Many health professionals and organisations are dedicated to the diagnosis, treatment, care and support of those with cancer in Northern Ireland. The arrangement of cancer services can involve GPs, pharmacists, radiologists, pathologists, surgeons, haematologists, oncologists, clinical nurse specialists, palliative care, researchers, the Northern Ireland Cancer network (NICaN) and cancer charities.
Suspicion of a potential cancer can be from a number of routes:
- GP referral for investigation which may have arisen from laboratory results (eg blood tests, liver function);
- incidental finding in a hospital setting whilst someone is being investigated or treated for another condition as an outpatient (eg chest x-ray), day case or as an inpatient;
- family history clinic;
- presentation at an emergency department;
- via a screening programme (ie breast, bowel and cervical).
Patient pathways for cancer diagnosis, treatment and management are complex and require the involvement of multi-disciplinary teams. All cancers have pathways which involve primary (eg GP), secondary (eg specialist health professional) and tertiary care (eg advanced treatment).
The first point of contact for someone who feels unwell or suspects cancer is likely to be their GP. GPs also have a role to play in screening, diagnosis and the long term management of cancer. GPs refer patients with signs and symptoms warranting investigation as “red flag”. Initial investigation can involve x-ray, ultrasound, CATscan, endoscopy, surgical procedure or biopsy.
All individuals with a suspect or confirmed cancer have their diagnosis, care and treatment agreed by a multidisciplinary team. Cancer treatments depend on the stage of disease, spread of disease and prognosis, and can involve surgery, chemotherapy, radiotherapy or palliative care. Treatment is delivered through a ‘hub and spoke model’, ie through a centralised cancer centre and regional cancer units.
Cancer units provide diagnosis and treatment for their local population and for the most common cancers such as lung, breast and colorectal. They also provide a range of chemotherapies, which allows more patients to be treated closer to home. The cancer units are located in Altnagelvin Hospital (Western Trust), Antrim Hospital (Northern Trust), Craigavon Hospital (Southern Trust), Ulster Hospital (South Eastern Trust) and the Belfast City Hospital and Royal Victoria Hospitals (Belfast Trust).
The cancer centre is located within Belfast City Hospital site and offers specialist advice and treatment for cancer patients from all over Northern Ireland. This includes radiotherapy, chemotherapy and a range of outpatients, day case and inpatient services. It specialises in the treatment of rare or less common cancers and those people with cancer who are undergoing complex or radical treatments. It is the only site providing radiotherapy, but late 2016 will see the opening of a radiotherapy unit on the Altnagelvin site for the Western Trust catchment area.
Cancer centre services are also provided at the Royal Victoria Hospital, Musgrave Park Hospital and the Mater Hospital.
The Northern Ireland cancer service works closely with the Medical School of Queen’s University Belfast and with the Queen’s University Centre for Cancer Research and Cell Biology (CCRCB) to develop new avenues for the prevention, diagnosis and treatment of cancer through scientific research and a clinical trial unit.