Cancer
Understand different cancers and get support if you or someone close has a diagnosis. Plus, find information on common symptoms and treatment.
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Cancer: your questions answered
Transcript
Who are you?
I'm Dr.
Francesca Jackson Spence. Everyone calls me Dr. Frankie.
I'm a medical doctor. I work
as a clinical research fellow in oncology,
so I work in cancer clinical trials
and I'm currently doing a PhD in that.
And I also am really interested in preventative medicine,
so I have an educational social media platform called Dr.
Frankie and I host a educational podcast called Vision
of Health outside of my work.
I am a dog mom to a beautiful visitor called Ruby.
I love running and keeping fit and playing tennis,
and I am someone in my thirties living a London life.
What is your background?
So I've been a medical doctor for seven years
and over the last five
or six years I've been working in oncology.
I'm a clinical research fellow in oncology
and I treat kidney and bladder cancer.
I'm currently actually doing a PhD at Queen Mey University
of London, and I'm looking at kidney and bladder cancer.
On the side of that, I also host a educational social
media platform called Dr.
Frankie and I spend a lot
of time looking at preventative lifestyle medicine
and reading all of the evidence about all
of the lifestyle behaviours that we can engage in
to reduce our long-term risk of developing cancer.
What is cancer?
Cancer is a disease of our body cells
where cells can grow out of control
and develop into a tumour.
Normally, our body has lots of processes
where our cells replicate themselves and they grow, divide,
and die in an orderly fashion.
But when these processes break down, cancers can develop.
How does cancer start?
Cancer starts when there's damage to our DNA.
In our cells, we call that a gene mutation,
and this can happen because we can inherit faulty
genes from our family members.
Sometimes spontaneous mistakes can happen when our cells
replicate their DNA and they divide and grow,
and that happens increasingly as we age.
Sometimes it's external factors in our environment
that can increase the risk of DNA.
Damage and accounts developing things like tobacco, smoke,
alcohol consumption, exposure to chemicals, radiation,
all those sorts of things in our environment.
Some viruses can also cause cancer.
The HPV virus, human papillomavirus is one
that's sexually transmitted
and causes most cases of cervical cancer.
There's a bacteria that lives in our stomach called h
pylori, and that can increase our stomach acid
and increase the risk of stomach cancer.
We also have viruses like Hepatitis B
and C, which can increase our risk of liver cancer.
Cancers can also be formed by other things in our lifestyle,
like what we eat, our diet, our obesity levels,
and also how sedentary we are.
We know that exercise is protective against cancer.
What causes cancer?
Cancer happens when there's damage or change to the DNA.
In our cells, we call that a mutation,
and this means that the cell tends to divide
and grow uncontrollably.
Usually we have processes in our body
that when cells replicate themselves, they grow, divide,
and die in a controlled fashion.
Any mistakes to the replication of our DNA,
our genetic makeup are fixed.
It's called DNA repair.
And if it's so severe that the cell can't repair the DNA,
it just kills itself.
And this prevents cells growing uncontrollably.
In cancer, this safeguarding mechanism fails
and that allows cells to grow uncontrollably into a tumour.
As the tumour gets bigger, it can invade local structures
and the organs that it started from,
and it can even invade into our blood vessels
or our lymphatic system,
and that can allow it to spread to other parts of the body.
And when it settles in distant organs, that's when it kind
of takes over the organ's function and causes illness.
Can drinking alcohol cause cancer?
Alcohol is a well-known risk factor for cancer.
The most common one that people know about is liver cancer,
but alcohol can also increase the risk
of mouth and throat cancer.
It can increase the risk of colorectal cancer
and other cancers.
It's actually a dose dependent relationship,
so the more alcohol you drink,
the more likely you will develop a cancer.
Can diet cause cancer?
That's a great question about whether
diet can cause cancer.
I think it's a little bit more complex than that.
I don't think we can say specifically that diet
causes cancer, but there are definitely things within our
diet that can increase cancer risk.
The well-known ones are alcohol and processed red meats,
and of course there's things in our diet
that can be protective against cancer.
We know that foods rich in fibre,
so whole foods like whole grains, fruits
and vegetables, beans, legumes,
all these plant-based foods can be protective against
certain cancers, particularly bowel cancer.
How does cancer progress?
Cancer progresses
because there's a DNA change
that allows the cells in the cancer to grow quickly
and replicate themselves quickly so that our tumour forms
and this can invade local structures.
As the cancer grows, it can invade into blood vessels
and lymphatic vessels,
and that allows it to spread to other parts of the body.
We call this cancer metastasis or stage four cancer,
and it can settle in other organs and cause serious illness.
What are the different stages of cancer?
Cancers tend to be staged from stages one to four,
but it really does depend on the type
of cancer we're talking about.
In general, the early stages, stage one
and two tend to be caught early, which means
that we can do surgery or things like radiotherapy
and they can be curative.
The latest stages of cancer, like stages three
and four get a little bit more complicated
because the cancer tends to have spread to
localised organs nearby or even distant sites in the body.
We call that cancer metastasis.
Now, stage four cancer is often got a lot of misconceptions
around it because people think stage four means terminal
cancer, and whilst it does mean that the cancer has spread
to other parts of the body for lots of cancers,
new treatments mean that we can apply breaks to that cancer,
stop it growing, and many people actually live
with the cancer for many years
and don't necessarily imminently die from it.
So I think there's lots of misconceptions about that.
Stage four.
Is the risk of cancer higher for older people?
Cancer is largely a disease of ageing.
If you imagine as we age, there's lots of wear
and tear in our body.
I want you to imagine a bike.
As we own a bike, no matter how much we look after it
and how much we care for it,
the bike will inevitably rust and break.
And that's a little bit like our body.
We have lots of protective mechanisms in our body to ensure
that when we replicate our cells, that we do it correctly
and that no mistakes in DNA replication happen as we age,
these repair mechanisms fail,
and that's how cancer can happen,
because mistakes in that DNA can occur.
So largely cancer is a disease of ageing,
and that's why the majority
of cancers we see happen in people over the age of 50.
Why do some people get cancer younger?
The majority of cancers do happen in people over the age
of 50 because cancer is largely a disease of ageing.
But that being said, we are seeing an increasing number
of young people with cancer.
I think it's a really complex question.
There's lots of lifestyle factors
that are increasing our risk of developing cancer.
Things like what we eat in our diets, the fact
that we are more sedentary than ever
and not getting enough exercise,
and that was an increasing rate
of obesity in the population.
They're just a few examples.
Cancers in young people also may
have a genetic element to them.
So someone who inherits a mutated gene from their family
members may have an increased risk
of cancer developing in the first place
and at a younger age.
But there's lots of research going on looking specifically
about why cancer is occurring at younger ages.
What are the chances of getting cancer?
Unfortunately, in our lifetime, the rates
of getting cancer now are one in two people,
which sounds really high.
The good news is, is
that whilst cancer incidence is increasing
to one in two people, the death rate from cancer has
actually reduced by a fifth in the last 50 years.
How does your body fight cancer?
Our body does its absolute best to fight cancer.
And actually our immune system,
our immune cells can recognise cancer cells.
So if you imagine you are infected with a bug,
something like the flu virus
or the covid virus, your immune system recognises that
that's a foreign substance and switches on its army to fight
and kill the virus off.
Now your immune system can actually do the same thing
to cancer cells, but cancer cells are very clever
and they almost develop like an invisible cloak around them,
which lets them hide from and invade the immune cells,
and that allows them to grow uncontrollably and progress.
So when you have a cancer, your immune system is working
as hard as it can to fight the cancer,
but often we need help from medical treatments,
things like surgery, radiotherapy, chemotherapy,
or immune therapy to name a few, just to help with
that process.
Can cancer be detected early?
Absolutely.
Cancer can be detected early,
and in fact, the earlier we pick a cancer up,
the better the outcomes for patients.
Now, it's a lot easier with certain cancers like skin cancer
or breast cancer that can present with an obvious lump
or swelling to pick them up early.
But some cancers like ovarian cancer
or pancreatic cancer have a more insidious presentation
that has a bit more vague symptoms,
and that means it's often picked up later at a later stage.
The good news is that doing things like at home,
self-examination, like checking your breasts
or doing self testicular exams
and engaging with cancer screening programmes like the
breast, cervical,
or bowel cancer screening programmes can increase your
chances of picking a cancer up early.
On that note, I think it's really important
that if you have any symptoms
to not put off seeing your doctor about them,
because usually it's nothing,
but if it is an early sign of cancer, it's always better
to pick it up earlier.
Can cancer be prevented?
This is a difficult question
because some cancers can't be prevented.
We can't change our genetic risk
and we can't change the fact that we age.
That being said, the majority of cancers are actually caused
by lifestyle factors,
and we can change our lifestyle behaviours
to reduce our cancer risk.
We can do things like not smoking
or stopping smoking if we already smoke, reducing the amount
of alcohol we drink, or cutting out completely
changing our diets, eating less processed red meats,
and improving things like fibre rich plant-based foods.
We can protect our skin.
We can wear daily high factor SPS, keep out the midday sun
and cover up when it's hot.
We can engage with cancer screening programmes,
things like the cervical cancer screening programme is
designed to detect abnormal cells that are pre-cancerous so
that you can remove them before cancer develops.
On the note of cervical cancer,
teenagers are offered vaccination against the high risk
strains of HPV Human Papilloma virus,
which cause most cases of cervical cancer.
So going to those immunizations can prevent
that cancer from developing.
We can stay active and engage in exercise.
We know that exercise reduces our risk of developing cancer
independent of BMI.
So even if you don't lose any weight,
maintaining a healthy weight throughout our life can
prevent cancer occurring.
And on the whole, there's so much you can do
to reduce your cancer risk.
What foods can prevent cancer?
The topic of diet and cancer prevention is a really
complex topic because some cancers can't be prevented,
and I think it's important to remember
that food isn't medicine.
That being said, we know that increased consumption
of processed red meats
and alcohol can increase cancer risk, namely bowel cancer.
There are also some foods that can be protective,
plant-based foods,
particularly things like berries are rich in antioxidants
and they can reduce cancer risk.
High fibre foods, so whole foods like whole grains, beans,
pulses, legumes, fruit, veg, nuts, seeds,
spices, I can name lots.
They can also reduce cancer risk, particularly bowel cancer.
What are the symptoms of breast cancer?
Most people when they think of breast cancer,
think about looking and feeling for a breast lump,
but actually one in six breast cancers
don't actually present as a lump.
So it's important to think about the other signs
and symptoms of breast cancer.
Things like skin changes.
So this is puckering or tethering of the skin.
Imagine a bit like an orange peel.
That's the kind of thing to look out for with the skin.
Look for any nipple changes that can be nipple inversion,
that's new for you, or any discharge
or bleeding from the nipple.
Any new pain or tenderness in the breast
can be a red flag for breast cancer.
Any new asymmetry between the breast.
Now remember, breasts are supposed to be sisters, not twins.
So a little bit of difference between your breast is normal,
so it's important to look for any changes
that are new for you.
Knowing these signs
and symptoms of breast cancer is
so important at picking up breast cancers as early
as possible, and what I would say is that
one in 10 breast lumps that go
to a breast cancer clinic turn out not to be cancer.
So please don't put off getting your breast checked.
If you're not sure. It's always better to get checked out.
What are the symptoms of bowel cancer?
The symptoms of bowel cancer can
vary from person to person.
It usually is associated with a change in bowel habits.
For some people that might be constipation.
Further it might be diarrhoea.
Sometimes there can be blood in the stool,
but that's not always obvious.
There may also be persistent abdominal pain or bloating,
and sometimes it can also be unexplained weight loss.
Sometimes if you have a bowel cancer,
when you've passed a stool
and been to the toilet, you might feel like you haven't
completely emptied your bowel.
What are the symptoms of lung cancer?
The most common symptom of lung cancer
that most people know about is a persistent
cough that won't go away.
But lung cancer can also present with coughing up blood,
chest pain, shortness of breath, recurrent chest infections,
or more vague symptoms like fatigue
or unexplained weight loss.
What are the symptoms of prostate cancer?
The symptoms of prostate cancer are largely related
to the fact that the prostate contains the urethra,
which is the tube that men we from
as prostate cancer develops, it can compress the urethra
and interfere with the urine flow.
This can cause lower urinary tract symptoms,
things like increased urinary frequency,
particularly overnight, a weak flow or dribbling.
Once you finish urinating,
it can also cause some abdominal bloating
and some pelvic pain,
and in more advanced disease it can also cause some lower
back pain.
What are the symptoms of cervical cancer?
Cervical cancer often presents
with abnormal vaginal bleeding that's bleeding
between your usual periods, bleeding after sex, or bleeding
after you've been through the menopause.
It can also present as vaginal discharge,
pelvic pain, or abdominal pain.
Pain during sex.
What are the symptoms of ovarian cancer?
Ovarian cancer is a really difficult one.
It's often picked up late
because the symptoms can be really nonspecific and vague
and often overlap with less serious conditions.
Things like irritable bowel syndrome,
ovarian cancer can present as persistent abdominal bloating
and feeling of fullness.
Some people get early satiety, so
that's feeling full more quickly after eating.
Sometimes it can be abdominal
or lower back pain, unexplained weight loss,
and generalised fatigue.
But it's really hard from those symptoms not to think
of a million other conditions,
and that's often why ovarian cancer is picked up late.
Are there any symptoms that relate to all cancer types?
There are lots of symptoms that overlap
with lots of different cancers.
The biggest one is unexplained weight loss.
We can also have generalised fatigue
or changes to blood counts, things like anaemia.
Any persistent abdominal bloating or swelling and lumps
or changes to the skin can often beat lots
of different cancers.
What are the symptoms of testicular cancer?
When people think about testicular cancer, often we assume
that there will be a palpable lump in the testicle.
But testicular cancer can also present as a heavy
and firm testicle, one testicle being larger than the other.
Any swelling or skin changes, any lower abdominal
or pelvic pain and unexplained weight loss.
What should I expect at a bowel cancer screening?
The bowel cancer screening programme is offered every two
years to people ages over 50 to 74,
and it's comprised of two parts.
The first is an at-home test called the FIT Test,
the Faecal Immunochemical Test,
and this is where you take a sample of your stool
and send it off in the post,
and they test it for the presence of blood.
Often it's a really small amount of blood
that you wouldn't be able to see with the naked eye.
If blood's found, you'll then be invited for a colonoscopy,
which is a direct visualisation of the bowel.
The practitioner will insert a camera into the rectum,
so look inside the bowel to see if there's any polyps
or bowel cancer present.
What happens at a prostate examination?
Prostate examination involves two parts.
The first is a physical examination where your nurse
or doctor will do a digital rectal examination
where they insert a gloved finger into the rectum
to feel the prostate,
particularly noting the size and texture.
You'll also have a blood test to check for PSA that stands
for prostate-specific antigen,
which is often raised in prostate cancer,
but can also be raised in other conditions.
How do they perform a mammogram on the breasts?
During a mammogram, x-ray, images
of the breast tissue are taken to look
for any changes in breast tissue density or any lumps.
The breast is inserted between two plates
and then slightly compressed.
It can feel a little bit
uncomfortable, but it shouldn't be painful.
The X-ray images of the breast will be taken in lots
of different directions to give us an image of the breast
where we can pick up if there's any masses
or change in breast tissue.
What happens at a smear test?
A smear test is actually a bit of an outdated term now.
We now call it cervical screening.
During a smear test
or cervical screening,
a nurse will insert a speculum into the vagina
to directly visualise the cervix.
They'll have a look to see whether the cervix looks healthy.
A small brush is then inserted to take a few cells
of the cervix, and they're tested for the presence
of HPV virus, human papillomavirus, which is responsible
for causing most cases of cervical cancer.
If HPV is detected in the sample, then the cells are tested
for any abnormal cell changes.
This is looking for any pre-cancerous early changes
to the cervix cells before a cancer develops.
A common misconception is that a smear test
or cervical screening is directly looking
for cervical cancer, but we're much earlier on than that,
and this is a preventative thing.
How is cancer identified on a scan?
A cancer can be picked up on a scan
because it usually has a different density or texture
or an irregular shape compared to
how our tissue in our body usually looks,
and it can't be identified on different scans like MRI
scans, CT scans, or PET scans.
Now, it's important to note,
you can't actually get a definitive diagnosis
of a cancer just from a scan.
We often have to do a biopsy, which is
where we take a sample of cells, maybe tissue or fluid,
and then diagnose the cancer under a microscope.
Can cancer be identified by blood tests?
That's a great question.
We can do blood tests to look for cancer biomarkers, so
that's things like PSA prostate specific antigen,
or for ovarian cancer.
There's one called CA 19,
and for bowel cancer, there's another one,
but they don't directly diagnose cancer
because they can be elevated in other conditions.
So often a blood test is part of a cancer diagnosis.
Now, really interestingly,
some new cancer blood tests looking
for something called circulating tumour, DNA,
which is the DNA of the cancer, have been developed
as a sort of liquid biopsy
and have been used for some cancers
for early detection of cancer.
But we're quite early on
and there is ongoing research into these blood tests.
What are the treatment options for cancer?
We've come such a long way in the treatment of cancer
and we have so many different
treatment options available now.
It really depends on the stage of your cancer
and the cancer type.
For early stage cancers, we often use surgery
to remove cancer cells
or radiotherapy to kill cancer cells
for later stage cancers, we use systemic therapies,
so they're cancer medicines that are given
through the vein via drip or via tablets,
and that's to mop up cancer cells
that could be elsewhere in the body, not just the organ.
It started from, you might have heard the term chemotherapy
or immune the, but we also have things like
targeted therapies or hormone therapies.
Often we actually use a combination of different treatments
to attack the cancer from lots of different angles
and give the patient the biggest chance of success.
Can cancer be cured?
That is the golden question.
I think absolutely. For early stage cancers,
we can cure lots
of patients if we catch the cancer early enough
and do things like surgery
or radiotherapy, often for later stage cancer.
So cancers that have spread to the other parts of the body,
it's a bit more difficult.
Sometimes we can give treatments
and on a scan it can look like the cancer is cured,
but sometimes there are lingering tiny cancer cells
that hide and they reappear years down the line
and cause a cancer relapse.
And so in these cases I'm always a little bit nervous
to tell a patient they're cured
and instead I'd use the term a long-term remission
because there are that kind of microscopic cancer
that could still be lingering.
But absolutely for some cancers
and for earlier stage cancer, a cure really is possible.
What is chemotherapy and how does it work?
Chemotherapy are medicines that we can give
to kill cancer cells.
Now they target rapidly dividing cells
and cause DNA damage,
which causes the cancer cell to kill itself.
They are usually given through a drip into the vein,
but they can also be given as tablets.
Chemotherapy is one
of the most longstanding cancer treatments we have now
because it targets rapidly dividing cells.
It can also target healthy tissue,
things like the cells in the gut lining,
causing nausea, vomiting, and diarrhoea.
Can target the hair follicles and cause hair thinning
and hair loss and it can cause generalised fatigue.
But there are lots of things we can do
to manage the side effects
and chemotherapy remains a very effective treatment for lots
of cancers.
What is immunotherapy and how does it work?
I think immunotherapy is the most exciting new cancer
treatment, and it's what most of my research is on.
Our immune system has the potential to kill cancer cells.
If you imagine you are infected with a bug,
something like the flu virus
or the Covid virus, our immune system recognises this
and kicks into action to kill the virus
and eliminate it from the body.
Now, your immune system has the same ability to do that
for cancer cells, but cancer cells are very clever
and they develop almost like an invisible cloak
that allows them to hide from the immune system
and evade that immune response, allowing them
to grow and take over.
Now, what immune therapy does is it targets
that invisible cloak and exposes your cancer cells
to your own immune system,
therefore harnessing the power
of your own immune cells to kill the cancer.
It's usually given via a drip in the
veins into the bloodstream.
And I think this is one
of the most exciting cancer treatments
because we are seeing long-term responses for patients
where your immune system can almost remember how
to fight the cancer years after the treatment has stopped.
What are the side effects of cancer treatments?
The side effects of cancer treatments really depends on
the type of treatment you're having, the dose,
and how long you're having the treatment for.
Generally treatments like chemotherapy can cause bowel
changes, so things like constipation
or diarrhoea can commonly cause nausea and vomiting.
Can target hair follicles, which can cause hair thinning
and hair loss, and it can target the bone marrow
and suppress immune counts, causing things like anaemia,
which presents as fatigue or lowered immunity.
Radiotherapy is designed to be given as precisely
as possible to minimise side effects,
but sometimes you can get side effects if it targets
the surrounding healthy tissue.
Things like skin rashes, pain, but also fatigue.
Hormone therapies can cause side effects like hot flushes,
fatigue or bone thinning.
Immune therapy is trying to harness your own immune response
to target the cancer, and sometimes your healthy tissue can
be accidentally targeted.
It can commonly cause fatigue, skin rashes,
or inflammation of any organ in your body.
Things like thyroid inflammation,
which can cause an underactive or overactive thyroid,
but there's lots of side effects for this one.
Side effects really do depend on what treatment type,
but your doctor will be well equipped at managing side
effects and usually the side effects just last
for the duration of the treatment.
Does cancer always need to be removed surgically?
For early stage cancers, we often remove them surgically
because we can remove the cancer cells with the best chance
of curing the patient.
But if the cancer has spread to other parts of the body,
we call this metastatic disease
or stage four cancer, then we often don't do surgery.
And instead the focus of treatment is on systemic therapies,
their treatments given via the veins through a drip
or via tablets.
And that's because they will target the cancer
and the organ it started from.
But also any cancer cells
that may have escaped elsewhere in the body.
So sometimes we don't do surgery at all.
Can cancer be treated with medication?
I think when we talk about cancer treatments,
most people's mind jumps to chemotherapy,
which is usually given through a drip,
but actually lots of cancer treatments now are
in tablet form as well.
I give lots of patients tablets.
Things like targeted therapies
or hormonal therapies, often covered in tablet form.
Does cancer ever go away on its own?
It's very unlikely if an established cancer has developed
and been diagnosed and picked up by medical tests
for it to go away on its own.
I think in the very early stages of cancer occurring,
when initial DNA mutations
and mistakes happen, our immune system can recognise those
mistakes and has DNA repair processes or causes cells to die
and prevent cancer developing.
But by the time you've got a established diagnosed cancer,
it would be very unlikely for cancer to go away on its own.
And that's why we usually recommend treatments
or a combination of treatments to help treat
and get rid of the cancer.
Can the body fight cancer itself?
Technically, your body can fight cancer itself
because our immune system is very strong
and it has the ability to detect and kill cancer cells.
But unfortunately, cancer cells are very clever
and they hide from the immune system.
They develop almost like an invisible cloak that allows them
to hide and evade our immune responses.
And so that's why some newer treatments,
things like immune therapy, are there to target
that invisible cloak
and expose your cancer cells to your own immune system,
which can then go and fight and kill the cancer cells.
Is cancer treatment dangerous?
Cancer treatments are always given
with the intention of helping you.
So usually your doctor will weigh up the potential risks
of the treatment with the expected benefits,
and a treatment will only be given if letting the cancer
grow without treatment is a bigger threat to you.
Of course, some of the side effects can be very severe,
particularly chemotherapy can cause immunosuppression
of your blood cells and lower your immunity.
And for some people, that puts them at risk
of life-threatening infections
or sepsis immunotherapy is trying
to harness your own immune
response to kill the cancer cells.
And sometimes that immune response can be so big
and target healthy tissues that can become life-threatening.
But on the whole, a treatment would only be given if it
could be given safely and with the intention
of benefiting you.
Is cancer genetic?
Cancer is largely a genetic condition
because what's happening is there's damage
to the DNA in our cells, which causes gene mutations
that allows a cancer to develop.
Now, this DNA damage
or gene mutation can happen due
to inherited causes or acquired causes.
So sometimes we can inherit a faulty gene from our family
members that happens in about five to 10% of cancers.
But damage to our genes
or our genetic makeup can also happen from
environmental factors.
Things like tobacco, smoke, alcohol,
harmful UV rays from the sun, radiation, harmful chemicals
to name a few.
What are the different genetic tests for cancer?
There's two types of genetic testing for cancer.
One is a screening test,
which is usually done in healthy people
who have a strong family history of cancer,
and that's to look whether they carry a gene
that will increase their risk of a cancer developing.
We can look for single gene variants, things like BRCA one
or two, which increase the risk of breast
and ovarian cancer,
but it can also look for multiple cancer genes as well.
That's called polygenic risk score.
There's another type of cancer, genetic testing,
which can happen for people
who already have an established diagnosis of cancer,
and that's where we look at the cancer itself
and see which mutations
or proteins driving the growth of that cancer,
and that can help guide which treatments we give.
What are the BRCA1 and 2 genes?
The BRCA one and two genes stand for breast cancer genes,
and these are probably the most well-known genes
that can cause cancer developing.
BRCA one and two are what we call tumour suppressor genes.
So these are designed to detect any DNA damage
that can occur in cells and prevent those cells replicating
and growing into a cancer.
BRCA one and two are the most commonly mutated genes
that cause breast cancer
and they increase a person's lifetime
risk of developing cancer.
Now, it's important to note that if you have a BRCA one
or two gene mutation, it doesn't mean that
for definite you will develop cancer, just
that you have an increased risk.
So for example, the average female in the population has a
lifetime risk of developing breast cancer at around 12%.
If you have the BRCA one
or BRCA two gene mutation, that risk increases
to 70% over your lifetime.
The reason it's important to know if you carry one
of these genes is that it can help you
with your decision-making and preventative strategies
to prevent that cancer developing.
For example, you might be more diligent
with at-home breast checking
and get any lumps or bumps checked out.
You'll be offered earlier screening so often
for people over the age of 30.
That's annual MRI scans. That can even be done from age 25.
If you're high risk from the age of 40,
that'll be an annual MRI and a mammogram.
Some people also choose to undergo preventative surgery,
things like a bilateral mastectomy,
to remove the breast tissue to reduce the risk
of cancer developing,
and that actually reduces the lifetime risk down
to less than 5%.
If you have the BRCA one
or two gene mutation, then you have a 50% chance
to passing it on to your children.
Can men carry the BRCA gene?
Absolutely.
I think when we talk about the BRCA one
and BRCA two gene, we just assume we're talking about women
because the first thing we think about is breast cancer,
but the BRCA one and two gene can be inherited by men
and increase the risk of not just breast cancer,
but also prostate and pancreatic cancer.
Men who have the mutated BRCA gene can also pass it down
to their children and would have a 50% chance of doing so.
What is the TP53 Gene?
TP 53 stands for tumour Protein 53,
and this is probably the most important
tumour suppressor gene.
This stops cancer cells growing out of control
and developing into a tumour.
TP 53 is the most commonly TATed mutation in cancer.
Over 50% of cancers have a TP 53 gene mutation.
This gene is often called the guardian of the genome
because what it does is it detects if there's any damage
to the DNA and signals for DNA repair pathways,
or if that damage to the cell is so severe,
it will cause the cell to self destruct
and die and prevent a cancer.
Developing mutations to this gene allow
for mutated cancer cells to divide and grow out of control,
and develop into a tumour.
What does polygenic risk score mean?
Polygenic risk score is kind of the cumulative changes
to your genetic makeup that increase your cancer risk.
So often when we think about cancer, we think about
individual genes
or single gene variants that increase cancer risk.
A common one is mutations to the BRCA one
or two gene, which increase breast cancer risk, for example.
But cancer's a bit more complex than that,
and it's often not just one single gene variant
that increases our cancer risk,
but actually lots of tiny changes to our genes
and our DNA that over time increase our cancer risk.
And we call that our relative risk of cancer compared
to the general population.
And that polygenic risk score is adding up all
of those tiny, small changes to our DNA
that change our cancer risk.
At the moment, it's largely used in research,
but we are increasingly moving towards using this
for people's individual risk.
What is genomic testing?
Genomics is the study
of a patient's entire genetic makeup.
We call that their genome, and that is individual genes,
but also how it interacts with each other
and also with the environment.
So genomic testing is where we can test people
and see whether they have any changes to any of their genes
that increased their risk of a cancer developing.
And it allows us to do early interventions, things like
increased self-checking like breast
or testicular examination at home,
or closer cancer screening.
If you have a gene variant
or something in your genetic makeup, that's going
to increase your risk of a cancer
developing over your lifetime.
We can also do genomic testing on the cancer itself.
So if you have been diagnosed with a cancer,
we can test the genetic makeup of the cancer itself
and look for any mutations
or proteins that are driving cancer growth
and help guide targeted treatments.
Can I use genomic testing to prevent cancer?
Genomic testing wouldn't actually prevent a cancer
developing because we can't change our genetic makeup
and we can't change the fact that we age
and new gene mutations can occur.
But what it can do is tell us about our
risk of developing cancer.
So if you have inherited a slightly altered gene
that increases cancer risk, something like BRCA one
or two for breast cancer, then it will allow us to do things
to try and catch the cancer early.
Things like at-home, checking our breasts regularly,
or doing an at-home testicular examination, for example.
It also allows us to enhance cancer screening,
so doing more rigorous cancer screening,
perhaps yearly MRI scans
or mammograms for breast cancer, for example.
Or doing them at an earlier age than
what you would usually do,
but it can't actually prevent a cancer developing.
It just allows us to intervene at an earlier stage.
What types of cancer does genomics test for?
Genomic testing can pick up lots of different cancers.
Things like breast cancer
or ovarian cancer, namely looking at things like
the BRCA one or two.
Gene Genomic testing can also be used for prostate cancer,
for bowel cancer, looking for lynch syndrome genes,
and it's commonly used for lung cancer.
Things like the EGFR mutation, BAF, or kras.
We can use genomic testing both
for looking at your individual cancer risk
and whether you carry any of these gene mutations,
but also in some cancers we can use it on the cancer itself
to help guide treatment decision making.
Why is it important to consider mental health when I have cancer?
Such a big question.
I think it's really important when we talk about cancer
care, to not forget about the mental toll
that cancer diagnosis
and treatment can have, not only on the patient going
through the journey, but also their family and loved ones.
Because we can talk about treatments to increase survival,
but it's not the whole story.
The patient's quality of life
and mental health is so important as well, particularly
for some of the cancers that we can't necessarily cure
and we're giving for patients to live with it.
We can't forget that their quality of life
and mental health is important.
And I think there's a few parts of this.
There's the mental health aspect
of whether a treatment's working
and the kind of anxiety waiting for cancer scan results
to see what the cancer treatment has done to the cancer.
But there's also mental health implications of treatments
that could be preventative.
Sometimes we give treatment
after surgery to reduce the risk of a cancer coming back.
And those patients, a patient whose cancer is cured,
but they're having treatment as a preventative thing,
and yet they still need to go up to the cancer ward
and sit in a chair next to someone who may be
in a terminal end stage of cancer.
And I think that mental load of being in that environment
isn't one that we should neglect.
I think as well for some patients whose cancer may be in
remission or in fact cured, there is likely always
something in the back of their mind about worrying about
whether cancer is going to relapse.
I think it's also really hard
because we focus so much on the patient,
but the mental health
and wellbeing of their support network, so their family
and loved ones is important as well.
And I think for anyone going through this journey,
even if you think you are dealing with it well,
or whether you've been through it
and you think you've processed it,
I think it's always worth having a conversation
with someone who's trained,
a trained professional about mental health, just to chat
and process what's happened
to you and what you're going through.
There's always mental health support available.
If I have cancer will I have mental health challenges?
I think it's really easy to just focus on the cancer,
but actually having a consideration
of the mental health challenges you might go
through on your cancer journey is important too.
I think stats do show that at least half of people that go
through a cancer journey suffer with things like anxiety
and depression, and I imagine it's actually a
lot more than that.
I think there's also important considerations
that sometimes mental health challenges can
show up as other symptoms.
It's not just feelings of worry and low mood,
but sometimes it can be problem with sleep, like insomnia,
changes in appetite, or even changes in sex life.
And so mental health challenges can show up in lots
of different ways, but I think it's very likely
that you will have some changes
to your mental health if you're going through this journey,
and that's why it's so important to address it head on,
get the support you need, and
to talk about how you're feeling.
Because although cancer is more common than ever,
it's not normal and it is going to be a stress to you
if you're going through it, and not just for you,
but also your support network
and the ones close to you as well.
I am worried about something that might be cancer, what should I do?
I think that you know your own body better than anyone
else, and if something doesn't feel quite right
or you're worried about something, it's always better
to get checked out than try
and push it to the back of the mind.
I think from experience, if you try
and push these things under the carpet, then they tend
to just build up and become a massive
stress and worry in your head.
We know that with cancer, it's always better
to pick it up early and face these things head on,
and it's easy to think, oh, I don't want to think about that
and not take action.
But it doesn't change the outcome.
In fact, it often makes the outcome worse
and we know that cancers always do better when pick them up
earlier, so if in doubt, always get checked out.
Does having terminal cancer mean that I am going to die?
I think it's a really good question
because actually stage four cancer means terminal cancer,
and it's a real misconception that that means you're going
to imminently die from the cancer.
In fact, we've come such a long way with treatments
that I have many patients with advanced stage four cancer
that live with the cancer for many years,
and lots of the treatments can either keep the cancer stable
and put the brakes on it and stop it growing,
or can shrink it down
so small we can't even see it on a scan.
And actually many patients can live for years
and years with this terminal cancer.
It does shorten their life expectancy,
but it definitely doesn't mean that end
of life is imminently approaching.
What are your top 5 tips to help prevent cancer risk?
I think we need to get really honest
with ourselves about our lifestyle behaviours
because there's lots of the things we do each day without
really thinking about it that can increase our cancer risk
or prevent cancer developing.
My number one thing would be
to make sure we are moving our bodies.
We know that exercise reduces a whole load of cancers.
Developing and exercise is protective even if
you don't lose any weight.
So get your body moving
and remember that movement looks different on everyone.
It doesn't have to mean going to the gym
or going on a run if you don't enjoy that.
Finding a movement that's enjoyable for you
and that you can be consistent
with is the most important thing.
If you smoke, stop smoking.
And if you don't smoke, please don't start Tobacco.
Smoke is the number one risk factor
for developing cancer globally,
and I'm always still staggered by how many people smoke.
So if you can cut down and even better stop.
I think being a little bit more intentional
with our alcohol consumption.
We're in a society where it's quite normal just
to have a glass of wine with a meal,
and we're not always aware how much we're actually drinking.
We know that alcohol increases our cancer risk,
and I'm not saying you need to completely cut out alcohol,
although that would be preferred,
but at least being a little bit more intentional
with your consumption and maybe saving it
for a special occasion or a meal out rather than just
randomly having drinks throughout the week
and not thinking about it.
I also think we can all make improvements to our diet.
I don't want to sit here and say you've got
to cut out everything you enjoy out of your diet,
but can you focus on adding things into your diet
that are going to reduce your cancer risk?
So we know that things like processed red meats increase
cancer risk, so maybe limit those, but try
and increase the fibre in your diet,
which we know is protective.
Eating more plant-based foods, whole grains, beans, pulses,
fruit and veg, fresh herbs, nuts
and seeds can all help increase the fibre in our diet.
And the last one I would say is make sure you prioritise
your health and attend your cancer screening.
Whether that's your breast cancer screening,
bowel cancer screening, cervical cancer screening.
Don't put booking that appointment
to the bottom of your to-do list.
We're all busy and it's very easy to think, oh,
I'll get around to that next week.
But actually without our health, we have nothing.
And that needs to be top of our own priority list.
So if you've got that letter in the post,
then make sure you book your appointment.
How can I best support someone with cancer?
It's a big question.
I think immediately
after someone's been diagnosed with cancer,
emotions are really running high
and it can be so overwhelming.
And I think offering to come with someone
to their appointments can be really helpful
because often we say so many things
that I know patients won't remember when they're at
that heightened state of emotion.
So offering to just be there, whether it's
to sit in the waiting room or to come into the appointment,
having that support is often needed,
even if someone says they're happy to go alone.
I think when you have been diagnosed with cancer,
it's very easy to just neglect all self-care
because it's just not your priority anymore.
And so doing things for someone without them asking
to just take off some of the burden of everyday life, maybe
that's doing a food shop for them
or doing some cleaning for them, something
that they probably aren't thinking about,
but that's just going to make their life a little bit easier
is a great way of sharing support.
I think we all like to dodge the topic of cancer.
It can be uncomfortable talking about patient's wishes,
whether they want to do treatment
or not, whether that's how they want to die.
All of these difficult conversations can be really easy
to avoid it because it can feel really challenging.
But some of the most supportive things you can do
for your loved ones is
to offer those conversations if they want to have them.
And actually I find that when you set the tone
that it's okay to talk about it, patients actually do want
to engage in those more challenging conversations.
And my final thing is that I think a lot
of patients do things
because they don't want to let their family down.
Lots of patients go through treatments
or stay having treatment, even if they're really suffering
with side effects and their quality of life is poor
because they don't want to give up on their family.
And sometimes I think the most supportive thing you can do
for a patient is to allow them to stop treatment
and to know that you are okay with that decision.
And it might be hard,
but sometimes that's the most caring thing you can do to put
that option in the room
that actually they can pursue a more palliative care route
and go down more symptom relief
and making them comfortable rather than always pursuing
aggressive cancer treatments.
But there's lots of things you can do to support someone.
It really depends on the journey that they're going on.
And I would encourage you to chat to your
loved ones, oncologist or nurses
and find out more about how you can support them.
I have just been diagnosed with cancer, what advice do you have?
Oh, I have lots of advice for you.
I think the first is to get as much knowledge as you can.
I really think knowledge is power
and sometimes when we're overwhelmed
and emotional, it's very easy to think, oh, I don't want
to know or I don't want to think about that.
But actually having the knowledge allows you to make
informed decisions about your own care and make plans.
I think it's important not to panic
because sometimes we hear that we have a diagnosis
of an advanced cancer
and you immediately think, well, this means
that I'm approaching end of life.
And often that's not the case.
Many patients live with advanced
or terminal cancers for a number of years,
and so don't panic and ask the difficult questions
because it's always better to plan in advance so
that you are part of those conversations
and decisions aren't being made on your behalf later down
the line in a heightened stress environment.
I think it's also really important to not let,
I know it's easier said than done.
The entire cancer diagnosis define your whole life.
It can be completely consuming when you have all these
appointments and tests and investigations
and it feels like you're
coming to the hospital all the time.
It can be really easy to forget your life before cancer,
but I really encourage patients to, on the days
that they're not coming in, to try
and get back to their old life,
to do the things they enjoy doing as much as possible.
If they can still work
and they enjoy it to still work, it's really easy
to let cancer completely define you,
and it's really important to remember who you were
before this happened because sometimes the treatments
are not curative and they are extending your life,
and if you're not living a life you're enjoying,
then what is the point?
So be really honest with yourself about that.
And I think that's my main bit of advice.
I think ask for support if you need it.
It's very common for people to want to be really brave
and stoic and think, I'll be fine.
I can get through this. And sometimes I find patients
breaking down years down the line
after they've already recovered from a cancer and it's
because they never really allowed themselves
to process what they're going through.
So allow yourself some grace
and take support where it's available.
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is what are the typical signs and symptoms
that we can look out for?
The commonest ones, commonest two are
bleeding from the bottom and change your bowel habit
and that normally means either more loose or more frequent.
So people often think it's constipation,
I'm bit constipated and that means I’ve got bowel cancer,
it's actually the opposite, It's actually looser
and it's actually more frequent.
So if that remains for a period of time,
obviously, we gone out for a night out
and we've had a curry the night before,
we're not talking about that
we're talking about a sustained period of time
where your bowels just become a little bit looser.
And there are other there are other symptoms,
you can get bloating, you can feel abdominal pain,
you can pass mucus from your button, but the two
commonest things,
bleeding from your bottom
and change your bowel habit towards looseness.
And how important is it to tackle these signs early?
So if anybody is noticing that they're having these symptoms,
how quickly should they act really,
It's really, really vital.
The earlier you pick up on these things,
the better your outcome will be.
Every single time.
So what we know is that bowel cancer,
colorectal cancer starts off life as a polyp.
So it goes from normal bowel to polyp to cancer
and there's a period of time between those different steps.
So if we can pick up something at the stage where
it hasn't become cancerous and it's a benign polyp,
then will prevent the cancer happening completely.
But even if it has become cancer, then the earlier you pick it up
the earlier you deal with it, the better the outcome,
you know, always
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The first thing is to really understand your personal risk.
And broadly, the older you are, the higher your risk of cancer.
In general terms.
If you're a smoker, if you're overweight, if you've got a strong family history
of some cancers, that may increase your risk of cancer, but often not always.
And if you drink more than the recommended
guidelines, these are all things that could increase your risk of cancer.
So the first thing I say is know your own risks and then know your own body.
People are aware of their bodies and knowing when there's a change.
And that's unusual for you, but importantly, persistent changes.
So if we were to talk about bowels, for example, many people's bowels change
all the time.
It depends on what they have eaten,
how stressed they are, how much exercise they've had, how much water they've
drank, as GP's what we're interested in is a persistent change in normal for you.
And broadly that applies to most cancers
and probably the most worrying symptom that worries all of us as GP’s
if someone has persistent unexplained weight loss is one of those things
that should not be happening and definitely needs to be checked out.
Then there's the skin lesions that aren't healing
or unexpected lumps or bumps or growths, and particularly
if they're growing over a short period of time.
Things that grow over a short period of time,
it's really important to get those checked out.
So I think
there's the six ways that I would say that we could tackle this
so that the most important is to stop smoking.
That is the most preventable cause of cancer for for all types of
cancer is implicated in 70% of lung cancers.
So definitely that would be my number one.
Number two try and reduce the amount of alcohol that you drink.
We know that that is implicated in a lot of cancers too.
Try and maintain a healthy weight, weight is implicated in that endometrial cancer,
as we've just heard, but also breast cancer and bowel cancer as well.
Try and have a healthy diet.
Try not to stay in the sun too long.
That would increase
our risk of skin cancers and, you know, move, move as much as you can.
So exercise.
We talk about the importance of exercise, not just to prevent cancers,
but also to reduce our risk of heart disease as well.
There's so many benefits to that.
So ensuring that we do get out every day and get some resistance
exercise as well and just keep moving.
The two probably main things are checking for breast cancer and skin cancer
would be the two things
that you're most able to do because there a kind of looking and touching thing.
And so, you know, for
for breast health, really, again, very important to know your own body.
So get really familiar with what your breasts look like and what they feel like.
And the best time for women to do that is often
when they're about to jump in the shower or jump in the bath.
So take a moment just to pause and look in the mirror in your
in your bedroom or bathroom, just to see if your breasts
look what they look like, if you're not really familiar with them.
But to make sure there's been no changes in appearance and the kind of things
we want to know about as GP's is does it suddenly look uneven?
It's not the same shape as before, and normally that would be on one side
more than the other. Is there any dimpling?
Are there any skin changes around the nipple?
Sometimes eczema over the nipple can be a sign of something
more worrying going on deeper within the breast.
And then what I tend to recommend women do is just get familiar
with how their breasts feel often, so we all wash on a regular basis.
That's a really good time to feel your breasts and know how they feel
because especially with the water in the soap, it's a really smooth surface
and I tend to recommend people think about when they think about examining breasts.
Women often worry that they
don't know how to do it, and actually breasts can be hard to examine.
The glandular tissue.
They're not smooth, they're not meant to be smooth.
And if you feel them with kind of a poking
motion, everyone's breasts will feel very uneven.
So it's about imagining that you've got I've tried to tell people to imagine
a kind of a Ziploc bag of jelly, and you've hidden a marble in it
and you're trying to find the marble in the jelly.
You wouldn't go like that because you'd keep you'd keep losing it.
What you do is you press it against a flat surface and run your hand.
So it's the same kind of process with examining your breast, pushing
the breast tissue against your chest wall with the flat of your hand.
And what I try to reassure women is that
if there is something abnormal there that is very worrying, it's
highly likely you might find it because they're not very subtle.
So it might feel like a small hard pea or a cherry or a stone.
You know, the kind of lumps we expect
women to find are quite different from normal breast tissue.
But if you find anything that makes you worry, it's
even if it's the same, both sides then come and see the GP.
Let us examine you. Let us have a feel.
And sometimes it's a case of especially if you're still having periods
come back after your period and we'll examine you again.
But if there is a lump there, then absolutely
we should be looking into that with either a mammogram or an ultrasound scan
and your GP should be making that happen for you.
And then mole checks again, quite simple, looking at your skin,
being familiar with your moles.
And when we're thinking about melanoma, we're thinking about moles that change
rapidly over a period of 6 to 8 weeks, growing crusting, bleeding
and being aware of that, sometimes even taking pictures of it,
and then going back a few weeks later and taking another picture,
maybe with something to reference the that can be a really good way
of reassuring yourself It's not growing over that period of time.
The same message.
If you're worried, go and go and talk to someone else, share the worries,
and then you can explore whether anything else needs to be done.
There's
no specific evidence to say that we should avoid certain foods
or have more certain foods at the moment in a particular type of food.
And and we'd worry maybe that people would become deficient
in certain nutrients if they did avoid food groups.
But having a healthy diet, lots of fruit and vegetables, high fibre,
trying to avoid some processed foods because we do know
that that is linked to bowel cancer and red meat as well.
So keeping that to the minimum, but making sure we get lots of those good proteins.
So, our white meat our chicken our fish and pulses
and that sort of thing is a lot better for us.
So we do say for men and women to try
and have less than 14 units of alcohol a week,
it doesn't matter what type of alcohol it is with regards to your cancer risk.
And it also doesn't matter whether that's spread out or whether it's
sort of binge drinking as such when we're looking at cancer risk.
I mean, it's obviously different
in other circumstances, but from that cancer risk point of view,
it's just staying below that 14 units a week
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