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GEM - cancer educational module

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team


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

With respect to the epidemiology of cancer:

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

Clinical features of Cancer

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

Cancer screening:

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

Referral guidelines

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

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


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

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