How can my doctors tell if I’ve got cancer and what next?

How can my doctors tell if I’ve got cancer?

Your GP will ask you questions about your symptoms and how long you have had them.  They may then examine you, for example to feel for any lumps or swellings, and will check your medical records to see what illnesses you have had in the past. They may ask you questions about your lifestyle (for example, whether you smoke) and about the work you do. If your GP thinks you may have cancer they will arrange some more tests, or send you to see a specialist doctor. There are cancer referral guidelines to help GPs decide who may need to see a specialist, and how quickly.

Tests

There are many tests that can help doctors to find out what is wrong. Tests may include blood tests, X-rays and scans. For some cancers the doctor may need to look more closely at the inside of your body using a special telescopic instrument. The surest way to tell whether you have cancer is to take a sample of cells or tissue from the place the cancer might be, and look at it under a microscope. This is called a biopsy.

If you do have cancer, it will need to be classified according to its grade and stage. Doctors work out the grade by looking at cancer cells under a microscope, and seeing how much they still look like normal cells. The less they look like normal cells, the higher the grade of the cancer. Higher grade cancers are more likely to grow and spread. The stage of the cancer means whether it has spread, and if so, how much. Doctors need the information about grade and stage to plan your treatment. It may take a few days before your doctor has the results of all the tests. They will then be able to tell you whether you have cancer, and talk with you about your treatment options. When you have a diagnosis of cancer, your case will be discussed at your hospital’s appropriate multidisciplinary team (MDT) meeting.

Asking questions

The time around diagnosis of cancer can be incredibly frightening. It can be reassuring to get as much information as possible so you feel that you can make informed choices. Your main source of information will be your Hospital Consultant and their clinical team. They are dealing with cancer patients all the time and are the experts. Your GP will also be able to give you valuable information and support but they may not be able to answer specific questions on your cancer. It is important to appreciate that we often think doctors have all the answers. Some questions they can only express an opinion about, and for others there may be no answer.

Some tips to help you –

  • You might only be able to absorb the answers to two or three questions at any one time.  It can be useful to write down any questions you want to ask, so you don’t forget anything. You could also let your doctor have your list of questions before you see them, so they have time to consider them.
  • Take someone with you, such as a relative or a close friend. They can jot down information and may also remember details you forget.
  • Do ask for any explanations to be given in layman’s terms, and where appropriate suggest that a diagram might help you understand.

What is a MDT, or multidisciplinary team?

There is a multidisciplinary team (MDT) for each type of cancer. The MDT usually meet weekly to discuss new patients and the continuing care of existing patients. Each MDT has a set of core members, but other specialists may join the team from time to time. Every team works by following national guidelines or rules on how they should work with each other, with your GP and with the other specialist services. The teams are there to ensure that each patient is given the same, high standard of care, and has the most appropriate investigations and treatment. Each team member is responsible for keeping up-to-date with changes and new treatments. This means that all patients should receive the best possible care, no matter which hospital they attend.

Who is part of the MDT?

The MDT is made up of people who are expert in different areas of medicine. A typical team may include:

    • a lead clinician (normally a physician or surgeon) who takes responsibility for the service
    • an administrator, who co-ordinates the team and makes sure your records are looked after
    • a surgeon, who specialises in performing the type of operations that may be needed to treat your condition
    • an oncologist – a doctor who is a specialist in the treatment of tumours
    • a radiologist – a doctor who does tests in the X-ray department
    • a histopathologist – a doctor who looks at tissue and cell samples under a microscope
    • a clinical nurse specialist (CNS), who is skilled in caring for patients with your kind of cancer
    • a palliative care nurse.

The MDT is responsible for

    • working out your treatment plan with you
    • deciding on further tests
    • making appropriate referrals to specialist services
    • collecting information and keeping good records.

You and the MDT
Your clinical nurse specialist (or CNS)  is part of the MDT and is the link between you and the team. Your GP will also be kept informed by letters from your consultant. You also have opportunities to decide which of the options for your treatment are best for you.

Where is cancer care provided in Northern Ireland
There are 5 Health and Social Care (HSC) Trusts providing cancer services across Northern Ireland. For more information on cancer services and cancer support in your area, link to your Trust area below.