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Cancer: your questions answered


Who are you?

Hi, I am Rita Trewartha

and I'm head of clinical services for Bupa UK Insurance.

I'm a nurse with over 40 years

experience, come and ask me about cancer.

What is cancer?

Cancer is essentially a group of abnormal cells.

So it starts in the cells in our bodies.

I try to explain it

that the cells are like tiny little building blocks

that make up our organs and tissues throughout our bodies

and for them to grow and divide

they get signals to do that.

And those signals also tell them when to stop growing

and dividing and to die because they're no use anymore.

But sometimes also those signals can go wrong

and the cell becomes abnormal.

And those abnormal cells may also keep dividing

and dividing more

and developing into essentially forming a lump.

Now, often you'll hear lumps referred to as tumours.

Now tumours aren't necessarily cancers, not all lumps,

not all tumours are cancers.

The way that we find out the difference is

by taking a biopsy or a small sample of cells from that lump

or that tumour to determine

what it's made up of, essentially.

So the tumour or the lump might not be cancer,

and that would be called a benign tumour.

It can still grow, but it doesn't spread anywhere else in

the body and it only causes problems

and needs treatment if it's pressing on a structure

or something nearby, a muscle or an organ.

If it's not doing that, it will live there quite happily

and not cause any harm whatsoever.

A tumour that is cancer is called a malignant tumour,

and that can grow into nearby tissues,

and that is called a primary cancer site.

But also what it can do is travel to other parts

of the body, and it can do that through the blood

or the lymphatic system in the body.

And if it does that,

then it can settle deposits elsewhere in the body,

which can form other lumps or tumours that can grow.

And that's called a metastatic cancer.

So a secondary cancer to the primary site,

but all part of the same cancer really.

I suppose the other thing to also mention is

that cancer can form in the blood cells or the bone marrow,

and that develops into what we call

as a group blood cancers.

So one of those that you might have heard

of quite frequently is leukaemia.

So in essence,

actually cancer is a group of abnormal cells.

How common is cancer?

So one in two of us will be diagnosed

with cancer in our lifetimes with the highest lifetime risk

for females being for breast, lung, and bowel cancer

and for males being prostate, lung, and bowel cancer.

And we have seen an increase over recent years in cases

that are being identified, but that's

because we are much more aware now of the risks

and we are being screened more regularly

through our national programmes.

So we are catching cancers much earlier.

For the 10 most common cancer types, more than 70% with

of those cases in the UK have been attributable

to known risk factors, and that includes lung

and melanoma, skin cancer, which are 2

of the 5 most common cancer types in the UK.

What can cause cancer?

When we think about causes of cancer,

we can't really just think about one thing.

I think it's really important to understand

that right at the outset.

So it could be, for example,

that there's been an inherited cancer gene variant.

So that's something a person inherits from a parent.

Now that doesn't mean you've got cancer,

it doesn't guarantee you are going to get cancer,

but it might mean that if you had some abnormal cancer cells

that would develop more rapidly than it would

for somebody without that gene variant.

And if that gene variant was common within a family,

as in more than one person in that family,

or several people had that gene variant in that family,

that could mean a certain type of cancer was more common in

that family than you would see somewhere else in

the larger population.

And I suppose we always need to throw in age as something

that is an increase in risk in terms of cancer.

But when we are thinking about that inherited gene variant,

it's really important to understand

that it's less than 5% to 10%.

So that's less than 5 to 10 people in every 100

that will actually carry that gene variant.

So lifestyle factors such as smoking, being overweight

or obese, drinking alcohol above recommended levels,

over exposure to UV radiation from the sun,

those are the things that are much more likely

to influence you or me on a day-to-day basis.

How do I know if I am at risk of cancer?

So a person's risk of developing cancer depends on lots

of different factors, including age, genetics,

and external risk factors.

So those more associated with lifestyle.

Understanding your risk means, for example,

understanding if there is any family history,

but also what those external risk factors are

and actually how they apply to your life.

So as we know, smoking and overweight

and obesity are the primary preventable risk factors,

and 35% of all cancers

that's about 135,000 cases every year are preventable.

So you can start to better understand your risk.

I think other things that help us understand risk include,

for example, that lung, breast, bowel,

and melanoma skin cancers account for almost two thirds

of preventable cancer cases in the uk. Over exposure to UV,

so the sunshine

and substances at work, drinking alcohol to excess,

and too little dietary fibre.

Each of those could be responsible for 3% to 4%

of cancer cases in the UK.

And then there's some lesser known exposure risks.

So ionising radiation, x-rays,

or eating processed food that can account for about 1%

to 2% of cases.

And then even smaller than that, air pollution

or doing too little physical activity

could cause about 1% of cancers in the UK.

What are the main forms of cancer?

Currently in the UK, more than half

of new cancer cases in males is prostate,

lung, or bowel cancer.

And in females, half of new cases are either breast,

lung, or bowel cancer.

Can cancer be prevented?

So research shows that 35% approximately

of cancers are preventable.

And we know that smoking is the largest single preventable

cause of cancer in the UK each year,

and that's according to Cancer Research UK.

And we also know that being overweight

or obese is the second highest preventable cause of cancer.

So these are what I would refer to

as modifiable risk factors.

So something we can try to influence or do something about.

Not always easy, it doesn't mean we can't try.

So stopping smoking, maintaining

or achieving a healthy weight through diet

and exercise, following the recommended alcohol intake

guidelines and protecting ourselves from those potentially

harmful UV rays

by simple things using sunscreen and covering up.

So there's lots that we can do to contribute

to the prevention of cancer.

What percentage of cancers are preventable?

According to Cancer Research UK, over 35%

of cancers are preventable.

There's been a lot of research on this

and the World Health Organisation estimate that figure is

between 30% and 50% worldwide.

The main point to remember is managing your risk factors

and watching for changes in your body or any symptoms.

Can vaccines help to prevent cancer?

So there's an awful lot of research going on in this area

at the moment that's looking really, really positive.

But one development that there has been is the vaccine

for HPV, that's the human papilloma virus

that was identified a number of years ago as certain strains

of it being responsible for a significant amount

of cervical cancers in women.

The HPV vaccine has now been rolled out as part

of a school's programme to 11 and 13 year olds,

and that has had a significant impact in terms

of the prevention of cervical cancer.

Does genetic testing help to prevent cancer?

No, but it can help to identify if you are at greater risk

of developing cancer.

Genetic testing is a really complex area

and the results can sometimes be very

difficult to interpret.

I think I would always recommend getting some advice

before getting any testing,

and then use that healthcare professional advice

to help you interpret the results.

Does the risk of cancer increase as you age?

Sadly, yes, but it's still important

to keep a healthy lifestyle.

Half of cancers in the UK are prevalent

in the over seventies.

It doesn't mean that you will get cancer, so

therefore it's still important

to manage those lifestyle risk factors,

and also important to access any screening

that you are eligible for,

and also seek health professional advice if you've got any

symptoms at all.

How can I protect myself against cancer?

So firstly, make sure

that you access your cancer screening programmes

as you become eligible

or any other routine health checks that are available

to you, either through your GP surgery

or possibly even through work.

But most importantly,

protecting yourself is about understanding

what the risks are and checking if there is anything in your

lifestyle that you can do to modify those risks.

We know, for example, smoking and being overweight

or obese are the leading risk factors,

and 1 in 20 cancer cases are caused

by being overweight or obese.

And that research identifies approximately 35 million people

in the country at the moment are overweight or obese.

Now, that's measured on the body mass index scale,

and A BMI of over 25 is considered overweight or obese.

So that's something easy that you can check.

So depending on your circumstances, there could be lots

of things that you can do to reduce your risk

of getting cancer.

Can I get cancer more than once?

Sadly, yes, it could be a recurrence

or it could be something new.

Follow-ups are important

and recurrent cancer starts with cancer cells

that the first treatment didn't fully remove or destroy.

Now, this doesn't mean

that the treatment you received was wrong.

It just means that a small number of cancer cells

survived the treatment and were too small

to show up in follow-up tests over time.

These then grew into tumours

or cancer that your doctor can now detect.

Sometimes a new type

of cancer will occur in people

who've had a history of cancer.

When this happens, the new cancer is known

as a second primary cancer,

and the second primary cancer is different

from a recurrent cancer.

A recurrent cancer can be localised,

so literally in the same place as the original cancer,

or it can be regional,

and that means it's grown into lymph nodes

and tissues near to the original cancer.

Or it can be a distant recurrence,

and this means that the cancer has spread to organs

or tissues far from the original cancer.

It's called metastatic cancer or metastases.

I've had cancer before can I prevent it reoccurring?

You can minimise the risk of recurrence.

So if you are on ongoing treatment

because you're in remission, sticking to that treatment

and having your regular follow-ups

is really, really important.

If you are completely in remission,

but you have lifestyle factors that might pose a risk.

So overweight

and obesity, exposure to UV radiation, sunshine,

it's about managing the risk factors associated

with a recurrence of cancer.

What are the most common misconceptions about cancer?

So I think the most common one is that it won't happen

to me or my family because there's no history,

but I think we all know somebody

that's probably been affected, so that just isn't true.

And then there's other myths around mobile phones

and the non-ionising radiation from those and burnt foods

and eating burnt foods.

Again, there's definitely no known link at this moment in

time in relation to cancer, plastic containers

and bottles drinking from them,

putting your food in plastic bags.

There's no evidence that increases your risk of cancer.

The same in relation to artificial sweeteners

and the same in relation to stress and pesticides

and genetically modified food.

None of those things have an increased link to cancer.

How can I check whether I have any cancer symptoms?

If you know what's normal for you, it's much easier

to notice anything that changes. So instead

of regular self checks doing the same thing the same

time on a regular basis.

Just be aware of what's normal for you

and listen to your body,

and if something doesn't feel right, then you need to go

and get that checked from a health professional.

Go and speak to someone.

Listen to your body and speak to that health professional

because we know if you spot cancer at an early stage,

that does save lives.

Now a lot of people do talk about those regular checks,

but there's no evidence that that really helps.

So think about if we are talking about bowel cancer,

for example, changes in that bowel habit.

How often you go to the toilet can be an indicator

and a symptom, but it's normal for you.

So if you normally go to the toilet twice a day

and everything's the same as normal,

then you don't need to speak to anyone.

But if you start going much, much more regularly

or you can't go at all,

or the consistency is different, then that's the time to go

and get some advice.

We try not to be too prescriptive of

how long those symptoms should be there

before you seek advice,

because what's normal for you

isn't necessarily normal for me.

So listen to what your body's telling you

and get that professional advice, even if it's only

to put your mind at rest.

What symptoms should I look out for?

So there are lots and lots of different types of cancers,

which means there's lots

and lots of different types of symptoms.

So it's really not easy to give a list

and not all of those might resonate with you

or ring true for you anyway.

So some symptoms are going to be really obvious.

You are going to have a lump somewhere

that you haven't had before.

You can see a mole that's changed and is different,

but other symptoms might be more vague than that.

So you might be off your food, you might have lost weight

when you're not trying to lose weight,

you might be tired all the time and not know why that is.

There might not be a really good rationale for that.

So it really is very much about you feeling

or seeing something different for you, or as a friend

or family member, notice something different.

Then go and get that checked out with a health professional.

What can I do if I think I have cancer symptoms?

So the first thing for me is be brave and speak up.

As soon as you can. Go and see a healthcare professional.

If you've had symptoms, write it down so that you know

what you're saying to the GP.

If you can take a friend with you to help you remember,

if nothing else, whatever the doctor says to you,

that's really, really helpful

because you'll come out of that appointment

and you'll have forgotten everything

that anybody's said to you.

So fundamentally, the really, really important thing

that you really must do is if you think you've got symptoms,

go and get it checked out.

When should I seek professional advice about cancer?

Trust your instinct.

If something isn't normal for you,

if you think you've got symptoms, please go

and seek some professional advice.

If you're a Bupa customer, we have our direct acts

to cancer service so that you can phone us up

and we can give you a direct referral

to a consultant without consulting a gp,

or you can see a GP through our digital GP service,

and we also have our 24 hour Anytime Healthline manned

by nurses 24 hours a day, seven days a week.

Also, if you're invited to NHS screening appointments such

as mammogram or bowel cancer screening,

or for testicular checks,

please make sure you keep those appointments.

And do remember, just

because you've been screened, that doesn't mean

that you don't need

to get checked if you develop new symptoms in

between those screening times.

So if you get any new symptoms, even between your screening,

please also go and get those checked.

What should I do before going to the GP?

So gather your information,

get some support if you want somebody

to accompany you to your appointment.

Remember, the more detail you can share, the better it is,

but it's also not a test.

You don't have to diagnose yourself.

That's what the doctor's going to do.

And think of the questions that you want to ask.

Take your time and don't be afraid to say

that you don't understand when you get

the answers from the doctor.

Just because they've explained it once doesn't mean they

can't explain it again.

Check what happens next.

If the doctor suggests you need some tests

or investigations,

make sure you find out when they're likely to happen,

when you are likely to get the results.

And I think another important thing to do is

to check what you need to do.

If you are waiting for any investigations

to happen, who do you contact?

Who's best to follow up with?

Where can I go for helpful information about cancer?

So there are lots of trusted resources out there,

Bupa's own website,, the McMillan website,

and also Cancer Research UK.

And of course, the NHS has got

loads and loads of information.

But please, please make sure you use one

of those trusted websites.

But if you've got some symptoms

that you are actually concerned about for you right now,

it's really important to speak to a health professional

and get the reassurance you need.

How do I access support through Bupa?

If you're a Bupa customer,

we have our direct access service where you can get straight

through to see a consultant without a GP referral.

If you already have a GP referral,

you can call our member services line.

We will assess your eligibility

and guide you to the most appropriate special.

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