What is cancer?
Cancer is any malignant growth or tumour caused by abnormal and uncontrolled cell division.
It is widely believed that damaged DNA and genes are the 'driving force' behind the development of cancer and they are therefore the focus of cancer research.
Unlike in healthy cells, damaged DNA is not capable of repair in cancerous cells.
People can inherit damaged DNA, which accounts for many cancers. A person's DNA may also become damaged by exposure to environmental factors, such as through smoke inhalation. Cancer cells travel around the body and begin to attack healthy tissue in a process called metastasis. This occurs when the cancer cells get into the bloodstream or lymph vessels of the body.
'Benign' tumours develop through the same process, but do not spread to other parts of the body (metastatize) and, with very rare exceptions, are not life-threatening.
There are over 200 different types of cancer that can occur anywhere in the body; the most frequently occurring are lung, breast and bowel cancer.
The development in scientific understanding of DNA structures and improvements in research techniques has vastly improved understanding of cancer and the effectiveness of some cancer treatments.
However, in the early 20th century understanding was limited: surgery was the only method for effectively treating cancer and only worked on small and localised cancers that could be completely removed.
Radiation techniques were subsequently developed for use after surgery to control small tumour growths. Chemotherapy (drug treatment) was later developed to destroy small tumour growths that were not treatable by other methods. The drugs used in chemotherapy prevent tumour cells from dividing, so they stop growing or die in a variety of ways.
A major breakthrough in the treatment of cancer was the development of multiple chemotherapeutic agents (known as combination chemotherapy).
Improved understanding of the biology of cancer cells has led to the development of biological agents that mimic some of the natural signals that the body uses to regulate growth. This cancer treatment, known as biological response modifier therapy or immunotherapy, has been effective against several cancers in clinical trials.
As understanding of the causes of cancer has improved, so has the ability of doctors to pre-empt the development of cancerous diseases through the use of screening tests.
Cancer research scientists have also reported significant potential improvements in radiotherapy techniques by using microbeams, said to be the "future of cancer treatment" by Cancer Research UK. This technique involves firing particles of radiation one at a time at individual cancer cells. This then has a 'by-stander' effect, as treated cells send out 'suicidal' signals to their neighbours. This technique is thought to significantly reduce damage to healthy cells during radiotherapy.
In December 2011, Health Secretary Andrew Lansley announced plans to invest up to £150 million in procuring the new cutting-edge ‘proton beam therapy’ (PBT) radiotherapy cancer service, which uses a precision high-energy beam of particles to destroy cancer cells.
PBT treatment is said to be particularly suitable for complex childhood cancers. It increases success rates and reduces side-effects, such as deafness, loss of IQ and secondary cancers.
Government cancer policies are a key feature of the NHS reform programme and are therefore an important way of measuring its success.
This made the ability of government to reach the targets set by the NHS Cancer Plan 2000 potentially highly controversial. The Plan said the ultimate goal should be to "offer patients a maximum one month wait from an urgent referral for suspected cancer to the beginning of treatment".
There were concerns that demand would outstrip the funds available to support the NHS supply of cancer services. For example, in 2003 the Christie Hospital in Manchester, one of the UK's leading cancer hospitals, said it might be forced to ration future treatment due to a lack of funds. This shortfall in cash meant that patients may face delays in chemotherapy, which could put lives at risk. The NHS can also suffer from shortages of trained staff, as consultant oncologists take many years to train, as do radiographers and other experts.
However, a report from the King's Fund think tank found that by June 2006, 98.9 per cent of people suspected of having cancer were seeing a specialist within two weeks, and 99 per cent of those diagnosed began treatment within a month.
In 2007, Gordon Brown used his keynote speech at the Labour conference to announce several new measures to improve cancer treatment: Breast cancer screening extended for six months and every case treated as urgent; colon screening extended to people in their seventies; £15 billion investment for research in genetics, stem cell research and new cancer drugs.
The Cancer Reform Strategy, launched on 3 December 2007, set out a clear direction for the development of cancer services in England over the following five years. More than 1000 stakeholders were involved in the development of the strategy, including representatives from cancer charities, cancer professionals, NHS managers, patients and social care professionals. The work was led by the National Cancer Director and chair of the National Cancer Research Institute Professor Mike Richards.
In April 2008 the NCRI published its 'Strategic Plan 2008-2013' which aimed by 2013 to have "further strengthened NCRI's reputation for connecting people, ideas and actions in cancer research, in the UK and internationally."
In January 2011, the DoH published 'Improving outcomes: a strategy for cancer', its stated aim being "to help the reformed NHS deliver cancer outcomes that are amongst the best in the world."
The first annual report on the strategy published in December 2011 noted both the achievements and the challenges which remain.
The achievements included: Improved data collection and analysis; expansion of the cancer screening programmes; campaigns to improve the public’s awareness of cancer symptoms and to encourage them to present promptly to the doctor; surgical training programmes; reducing inpatient bed days.
Challenges highlighted for the year ahead were: Moving forward on piloting flexible sigmoidoscopy bowel screening; a national awareness campaign on bowel cancer; improving diagnostic capacity and productivity; the needs of survivors in different post-treatment phases; providing information to commissioners and providers about patients’ experience of care; giving support to tackle issues such as information provision and better communication.
Waiting times for suspected and diagnosed cancer patients: quarter ending December 2011
The key results for outpatient services and first definitive treatments show that, in England during the period October to December 2011:
Two week wait –96.2% of patients were seen by a specialist within two weeks of an urgent GP referral for suspected cancer – (95.7% in Q2 2011-12)
Breast symptom two week wait – 96.3% of people urgently referred for breast symptoms (where cancer was not initially suspected) were seen within two weeks of referral (96.0% in Q2 2011-12)
One Month (31-day) wait – 98.5% of patients began first treatment within 31 days of diagnosis, for all cancers – (98.4% in Q2 2011-12)
One Month (31-day) wait – 99.2% of patients began first treatment within 31 days of a diagnosis of breast cancer – (99.3% in Q2 2011-12)
The proportion of patients treated within 31 days of diagnosis for various cancer types is as follows: Lung cancers – 99.2% treated within 31 days of diagnosis. Lower gastrointestinal cancers –98.5% Urological cancers –97.0%Skin cancers –98.5%
Two Month (62-day wait) - 87.9% of patients began first treatment within 62 days of an urgent GP referral for suspected cancer, for all cancers – (87.3% in Q2 2011-12)
Two Month (62-day) wait – 98.0% of patients began first treatment within 62 days of an urgent GP referral for suspected cancer, breast cancer – (97.5% in Q2 2011-12)
The proportion of patients treated within 62 days of an urgent GP referral for various cancer types is as follows: Lung cancers – 83.3% treated within 62 days of an urgent GP referral for suspected cancer. Lower gastrointestinal cancers – 78.4% Urological cancers (excluding testicular cancers) –84.7%. Skin cancers –97.7%
31-day wait for second or subsequent treatment
31-day wait –97.6% of people were treated within 31 days where the subsequent treatment was surgery – (97.7% in Q2 2011-12)
31-day wait – 99.8% of people treated within 31 days where the subsequent treatment was an anti-cancer drug regimen – (99.8% in Q2 2011-12)
31-day wait – 98.6% of people treated within 31 days where the subsequent treatment was a course of radiotherapy – (98.2% in Q2 2011-12)
62-day wait extension
62-day wait – 94.0% of people began first treatment within 62 days following a consultants decision to upgrade a patient’s priority, for all cancers – (93.4% in Q2 2011-12)
62-day wait – 94.5% of people began first treatment for cancer within 62 days of referral from an NHS cancer screening service, for all cancers – (93.2% in Q2 2011-12).
Source: DoH – February 2012
“This investment will ensure that Britain remains at the cutting edge of the fight against cancer.
“For too long our cancer survival rates have lagged behind other comparable countries. I am determined that we do everything we can to change that and this new investment will help significantly."
Health Secretary, Andrew Lansley, unveiling plans to invest up to £150 million in procuring a new cutting-edge ‘proton beam therapy’ radiotherapy cancer service – December 2011