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Accelerating diagnosis in people with non-specific symptoms of cancer

Only 6% of cancers in the UK are diagnosed through the national screening programmes. For cancers with no screening programme or for individuals that are not eligible for screening, most cancers will be diagnosed following symptomatic presentation. Urgent referral pathways for suspected cancer have been developed for symptoms specific to one cancer site. However, one in two people diagnosed with cancer only ever report non-specific symptoms of cancer, such as unexplained weight loss, fatigue, nausea, or abdominal pain. These people often experience delays because they are referred sequentially to multiple different tumour site-specific clinics before receiving a diagnosis.

The Suspected CANcer (SCAN) pathway

The Suspected CANcer (SCAN) pathway was designed by Dr Brian Nicholson and Professor Fergus Gleeson to accelerate cancer diagnoses in patients with non-specific cancer symptoms. Patients are referred by their GP to the pathway based in the Churchill Hospital, Oxford, where they are investigated with a whole body computed tomography (CT) scan and undergo blood and stool testing. The outcome of these tests directs the patient to the most appropriate clinical expertise to reach a diagnosis as quickly as possible.

Since its implementation across Oxfordshire in November 2017, the SCAN pathway has seen over 3250 patients and diagnosed over 300 incidences of cancer, most commonly lung, bowel, pancreas, lymphoma and breast. In addition to cancer diagnoses, the SCAN pathway has diagnosed a large number of serious non-cancer conditions, including tuberculosis, endocrine diseases and inflammatory bowel disease.

SCAN directly informed the specification of the NHS’s new Rapid Diagnostic Centres being rolled out in England and the development of the Welsh Single Cancer Pathway. In recognition of their achievements, the SCAN team won the BMJ Awards 2020 Cancer Care Team of the Year.

Research using the SCAN pathway

SCAN was the first and only non-specific symptoms pathway to develop an associated research database including comprehensive imaging, laboratory, and clinical data and biobanking of blood and urine samples. This research infrastructure underpins several projects in Oxford, including:

Metabolomics blood test for cancer

A study using blood samples from patients who were referred to the SCAN pathway demonstrated the ability of a new blood test to discriminate between patients who did and didn’t have cancer, and whether this cancer had already spread. This test uses a technique called NMR metabolomics to profile levels of natural chemicals (metabolites) in the blood. Healthy individuals, people with localised cancer, and people with metastatic cancer each have different profiles of blood metabolites, which can be detected and then analysed by the researchers’ algorithms to distinguish between these states.

SYMPLIFY clinical study

A partnership between the University of Oxford and GRAIL, LLC is evaluating the use of the Galleri™ non-invasive, multi-cancer early detection test in patients with suspected cancer, including those referred to the SCAN pathway. Galleri is a blood test that can detect over 50 types of cancer. The aim of the SYMPLIFY study is to demonstrate how the test could be used to increase cancer detection rates and simplify diagnostic pathways.

Future directions

Targeting patients based on their non-specific symptoms for testing with multi-cancer early diagnostic technologies in the community represents a significant opportunity for improving patient care through earlier detection. However, the ideal setting for these tests and how to integrate them into existing cancer services remains unclear. Building on the SCAN pathway, Oxford is working with partners nationally to establish a national platform to develop, pilot and trial community-based multi-cancer detection technologies to address these questions.