Most Common Cancers in the UK & Red Flags

📊 Top 10 by New Diagnoses (Incidence) – UK Overall

• 1. Prostate (men: ~55,000 cases; now most common overall)
• 2. Breast (women: ~58,000; most common in females)
• 3. Lung (~50,000–51,000)
• 4. Colorectal / Bowel (~49,000–50,000)
• 5. Bladder (~23,000)
• 6. Melanoma (~17,000–18,000)
• 7. Non-Hodgkin lymphoma (~14,000)
• 8. Kidney (~14,000)
• 9. Head & neck (including oesophagus/oral)
• 10. Pancreas / Uterus (corpus) – varying by year

Source: CRUK 2025 overview / NHS England 2022 registrations (prostate overtook breast overall; lung/bowel stable). ~425,000 new cases/year UK-wide.

💀 Top 10 Causes of Cancer Death (Mortality) – UK

• 1. Lung (leading cause; ~35,000 deaths/year)
• 2. Colorectal / Bowel (~17,000–18,000)
• 3. Breast (~11,000–12,000)
• 4. Prostate (~12,000)
• 5. Pancreas (~9,000–10,000; high fatality)
• 6. Oesophagus (~8,000)
• 7. Stomach / Liver
• 8. Bladder
• 9. Non-Hodgkin lymphoma
• 10. Leukaemia / Ovarian

Note: Lung cancer kills most despite lower incidence than breast/prostate – due to late presentation & poor survival. ~168,000–170,000 cancer deaths/year UK.

🚩 NICE NG12 Red Flag Symptoms – Recognition & Referral (2026 Update)

Use these to trigger investigations or 2-week wait (2WW) suspected cancer pathway referral (aim: diagnosis/exclusion within 28 days). Threshold often ≥3% risk of cancer. Consider age, risk factors (smoking, family history, obesity), and non-specific symptoms.

• Unexplained weight loss: Offer tests (FBC, CRP, LFTs, TFTs, coeliac screen, CXR, upper/lower GI endoscopy if ≥3% risk) or 2WW if high suspicion.
• Change in bowel habit / rectal bleeding (≥40–60 y): Quantitative FIT test; if ≥10 µg Hb/g → urgent colonoscopy (2WW colorectal).
• Dysphagia / persistent dyspepsia + weight loss / reflux symptoms >55 y: Urgent direct access OGD (upper GI 2WW).
• Persistent cough / haemoptysis / dyspnoea / chest pain (>40 y, smoker/ex-smoker): Urgent CXR; if abnormal or high risk → 2WW lung pathway.
• Postmenopausal bleeding (any age): Urgent transvaginal USS ± hysteroscopy/endometrial biopsy (gynae 2WW).
• Unexplained fatigue / iron-deficiency anaemia: Screen with FBC/ferritin; men/postmenopausal women → urgent upper/lower GI endoscopy (colorectal/upper GI 2WW).
• Prostate symptoms + raised PSA (age-specific threshold) or DRE abnormality: 2WW prostate pathway.
• Non-resolving skin lesion / mole change: Urgent dermatology referral or excision biopsy if suspicion of melanoma.
• Non-specific symptoms (e.g., fatigue + weight loss + sweats): Consider non-specific symptoms pathway or direct tests (CXR, abdo USS) before 2WW if risk ≥3%.

📑 NICE NG12 Referral Pathways Summary (2026)

• 2-week wait (2WW) suspected cancer referral: For symptoms/signs indicating ≥3% risk of specific cancer (or defined criteria, e.g., dysphagia any age, postmenopausal bleeding any age).
• Direct access tests: Often first-line (FIT for bowel, CXR for lung, OGD for upper GI, PSA/DRE for prostate) – can be arranged by GP before/alongside referral.
• Non-specific symptoms pathway: For vague symptoms (weight loss, fatigue) with low but concerning risk – may include bloods + imaging before specialist referral.
• Urgent referral: If very high suspicion or safety-netting needed (e.g., repeat tests if initial normal but symptoms persist).
• Always document discussion, safety-net (re-present if worsening), and risk factors (smoking, family history, obesity, HPV, etc.).

Clinical Pearl (Exam/OSCE/MCQ):
Commonest incidence ≠ commonest cause of death: Prostate/breast highest incidence, but lung cancer kills most (poor survival).
Any red flag in older patients/smokers → think 2WW referral without delay (NICE NG12 ≥3% threshold).
FIT test revolutionised bowel referrals – positive → urgent colonoscopy.
Always ask about weight loss, anaemia, bleeding – broad screen if unexplained.

📚 Key References (2026)

• NICE NG12: Suspected cancer: recognition and referral (last updated Jan 2026)
• Cancer Research UK: Cancer Statistics (2025 overview)
• NHS England: Cancer Registration Statistics (2022–2023 data)
• ONS / Macmillan Cancer Support fact sheets