My name is David Plume, I'm a GP in Norfolk and I'm Macmillan's Lead GP for cancer and
end of life for East Anglia. When I see someone who's got signs or symptoms suggestive of
cancer I'll be looking at referring them off to the specialist at the hospital for further
tests and investigations. This is often going to be under what we call 'the two-week wait',
which means they get seen very quickly and the appropriate investigations and tests get
done by the specialists at the hospital. We won't necessarily get those investigations
and tests back because they've been done by the specialists but we will get a letter back
from the hospital to tell us either that the tests and investigations were fine,
or in unfortunate cases where people are diagnosed with cancer, to tell us that the investigations
and tests weren't okay and that the case is then going to be discussed by the multi-disciplinary
team at a point in the short future.
The length of time needed for these investigations
can differ depending on the type of investigation. Some things like blood tests are very simple
and can be done in a couple of minutes. Scans, for example a CT scan, might take 30-40 minutes,
an MRI scan might take 40-50 minutes and other investigations, such as bronchoscopies
or colonoscopies can require general or local anaesthetic or sedation and can take anything
up to an hour or so to do. In some clinics there is what's called a 'one-stop
shop', which is often where investigations and tests may well be done on the same day.
In other specialties, investigations and tests may be done over a more protracted period
of time, over a couple of days or a couple of weeks in order to reach a diagnosis.
The period of time between being referred up to the hospital under the two-week wait
and being seen, and a diagnosis being made could be two weeks, or could be a little bit
longer depending on when the investigations happen. We know that this waiting around and
this waiting for a diagnosis can be really really distressing and difficult for people.
What we'd suggest in the first instance is that you don't worry. Just because you've
been referred up under a two-week wait doesn't necessarily mean you have a diagnosis of cancer.
Inevitably however, you're going to worry that you do have a diagnosis of cancer and
so things to do in the meantime would be to seek support from friends and relatives, maybe
see your GP again to get some support, allow your GP to talk you through the process and
what's happening. Or maybe to seek external sources of support, such as from the Macmillan
helpline and things like that. Once you've had the investigations and tests,
the specialist doctors will call you back to the hospital for an appointment to discuss
the results. They would already have discussed the results within the multi-disciplinary
team meeting and so will have a very good idea of what type of cancer that you may have
and also what the potential treatment options might be.
Unfortunately, it takes a period of time between having investigations, having the discussion
with the multi-disciplinary team and the specialist doctors being able to give you the diagnosis
but they will offer you an appointment to come in and have a talk to them about the
diagnosis, and they'll be able to run you through both the diagnosis and also the treatment
options that exist. We do know that this is a really difficult time for people, and having
had the investigations and tests you want nothing more than to get the results as soon
as possible but the specialist doctors will see you as quickly as they possibly can and
put your mind at rest, hopefully. If the diagnosis is not good and it's found
that you do have cancer, the oncologist may want to run some other tests and diagnosis
to look at the cancer in more specific detail to help them with the treatment options,
but what they will do is discuss with you the treatment options that are available.
These might involve medical treatment with chemotherapy or drugs,
radiation treatment with radiotherapy
and/or some surgical treatment either to remove the tumour, either partially or completely.
As GPs we have a lot to offer at this point. It's completely appropriate for you to come
in and talk things through with us at this point and it may be just that you just want
a friendly face or a sounding board to discuss ideas and worries and to talk through the
treatment that you've received at the hospital or advice that you've received at the hospital.
It may be that you require some more information about your diagnosis or to validate some of
the information that you've already received. Your oncologist might offer you the opportunity
of taking part in a clinical trial and this can often be a quite daunting prospect for
people because they're worried about what being in a trial means and whether that means
they're not going to get some treatment for their cancer. It's completely appropriate
to discuss that with your oncologist, or come and discuss it with your GP who can put your
mind at rest and talk you through the specifics of being in a clinical trial and what the
implications of that might have for you and your treatment.
No matter how much you might have prepared yourself for the possibility that you might
have cancer when you're told you have cancer all logic goes out of the window and you can
often forget to ask questions that latterly seem very sensible. Things that your friends
and family say 'did you ask this? Did you ask that?' go completely out of your head.
I think the key thing to remember is that there's no such thing as a silly question
and what I'd encourage you to do is go and see you GP, ask those 'silly questions', because
your GP's there to support you, help you and if they don't know the answer to the question
they can send you off to someone who does.
For information, help, or if you just want to chat
call the Macmillan support line on 0808 808 00 00 or visit macmillan.org.uk