice for the early diagnosis of cancer and patient survival by NHS England. Since our pilot in Sutton CCG, we are now working with 130 GP practices across 4 CCGs and have over 500 primary care health professionals using the decision support tool.


Unfortunately, in the UK the instances of people being impacted by ‘cancer poverty’ are rapidly rising. As we are all aware, a mobile phone is no longer a luxury, but a necessity – particularly when you are dealing with a cancer diagnosis. SimPal, a young and innovative charity, is providing mobile phones and pre-paid sim-cards for people affected by cancer. Currently there is no other service like this in the world.

How do we get to 3 in 4 people being diagnosed early with cancer?

Last week, the C the Signs Team were proud to present a poster about our progress at Cancer Research UK’s Fifth Biennial Early Diagnosis Conference. The conference took place over three days and celebrated the research from the last decade, alongside the implementation of evidence into policy and practice.


Jane, a 34 year old women, presents with a 2 week history of a right sided breast lump she found incidentally in the shower. The lump is non-tender and mobile. She reports regular menses and is due her next period in 4 days. There is no relevant past medical history or family history of breast cancer. She reports she commonly experiences bilateral mastalgia before her period. On examination you confirm the presence of a 2x2cm mobile lump on the right upper quadrant of her right breast. There is no associated lymphadenopathy.

What should you do next?

  1. Safety net the patient and ask her to come back in two weeks
  2. Reassure the patient and advise her that the if the lump remains after her period to come back for review
  3. Refer the patient for a non-urgent breast referral
  4. Referral the patient along an urgent 2-week-wait breast referral


Every day in the UK 34 young adults are told the life shattering words ‘you have cancer’, stopping them in their tracks. Trekstock is working hard to be here for each and every one of them.

The state of screening in the UK

Last week the BBC published an article exploring the deteriorating state of screening in the UK. The programmes can save lives by detecting cancer at an early stage, prior to symptoms developing. The UK has three main screening programmes for bowel, breast and cervical cancer. Here we explore some of the complex issues involved.


A 21 year old women presents with new onset symptoms of crampy lower abdominal pain, bloating and increased flatulence. She reports experiencing these symptoms on average 3-4 x a week. Her diet is mainly fast food and can bee erratic since she started university 6 months ago. The symptoms are not related to any particular foods and she is opening her bowels normally with no rectal bleeding. Her weight is normal. No symptoms of fatigue or clinical signs on examination.

What would you do next?

  1. Reassure her that her symptoms are suggestive of IBS with safety netting advice
  2. Order baseline bloods, FBC, U+E, LFT and reassure if normal
  3. Order a CA125 to evaluate her risk of ovarian cancer and a FIT test for low risk colorectal cancer
  4. Organise an abdominal ultrasound scan and Ca125
  5. Offer dietary advice, gut health and recommend a food diary

Dry January is not really about January

Dry January, the campaign set up by Alcohol Change, challenges participants to give up alcohol for a month. The initiative has now been running for six years, with increasing numbers of people participating each year. This January 1.1 million more people than last year vowed to give up alcohol. Rather than a campaign about giving up alcohol forever, Dry January asks the social drinker to reflect on their drinking habits and to give their body a break from their normal drinking routine (especially after the festive period)!

This article explores the potential long-term benefits of Dry January and why the message behind the campaign ought to be considered throughout the year.

A 21-year low on Cervical Cancer Screening in England

Cervical cancer affects women of all ages. There are currently over 49,000 women living with or beyond the diagnosis in the UK, with a further 3,000 diagnosed every year.

We know that one day we can eliminate this cancer. This is through the HPV vaccination and cervical screening programmes that we are fortunate to have – with screening providing the best protection against the disease. Worryingly though, attendance for screening is falling year on year and is at a 21-year low in England alone. This means our vision of making cervical cancer a disease of the past is getting further away.

Cases corner – 62 years old with back pain

Mr K, a 62 year old man, attends with persistent upper back pain for the last 3 months. He denies any other symptoms and denies radiation of the pain. On examination, the pain is elicited on firm pressure over the vertebral body.

What would you do next?

  1. Reassure him and offer safety-netting advice if he deteriorates
  2. Request a full blood count, serum calcium and erythrocyte sedimentation rate (ESR)
  3. Request protein electrophoresis
  4. Request serum immunoglobulins
  5. Refer the patient along a 2-week-wait pathway to haematology


In December, C the Signs visited 10 Downing Street to discuss the impact C the Signs has been having and how it can improve the early diagnosis of cancer. This week we welcome the publication of NHS England’s much awaited Long Term Plan to tackle the challenges the NHS is going to face in the coming years. Here we take a look at the cancer priorities and what it means for primary care.


As 2019 begins I am sure many of us will be setting ‘New Year’s resolutions’, as will be the case for many of your patients. Quitting smoking is one of the most popular health-related resolutions, but also one of the least successful, with the Royal Society for Public Health reporting quitting smoking to be the most difficult resolution to keep (and by some margin). In the New Year of 2016, of those who resolved to quit smoking, 3 in 5 were smoking again by the end of January 2016 and just 13% had stuck to their resolution by the end of the year.

Make Every Contact Count – Tackling Obesity

Obesity is the second biggest preventable cause of cancer in the UK, with Cancer Research UK reporting that more than 1 in 20 cancer cases are caused by excess weight. The risk increases with the more weight a person gains and the longer they are overweight for. Yet small changes that are maintained long-term can make a significant difference. Making every contact count (MECC) is an approach to behaviour change that utilises daily interactions to encourage others to make a behaviour change which would have a positive effect on health. This is an important initiative run by NHS Health Education England which can be implemented by GPs to encourage patients to lose weight.


Mr X, a 19 year old man, presents to you with a one week history of lumps in his groin. He is otherwise well, denying any fever, sore throat, appetite loss, pain, urethral discharge, urinary frequency or dysuria. On examination you note generalised lymphadenopathy (cervical, axilla and groin). There is no evidence of pharyngitis and his spleen is not palpable.

What would you do next?

  1. Reassure him and offer safety-netting advice if he deteriorates
  2. Request a very urgent full blood count
  3. Request an urgent blood film
  4. Refer the patient along a 2-week-wait pathway to haematology
  5. Refer the patient immediately to hospital

Loneliness this Christmas

In 2016, approximately 400,000 people with cancer in the UK reported feeling lonely over the festive period. MacMillan Cancer Support reported that 16% of cancer patients felt that the Christmas and New Year period was one of the loneliest times of the year, equalling that of the anniversary of the death of a loved one.

Several factors may contribute to feelings of loneliness among people living with cancer over Christmas, but there is support available for these people over the festive period.

Read about why this time of year can be particularly lonely and some examples of support to recommend to your patients.

Shining a light on – Samaritans

For more than 60 years, Samaritans volunteers have been there for anyone who is struggling. During December 2017, Samaritans responded to more than 400,000 calls for help by phone, email and text throughout the UK and Ireland. Despite the festivities, more than 11,000 of those calls for help and emotional support came in on Christmas Day, with a third dealing with loneliness and isolation.

Samaritans volunteers will be making sure there’s a listening ear day and night again this year for anyone who’s feeling overwhelmed and needs to talk, throughout the festive period.

Cases corner – 8 year old boy with a rash

An 8 year old boy presents to you with his mum, with a 2-day history of a spreading rash over his lower limbs. He is otherwise well with no other symptoms. There is no evidence of confusion, neck stiffness, photophobia or fever. He has previously been fit and well and is up to date with his immunisations. His observations are all within the normal range. You examine his lower legs and see the following rash on his feet and legs. Otherwise, the examination is unremarkable.

What would you do next?

  1. Reassure his mum and offer safety-netting advice if he deteriorates
  2. Refer the patient for an urgent full blood count (within 48 hours)
  3. Refer the patient for a full blood count (within 2 weeks)
  4. Consider urgently referring the patient to a specialist within 48 hours
  5. Refer the patient immediately to hospital

GPs need to be encouraged to become gate openers rather than asked to be gate keepers

On Tuesday 4th December, C the Signs was invited to present at the Britain Against Cancer 2018 Conference, hosted by the All Party Parliamentary Group on Cancer. C the Signs outlined the challenge GPs face in primary care with rising demand and the pressure they are under as gatekeepers, the need for better straight to test pathways and why GPs aren’t the barrier to early diagnosis.

Shining a light on – BOOBS!

CoppaFeel! is an education charity on a mission to educate young people on the signs and symptoms of breast cancer, encourage them to get to know their boobs/pecs and empower them to visit their GP if they spot something abnormal.

“I have lost count of the number of times I have heard a woman say that her GP kept telling her that she was ‘too young’ to have womb cancer”

On 23rd December 2009, I was diagnosed with womb cancer. The diagnosis came out of the blue. I was being seen by a gynaecologist for fibroids when an MRI scan picked up the cancer. I had never heard of “endometrial carcinoma” and actually had to ask where exactly the cancer was. I know now that this happens to many other women.

Cases corner – 50 years old with thrombocytosis

Mr D, a 50 year old man, attends for his annual health check. He is currently fit and well and his examination is unremarkable. A urine dipstick is negative. You perform routine bloods as part of your assessment. The results of this show an abnormal platelet count of 620 x10⁹/L. His previous blood test 6 months ago, was normal. A repeat 2 weeks later is also raised at 624 x10⁹/L.

What would you do next?

  1. Reassure, as patient is asymptomatic, and safety net if symptoms arise to comeback
  2. Re-book patient for a repeat platelet count in 3 months
  3. Refer for a chest x-ray
  4. Refer under a 2-week-wait pathway to haematology for further investigation

Shining a Light on – Pancreatic Cancer Action

Pancreatic cancer is the 5th biggest cause of cancer death in the UK. However, it is set to become the 4th biggest by 2026 as other cancers’ survival rates continue to improve. The survival statistics for pancreatic cancer have not changed significantly in nearly 50 years, with less than 7% surviving 5 years. Pancreatic Cancer Action is the only UK charity that specifically focuses on early diagnosis of the disease.

"I went to the GP that morning with non-specific symptoms and I was admitted to hospital that night with a confirmed diagnosis of Chronic Myeloid Leukaemia"

On Friday 19th January 2007 I received a phone call that would change everything. I went to the GP that morning with non-specific symptoms including lack of concentration, weight loss, fatigue and I had nearly fainted twice that week. I was sent for a blood test and was told to come back next week. I was admitted to hospital that night with a confirmed diagnosis of Chronic Myeloid Leukaemia. I was 22. To say this was a very unexpected shock is an understatement!

Cases corner – 62 year old with dysuria and urinary frequency

Mrs G, is a 62 year old female, who presents to you with a two month history of urinary frequency and polydipsia. She has also noticed that her clothes feel looser. She is otherwise well in herself with no other symptoms. You perform a random plasma glucose which is 13 mmol/L. You also weigh her and she’s 7 kg lighter than last year (last recorded weight).

What would you do next?

  1. Confirm the diagnosis of diabetes and start treatment
  2. Refer the patient to endocrinologist
  3. Refer the patient along a 2-week-wait pathway
  4. Refer the patient for a CT scan of the pancreas

“Could this patient have cancer and how best should I investigate this possibility?”

C the Signs is a clinical decision support tool that makes my life as a GP so much easier. When faced with the clinical dilemma of “Could this patient have cancer and how best should I investigate this possibility?”, C the Signs offers me a tool that I can use during the consultation to check the best options available to me.

Born out of humour – Cancer on board

James was diagnosed with stage 3 cancer of the tonsil at the age of 44. The difficulties he experienced when accessing public transport for his appointments led him to start Cancer on Board.

“We joked with each other that we should pretend we were pregnant, so that people would offer us seats on the tube”

Cases corner – 65 years old with haematuria

Mrs B, a 65 year old woman, presents to you with a 2 week history of visible haemturia. She denies any other symptoms. Examination is unremarkable, but the blood tests you requested show an iron deficiency anaemia. A urine sample confirms visible haemturia and a culture is negative for infection.

Which cancer is Mrs B at risk of? (more than one may apply)

  1. Bladder
  2. Colorectal
  3. Endometrial
  4. Lung
  5. Renal

Shining a Light – The Brain Tumour Charity

Every day, 31 people in the UK are diagnosed with a brain, spinal or other intracranial tumour. The Brain Tumour Charity provides a variety of services online, over the phone and face-to-face to support as many people as possible.

News – C the Signs announces £1,000,000 award from SBRI Healthcare, an NHS England Initiative

We are delighted and honoured to be awarded £1m in funding from SBRI Healthcare. This funding will be transformative in how we diagnose patients with cancer, using our technology. Early diagnosis of cancer has the potential to save more lives than any cancer treatment in history. Using C the Signs technology, patients can be identified at the earliest and most curable stage of the disease. The future of cancer is survival.