How cancer is diagnosed and treated is very different depending where in the body it comes from. Please select the button below for more information about the type of cancer that you are interested in.
Cancer of unknown primary means doctors don't know where the cancer first started. They have found cancer has spread. This is called secondary cancer. It is when it is found in another part of your body.
Cancer of unknown primary can develop at any age. But almost 60 out of 100 cases (almost 60%) are in people over the age of 75.
Please select a box below for more information about this. Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail.
What normally happens when cancer develops?
The place a cancer starts to develop is the primary site. Cells from this primary site may break away. They spread to other parts of the body. This can happen through the bloodstream or lymphatic system. These escaped cells can then grow. They form other tumours. These are known as secondary cancers or metastases.
Doctors name and treat cancers depending on where they first started. This is even if they have spread to other parts of the body. For example, if a bowel cancer has spread to the liver, it is called bowel cancer with liver metastases or secondaries. This is rather than liver cancer. This is because the cancerous cells in the liver are cancerous bowel cells. They are not liver cells that have become cancerous. Doctors confirm this by looking at the cells under the microscope.
Cancer of unknown primary (CUP) means that cancer spread has been found in your body (secondary). However, your doctors can't find where the cancer started (primary). It is sometimes called unknown primary cancer or unknown primary tumour.
Why might a primary cancer not be found?
Sometimes there are different reasons why doctors can't find a primary cancer. They don’t always know for certain why and how this happens. This might be because:
- the secondary cancer has grown very quickly, while the primary cancer is still very small. The very small cancers might not cause symptoms or be seen on scans.
- your immune system has attacked the original primary cancer. It may have disappeared. All while the secondary cancer is still growing (this is not common, but it can happen).
The most common places for secondary cancers to be found are:
- the lungs
- liver
- bones
- lymph nodes
- skin
How can doctors tell that someone has cancer of unknown primary (CUP)?
Doctors can often tell the type of cancer by what the cells look like. They are looked at under a microscope. For example, cells taken from a tumour in the lung might look like breast cancer cells.
This is how the doctor knows it is breast cancer that has spread to the lung, rather than a cancer that started in the lung.
Sometimes cancer cells don’t look like any particular type of normal cell. The cells are abnormal. They might not have become specialised enough. This can make it very difficult for the doctor to tell what kind of cell the cancer started from.
Symptom management
Symptoms of CUP depend on where the cancer has spread to in your body. Possible symptoms of CUP include:
- weight loss
- sickness and loss of appetite
- weakness or feeling very tired
- pain
- breathlessness
- a cough that won't go away
- swollen lymph nodes
These symptoms listed here are more often caused by other medical conditions. But if you have any of them it is important to see your doctor. Click here to read more on symptom management.
Types of cells and cancer
Most cancers are cancers of the epithelial cells. Epithelial cells are found in the skin. They are also in tissues that line or cover the internal organs. Cancers that start in epithelial tissue are called carcinomas. Most cancers of unknown primary are types of carcinoma.
Other types of cancer develop from different types of body cell.
They include:
- sarcomas which develop from cells of the connective and supportive tissue. These can be bones, muscle, fat, blood vessels or other soft tissues.
- leukaemias, which are cancers of white blood cells found in the bone marrow
- lymphomas, which are cancers that begin in cells of the immune system
- Click here to read more about different cell types and cancer
Service leaflets
Cancer of unknown Primary Nurse Specialist
Video
Click here to watch a video for more information about Cancer of Unknown Primary and local STSFT service.
Useful websites
The attached websites are useful regarding Cancer of Unknown Primary.
Cancer of unknown primary (CUP) | Cancer Research UK
Unknown primary cancer (CUP) (christie.nhs.uk)
What is your thyroid?
The thyroid is a small gland in the front of your neck. It is just below your voice box (larynx) with your windpipe above it. It is shaped like a butterfly and it is made up of 2 lobes (left and right). These lobes are connected by a thin piece of thyroid tissue which is called the isthmus.
Lymph nodes are on either side of the thyroid gland and under the chin. These nodes are carefully joined together by fine tubes called lymph vessels.
The thyroid gland is positioned close to the parathyroid glands. Although they have similar names, they do different jobs.
What does your thyroid gland do?
The thyroid gland is part of the endocrine system. This system makes the hormones that help to control the way the body functions. The thyroid gland makes the following hormones:
- thyroxine (T4)
- triiodothyronine(T3)
Thyroid hormones T3 and T4
The thyroid gland needs a regular supply of iodine to produce thyroid hormones. We get iodine from our diet. It is mainly found in fish, seafood and dairy products. Some types of salt also contain iodine, but they are not commonly used in the UK. These hormones keep the body functioning at the right pace.
Types of thyroid cancer
There are different types of thyroid cancer. The most common types are papillary and follicular thyroid cancer. These types of thyroid cancer together are called differentiated thyroid cancer (DTC).
Palillary - This is the most common type of thyroid cancer. It is usually slow-growing. Papillary thyroid cancer can affect anyone. It is more common in younger people and women.
Follicular - This is a less common type of thyroid cancer and tends to be mostly found in middle-aged people.
Other types of thyroid cancer
Medullary - Medullary thyroid cancer (MTC) is a rare type of thyroid cancer which can sometimes run in families.
Anaplastic - Anaplastic thyroid cancer is a very rare type of thyroid cancer which is very fast-growing.
Symptom Management
The most common symptom of a thyroid cancer is a painless lump in the neck. Most thyroid lumps are not cancerous (benign). But it is always important to get any lump checked.
Other symptoms include:
- a hoarse voice that has no obvious cause and does not go away after a few weeks
- difficulty swallowing – caused by a thyroid tumour pressing on the gullet (oesophagus)
- difficulty breathing – caused by a thyroid tumour pressing on the windpipe (trachea)
- pain in the front of the neck.
Always make an appointment to see your doctor if you have any of these symptoms. Different types of thyroid cancer may have other symptoms.
Always contact your Cancer Nurse Specialist during working hours. For anything urgent call NHS 111 or attend Emergency Department (ED)
Click here for more information on symptom management.
Important things to remember
- You will have lifelong follow up and regular blood tests to review your thyroid levels.
- Your scar after surgery will improve overtime and is usually in the natural folds of your neck. Camouflage make up can be used to help in the early stages speak to your nurse if any concerns.
Service Leaflets
Parathyroid Gland and Calcium after Total Thyroid Surgery
Levothyroxine after Total Thyroid Surgery
Radioiodine Treatment Information Leaflet
MDT Key Members - Patient Information List
Nurse Led Thyroid Cancer Follow up Clinic
Nurse Led Thyroid Cancer GP Information
Videos
The following links to videos from STSFT and Newcastle Hospital about Thyroid Cancer.
Butterfly Thyroid Cancer Trust: Project RAI Update 2017
Butterfly Thyroid Cancer Trust: QR Code Thyroid Cancer Information Video
Useful Websites
These websites are useful for different aspects of Thyroid cancer information:
Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail.
For a short video from our team about this type of cancer and your local service click here.
What is head and neck cancer?
Doctors do not know the exact causes of head and neck cancers. But there are risk factors that can increase your chance of developing it.
The main risk factors for head and neck cancers are tobacco and alcohol. It is thought that about 3 out of 4 head and neck cancers (75%) are linked to tobacco or alcohol use.
Many cancers at the back of the tongue and in the tonsils (cancers of the oropharynx) are linked to infection with a type of virus called human papilloma virus (HPV).
Having one or more risk factors does not mean you will get a head and neck cancer. Also, having no risk factors does not mean you will not develop a head and neck cancer. More information can be found here.
Head and neck cancer is a relatively uncommon type of cancer. Around 12,000 new cases are diagnosed in the UK each year. There are more than 30 areas within the head and neck where cancer can develop.
They include the:
- mouth and lips
- salivary glands
- voice box (larynx)
- nose and sinuses
- throat (pharynx)
- area at the back of the nose and mouth (nasopharynx)
It is important to remember that Oesophageal (gullet) cancer, thyroid cancer, brain tumours and eye cancer don't tend to be classified as a head and neck cancer.
Below is further information on types of Head and Neck cancers.
Mouth cancer
Mouth cancer is the most common type of head and neck cancer. It can affect a number of areas in and around the mouth, including the:
- Lips
- Tongue
- Inside of cheeks
- Floor or roof of mouth
- Gums
Symptoms of mouth cancer can include persistent mouth ulcers and/or a lump in the mouth, both of which may be painful. Click here to find out more about mouth cancer.
Laryngeal cancer
Laryngeal cancer develops in the tissue of the larynx. This is also known as the voice box.
Symptoms of laryngeal cancer can include:
- a change in the voice, such as persistent hoarseness
- difficulty or pain when swallowing
- noisy breathing
- persistent cough or sore throat
- shortness of breath
- a lump or swelling in your neck
Click here to find out more about laryngeal cancer.
Salivary gland cancer
Salivary glands produce saliva, which keeps your mouth moist and helps with swallowing and digestion. There are 3 main pairs of salivary glands.
They are the:
- parotid glands – located between your cheeks and your ears
- sublingual glands – located under your tongue
- submandibular glands – located under each side of your jawbone
Salivary gland cancer most commonly affects the parotid glands. The main symptom of salivary gland cancer is a lump or swelling on or near your jaw or in your mouth or neck. Although the vast majority of these lumps are non-cancerous.
Other symptoms can include numbness in part of your face and drooping on one side of your face. Click here to read more.
Nose and sinus cancer
Nose and sinus cancer affects the nasal cavity. This is above the roof of your mouth and the sinuses. These are the small cavities inside the bones of the nose and within the cheekbones and forehead. The symptoms of nose and sinus cancer are similar to viral or bacterial infections. These can include the common cold or sinusitis.
Look out for:
- a persistent blocked nose, which usually only affects 1 side
- nosebleeds
- a decreased sense of smell
- mucus running from the nose or down the throat
Read more about nose and sinus cancer.
Nasopharyngeal cancer
Nasopharyngeal cancer affects the part of the throat that connects the back of the nose to the back of the mouth. It's one of the rarest types of head and neck cancer in the UK. Symptoms can include:
- a lump in the neck, due to the cancer spreading to the lymph nodes (pea-sized lumps of tissue that make up part of the immune system) in the neck
- a blocked or stuffy nose
- nosebleeds
- hearing loss (usually only in 1 ear)
Read more about nasopharyngeal cancer.
Service Leaflet
Head & Neck MacMillan Clinical Nurse Specialist leaflet
Videos
The following links are to videos covering a range of topics around head and neck cancer care.
Skincare following Radio Therapy
Patient experience Tonsil cancer
Useful speech and language videos.
The National Association of Laryngectomy Clubs
LaryngectomyOrg - Talking it through part 1
LaryngectomyOrg - Talking it through part 2
Macmillan Speech and Language Therapist Kelly Jackson-Waite talks about speech therapy for people who have difficulties with swallowing or speaking due to head and neck cancer.
Communication after total laryngectomy
"You can get your voice back!" - John's laryngectomy TEP valve story
Speech using a voice prosthesis after a laryngectomy
Useful Websites
The attached websites are useful information for different aspects of head and neck cancer.
Head and neck cancers booklet - Macmillan Cancer Support
Head and neck cancer | Cancer Research UK
The Swallows Head & Neck Cancer Support Group (nottshncs.nhs.uk)
There are a many different features of Colorectal cancer.
Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail. For a short video from our team about this type of cancer and your local service click here.
What is colorectal cancer?
The bowel is part of our digestive system. It is divided into the small bowel and large bowel. The large bowel is made up of three areas. These are called the colon, rectum and anus. The term Colorectal cancer or bowel cancer is often used to talk about these together.
If you are diagnosed with bowel cancer, it means you have one of the cancers listed above. If you are not sure which type, ask your GP, cancer doctor or specialist nurse for more information. Bowel cancer is one of the most common types of cancer diagnosed in the UK. Most people diagnosed with it are over the age of 60.
Signs and Symptoms of bowel cancer
The three main symptoms of bowel cancer are:
- persistent blood in your poo. That happens for no obvious reason or linked with a change in bowel habit.
- a persistent change in your bowel habit. Usually having to poo more. Your poo may also become more runny.
- persistent lower abdominal (tummy) pain, bloating or discomfort. This is always caused by eating. It may linked with loss of appetite or weight loss which has not been part of a diet, exercise or lifestyle change.
Other health problems can cause similar symptoms.
For example:
- blood in the poo when associated with pain or soreness is more often caused by piles (haemorrhoids)
- a change in bowel habit or abdominal pain is usually caused by something you've eaten
- a change in bowel habit to going less often, with harder poo, is not usually caused by any serious condition. It may be worth trying laxatives before seeing a GP
These symptoms are less likely to be a sign of cancer. But they should be taken more seriously as you get older and when they continue. You should see a GP if you are worried about these symptoms.
Tests and scans
The tests you are given will depend on your symptoms, your general health and the type of bowel cancer you may have.
Tests may include:
- Rectal examination
- Blood test
- Colonoscopy
- Virtual colonoscopy
- Sigmoidoscopy
- Biopsy
Click here to read more.
Service Leaflets
Attached are information leaflets regarding the local services.
Colorectal Cancer Nurse Specialist/Key Worker Leaflet
Colorectal Nurse Led Follow Up Clinic
NCA supported self-management patient information booklet
Your guide to looking after yourself after surgery
Videos
The following links to videos cover a range of topics around Colorectal cancer care.
The Role of the Colorectal Cancer Nurse Specialist Jane Barnes
Overview of Bowel Cancer Mr Krishna
How we diagnose bowel cancer Mr Krishna
Useful Websites
The attached websites are useful for different aspects of bowel cancer information.
Understanding bowel cancer screening - Macmillan Cancer Support
Are you worried about bowel cancer - Macmillan Cancer Support
Signs of cancer - easy read - Macmillan Cancer Support
Rectal cancer | Booklet - Macmillan Cancer Support
Bowel cancer (including rectal cancer and colon cancer) - Macmillan Cancer Support
Colon cancer booklet - Macmillan Cancer Support
Managing the late effects of bowel cancer treatment | Booklet - Macmillan Cancer Support
Anorectal melanoma - Macmillan Cancer Support
Bowel Cancer UK - A UK based charity that is dedicated to supporting people affected by bowel cancer. They offer information and advice on all aspects, from signs and symptoms to living with and beyond bowel cancer. They campaign for service improvements and fund essential research into improving prevention, earlier detection and better treatment of bowel cancers. Bowel Cancer UK also covers anal cancers.
Lung cancer is one of the most common and serious types of cancer. Around 47,000 people are diagnosed with the condition every year in the UK. Lung cancer is the leading cause of cancer deaths worldwide. 4 out of 10 people diagnosed with lung cancer in the UK are aged 75 and older.
Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail. For a short video from our team about this type of cancer and your local service click here.
What are the signs and symptoms of lung cancer?
There are usually no signs or symptoms in the early stages of lung cancer. Many people with the condition eventually develop symptoms including:
- a persistent cough
- coughing up blood
- persistent breathlessness
- unexplained tiredness and weight loss
- an ache or pain when breathing or coughing
You should see a GP if you have these symptoms.
What are the types of lung cancer?
Cancer that begins in the lungs is called primary lung cancer. Cancer that spreads to the lungs from another place in the body is known as secondary lung cancer.
There are two main forms of primary lung cancer.
These are classified by the type of cells in which the cancer starts growing.
They are:
- non-small-cell lung cancer. This is the most common form, accounting for more than 87% of cases. It can be one of three types. These are squamous cell carcinoma, adenocarcinoma or large-cell carcinoma.
- small-cell lung cancer. This is a less common form that usually spreads faster than non-small-cell lung cancer.
The type of lung cancer you have determines which treatments are recommended.
How do you treat lung cancer?
Treatment depends on the type of mutation – changes - the cancer has. It depends on how far it's spread . Your team will also look at how good your general health is. If the cancer is diagnosed early and the cancerous cells are in a small area, surgery to remove the affected area of lung may be what will be best for you.
If surgery is unsuitable, you may be offered radiotherapy. Chemotherapy is usually offered if the cancer has spread too far for surgery or radiotherapy.
There are also a number of other medicines. These are known as targeted therapies. They target a specific area in or around the cancer cells that is helping them to grow. Targeted therapies cannot cure lung cancer. But they can slow its spread. Survival rates vary widely. This depends on how far the cancer has spread at the time of diagnosis. Early diagnosis can make a big difference.
Lung cancer is treated in different ways. This depends on the stage of cancer, whether it has spread outside of the lung and on your general health.
Treatment for lung cancer - Macmillan Cancer Support
Tumour Ablation for Lung Cancer
Additional cancer treatments for Lung Cancer Roy Castle
What are the symptoms if cancer has spread to your lymph nodes?
Lymph nodes are part of a system of tubes and glands in your body. They filter body fluid and fight infection. The most common symptom if cancer has spread to the lymph nodes is that they are usually bigger than normal. But lymph nodes also can get bigger if you have an infection.
So you can't be sure of the cause of a lump until your doctor has examined you. They will do some tests. Tell your doctor if you find any lumps or swollen areas. This is important if they are in your neck or armpits.
What are the symptoms if lung cancer has spread to your brain?
Lung cancer can spread to the brain causing the symptoms below.
Tell your doctor or cancer nurse specialist if you are experiencing any of the symptoms below.
- drowsiness and confusion
- severe headaches, often with sickness
- weakness of an arm or leg
Service Leaflets
Here are our information leaflets.
Lung Cancer Nurse Specialist/Key Worker
Videos
The following links are to videos on a range of topics around lung cancer care.
Investigations & Diagnosis of Lung Cancer
Useful Websites
The attached websites are useful information on different aspects of Lung cancer care.
Breast cancer is the most common type of cancer in the UK. Most women diagnosed with breast cancer are over the age of 50. But young women can also be diagnosed with it.
Please select a box below for more information. Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail.
Causes of breast cancer
The exact causes of breast cancer are not fully understood. However, there are certain factors which are known to increase the risk of breast cancer. These include:
- age – the risk increases as you get older
- a family history of breast cancer
- a previous diagnosis of breast cancer
- a previous non-cancerous (benign) breast lump
- being tall, overweight or obese
- drinking alcohol
Click here to find out more breast cancer in women.
What are the symptoms of breast cancer?
Breast cancer can have several symptoms. But the first noticeable symptom is often a lump or area of thickened breast tissue. Click on the link below for more information.
Common symptoms
- Breast lump or area of thickened breast
- a change in the size or shape of one or both breast
- a lump or swelling in either of your armpits
- a change in the look or feel of your skin, such as puckering or dimpling, a rash or redness
- a rash like eczema, crusting, scaly or itchy skin, or any redness on or around the nipple
- discharge or bleeding from one or both nipples
- a change in the appearance of your nipple, such as becoming sunken into your breast
It is worth noting that Breast pain without other symptoms is not usually a symptom of breast cancer.
Useful websites
Videos and podcasts
The following links to Podcasts from the Queen Elizabeth Hospital Gateshead cover a range of topics around breast cancer care:
Breast Cancer Awareness Month - Breast Screening
Gynaeoncology & breast cancer trials
Videos
Breast care Nurses Michelle Derbyshire & Rachel Lockerbie explain what happens in a one stop clinic
Know your breast - how to check for signs of breast cancer
Northern Radiotherapy Network Information Videos
What Does Male Breast Cancer Look Like and How it can be Treated? - with Dr Tasha
Ian's Story | Men & Breast Cancer | Prevent Breast Cancer
Tests and scans
Stage and grade of breast cancer
When breast cancer is diagnosed, your doctors work out what stage it is. The stage means the size of the cancer and how far it has spread. We use staging information to help us plan the right treatment. It will also help understand what the aim of treatment is and how well treatment may work.
TNM staging system
The TNM staging system describes breast cancer. It provides information about the diagnosis: T – the size of the tumour N – whether the cancer has spread to the lymph nodes M – whether the cancer has spread to other parts of the body
This information is then summarised as a stage.
Ductal carcinoma in situ (DCIS) is sometimes described as stage 0. Other stages of breast cancer describe invasive breast cancer and include:
- stage 1 – the tumour measures less than 2cm and the lymph nodes in the armpit are not affected. There are no signs that the cancer has spread elsewhere in the body
- stage 2 – the tumour measures 2 to 5cm, the lymph nodes in the armpit are affected, or both. There are no signs that the cancer has spread elsewhere in the body
- stage 3 – the tumour measures 2 to 5cm and may be attached to structures in the breast, such as skin or surrounding tissues, and the lymph nodes in the armpit are affected. There are no signs that the cancer has spread elsewhere in the body
- stage 4 – the tumour is of any size and the cancer has spread to other parts of the body (metastasis)
This is a simplified guide. Each stage is divided into further categories: A, B and C. If you're not sure what stage you have, talk to your doctor or cancer nurse specialist.
Grades of breast cancer
The grade describes the appearance of the cancer cells, this often tells us how useful different treatments may be.
- low grade (G1) – the cells, although abnormal, appear to be growing slowly
- medium grade (G2) – the cells look more abnormal than low-grade cells
- high grade (G3) – the cells look even more abnormal and are more likely to grow quickly
Breast Cancer specific tests
Once a diagnosis of Breast cancer is made there are additional tests that are done to the cancer specimen in the laboratory. This will help understand better how your cancer may respond to treatment. The results of these tests can give your doctors a more complete picture of the type of cancer you have. It will help them look at how to treat it.
Hormone receptors
In some cases, breast cancer cells can be encouraged to grow by hormones that occur naturally in your body. These areas oestrogen and progesterone.
We may say that your Breast cancer is:
- ER positive – which means your cancer has receptors that are sensitive to oestrogen
- ER negative – which means your cancer does not have any of these oestrogen receptors
- Or mildly ER positive – in that your cancer has receptors and responds to oestrogen to only a small extent.
- PR positive – which means your cancer has receptors that are sensitive to oestrogen
- PR negative – which means your cancer does not have any of these oestrogen receptors
- Or mildly PR positive – in that your cancer has receptors and responds to oestrogen to only a small extent.
If your Cancer is ER or PR positive, we may talk to you about hormone manipulation treatment. If your cancer is mildly ER / PR positive we may still talk about whether this may be a treatment option for you.
HER2 testing
Another test that is done in the laboratory looks to see if your cancer has HER2 receptors, meaning that your cancer may be encouraged to grow by a protein called human epidermal growth factor receptor 2 (HER2).
If your cancer is HER2 positive we may recommend a treatment with a medicine that blocks the HER2 receptors so that the HER2 protein is stopped from encouraging your cancer to grow. This is known as targeted therapy.
Click here to read more on diagnostics.
Genetic Testing in Breast Cancer
These links tell you about genetic testing in breast cancer. If you would like further information, please contact the Institute of Genetic Medicine at Centre for Life Telephone 0191 2418600 or email geneticcounsellorenquiries@nhs.net
Breast Cancer Now -Genetic testing for altered breast cancer genes
Macmillan Cancer Support -Family history, genes and cancer risk
Breast Examination
Breast self-examination is the best way to find any changes in the breast. While many changes in the breast are not cancer you should discuss any changes with your cancer team. Or you can talk to your GP if you do not have a breast cancer diagnosis. They will decide if further tests are needed.
How should I check my breasts? There's no right or wrong way to check your breasts. But it's important to know how your breasts usually look and feel. That way, you can spot any changes quickly and report them to a GP or your cancer team.
Be breast aware
Every woman's breasts are different in terms of size, shape and consistency. It's also possible for one breast to be larger than the other. Get used to how your breasts feel at different times of the month. This can change during your menstrual cycle. For example, some women have tender and lumpy breasts, especially near the armpit, around the time of their period. After the menopause, normal breasts feel softer, less firm and not as lumpy. The NHS Breast Screening Programme has produced a 5-point plan for being breast aware.
- know what's normal for you
- look at your breasts and feel them
See a GP or your cancer team if you notice any of the following changes:
- a change in the size, outline or shape of your breast
- a change in the look or feel of the skin on your breast, such as puckering or dimpling, a rash or redness
- a new lump, swelling, thickening or bumpy area in one breast or armpit that was not there before
- a discharge of fluid from either of your nipples
- any change in nipple position, such as your nipple being pulled in or pointing differently
- a rash (like eczema), crusting, scaly or itchy skin or redness on or around your nipple
- any discomfort or pain in one breast, particularly if it's a new pain and does not go away (although pain is only a symptom of breast cancer in rare cases)
Always see a GP or your cancer team if you are concerned.
Breast changes can happen for many reasons, and most of them are not serious. Lots of women have breast lumps, and most breast lumps are not cancerous. However, if you find changes in your breast that are not normal for you, it's best to see a GP or your cancer team as soon as possible. This is because it's important to rule out breast cancer. If cancer is detected, then appropriate treatment should be planned as quickly as possible.
Breast Screening
Woman between the ages of 50 and 70 years are invited to take part in the National Breast screening programme receiving Mammograms every three years. This is an important test that can diagnose Breast cancer at an early stage
If you have been diagnosed with Breast cancer, depending upon the surgery that you have had you may have additional breast screening every year for the first five years after your surgery or until you are aged 50. After that time you will be invited to go back into the national breast screening programme. Your Cancer nurse specialist will be able to tell you more about your individual screening plan post breast cancer.
Click on the links below to get further information and support.
Breast Screening
Woman between the ages of 50 and 70 years are invited to take part in the National Breast screening programme. This will mean they have a mammogram every three years. This is an important test. It can help diagnose breast cancer at an early stage
If you have been diagnosed with breast cancer, depending upon the surgery you have had, you may have additional breast screening every year. This will be for the first five years after your surgery. Or it will be until you are aged 50. After that time you will be invited to go back into the national breast screening programme. Your Cancer nurse specialist will be able to tell you more. They will be able to tell you about your individual screening plan post-breast cancer.
Click on the links below to get further information and support.
Useful Websites
Useful Websites
Breast Cancer Now: What to expect at a breast clinic appointment
Cancer Research UK: diagnosing breast cancer
Macmillan Cancer Support: how breast cancer in women is diagnosed
GOV.UK: breast screening information leaflets
Triple negative breast cancer | Macmillan Cancer Support
Service leaflets
Follow up care after treatment for breast cancer
Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail.
You can also find further information on gynaecological cancers in the sections below.
What are gynaecological cancers?
Gynaecological cancer is any cancer that starts in a woman’s reproductive organs.
There are 5 main types of gynaecological cancer.
What are the 5 Gynaecological cancers?
The 5 main types of gynaecological cancer are: cervical, ovarian, uterine, vaginal, and vulva. A sixth type of gynecological cancer is the very rare fallopian tube cancer.
- Cervical cancer begins in the cervix. This is the lower, narrow end of the uterus. The uterus is also called the womb.
- Ovarian cancer begins in the ovaries. These are located on each side of the uterus.
- Uterine cancer begins in the uterus. This is pear-shaped organ in a woman’s pelvis where the baby grows when she is pregnant.
- Vaginal cancer begins in the vagina. This is the hollow, tube-like channel between the bottom of the uterus and the outside of the body.
- Vulva cancer begins in the vulva. This is the outer part of the female genital organs.
Each gynecological cancer is unique,. It has different signs and symptom. They have different risk factors. This means things that may increase your chance of getting a disease. They will also have different prevention strategies.
All women are at risk for gynecological cancers. Risk increases with age. When gynecological cancers are found early, treatment is most effective.
Videos
The following links to videos cover a range of topics around Gynaecology cancer care
The role of the CNS specific to Gynae
Service Leaflets
Gynae Oncology Clinical Nurse Specialist
Patient initiated follow up after finishing radiotherapy and surgery for Endometrial Cancer
Useful Websites
The attached websites are useful for different aspects of Gynaecology cancer information.
Vulval cancer - Macmillan Cancer Support
Vaginal cancer - Macmillan Cancer Support
Womb cancer - symptoms, stages, causes and treatment - Macmillan Cancer Support
Ovarian cancer - Macmillan Cancer Support
Cervical cancer - stages, symptoms, diagnosis, treatment - Macmillan Cancer Support
Haematology cancers or blood cancer is a type of cancer that affects your blood cells.
Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail. For a short video from our team about this type of cancer and your local service click here.
What are the types of blood cancer?
There are different types of blood cancer.
Please follow the links below. They will offer more information from Blood Cancer UK:
Each one of the above have different symptoms, treatments and prognoses. If you've recently been diagnosed with any type of blood cancer, click here to order a free booklet or download 'Your blood cancer diagnosis - what happens now?'. It tells you the key things to know about blood cancer. It includes tips from other people who have been diagnosed.
Acute and chronic blood cancers
You might see blood cancers described as:
- acute – this means a fast-growing cancer
- chronic – this means a slower-growing cancer
What are the signs and symptoms of blood cancers?
Blood cancer symptoms vary depending on the type of blood cancer. This is whether it's leukaemia, lymphoma, myeloma or any other blood cancer.
Blood cancer symptoms include:
- Weight loss that is unexplained
- Bruising or bleeding that is unexplained
- Lumps or swellings
- Shortness of breath (breathlessness)
- Drenching night sweats
- Infections that are persistent, recurrent or severe
- Fever (38°C or above) that is unexplained
- Rash or itchy skin that is unexplained
- Pain in your bones, joints or abdomen (stomach area)
- Tiredness that doesn’t improve with rest or sleep (fatigue)
- Paleness (pallor)
Click here to look at more specific information about symptoms for different types of blood cancer. Not everyone will have the same symptoms. Some people may have symptoms that are not listed on this page.
Symptoms in different skin tones
Some symptoms of blood cancer may look different on different skin tones.
- Bruises generally start as red patches which change colour and get darker over time. They often feel tender. On black and brown skin, bruises may be difficult to see initially. But as they develop, they show up as darker than the skin around them.
- Rashes often appear as clusters of tiny spots (petechiae) or larger blotches (purpura). On black and brown skin, they may look purple or darker than the surrounding skin. On lighter skin, they typically look red or purple. If you press on them, petechiae and purpura don’t fade.
- Paleness (pallor) might mean someone looks unusually pale because they have too few red blood cells. Pallor is often more immediately noticeable in light skin. People with black or brown skin may look greyish and their palms may look paler than usual. They might also notice pallor in their lips, gums, tongue or nail beds. In all skin tones, pallor can be seen by pulling down the lower eyelid. The inside is normally dark pink or red, but if it’s pale pink or white, it’s a sign of pallor.
We'd like to thank the ACLT (African Caribbean Leukaemia Trust) for their help reviewing this information. ACLT raises awareness about stem cell, blood and organ donation in all UK communities, with a focus on the African and Caribbean communities. You should see a GP if you have these symptoms.
Haematology Services
Our Haematology Service is the clinical speciality involved in the diagnosis and management of patients with blood-related disorders.
- Leukaemia
- Lymphoma
- Myeloma
- Myelodysplastic syndromes (MDS)
- Myeloproliferative neoplasms (MPN)
- Haematological disorders
We have links to regional centres at Newcastle upon Tyne Hospitals NHS Foundation Trust and Gateshead Queen Elizabeth hospital. We are involved in specialised care planning within the northern region. This is a plan the best care possible for our patients. This will include trials that may also be available. Trust for haematological malignancy and haemophilia when appropriate.
There are two aspects to this service: laboratory and clinical. Laboratory haematology is carried out by biomedical scientists. They analyse blood samples. They work closely with clinical haematologists to discuss the results.
The clinical service consists of:
- inpatient care on a specialised ward with trained haematology staff at Sunderland Royal Hospital
- day cases for chemotherapy investigations
- therapeutic interventions at South Tyneside and Sunderland ward referrals and outpatient clinics.
Our aim is to provide the best cancer care closer to home throughout the region.
The laboratory supports the hospital and local GPs. This is by offering a range of haematological investigations and a blood transfusion service.
A 24 hour consultant advisory service covers both the laboratory and clinical services. There is always a haematologist available on call 24 hours per day.
On both sites there are purpose-built outpatient clinics and day case / chemotherapy clinics. Inpatient facilities are available at Sunderland. We have isolation rooms with heap-air filtration to protect patients with low immune systems.
Our consultant-led service has dedicated clinical nurse specialists, additional specialist nursing support and therapies. All of these provide comprehensive care throughout the patient's journey.
Contacting your Specialist Nurse/Key Worker
Contact numbers are detailed on the specialist nurse’s card. This is given at your first meeting.
Your Specialist Nurse will be available Monday to Friday from 8.30am to 4.30pm. If they are not available to take your call, there is an answer phone service for you to leave a message. When using this service, please leave your name and telephone number. The answer phone is checked regularly throughout the day. Your specialist nurse will always try to return your call within the next working day.
Your specialist nurse is happy to be contacted to discuss anything you feel is important. Your discussions will be confidential.
Useful contact numbers:
If you have any concerns, you may contact your Consultant or the specialist team by the telephone numbers below:
Urgent advice line:
- In Hours: Monday to Friday 8:15am – 18:45pm; Saturday 8:30am -14:30pm. Tel: 0191 5656256 Bleep 52524
- Out of Hours: 0191 5656256 bleep 57531
Please wait for a nurse to answer.
Your Consultant & Specialist Team
- Dr Marshall and Dr Upadhye secretary: Tel: 0191 5656256 ext. 47582
- Dr Hervey, Dr Mathews, Dr Nicolle secretary: Tel: 0191 5656256 ext. 47248
- Dr Chattree and Dr Graves secretary: Tel: 0191 5656256 ext. 47252
- Anita Carr Haematology Specialist Nurse (Myeloma): Tel: 07920708134
- Faye Marshall Haematology Specialist Nurse (Leukaemia and MPN): Tel 07876496750
- Jill Bell Haematology Specialist Nurse (Lymphoma): Tel: 07789948675
- Lisa Dryburgh Haematology Specialist Nurse: Tel: 07385394420
- Paula Newton/Jennie Jobling/Angela Dixon; Haematology Research Nurses: Tel: 0191 5656256 ext. 47264
- Phoenix Unit: Tel: 0191 5656256 ext. 49822
- OHDU: Tel: 01914041053
- B28 Inpatient Ward: Tel: 0191 5699728
Videos
The following links to Videos cover a range of topics around Haematology cancer care
Service leaflets
Haematology Specialist Nurse/Keyworker
Macmillan Understanding Myeloma
Myeloma (bone marrow cancer) (christie.nhs.uk)
Anaplastic large cell lymphoma
CLL Support Vaccination Leaflet
Receiving Irradiated Blood -Information for Patients
Receiving a Blood Transfusion Easy Read Leaflet
Receiving a Blood Transfusion Patient Information Leaflet -Translations
Toe Tapping Oncology (northumbria.nhs.uk)
Toe Tapping Generic (northumbria.nhs.uk)
Mental Health & Emotional Support for Children, Young People & Families in County Durham
Useful Websites
Blood Cancer UK Myeloproliferative Neoplasms
JPAC Receiving a Blood Transfusion Patient Information Leaflet -Translations
NHS Blood and Transplant -Transfusion FAQ's
Understanding stem cell transplants
Preparing for a stem cell transplant
Order or download publications
Preparing for Hospital Isolation e-booklet
Stomach cancer
The stomach is a stretchy, muscular bag, which stores food and helps to break it down (digestion). It is in the upper left-hand side of the tummy area (abdomen). An adult’s stomach is about 25cm long. But it can expand to hold about 1 litre of food. The stomach is at the bottom of the foodpipe (oesophagus). The other end of the stomach is joined to the bowel.
The stomach has three main parts, they are the:
- top (fundus)
- middle (body)
- bottom (antrum or pylorus)
At each end of the stomach there is a valve called a sphincter. These valves control the movement of food through the digestive system.
These are called the:
- cardiac sphincter - at the top joining the oesophagus to the stomach
- pyloric sphincter - which is at the bottom joining the stomach to the bowel
Cancer that develops in the stomach is called stomach cancer. Sometimes it is called gastric cancer. The risk of developing stomach cancer increases as we get older. Over half of the people who get Stomach cancer are 75 years or older. Stomach cancer is more common in men than in women.
Click here to read more.
Oesophageal cancer (Cancer of the gullet)
The Oesophagus is sometimes known as the gullet. It is part of the digestive system. We often call the digestive system the gastro-intestinal tract (GI tract). The oesophagus is a muscular tube. It connects your mouth to your stomach. In the UK, around 9,000 people are diagnosed with oesophageal cancer each year.
There are two main types of oesophageal cancer:
- Squamous cell carcinoma. This develops in the thin, flat cells of the oesophageal lining (the mucosa)
- Adenocarcinoma. This develops from glandular cells in the Oesophagus. It is often linked with Barrett’s oesophagus.
There are other, rarer types of oesophageal cancer.
These include:
- Poorly differentiated neuroendocrine cancer
- Small cell cancer
- Soft tissue sarcomas, such as gastro-intestinal stromal tumours (GISTs).
Knowing the type of oesophageal cancer you have helps plan your treatment. Cancer can develop anywhere in the oesophagus. Cancers in the upper or middle oesophagus are usually squamous cell cancer. Cancers in the lower oesophagus and including the place the oesophagus joins the stomach are usually adenocarcinomas.
To learn more click here to visit the Macmillan website or click here to watch a short video.
Gastro-intestinal Stromal Tumours (GISTs)
Gastrointestinal stromal tumours (GISTs) are rare cancers. They develop in the digestive system. They are a type of soft tissue sarcoma. Most GISTs start in the stomach or small bowel. But they can develop anywhere along the length of the digestive system.
This includes in the:
- Gullet (oesophagus)
- Back passage (rectum)
Very rarely, they can develop outside the digestive system. Every year, about 900 people in the UK are diagnosed with a GIST.
GISTs are most common in people who are aged 50 and over, and it is rare in people who are less than aged 40 years. Click here to read more.
Pancreatic cancer
The pancreas is an organ in the top part of your tummy. The pancreas helps you digest food, it makes hormones such as insulin to do this. Pancreatic cancer is a cancer that is found anywhere in the pancreas.
How we can treat pancreatic cancer depends upon:
- where it is in the pancreas
- what size it is
- how close it is to important blood vessels
- whether it has spread to other areas of your body
- your general health and fitness
Click here to read more and click here to watch a short video.
Take a look at an app Pancreatic Cancer UK have developed here
Liver cancer
The liver is the biggest organ in the body. It is in the upper right hand side of your tummy.
The liver has many important jobs.
It:
- stores sugars and fats to be made into energy for you
- makes proteins that help your blood to clot and prevents bleeding
- makes bile, which is used to break down fats so that they can be used by the body
- breaks down harmful substances.
The liver is good at repairing itself and it can work even if only a small part is working well.
Liver cancer starts in the liver. It is sometimes called primary liver cancer. Primary liver cancer is rare in the UK. Around 5,700 people in the UK are diagnosed a year. A cancer that starts somewhere else in the body and spreads to the liver is called secondary (metastatic) cancer. The Gastro-Intestinal team don’t look after these types of cancer. For information about this type of cancer please follow the links to your primary cancer for example breast or colon.
Click here to read more or click here to watch a short video.
Bile duct cancer
The Gallbladder and bile ducts are parts of the digestive system.
The gallbladder is a small pouch that stores bile
Bile ducts are the tubes that connect the liver and gallbladder to the small bowel and carry bile.
Bile is made by the liver. It is stored in the gallbladder and is used by the body to break down fats from food to help us digest this. The bile ducts and gallbladder together are known as the biliary system. This is sometimes called the biliary tree.
Gallbladder cancer is rare.
- Just under 1000 people in the UK are diagnosed with it each year.
- It is most common in people over 75 years of age.
- It is more common in women than men..
The types of bile duct cancer are named after the part of the bile duct where the cancer started.
- Intrahepatic bile duct cancers, around 1 in 10 of bile duct cancers (10%).
- Extrahepatic bile duct cancers
There are two types of extrahepatic bile duct cancers:
- perihilar bile duct cancers make up 5 in 10 bile duct cancers (50%)
- distal bile duct cancers make up 4 in 10 bile duct cancers (40 %)
Click here to read more about bile duct cancer and click here to read more about gallbladder cancer.
Useful links and leaflets
Websites
It is a UK based charity which campaigns for better awareness of pancreatic cancer. It aims to improve earlier detection rates. There is also plenty of information and advice for people who may be worried about pancreatic cancer. It is also helpful for people who have had a diagnosis.
This charity provides expert advice and support to people who are worried about pancreatic cancer. It also helps those who have just been diagnosed. It operates a support line. It offers online forums for discussion. The charity also funds vital research into improving how pancreatic cancer is diagnosed and treated. It leads campaigns for better awareness of the disease.
You only have one liver and it's important to look after it. It performs hundreds of essential tasks. These include processing digested food from the intestine, controlling levels of fats, amino acids and glucose in the blood and combating infections.
It raises public awareness. Its research shows 58% of people are embarrassed to talk about their digestive condition or symptoms. 51% of people delay seeking advice for their symptoms for more than 6 months. When the Guts UK roadshow comes to town, we empower people to seek help. Guts UK is the only UK charity funding research into the digestive system from top to tail. It provides expert information. When armed with information, patients can take control of their health and make informed decisions
Information leaflets
gastrointestinal stromal tumour
Service leaflets
Upper Gastro Intestinal & Hepato-Biliary Cancer Nurse Specialist/Keyworker
Upper Gastro Intestinal & Hepato-Biliary Cancer
Upper GI Clinical Nurse Specialist
Faster diagnosis Gastro-intestinal Pathway
Videos
The urology system is sometimes known as urinary tract. It is the body’s system that gets rid of waste. It keeps a check on blood volume. It keeps a check on your blood pressure. The urology system includes your kidneys, ureters (pipes from the kidney to the bladder) bladder and urethra (the pipe leading urine/wee from the bladder and out of your body). Cancer can grow in each of these areas. The urology team also look after cancers of the prostate and testes. They are also linked to this system.
The majority of urologic cancers are detected are found at early stages. This is when they are still in the organ. Diagnosing and treating cancers at an early stage can help improve good outcomes for patients. Cancers of the urinary tract (or urologic cancers) may be linked to environmental, lifestyle, genetic and other factors. Over the years, methods for finding and treating cancers have improved. Patients are now offered a range of options to suit their goals and needs.
Please select a box below for more information. Your Consultant or Cancer Nurse Specialist will be able to talk to you about your cancer in more detail.
Bladder Cancer
The bladder is a hollow and muscular organ. It collects and stores urine (wee). In the UK, over 10,000 people are diagnosed with bladder cancer each year. Bladder cancer is where a growth of abnormal tissue, known as a tumour, develops in the bladder lining. In some cases, the tumour spreads into the nearby muscles.
The most common symptom of bladder cancer is blood in your wee. This is usually painless.
The most useful test to diagnose bladder cancer is a cystoscopy. This is when a thin tube with a light on is put into your bladder. The doctor or nurse doing the test will take a close look at your bladder. They will make take a biopsy (small sample of the tissue).
Treatment of bladder cancer depends of the type of cancer you have. For non-muscle-invasive bladder cancer a surgical technique called transurethral resection of a bladder tumour (TURBT) is used. It removes the cancer cells. It is followed by a dose of chemotherapy medication. This is sent directly to the bladder.
Treatment for high-risk non-muscle-invasive bladder cancer, or muscle-invasive bladder cancer, may involve surgically removing the bladder. This operation is known as a cystectomy. As an alternative to removing the bladder, or if surgery is not suitable, a course of radiotherapy and chemotherapy may be recommended. Chemotherapy may sometimes be used on its own.
Kidney cancer
Kidney cancer, also called renal cancer, is one of the most common types of cancer in the UK. It usually affects adults in their 60s or 70s. It is rare in people under 50. It can often be cured if it's found early.
Prostate Cancer
Prostate cancer starts in the cells of the prostate. The prostate is a small gland that is just below the bladder and in front of the rectum (back passage).
What are the different types of prostate cancer?
- early prostate cancer (or localised prostate cancer) – the cancer is only inside the prostate gland
- locally-advanced prostate cancer – the cancer has spread through the capsule surrounding the prostate gland and may have started to spread into tissue or organs close by
- advanced prostate cancer (or metastatic prostate cancer) – the cancer has spread to other parts of the body, such as the bones.
If you are a trans woman or are non-binary assigned male at birth, you also need to be aware of prostate cancer.
What are the symptoms of prostate cancer?
Prostate cancer symptoms only happen when the cancer is large enough to press on the tube that carries the urine from the bladder (urethra). If the cancer is in the early stage it may not cause any symptoms.
The prostate gland can also become enlarged. This is due to a prostate condition called benign prostatic hyperplasia (BPH). This is non-cancerous.
The symptoms of benign (non-cancerous) prostate conditions and prostate cancer are similar.
They can include:
- needing to pee more often than usual, especially at night
- difficulty peeing – for example, a weak flow or having to strain to start peeing
- feeling like you have not completely emptied your bladder
- an urgent need to pee
- blood in your urine or semen
- rarely, pain when peeing or ejaculating.
If you have any of these symptoms, it is important to have them checked by your doctor.
What are prostate cancer risk factors?
Age
This is the strongest risk factor for prostate cancer. Your risk increases from the age of 50. It is uncommon under the age of 50. It is more common over the age of 65. Risk factors such as ethnicity and family history are linked with getting prostate cancer at a younger age.
Ethnicity
If you are Black, you have a much higher risk of developing prostate cancer. The reason for this is not clear. But it may be because of genetic factors. You are also more likely to develop prostate cancer at a younger age. If you are Black and aged 45 or over, Prostate Cancer UK has more information about your risk. It gives advice on talking to your GP about your risk of getting prostate cancer. It helps you to make decisions about having a PSA test. If you are Asian, your risk of prostate cancer is much lower. We do not know why this is.
Family history
Sometimes there may be a possible family link (inherited). The risk of prostate cancer is higher if you have:
- either a father or brother who had prostate cancer – the risk is greater if they were diagnosed under the age of 60
- 2 or more close relatives (father, brother, grandfather, half-brother, uncle) on the same side of the family who had prostate cancer
- a mother who had breast cancer
- inherited certain cancer gene changes (mutations).
Body weight and diet
Being very overweight (obese) may increase the risk of having a more advanced prostate cancer. It may also increase the risk of having a faster-growing type of prostate cancer. Eating a balanced diet and doing regular physical activity will keep you at a healthy weight.
What is the PSA test?
The PSA (Prostate-specific antigen) test is a blood test. Used with other tests it can help doctors diagnose prostate cancer. PSA is a protein made in the prostate gland. Some PSA leaks into the blood. It can be measured in the test. A small amount of PSA in the blood is normal. If the prostate becomes enlarged, inflamed, or infected, larger amounts of PSA get into the blood. The amount of PSA in the blood may also increase if there is cancer in the prostate. A raised PSA level may be a sign of prostate cancer. But it can also be caused by other things. These can include non-cancerous prostate conditions.
Who can have the PSA test?
If you are over 50, you can ask your GP for a PSA test. GPs do not routinely offer PSA testing as part of a general health check, or if you do not have any symptoms. If you ask for a PSA test, your GP will advise you to think carefully about the positive and negative sides of this. If you have a higher risk of prostate cancer, it is important to talk to your GP about your personal risk. This is even if you do not have any symptoms. Early prostate cancer does not usually cause symptoms. Talking to your GP can help you to make a decision about having a PSA test.
If you are transgender
People who have a prostate include men, transgender (trans) women and people assigned male at birth. If you are a trans woman and have had genital gender affirming surgery as part of your transition, you will still have a prostate. It is important to talk to your GP or nurse if you are worried about prostate cancer. Or you may have any symptoms and want to have the PSA test.
Is there a national screening programme for prostate cancer?
Screening is a way to try to find cancer early in people who do not have any symptoms. In the UK, there are screening programmes for breast, bowel, and cervical cancer. But there is no UK national screening programme for prostate cancer. The PSA test on its own is not accurate enough to be used in a screening programme to diagnose early prostate cancer. It may falsely diagnose prostate cancer. It may also miss some cancers. Some studies show that lives may be saved by PSA screening because it may lead to prostate cancer being diagnosed at an early stage.
But they also show that screening may lead to:
- more invasive tests, such as a prostate biopsy, which can cause complications
- more treatment of slow growing prostate cancers that would never have caused serious harm.
Treatment side effects include:
- urinary incontinence
- bowel problems
- or difficulty getting an erection.
For a screening programme to be effective, the benefits need to outweigh the disadvantages.
Why a PSA test is done
The PSA test may help to diagnose very early prostate cancer before any symptoms develop. There are benefits and disadvantages of having treatment for early prostate cancer. Sometimes a PSA test can lead to an earlier diagnosis of prostate cancer. This is when treatment to cure the cancer could be more effective. This is particularly the case if you have higher risk factors of prostate cancer. Some prostate cancers grow very slowly. With early prostate cancer, you are not likely to die from it within the next 10 years. For some people, the possible side effects of treatment may be worse than the effects of the cancer itself. You may decide you do not want to know if you have prostate cancer because of the anxiety or uncertainty it might cause you. You may not want further tests. Or you might not want to make difficult decisions about treatment. Or you may have concerns about the side effects of treatment. Some treatment for prostate cancer may cause urinary incontinence or bowel problems. They might affect your ability to get an erection.
Having the PSA test
If you decide to have the PSA test, your GP or nurse will take a blood sample. It will then be sent to a laboratory for testing. You can ask how long the result will take. If you are having the PSA test, you usually have a rectal examination as well. The doctor gently inserts a gloved finger, using lubricating gel, into your back passage (rectum). This is so they can feel the prostate. It may be uncomfortable, but it is quick and should not be painful.
PSA test results
There is not one normal PSA level for everyone. The PSA level naturally gets higher as you get older. It varies depending on the size of your prostate. The size of the prostate is different for everyone. The prostate also gets bigger with age. There are different things that can affect the PSA level. For example, non-cancerous prostate problems or a urine infection. Hospitals may have normal ranges for PSA testing based on age. But they do not consider all these other factors.
What is a normal PSA level?
Your GP will think about different things when assessing the results of your PSA test. They will tell you if they think your PSA result is higher than it should be for your age and situation. PSA is usually measured in nanograms per millilitre of blood (ng/ml). If your PSA level is, for example, 3 ng/ml or higher (depending on your age and situation), you may be referred to see a specialist. Or your GP may recommend repeating your PSA test in a few weeks. A continuous rise in PSA level over time may also be a sign of prostate cancer. A normal PSA level does not mean you will never get prostate cancer. Sometimes prostate cancer can be present even when PSA levels are lower.
Prostate conditions that can affect PSA levels
Different things other than prostate cancer can also raise PSA levels.
These includes common prostate conditions, such as:
- benign prostatic hyperplasia (or hypertrophy) called BPH for short
- prostatitis (inflammation of the prostate).
BPH and prostatitis can both cause a raised level of PSA in the blood, but they are not prostate cancer.
- benign prostatic hyperplasia (BPH)
- prostatitis
Other reasons for a raised PSA
There are some situations where PSA levels can be raised for a short while. These may affect how accurate the test result is. If you decide to have the PSA test, your doctor may suggest you wait for a while if any of the following apply to you:
- urine infections
- recent ejaculation (within the last 48 hours)
- having a tube in your bladder to drain pee (urinary catheter)
- recent prostate biopsies
- prostate or bladder surgery
- exercising energetically 48 hours before the test (some doctors include cycling in this advice)
- receiving anal sex or prostate stimulation during sex (best to avoid for 1 week before the PSA test).
If you have the PSA test, always tell your GP/nurse about any medicines you are taking. This includes ones you buy over the counter, complementary therapies or drugs made from herb and plant extracts.
Seeing a specialist
You will usually be seen within 2 weeks of your GP making a referral. The specialist will talk to you about having a specialised scan. This is called a multi-parametric MRI scan. Depending on the results of your scan your doctor may:
- explain that you do not need any further tests
- ask you to think about having a prostate biopsy.
Before a biopsy your specialist doctor will explain the risks and benefits to help you to decide. If you have prostate cancer, your specialist will talk to you about your options.
Questions to think about
Deciding whether to have the PSA test can be hard. Thinking about what is important to you can help you make the best decision. You could think about the following questions:
- What would you do if your PSA level is raised?
- What would you do if further tests find that you have early prostate cancer?
- What difference will it make for you to know about an early prostate cancer?
We understand that it is important you feel prepared and informed regarding treatment for your prostate cancer. You may have lots of questions regarding the treatment and potential side effects of treatment. Your clinical consultant and their team will be able to answer any specific questions regarding your treatment.
Testicular Cancer
Testicular cancer is cancer that happens in the testicle. The testicles produce sperm. They also produce the hormone testosterone when you go through puberty. This is the time when your body develops and changes as you become an adult.
Types
The main types of testicular cancer are non-seminoma. This is more common in young people. The other type is seminoma. If you or your child has been diagnosed with a different type of testicular cancer, talk to your specialist for more information. They will tell you about that particular type of cancer and its treatment.
Symptoms
The most common symptoms of testicular cancer are a painless lump or swelling in the testicle. People may have a painful or heavy feeling in the scrotum (the sac that holds the testicles) or a change in the shape or feeling of the testicle.
How is it treated?
Treatment for testicular cancer normally involves surgery and chemotherapy. Your exact treatment will depend on the stage and type of your tumour though. It’s best to talk to your specialist for further information.
You normally have the affected testicle removed during an orchidectomy while going through diagnosis. If you’ve only had one testicle removed, this won’t affect you or your child’s ability to have children. It’s not common to have both testicles removed. But if they are, the patient won’t be able to have children. In both cases they will still be able to have sex.
Chemotherapy, which uses anti-cancer drugs to kill cancer cells, is usually given as an injection or through a drip. This will be every 3–4 weeks for four or more sessions of treatment. A course of radiotherapy, where radiation is used to kill cancer cells, may also be used.
How is it diagnosed?
If your GP thinks you need to have further tests, you’ll normally be sent to the hospital. This will be where a specialist will give you an ultrasound scan of your scrotum and testicles to check for anything unusual. You will normally also have blood tests to check if any hormones produced by testicular cancer, known as ‘markers’, are present. If the tests show that you, or your child, are likely to have testicular cancer – in the form of a tumour, or lump – you will normally have an operation to confirm the diagnosis.
The operation will remove the whole of the affected testicle and is known as an orchidectomy. You may have further tests if your specialist thinks your cancer might have spread. The specialist will be able to work out the stage of cancer from these tests. The stage is the size of the tumour and whether it has spread to other parts of your body.
After treatment
Your specialists will do everything they can to keep your ability – or your child’s ability – to have children. But the most important thing will need to be fighting the cancer.
If your or your child’s treatment for testicular cancer does affect your or their ability to have children, it’s important you talk this through with your specialist or nurse.
You will still need to attend an outpatient clinic regularly. This is so your specialist can check your progress. They will make sure your cancer hasn’t come back. This is known as surveillance, or monitoring. Many people don’t have long-term health problems following treatment, but some do. Talk to your specialist about the potential long-term side effects of your treatment.
How your sex life, sexuality, relationships and fertility is impacted by cancer.
Read more on the links below:
Sex and fertility | Macmillan Cancer Support
Sex During and After Testicular Cancer Treatment
Fertility after testicular cancer
Penile Cancer
Penile cancer (cancer of the penis) is rare. Nearly all cancers of the penis are squamous cell cancers. Squamous cells are found in the skin. They cover the surface of most parts of the body. Rarely, other types of cancer can affect the penis. These include types of skin cancer such as basal cell carcinomas and malignant melanomas. Most penile cancer is diagnosed over the age of 50. It can sometimes also affect younger men.
Symptoms
Signs and symptoms of penile cancer can include:
- a growth or sore (ulcer) on the head of the penis (the glans), the foreskin or the shaft
- changes in the colour of the skin, such as a redness, white patches or areas that look blueish, brown or black in colour
- discharge or bleeding
- pain, a lump or discharge underneath the foreskin, this is usually only seen if the foreskin is pulled back.
These symptoms can also happen with other conditions. However always see your GP straight away if you have any of these symptoms or any other changes. Penile cancer is easier to treat if it is diagnosed early.
The exact cause of penile cancer is not known. Penile cancer is not infectious and cannot be passed on to other people.
Diagnosis
If you have any symptoms, make an appointment to see your GP. If your GP thinks that your symptoms could be caused by cancer they usually refer you to a doctor. They are called a urologist. A urologist specialises in urinary or genital problems. They will ask you about your symptoms. They will examine the penis and check the area at the top of the legs (groin) for any swellings.
The doctor will take a sample of tissue (a biopsy) from any abnormal or sore-looking area on the penis. This will help diagnose if you have penile cancer. The specialist team will arrange further tests. These are to find out whether the cancer is only in the penis or if it has spread. The results help your specialist team plan the best treatment for you.
Click here to read more about diagnosis and click here to read about treatment.
After penile cancer treatment
After your treatment, you will have regular follow-up appointments with your surgeon or cancer specialist. They will examine you. You may have blood tests or scans. This may continue for five years if you have any problems. If you notice any new symptoms between appointments, let your doctor know as soon as possible.
Relationships and sex
Your doctor or nurse will explain any possible effects your treatment may have on your sex life. If you have an early-stage cancer, treatment is unlikely to directly affect your sex life. It is usually safe for you to have sex as soon as the treated area has completely healed and you feel ready. Your doctor or nurse will give you advice on this.
Late effects after treatment
Some men may get side effects months or years after radiotherapy treatment. These are called late effects. After radiotherapy, the healthy tissue in the penis may get thicker. This can cause narrowing of the tube that carries urine through the penis (the urethra). If this happens, you may find it difficult to pass urine. This can be treated with a simple operation. This will stretch the urethra. If you have difficulty passing urine, tell your doctor straight away. We have more information about the late effects of pelvic radiotherapy for men. Organisations such as Orchid offer more information and support for people with penile cancer.
Well-being and recovery
Even if you already have a healthy lifestyle, you may choose to make some positive lifestyle changes after treatment. Making small changes such as eating well and keeping active can improve your health and wellbeing. They can help your body recover. The blue highlighted in the document takes you to the Macmillan support website to see more detailed information.
Useful websites and service leaflets
Websites
Testicular Cancer - Young lives vs cancer
Get a Young Lives vs Cancer Grant - Young Lives vs Cancer
How to check your balls (testicles) - easy read - Macmillan Cancer Support
Trans Women and Prostate Cancer
Service leaflets
Macmillan Urology Cancer Nurse Specialist
Faster Diagnosis Prostate Pathway
Trans-urethral Resection of the Prostate Gland
Glansectomy Surgery for Cancer of the Penis
Prostate Direct to Test Imaging & Diagnostic Pathway
Sentinel Node Biopsy for Cancer of the Penis
Videos
Living with & Beyond Erectile Dysfunction
Testicular Cancer - Mark's Story - Stand Up To Cancer
What is prostate cancer? Macmillan Support
Northern Radiotherapy Network Information Videos
Radiotherapy for Prostate Cancer and side effects following radiotherapy
Testicular Cancer in under 2 minutes!
About Testicular Cancer - symptoms and treatments
Our People Podcast - Men's Cancer
