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Cancer Services

Getting Diagnosed

Patients are often diagnosed with cancer either as a result of a screening test or through investigation of particular symptoms.

If you are already concerned about any symptoms you have, don't wait to be screened - make an appointment to see your GP immediately.

Our Macmillan Cancer Information and Support Service  provides information about cancer awareness, screening and the tests you may have in order to confirm a diagnosis. The staff and volunteers offer support and information to anyone who is worried they may have cancer or who have recently been diagnosed with cancer.

Cancer diagnosis is supported by our expert radiologists and pathologists.

Screening

The cancer screening programmes of England are nationally coordinated. They are the NHS Breast Screening Programme, the NHS Cervical Screening Programme and the NHS Bowel Cancer Screening Programme. Visit the Cancer Screening website for more information.

Breast

Ladies aged 50 – 70 are invited for Breast Screening once every three years. A GP practice will be contacted and all women eligible for screening registered with the practice will be invited. In December 2007, the Department of Health’s Cancer Reform Strategy announced that from 2012 the NHS Breast Screening Programme would be extended to cover women between the ages of 47 and 73. The age extension will be gradually phased in across England and currently we are inviting just some of the women from the new age groups. Any woman aged over 70 can request screening every three years by calling the screening unit to make an appointment. The unit telephone number is 01527 488 055. Not every woman will receive an appointment as soon as she is 50 but will receive her first appointment before her 53rd birthday. For more information visit the Hereford and Worcester Breast Screening Service.

Bowel

Within Worcestershire the NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 75. Men and women eligible for screening will receive an invitation letter and information leaflet explaining the programme. A week later, a Faecal Occult Blood test (FOBt) kit will be sent out along with step-by-step instructions for completing the test at home and sending the samples to the hub laboratory. The test will then be processed and the results sent within two weeks. Around 98 in 100 people will receive a normal result and will be returned to routine screening. They will be invited for bowel cancer screening every two years if still within the eligible age range. Around 2 in 100 people will receive an abnormal result. They will be referred for further investigation and usually offered a colonoscopy. Bowel cancer screening aims to detect bowel cancer at an early stage (in people with no symptoms), when treatment is more likely to be effective. Screening can also detect polyps. These are not cancers, but may develop into cancers over time. They can easily be removed, reducing the risk of bowel cancer developing. Currently people over 75 can request a screening kit by calling the freephone helpline 0800 707 6060.

Prostate

There is no organised screening programme for prostate cancer but an informed choice programme has been introduced. The aim of Prostate Cancer Risk Management is to ensure that if you are concerned about the risk of prostate cancer, you can receive clear and balanced information about the advantages and disadvantages of the PSA test and treatment for prostate cancer. Your GP can provide you with an information pack.

Radiology

Our clinical radiologists are medical specialists who provide a diagnostic imaging service to patients. This includes x-ray, ultrasound and CT, MRI scans and mammography. They provide assistance both in diagnosing and in deciding on the best way to manage a patient's condition. In addition, patients on treatment will often have follow up scans to assess how well the treatment is working. On occasion, scan guided biopsy or treatment is also carried out by radiologists in the radiology department.

Extensive patient information is available on the website of the Royal College of Radiologists.

Pathology

Pathologists play a part in the diagnosis of 80% of all cancers. They take cells and samples of tissue and, by microscopic examination, diagnose whether they are cancerous. They also grade tumours, giving an indication of whether the cancer is high or low grade. This gives some idea of how the cancer might behave.

High grade cancers - which look least like normal cells - may be faster growing or more likely to spread.  This is highly significant; for many types of cancer, the treatment may be different depending on whether the tumour is high or low grade.

Some patient resources are available from the Royal College of Pathologists.

Scans and tests

X-RAYS AND SCANS

X-rays and scans are used to help diagnose a cancer, to check whether it has spread and to show how effective treatment has been.

CT

Computerised Tomography Scan - This is a scan that uses X-rays and computers to create pictures of the body in cross-section. It gives more detailed information than a plain X-ray and shows up organs in the body much more clearly.

CT Guided Biopsy

A sample of cells is taken from the designated area using CT scan for accuracy. This involves a local anaesthetic, which only takes a few minutes and is done in the X-Ray Department.

USS - Ultrasound Scan

This is a scan using sound waves to build up a picture of organs and other body parts. It is particularly good at showing up the liver.

MRI

Magnetic Resonance Imaging Scan. This is a scan using magnetic waves to create images of the body. It gives very detailed information about all parts of the body.

Bone Scan

This is a scan that looks specifically at the bones to see if cancer is present, or if there is damage or healing.

PET-CT

Positron Emission Tomography Computerised Tomography. This combines a CT scan with a technique using injected markers to give greater clarity in some specific areas of care.

Other general tests

Biopsy A sample of cells or tissue is taken from the body, to be looked at under a microscope. This may require an operation.

FNA

Fine Needle Aspiration - a fine needle is used to draw up cells into a syringe to look at under a microscope.

Endoscopy

This is a test to look at part of the inside of the body using a flexible tube with light and camera - for example the stomach (gastroscopy), lung (bronchoscopy), bladder (cystoscopy), or large bowel (colonoscopy). A tissue sample (biopsy) can be taken.

Echocardiogram

An echocardiogram is a non-invasive ultra sound scan of the heart to check cardiac function to help assess fitness for surgery.

ECG

Electrocardiogram or Heart Monitor These are medical tests of the heart. Small pads are stuck to the chest around the heart. Wires are attached to the pads. These are connected to an ECG machine that takes an electrical recording of the heartbeat. The trace of the heart beat is examined to see if the heart is working normally.

EUS

Endoscopic ultrasound. Procedure performed under sedation similar to an endoscopy but has a scanner attached in order to give more information about the area.

Lung function tests Breathing Tests

There are a number of different tests that can be done to find out how well your lungs are working. For example, doctors can measure the volume of air you breathe in or out normally; the amount you can breathe in or out when you are trying as hard as you can; or the extra you can breathe in when you try after you have breathed in normally. All these measurements tell them more about the workings of your lungs. Lung function tests will be done before certain types of surgery to see if you are fit enough to have the operation.

Bone Marrow biopsy

This refers to an investigation that involves taking a sample of bone marrow and a small piece of bone from the back of the pelvis to be examined microscopically. This enables the doctors to make a diagnosis and plan treatment. The biopsy is normally performed under a local anaesthetic as a 'day' patient in an outpatient setting and takes about half an hour. This means that you will not need to stay in hospital for more than 1 hour on that occasion. Patients may request a sedative injection which minimises what you remember about having the test done, but you will need to stay in hospital for approximately 2 to 3 hours post procedure to recover. Procedures under sedation can only be performed at Worcestershire Royal hospital and will be placed at the end of the clinic. You will need to have somebody with you for about 6 hours following the procedure if you have a sedative. You will not be able to drive for 24hrs after sedation or operate heavy machinery.  Results are available approximately 14 days following the procedure.

The procedure involves the patient lying on a bed on their side in the foetal position with their knees up as far as is comfortable. The Nurse/Doctor with palpate the back of the pelvis to find the exact point from which to extract the samples. The area (skin and Muscle) will then be numbed using Lidocaine. Unfortunately the bone cannot be anaesthetised so there may be a measure of discomfort during the procedure. Once the area is numb a small incision is made in the skin to facilitate easy entry of the needles. The first part of the procedure is to obtain liquid bone marrow from the centre of the bone (aspirate). The needle is carefully pushed into the bone and once the tip is in the hollow lumen of the bone a syringe is attached and a sample of the bone marrow is removed. This can cause an uncomfortable sensation to travel down the adjacent leg but this stops when the withdrawal of bone marrow stops. The marrow is decanted into sample pots and slides are made.

 The aspirate needle is then replaced with the trephine needle. This is pushed into the bone until it has penetrated sufficiently to be firmly supported. The central trocar is then removed from the needle which is then advanced until there is a trephine sample of approximately 3 – 4 cms. This is then broken off by winding clockwise and anticlockwise for a dozen turns and the needle is removed. The trephine sample is then placed onto the slides previously made and rolled to dislodge some of the marrow cells also onto the slide. The trephine is then placed in a 4% formaldehyde ready for further processing.

A sterile dressing is applied to the wound and after care advice is given to the patient.

At all times throughout the procedure the practitioner will be talking to the patient advising of the next step and enquiring of their welfare and comfort.

The procedure will be discontinued if the patient is unable to tolerate it and makes the request.