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Maggie’s offers the best possible support free to anyone with cancer and their families who walk through their doors. The Maggie's Centre Cardiff is located at the back of the Velindre hospital and patients and their families can drop in the centre at any time with no appointment needed.

Please click on link below to find out opening times and everything Maggie's has to offer ..........

https://www.maggies.org/our-centres/maggies-cardiff/

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Flu vaccinations All patients receiving chemotherapy and immunotherapy are at risk from flu. Flu immunisation is recommended if you will be receiving treatment during the autumn and winter. Ideally you should be vaccinated 7 - 10 days before your treatment starts. The immunisation may not be as effective if you have already started treatment because your immune response may be lowered. This reduces your body's ability to form the antibodies needed to protect you from flu.
If you are vaccinated during a course of chemotherapy or immunotherapy, this should be done when your white cell count is at a normal level. You should avoid being vaccinated when your white cell count is low because you may develop a raised temperature. This could be confused with a fever, caused by infection, and could result in unnecessary hospital treatment. Your doctor or nurse will be able to advise you on the right time to have your vaccine.
The adult flu vaccine
This vaccine does not contain any live flu virus so cannot give you the flu.
Child flu vaccine
The children's flu vaccine is given as drops into the nose. This does contain a weakened live virus and so there is a very small chance of catching flu from a child if your white cell count is low. Or if you have not been vaccinated in the 2 weeks before contact with that child. In this situation you should avoid close contact with children who have had the nasal flu vaccine for 2 weeks. If close contact with a child is unavoidable e.g. you are the parent, guardian or carer then you need to discuss with your GP if it is safer for the child to have the adult injected vaccine instead.
Other vaccines
You should not have any live vaccines while you are having chemotherapy and for 6 months afterwards. Examples of live vaccines include:
Who will give the vaccination?
All vaccinations will be given by your own GP practice.
Further questions
If you have any further questions about vaccines please speak to your doctor, nurse or pharmacy team.

Simple measures for you and your family to prevent the spread of flu include covering the mouth or nose when coughing and sneezing, washing your hands and the safe disposal of used tissues. Catch it - Bin It- Kill It!
Infection
You are at an increased risk of picking up infections because your white blood cells which help fight infections can be reduced by this treatment.
If you develop an infection whilst your white blood cells are low, you are at risk of sepsis, this can be life threatening.
Contact Velindre Cancer Centre immediately if you develop any signs of infection, for example flu like symptoms or a temperature above 37.5°centigrade or if your temperature is below 35.5°. The telephone number is at the end of the leaflet.
Contact telephone numbers Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night.
Pharmacy department 029 2061 5888 ext 6223
Monday - Friday 9am - 5pm for queries about your medicines
Macmillan freephone Helpline 0808 808 0000 7 days a week 8am - 8pm for general queries on cancer Tenovus freephone 0808 808 1010 cancer helpline 7 days a week 8am - 8pm for general queries on cancer
This information is also available in Welsh

This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

Prepared October 2013 Reviewed December 2019

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Flu vaccinations All patients receiving chemotherapy and immunotherapy are at risk from flu. Flu immunisation is recommended if you will be receiving treatment during the autumn and winter. Ideally you should be vaccinated 7 - 10 days before your treatment starts.

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At Velindre Cancer Centre we have a  range of therapy services that you may find beneficial for your health and wellbeing. If you would like to be referred to any of the services  below please contact your keyworker (Clinical Nurse Specialist) or Navigator to arrange. 

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At Velindre Cancer Centre we have a  range of therapy services that you may find beneficial for your health and wellbeing. If you would like to be referred to any of the services  below please contact your keyworker (Clinical Nurse Specialist) or Navigator to arrange. 

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Oesophageal cancer is a cancer that starts in the food pipe. The food pipe is also called the oesophagus or gullet.

Cancer is when abnormal cells start to divide and grow in an uncontrolled way. The cells can grow into surrounding tissues or organs, and may spread to other areas of the body.

The food pipe

The food pipe (oesophagus) is part of your digestive system. It is the tube that carries food from your mouth to your stomach. It lies behind the windpipe (trachea) and in front of the spine.

At the top of the oesophagus there is a ring of muscle (sphincter). This sphincter opens the oesophagus when food or liquid comes toward it. It also stops food from going down the windpipe.

The lower part of the oesophagus joins the stomach. This is called the gastro-oesophageal junction (GOJ). There is a ring of muscle (sphincter) close to the GOJ which controls food moving from the oesophagus into the stomach. Between meals, this sphincter closes. This stops stomach contents and acid moving backwards from the stomach into the oesophagus.

Where it starts

The wall of the oesophagus is made of several layers of tissue. These include the inner layer (mucosa), muscle, and connective tissue. Oesophageal cancer starts in the inner lining of the oesophagus and spreads outward through the other layers.

Cell type

There are 2 main types of cell lining the oesophagus:

squamous cells

glandular (adenomatous) cells

Cancer can start in either type of cell. So there are 2 main types of oesophageal cancer - squamous cell carcinoma and adenocarcinoma.

Parts of the oesophagus

Cancer can develop in any part of the oesophagus.

Upper and middle part

Cancers in the upper part and middle part tend to be squamous cell carcinomas. These develop from cells that make up the inner lining of your oesophagus.

Lower part

Cancers in the lower part of the oesophagus tend to be a type called adenocarcinoma. These cancers start in gland cells.

The gastro oesophageal junction

The lowest end of the oesophagus joins the stomach. The area where the oesophagus and stomach join is called the gastro oesophageal junction (GOJ). Cancers that start here are called gastro oesophageal junction cancers.

It can sometimes be difficult to tell the difference between oesophageal, stomach and GOJ cancers. But we know from research that GOJ cancers are a separate type of cancer. They can behave differently to cancers of the oesophagus and stomach.

How common it is

Around 9,300 people are diagnosed with oesophageal cancer in the UK each year. It’s the 14th most common cancer in adults.

Who gets it

Oesophageal cancer is more common in men than women.

It's more common in older people. In the UK, on average each year around 40 out of 100 (around 40%) of new cases are in people aged 75 and over. It's very rare in people younger than 40.

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What is oesophageal cancer? | oesophageal cancer |Cancer Research UK

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Oesophageal cancer is a cancer of the food pipe. The foodpipe is also called the oesophagus or gullet and is part of the digestive system.

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Stomach cancer is cancer that starts anywhere inside the stomach or the stomach wall. It's also called gastric cancer.

The stomach

The stomach is part of the digestive system. It's in the upper left side of the tummy (abdomen). The top of the stomach joins the bottom of the foodpipe (oesophagus) and the other end is joined to the bowel.

It is a muscular bag that has three main parts. They are the:

top (fundus)

middle (body)

bottom (antrum or pylorus)

At each end of the stomach there is a valve called a sphincter. These valves control the movement of food through the digestive system.

They are the:

cardiac sphincter - at the top joining the oesophagus to the stomach

pyloric sphincter - which is at the bottom joining the stomach to the bowel

How the stomach works

Food passes from the oesophagus into the stomach. The stomach then stores the food and breaks it down (digests it) so our body can absorb it. It does this by producing juices and mixing the food up with them so it is easily digestible.

Glands in the wall of the stomach make the juices. These juices are stomach acid and a protein called pepsin. They begin to flow as soon as we smell something.

The muscle wall of the stomach contracts, churning the food with the juices, which changes it to a thick liquid. It takes a couple of hours for this to happen and then it moves into the bowel where the body absorbs it.

Even when it is empty, the stomach continues to produce juices and hormones. So, to protect the lining of the stomach from the acid and pepsin it also produces a thick mucus.

Where stomach cancer starts

Cancer can start in any part of the stomach or the stomach wall. Your treatment depends on where in the stomach the cancer starts.

Most stomach cancers start in the gland cells in the inner stomach lining. These are called adenocarcinomas.

Stomach cancer can start in the wall of the stomach. These are called gastrointestinal stromal tumours (GIST) and are a type of soft tissue sarcoma.

Some cancers can also start in immune system cells in the stomach. These are called non Hodgkins lymphoma.

Or they can start in the hormone cells in the stomach. These are called neuroendocrine cancers.

How common is stomach cancer?

Around 6,500 people are diagnosed with stomach cancer in the UK each year. The number of people in the UK diagnosed with stomach cancer has fallen since the early 1990s.

Who gets stomach cancer?

Stomach cancer is more common in older people. Around 50 out of 100 cases (around 50%) occur in people aged 75 or over.

It is more common in men than women.

Many stomach cancers are linked to lifestyle or environmental factors, including diet. Stomach cancer is linked with a bacteria that lives in the stomach called Helicobacter pylori. But not everyone with Helicobacter pylori will develop stomach cancer.

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Stomach cancer is cancer that starts anywhere inside the stomach or the stomach wall. It's also called gastric cancer. The stomach is part of the digestive system. It's in the upper left side of the tummy (abdomen). The top of the stomach joins the bottom of the foodpipe (oesophagus) and the other end is joined to the bowel.

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All About Having A CT Scan - Macmillan Cancer Support

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Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.
An MRI scanner is a large tube that contains powerful magnets. You lie inside the tube during the scan.

An MRI scan can be used to examine almost any part of the body, including the:

brain and spinal cord

bones and joints

breasts

heart and blood vessels

internal organs, such as the liver, womb or prostate gland

The results of an MRI scan can be used to help diagnose conditions, plan treatments and assess how effective previous treatment has been.

What happens during an MRI scan?

During an MRI scan, you lie on a flat bed that's moved into the scanner.

Depending on the part of your body being scanned, you'll be moved into the scanner either head first or feet first.

The MRI scanner is operated by a radiographer, who is trained in carrying out imaging investigations.

They control the scanner using a computer, which is in a different room, to keep it away from the magnetic field generated by the scanner.

You'll be able to talk to the radiographer through an intercom and they'll be able to see you on a television monitor and through the viewing window throughout the scan.

At certain times during the scan, the scanner will make loud tapping noises. This is the electric current in the scanner coils being turned on and off.

You'll be given earplugs or headphones to wear.

It's very important to keep as still as possible during your MRI scan.

The radiographer may ask you to hold your breath for a few seconds or follow other instructions during the scan.

The scan lasts 15 to 90 minutes, depending on the size of the area being scanned and how many images are taken.

Read more about how an MRI scan is performed.

How does an MRI scan work?

Most of the human body is made up of water molecules, which consist of hydrogen and oxygen atoms.

At the centre of each hydrogen atom is an even smaller particle called a proton. Protons are like tiny magnets and are very sensitive to magnetic fields.

When you lie under the powerful scanner magnets, the protons in your body line up in the same direction, in the same way that a magnet can pull the needle of a compass. You will not be able to feel this.

Short bursts of radio waves are then sent to certain areas of the body, knocking the protons out of alignment.

When the radio waves are turned off, the protons realign. This sends out radio signals, which are picked up by receivers.

These signals provide information about the exact location of the protons in the body.

They also help to distinguish between the various types of tissue in the body, because the protons in different types of tissue realign at different speeds and produce distinct signals.

In the same way that millions of pixels on a computer screen can create complex pictures, the signals from the millions of protons in the body are combined to create a detailed image of the inside of the body.

Safety

An MRI scan is a painless and safe procedure. You may find it uncomfortable if you have claustrophobia, but most people are able to manage it with support from the radiographer.

Most modern MRI scanners have a wider tunnel, which can help reduce claustrophobia. Going into the scanner feet first may be easier, although this isn't always possible.

Extensive research has been carried out into whether the magnetic fields and radio waves used during MRI scans could pose a risk to the human body.

No evidence has been found to suggest there's a risk, which means MRI scans are one of the safest medical procedures available.

But MRI scans may not be recommended in certain situations. For example, if you have a metal implant fitted, such as a pacemaker or artificial joint, you may not be able to have an MRI scan.

If you're pregnant, a doctor will discuss with you whether an MRI scan is suitable for you.

Read more about who can and can't have an MRI scan.

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Magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body.

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Positron emission tomography (PET) scans produce detailed 3-dimensional images of the inside of the body.
The images can clearly show the part of the body being investigated, including any abnormal areas, and can highlight how well certain functions of the body are working.

PET scans are often combined with CT scans to produce even more detailed images. This is known as a PET-CT scan.

They may also occasionally be combined with an MRI scan (known as a PET-MRI scan).

Why PET scans are used

A PET scan can show how well certain parts of your body are working, rather than simply showing what they look like.

PET scans are particularly helpful for investigating confirmed cases of cancer to determine how far the cancer has spread and how well it's responding to treatment.

PET scans are sometimes used to help plan operations, such as a coronary artery bypass graft or brain surgery for epilepsy.

They can also help diagnose some conditions that affect the normal workings of the brain, such as dementia.

How PET scans work

PET scanners work by detecting the radiation given off by a substance injected into your arm called a radiotracer as it collects in different parts of your body.

In most PET scans a radiotracer called fluorodeoxyglucose (FDG) is used, which is similar to naturally occurring glucose (a type of sugar) so your body treats it in a similar way.

By analysing the areas where the radiotracer does and does not build up, it's possible to work out how certain body functions are working.

For example, using FDG in the body's tissues can help identify cancerous cells because they use glucose at a much faster rate than normal cells.

Preparing for a PET scan

PET scans are usually carried out on an outpatient basis. This means you won't need to stay in hospital overnight.

It's important you arrive on time because the radiotracer used for your scan only works well for a short time. Your scan may have to be cancelled if you're late.

Your appointment letter will mention anything you need to do to prepare for your scan.

Usually, you'll be advised not to eat anything for 6 hours beforehand, but you can drink water.

You should also avoid strenuous exercise for 24 hours before your appointment.

It's a good idea to wear loose, comfortable clothes. It may be possible to wear these during the scan, although sometimes you may be asked to change into a hospital gown.

Avoid wearing jewellery and clothes that have metal parts, such as zips, because these will need to be removed.

If you're claustrophobic, ask the hospital staff before the day of the scan about the possibility of having a mild sedative to help you relax.

What happens during the scan

Radiotracer injection

The radiotracer is injected into a vein in your arm or hand about an hour before your scan, as it takes time for it to reach the right cells in your body.

It's important to relax, keep as still as possible, and avoid talking while you wait because moving and speaking can affect where the radiotracer goes in your body.

You can go to the toilet if you need to before having the scan.

The scan

During the scan, you lie on a flat bed that's moved into a large, cylindrical scanner.

Stay still and don't talk while the scanner takes pictures of your body.

The scan usually takes 30 to 60 minutes. Having the scan is completely painless, but you may feel uncomfortable lying still for this long.

The medical team can see and talk to you throughout the scan.

After the scan

You shouldn't experience any side effects after having a PET scan and can usually go home the same day.

The results of your scan won't usually be available on the same day. They'll be sent to your specialist to be discussed at your next appointment.

Possible risks of a PET scan

Any exposure to radiation carries a very small risk of potential tissue damage that could cause cancer at a later date.

But the amount of radiation you're exposed to in a standard PET scan is safe.

The radiotracer becomes quickly less radioactive over time and will usually be passed out of your body naturally within a few hours. Drinking plenty of fluid after the scan can help flush it from your body.

As a precaution, you may be advised to avoid close contact with pregnant women, babies and young children for a few hours after having a PET scan. This is because you'll be slightly radioactive during this time.

The CT component of a PET-CT scan also involves exposure to a small amount of additional radiation, but the risk of this causing any problems in the future is still very small.

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Find out about positron emission tomography (PET) scans and how these three-dimensional images of the inside of the body can be used.

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What is it?

An upper gastrointestinal endoscopy (UGI endoscopy), sometimes also known as a magic eye or an oesophageal gastro duodenoscopy (OGD), is where a narrow, flexible camera is passed into your mouth and down your food pipe (oesophagus) and into your stomach and the first bit of your small bowel (duodenum).

If we see an abnormality, such as an enlarged blood vessel, we can often treat this at the time.

What do I need it for?

There are many reasons to perform this procedure. In patients with liver disease there is a risk of a condition known as "Varices".

The oesophagus and stomach (GI tract) are surrounded by a network of blood vessels which can take up nutrients from the GI tract all flow into the liver. When the liver has scarring (Cirrhosis) the blood flow is slower through the liver, this means that the vessels brining blood from the GI tract into the liver become swollen.

This can make the stomach lining inflamed (portal gastropathy), or can cause prominent visible blood vessels known as varices in the stomach or food pipe (oesophagus). In the worst case scenario these vessels can bleed, which can lead to significant blood loss and have a knock on effect on your ability of the liver to function.

How is it performed?

You will be sent information about the procedure, including how long you need to be "nil by mouth", before your procedure. This will contain detailed information about the procedure including how it is performed and the risks and benefits.

For individuals with liver disease there is a risk of swollen blood vessels. This are often treated with medication, but on some occasions you may need treatment at the time of your endoscopy. This will not be painful and will be explained at the time.

What are the risks?

The risk of the procedure are outlined in the information you will be given before the procedure. If there are any specific risks you would like to discuss you will be given the opportunity to discuss the procedure further at the time of your procedure/

How will I receive my results?

You will be given a print out of the procedure results on the day of the test.

If we have taken tests such as a "CLO Test"- to look for bacteria in the stomach, or if we took tissue samples (biopsies), you will also receive a letter with your results and any further action that may be required.

If the results need further action, for instance if we need to consider medication to treat swollen blood vessels, then your doctor may discuss this with you on the day of the procedure or may arrange a further clinic appointment to go through the pros and cons of treatment.

Will I need repeated tests?

You many need further endoscopy procedures depending on the findings. This will be discussed with you as part of your follow up in the liver clinic.

What if I do not want the test?

Endoscopy can be a scary thought, but the test is often easier to tolerate than you would expect. We advise the procedure for several reasons and you should have the opportunity to discuss alternatives or risks of not having the procedure with your doctor or nurse at the time the procedure is suggested.

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What is it? An upper gastrointestinal endoscopy (UGI endoscopy), sometimes also known as a magic eye or an oesophageal gastro duodenoscopy (OGD), is where a narrow, flexible camera is passed into your mouth and down your food pipe (oesophagus) and into your stomach and the first bit of your small bowel (duodenum).

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Cardiff and Vale University Health Board

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An oesophageal stent is a small metal or plastic tube put into the food pipe (oesophagus). It keeps the food pipe open.

A cancer in the food pipe can partly or completely block it and make it difficult to swallow. Putting a stent into the blocked area opens up the food pipe again. This allows you to swallow food and drink more easily.

You have the stent fitted in hospital in the endoscopy department or x-ray department. It usually takes about 30 minutes. You need to stay in hospital overnight or for a few days.

Before your treatment

Your doctor or specialist nurse explains what happens and how they fit the stent. They ask you to sign a consent form saying that you agree to have the procedure. You can ask them any questions that you have. Tell them about any medicines you are taking.

You shouldn't eat or drink for at least 6 hours beforehand.

A nurse puts a small tube called a cannula into a vein in the back of your hand. They go with you to the endoscopy or x-ray department.

The doctor or nurse injects a medicine to make you sleepy into the cannula in your hand. Or you might have a general anaesthetic, so that you'll be asleep for the procedure.

Having treatment
There are 2 ways of fitting the stent. Your doctor can use a:

long, flexible tube called an endoscope put down your throat

thin wire to fit the tube during an x-ray

Stent using endoscopy

While you are very sleepy or asleep your doctor puts a long flexible tube called an endoscope into your food pipe. It has a light and a small camera on the end so the doctor can see the blockage. They then put the small mesh tube (stent) into the narrowed area.

Stent using x-ray

Your doctor passes a fine wire down into your food pipe until it reaches the blockage. You then have an x-ray so the doctor can see the blocked area on a screen. They pass the stent down the wire until it is in the right place.

After treatment

You stay in the endoscopy department or x-ray department until the sedation or anaesthetic wears off. You wear an oxygen mask for a short time. A nurse then takes you back to your ward. You need to stay in hospital overnight or for a few days.

The stent expands over a couple of days. This opens up the food pipe or stomach so that food and drink can pass through again.

Eating and drinking with a stent

You can't eat or drink for the first 2 to 4 hours after having the stent. Your nurse tells you when you can start drinking. Then you can build up to eating soft foods.

You need to have a soft diet because solid food won't pass through the stent.

Your dietitian tells you which foods you can eat.

Tips

Take your time when eating and sit upright.

Chew food well and remove any lumps or gristle.

If you have dentures, wear them to make chewing easier.

Sip nourishing fluids while eating to help food pass down through the stent.

Avoid tough lumps of meat, white bread and stringy fruits and vegetables.

Side effects

Pain

You might feel some soreness as the stent expands. Taking painkillers for a few days helps.

After a few days, the soreness usually goes away but you might still have some soreness at times.

Tell your nurse or doctor if you still have pain.

Feeling sick

Let your nurse or doctor know if you feel sick. They can give you medicines to reduce sickness.

Heartburn or acid reflux

Tell your nurse or doctor if you have heartburn or acid reflux. They can give you anti acid medicine.

Sleeping upright in bed helps to prevent heartburn. You can use pillows or cushions to support yourself.

Bleeding

You might have some slight bleeding in the food pipe. It might give you a metallic taste in your mouth. This usually gets better over a few days.

Your nurse will give you mouthwashes. Tell them if you cough up blood.

A hole in the food pipe

Damage to the food pipe can tear it or make a hole (perforation). This is very rare.

In the first 3 days after having treatment, tell your doctor or nurse straight away if you

have difficulty breathing

get severe chest pain

vomit blood

can't keep food or drinks down

If food blocks the stent

Your swallowing might change or eating and drinking gets difficult or uncomfortable. Or you may find that you suddenly can't swallow.
If this happens

try not to panic

drink plenty of fizzy or warm drinks to try and clear the blockage

walk around as this sometimes helps

If the stent moves

After a time, the stent might move and food may not be able to pass through. If this happens you won't be able to swallow and food or drink will come back up. Your doctor will remove or replace the stent.

At home with a stent

You have support from community nurses or your local symptom control team. You also have regular appointments at the hospital to check the stent.

The hospital or your GP give you any medicines that you need.

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An oesophageal stent is a small metal or plastic tube put into the food pipe (oesophagus). It keeps the food pipe open. You have the stent fitted in hospital in the endoscopy department or x-ray department. It usually takes about 30 minutes.

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Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin.
This procedure is also known as keyhole surgery or minimally invasive surgery.

Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope.

This is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor.

The advantages of this technique over traditional open surgery include:

a shorter hospital stay and faster recovery time

less pain and bleeding after the operation

reduced scarring

When laparoscopy is used

Laparoscopy can be used to help diagnose a wide range of conditions that develop inside the abdomen or pelvis. It can also be used to carry out surgical procedures, such as removing a damaged or diseased organ, or removing a tissue sample for further testing ( biopsy).

Laparoscopy is most commonly used in:

gynaecology - the study and treatment of conditions affecting the female reproductive system

gastroenterology - the study and treatment of conditions affecting the digestive system

urology - the study and treatment of conditions affecting the urinary system

Read more about when laparoscopy is used.

How laparoscopy is carried out

Laparoscopy is carried out under general anaesthetic, so you won't feel any pain during the procedure.

During laparoscopy, the surgeon makes one or more small incisions in the abdomen. These allow the surgeon to insert the laparoscope, small surgical tools, and a tube used to pump gas into the abdomen. This makes it easier for the surgeon to look around and operate.

After the procedure, the gas is let out of your abdomen, the incisions are closed using stitches and a dressing is applied.

You can often go home on the same day of your laparoscopy, although you may need to stay in hospital overnight.

Read more about how laparoscopy is performed.

Safety

Laparoscopy is a commonly performed procedure and serious complications are rare.

Minor complications

Minor complications are estimated to occur in 1 or 2 out of every 100 cases following laparoscopy. They include:

infection

minor bleeding and bruising around the incision

feeling sick and vomiting

Serious complications

Serious complications after laparoscopy are estimated to occur in 1 out of every 1,000 cases. They include:

damage to an organ, such as your bowel or bladder, which could result in the loss of organ function

damage to a major artery

complications arising from the use of carbon dioxide during the procedure, such as the gas bubbles entering your veins or arteries

a serious allergic reaction to the general anaesthetic

a blood clot developing in a vein, usually in one of the legs (deep vein thrombosis or DVT), which can break off and block the blood flow in one of the blood vessels in the lungs (pulmonary embolism)

Further surgery is often required to treat many of these more serious complications.

Page last reviewed: 01 August 2018
Next review due: 01 August 2021

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Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery. Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope.

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Evidence shows that actively improving your physical and mental health can help you recover more quickly from surgery, chemotherapy and radiotherapy, and reduce the chance of further problems during and after your treatment, as well as many other benefits.

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Evidence shows that actively improving your physical and mental health can help you recover more quickly from surgery, chemotherapy and radiotherapy, and reduce the chance of further problems during and after your treatment, as well as many other benefits.

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The new online rehabilitation sessions offered at the Maggie's Centre are designed to help people take an active role in their cancer care.

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The pancreas is a gland that produces digestive juices and hormones. Pancreatic cancer is when abnormal cells in the pancreas start to divide and grow in an uncontrolled way and forms a growth (tumour).

The cancer cells can grow into surrounding blood vessels or organs such as the small bowel (duodenum). And may spread to other areas of the body.

The pancreas

The pancreas is part of the digestive system.

The pancreas is quite high up in your abdomen. It lies across your body where your ribs meet at the bottom of your breastbone, just behind your stomach. It is about 6 inches (15 centimetres) long and shaped like a leaf.

The pancreas has 3 parts:

the wide end is called the head

the thin end is called the tail

the bit in the middle is called the body

The pancreas is a large gland that makes digestive juices and hormones, including insulin. The digestive juices flow down a tube (pancreatic duct) into the duodenum. The duodenum is the first part of the small bowel and is joined to the stomach.

Another tube (duct) joins the duodenum. The bile duct comes down from the gallbladder and liver and joins the duodenum right next to the pancreatic duct. The place where the two ducts join and meet the bowel is called the ampulla of Vater.

What does the pancreas do?

The pancreas produces digestive juices and insulin, as well as other hormones to do with digestion.

The part which produces the digestive juices is called the exocrine pancreas. The part which produces hormones, including insulin, is called the endocrine pancreas.

Cancers that develop from these two parts can behave differently and cause different symptoms.

What does the digestive system do?

The digestive system breaks up and digests food. After about 2 hours in the stomach, the partly digested food moves into the beginning of the duodenum.

When the food reaches the duodenum, the pancreas releases its digestive juices which flow down the pancreatic duct and mix with the food.

The juices contain enzymes that help to break down the food into very small fragments. These fragments are absorbed into the body through the small bowel.

The pancreas and insulin

The pancreas makes insulin. Specialised cells within the pancreas releases insulin directly into the bloodstream.

Insulin keeps the level of sugar (glucose) in the blood at a stable level. This means that the body cells get enough sugar, but not too much. The pancreas makes and releases more insulin if the level of sugar in the blood is high. If the level is too low, it releases less.

You have a condition called diabetes if you don't make enough insulin.

How common is pancreatic cancer?

Around 10,500 people are diagnosed with pancreatic cancer in the UK each year. It is the 10th most common cancer in the UK.

Who gets pancreatic cancer?

Pancreatic cancer is more common in older people. More than 45 out of 100 people diagnosed (more than 45%) are aged 75 and over. Pancreatic cancer is uncommon in people under 40 years old.

In England, pancreatic cancer is more common in people living in poorer areas. It is more common in White and Black people than in Asian people.

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About pancreatic cancer | Cancer Research UK

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The pancreas is a gland that produces digestive juices and hormones. Pancreatic cancer is when abnormal cells in the pancreas start to divide and grow in an uncontrolled way and forms a growth (tumour). The cancer cells can grow into surrounding blood vessels or organs such as the small bowel (duodenum).

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Bile duct cancer (cholangiocarcinoma) is a rare cancer that starts in the lining of the bile duct.

Bile and the bile ducts

The bile ducts are part of the digestive system. They are the tubes that connect the liver and gallbladder to the small bowel. Bile ducts carry bile.

Bile breaks down fats in food to help us digest them. It is made by the liver and stored in the gallbladder. The bile ducts and gallbladder together are known as the biliary system (sometimes called the biliary tree).

Types of bile duct cancer

The types of bile duct cancer are named after the part of the bile duct where the cancer started.

Intrahepatic bile duct cancers

Intrahepatic bile duct cancers make up 1 in 10 of bile duct cancers (10%).

Extrahepatic bile duct cancers

There are two types of extrahepatic bile duct cancers:

perihilar bile duct cancers make up 5 in 10 bile duct cancers (50%)

distal bile duct cancers make up 4 in 10 bile duct cancers (40 %).

Follow-up care

You will have regular check-ups during and after your treatment. Tell your doctor or specialist nurse as soon as possible if you have any problems or notice new symptoms between appointments.

We have more information about follow-up care after treatment.

Your feelings

You may have many different emotions, including anxiety, anger and fear. These are all normal reactions. They are part of the process that many people experience when dealing with cancer.

Everyone has their own way of dealing with illness and the emotions they have. You may find it helpful to talk to family and friends or to your doctor or nurse.

Macmillan is also here to support you. If you would like to talk, you can:

A UK based charity called AMMF also support people with bile duct cancer.

Macmillan Cancer Support Line

The Macmillan Support Line offers confidential support to people living with cancer and their loved ones. If you need to talk, we'll listen.

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Bile duct cancer (cholangiocarcinoma) is a rare cancer that starts in the lining of the bile duct. The bile ducts are part of the digestive system. They are the tubes that connect the liver and gallbladder to the small bowel. Bile ducts carry bile. Bile breaks down fats in food to help us digest them.

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Gallbladder cancer is a cancer that's found anywhere in the gallbladder.

The gallbladder is a small organ in the top part of your tummy that helps you digest your food.

Gallbladder cancer is often found when someone is having treatment for another condition, such as gallstones.

How serious gallbladder cancer is depends on where it is in the gallbladder, how big it is, if it has spread and your general health.

Coronavirus advice

Get advice about coronavirus and cancer:

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Gallbladder cancer is a cancer that's found anywhere in the gallbladder. The gallbladder is a small organ in the top part of your tummy that helps you digest your food. Gallbladder cancer is often found when someone is having treatment for another condition, such as gallstones.

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Cancer is when abnormal cells start to divide and grow in an uncontrolled way. The cells can eventually grow into surrounding tissues or organs, and may spread to other areas of the body.

Liver cancer is a cancer that starts in the liver. You might hear it called a primary liver cancer. Primary cancers are named after the part of the body where the cancer first started growing.

Primary liver cancer is an uncommon cancer in the UK. It is more common to have cancer that has spread to the liver from somewhere else in your body. This is called secondary liver cancer.

Secondary cancers happen when cancer cells break away from the primary site and travel to other parts of the body in the blood or lymphatic system. The cells might lodge in another body organ, such as the lungs or liver, and begin to grow there. The cells are still the same type as the primary cancer.

This is important because your doctor treats cancers according to the original cell type. For example, secondary breast cancers that have spread to the liver are treated with breast cancer treatments. This is because the cancer cells in the liver are breast cancer cells.

The information on this page is about cancers that start in the liver.

The liver

The liver is the second largest organ in the body after your skin. It is just below your right lung and is protected by the lower ribs on the right side of your body.

What does the liver do?

Stores nutrients

Two blood vessels supply your liver with blood. They are the hepatic artery and the hepatic portal vein.

Just before it reaches the liver, the blood in the portal vein comes through the gut (digestive system). As it flows through, it picks up the carbohydrates, proteins, fats and vitamins. These are the nutrients that the digestive system breaks down from the food that you eat. The blood then carries these nutrients to the liver.

Converts fat to energy when the body needs it

Your liver uses chemicals to convert foods that you eat into energy. It does this with food containing carbohydrates and fat.

Makes bile

Your liver makes bile. This is a substance that helps the digestion and absorption of food. Bile is stored in a small sack below the liver called the gallbladder. The bile passes into the bowel through the bile duct. This is a tube that goes from the liver to the first part of the small bowel (duodenum).

Makes proteins

Your liver makes proteins including albumin. Albumin is a protein found in blood. It helps to keep the right balance of fluid between the body's tissues and the bloodstream.

Helps to clot the blood

Your liver makes substances that help your blood to clot. These substances help to control bleeding when you cut yourself.

Makes substances the body needs

Your body makes substances that are essential for healthy bones and tissues. It also makes cholesterol, which is an important part of cell walls.

Breaks down harmful substances

Your liver breaks down harmful substances so that the body can get rid of them in your wee (urine) or poo (faeces). This includes alcohol, many drugs, and waste products from normal body processes. If the liver is not working properly, harmful substances can build up and cause problems.

Types of liver cancer

The liver is made up of different types of cells.

The type of liver cancer you have depends on where it starts and the type of cell it starts in. Knowing which type of liver cancer you have helps your doctors decide what treatment you need. The different types of primary liver cancer are:

hepatocellular carcinoma (HCC), this is the most common type of liver cancer

fibrolamellar cancer, this is a rare type of HCC

bile duct cancer - this is also called cholangiocarcinoma, this can start in the bile ducts within or outside the liver

angiosarcoma (or haemangiosarcoma), which starts in the blood vessels of the liver and is extremely rare

hepatoblastoma, is a rare childhood cancer

Most of the information in this section of the website is about hepatocellular carcinoma (HCC).

How common is liver cancer?

Around 6,200 people are diagnosed with cancer that starts in the liver each year in the UK. That's 17 new cases every day.

It is more common in men than in women. The risk of developing liver cancer gets higher as we get older.

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Cancer is when abnormal cells start to divide and grow in an uncontrolled way. The cells can eventually grow into surrounding tissues or organs, and may spread to other areas of the body. Liver cancer is a cancer that starts in the liver. You might hear it called a primary liver cancer.

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A computerised tomography (CT) scan uses X-rays and a computer to create detailed images of the inside of the body.

CT scans are sometimes referred to as CAT scans or computed tomography scans.

They're carried out in hospital by specially trained operators called radiographers, and can be done while you're staying in hospital or during a short visit.

When CT scans are used

CT scans can produce detailed images of many structures inside the body, including the internal organs, blood vessels and bones.

They can be used to:

diagnose conditions - including damage to bones, injuries to internal organs, problems with blood flow, stroke, and cancer

guide further tests or treatments - for example, CT scans can help determine the location, size and shape of a tumour before having radiotherapy, or allow a doctor to take a needle biopsy (where a small tissue sample is removed using a needle) or drain an abscess

monitor conditions - including checking the size of tumours during and after cancer treatment

CT scans wouldn't normally be used to check for problems if you don't have any symptoms (known as screening).

This is because the benefits of screening may not outweigh the risks, particularly if it leads to unnecessary testing and anxiety.

Preparing for a CT scan

Your appointment letter will mention anything you need to do to prepare for your scan.

You may be advised to avoid eating anything for several hours before your appointment to help make sure clear images are taken.

You should contact the hospital after receiving your appointment letter if you have any allergies or kidney problems, or if you're taking medication for diabetes, as special arrangements may need to be made.

You should also let the hospital know if you're pregnant. CT scans aren't usually recommended for pregnant women unless it's an emergency, as there's a small chance the X-rays could harm your baby.

It's a good idea to wear loose, comfortable clothes as you may be able to wear these during the scan.

Try to avoid wearing jewellery and clothes containing metal (such as zips), as these will need to be removed.

Before having a CT scan

Before having the scan, you may be given a special dye called a contrast to help improve the quality of the images.

This may be swallowed in the form of a drink, passed into your bottom (enema), or injected into a blood vessel.

Tell the radiographer if you feel anxious or claustrophobic about having the scan.

They can give you advice to help you feel calm and can arrange for you to have a sedative (medication to help you relax) if necessary.

Before the scan starts, you may be asked to remove your clothing and put on a gown.

You'll also be asked to remove anything metal, such as jewellery, as metal interferes with the scanning equipment.

What happens during a CT scan

During the scan, you'll usually lie on your back on a flat bed that passes into the CT scanner.

The scanner consists of a ring that rotates around a small section of your body as you pass through it.

Unlike an MRI scan, the scanner doesn't surround your whole body at once, so you shouldn't feel claustrophobic.

The radiographer will operate the scanner from the next room. While the scan is taking place, you'll be able to hear and speak to them through an intercom.

While each scan is taken, you'll need to lie very still and breathe normally. This ensures that the scan images aren't blurred.

You may be asked to breathe in, breathe out, or hold your breath at certain points.

The scan will usually take around 10 to 20 minutes.

What happens afterwards

You shouldn't experience any after-effects from a CT scan and can usually go home soon afterwards. You can eat and drink, go to work and drive as normal.

If a contrast was used, you may be advised to wait in the hospital for up to an hour to make sure you don't have a reaction to it.

The contrast is normally completely harmless and will pass out of your body in your urine.

Your scan results won't usually be available immediately. A computer will need to process the information from your scan, which will then be analysed by a radiologist (a specialist in interpreting images of the body).

After analysing the images, the radiologist will write a report and send it to the doctor who referred you for the scan so they can discuss the results with you. This normally takes a few days or weeks.

Safety of CT scans

CT scans are quick, painless and generally safe. But there's a small risk you could have an allergic reaction to the contrast dye used and you'll be exposed to X-ray radiation.

The amount of radiation you're exposed to during a CT scan varies, depending on how much of your body is scanned.

CT scanners are designed to make sure you're not exposed to unnecessarily high levels.

Generally, the amount of radiation you're exposed to during each scan is equivalent to between a few months and a few years of exposure to natural radiation from the environment.

It's thought exposure to radiation during CT scans could slightly increase your chances of developing cancer many years later, although this risk is thought to be very small (less than 1 in 2,000).

For more information, read GOV.UK: patient dose information.

The benefits and risks of having a CT scan will always be weighed up before it's recommended.

Talk to your doctor or radiographer about the potential risks beforehand if you have any concerns.

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Read about why CT scans are carried out, and find out what happens before, during and after the scan.

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MRI (magnetic resonance imaging) is a type of scan that uses magnetism and radio waves to take pictures of inside the body.

The scan takes between 15 and 90 minutes.

You might have one to find out whether you have cancer and if you do to measure how big it is and whether it has spread. You might also have one to see how well treatment is working.

It is a safe test. If you have an injection of contrast dye it can cause a headache, dizziness or a warm flushed feeling

An MRI is a type of scan that creates pictures using magnetism and radio waves. MRI scans produce pictures from angles all around the body and shows up soft tissues very clearly.

MRI stands for magnetic resonance imaging.

They take between 15 and 90 minutes.

Why you might have it

MRI can be used to look at most areas of the body. For some parts of the body and for some types of tissues, it can produce clearer results than a CT scan.

An MRI can be used to:

find a tumour

find out how big it is and whether it has spread (stage a cancer)

measure blood flow

to check how well treatment is working

You might have an injection of a special dye (contrast medium) before the scan to help make the pictures clearer.

MRI is particularly good for :

brain tumours

primary bone tumours

soft tissue sarcomas

tumours affecting the spinal cord

tumours in the pelvic organs (prostate, bladder, uterus and ovaries)

MRI instead of CT scans

In some situations, your doctor may suggest MRI if a CT scan hasn't been able to give all the information they need.

In some cancers, such as cervix or bladder cancer, MRI is better than CT at showing how deeply the tumour has grown into body tissues. It can be particularly useful for showing whether the tissue left behind after treatment is cancer or not.

Preparing for your MRI scan

Before you go to your appointment, or when you arrive, you fill in a safety checklist. This asks about:

any operations you've had

whether you have any metal implants or other metals in your body

An MRI scan uses strong magnetism which could affect any metal in your body. This includes:

pacemakers or an implantable defibrillator (to treat abnormal heart rhythms)

surgical clips, pins or plates

cochlear implants (for deafness)

metal fragments anywhere in your body - for example from an injury, dental fillings and bridges

You can still have an MRI scan if you have some metals in your body, but your doctor and radiographer decide if it's safe for you. Tell the scanner staff about any metals in your body.

Some people feel claustrophobic or closed in when they're having an MRI scan. Contact the department before your test if you're likely to feel like this. The hospital staff can take extra care to make sure you're comfortable and that you understand what's going on. Your doctor can give you medicine to help you relax if you need to.

An MRI is generally safe during pregnancy. But as a precaution, you usually won't have one during the first 3 months of your pregnancy.

Tell the department staff beforehand if you think you're pregnant.

What to expect

When you arrive at the scanning department, the radiographer might ask you to change into a hospital gown. You might not have to undress if your clothing doesn't have any metal, such as zips or clips.

You have to:

remove any jewellery, including body piercings and your watch

remove your hair clips

empty your pockets of coins and keys

It's safe to take a relative or friend into the scanning room with you. But check with the department staff first. Your friend or relative will also need to remove any metal they have on them.

In the scanning room

Your radiographer takes you into the scanning room. The MRI machine is large and shaped like a doughnut.

You lie on your back on a couch that can slide into the MRI machine.

You might have an injection of a dye (contrast medium) through a small plastic tube (cannula) into a vein in your arm. This helps to show up your body's organs more clearly. Some people are allergic to the dye, so your radiographer will check first about any medical conditions or allergies you have.

After the dye injection you may:

feel sick

have a headache

feel warm or flushed

have a metallic taste in your mouth

feel a little dizzy

These effects are usually mild and last for a short time. Tell your radiographer if you feel unwell at any point during or after your scan.

Having the MRI scan

You need to lie as still as possible. The scan is painless but it can be uncomfortable to stay still. Tell the radiographer if you're getting stiff and need to move.

The scan can take between 15 and 90 minutes. It depends on the area that they need to scan and how many images they need.

Once you're in the right position on the couch, your radiographer leaves the room. They can see you on a TV screen or through a window at all times from the control room. You can talk to each other during the scan, usually through an intercom.

The couch moves through the MRI scanner. It takes pictures as you move through it. Your radiographer might ask you to hold your breath at times.

The scanner makes a very loud clanging sound throughout the scan. You wear headphones to protect your hearing. You can also listen to music. Keeping your eyes closed can help.

This 1 minute video shows you what happens when you have an MRI scan.

After your scan

When the scan is over, your radiographer comes back into the room and lowers the couch so that you can get up.

You usually stay in the department for about 15 minutes after your scan if you've had the dye. This is in case it makes you feel unwell.

Your radiographer removes the cannula from the vein in your arm before you leave.

You should then be able to go home or back to work, and also eat and drink normally.

Possible risks

An MRI is very safe and doesn't use radiation. Some people can't have an MRI but the checklist picks this up beforehand. Your doctor and radiographer make sure the benefits of having the test outweigh any possible risks. The risks include:

Bruising and swelling

You might get a small bruise around the area where they put the needle in for the cannula.

There's a risk that the contrast medium will leak outside the vein. This can cause swelling and pain in your arm but it's rare. Tell your radiographer if you have any swelling or pain. Let your GP know if it doesn't get better or starts to get worse when you're at home.

Allergic reaction

An allergic reaction to the contrast medium injection is rare. This most often starts with feeling weak, sweating and difficulty breathing. Tell your radiographer straight away if you feel unwell so they can give you medicine to control the reaction.

Getting your results

You should get your results within 1 or 2 weeks.

Waiting for results can make you anxious. Ask your doctor or nurse how long it will take to get them. Contact the doctor who arranged the test if you haven't heard anything after a couple of weeks.

You might have contact details for a specialist nurse who you can contact for information if you need to. It may help to talk to a close friend or relative about how you feel.

More information

We have more information on tests, treatment and support if you have been diagnosed with cancer.

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An MRI is a scan that looks at most areas of the body. It uses magnetism and radio waves to create a picture of the inside of your body. Find out why you might have it, how you have it and the possible risks.

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What is it Like to Have a PET Scan? | Cancer Research UK

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Blood test for pancreatic tumour markers (CA19 9)

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Blood test for pancreatic tumour markers (CA19 9)

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What is a tumour marker?

Some types of cancer produce chemicals that can show up in the blood on a blood test. These chemicals are called tumour markers.

Many pancreatic cancers produce a tumour marker called CA 19-9.

CA 19-9 and pancreatic cancer

Your doctor may test a sample of your blood for CA 19-9. This can sometimes help diagnose pancreatic cancer. But some people who have pancreatic cancer do not have raised levels of CA 19-9.

Also, other conditions, such as jaundice that has not been caused by cancer, may cause high levels of CA 19-9. Doctors will consider these things when looking at your test results.

Doctors may also measure your level of CA 19-9 during treatment and follow-up. This is because it can also show how pancreatic cancer is responding to treatment.

Macmillan Cancer Support Line

The Macmillan Support Line offers confidential support to people living with cancer and their loved ones. If you need to talk, we'll listen.

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Tumour marker blood tests for pancreatic cancer - Macmillan Cancer Support

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Some types of cancer produce chemicals that can show up in the blood on a blood test. These chemicals are called tumour markers. Many pancreatic cancers produce a tumour marker called CA 19-9. Your doctor may test a sample of your blood for CA 19-9. This can sometimes help diagnose pancreatic cancer.

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This leaflet provides information on dihydropyrimidine dehydrogenase (DPD) testing. If you are due to receive 5FU or capecitabine chemotherapy as part of your cancer treatment, it will be necessary to have genetic blood test prior to starting treatment. This is to check whether your body is able to breakdown the chemotherapy drugs safely or not. This leaflet will explain why the test is needed in more detail.
What is DPD?
DPD is an enzyme made by the liver. It helps break down certain chemotherapy drugs (such as 5FU and capecitabine) that are used to treat cancer.

DPYD is a gene. Genes are our cells' instruction manuals and tell our body how to work normally. The DPYD gene helps to control how much DPD enzyme is made. Changes in the DPYD gene can mean your body does not make enough (or any) of the DPD enzyme. This is called DPD deficiency.
Why am I being offered a DPD test?
If your body does not make enough DPD, the chemotherapy drugs can build up in the body. This can cause more severe side effects than usual and in some situations may be life-threatening. The side effects include:

a drop in the level of blood cells which may increase the risk of having infections, breathlessness and bleeding

diarrhoea, which can be severe

a sore mouth

feeling or being sick, which can cause dehydration

a severe skin reaction, which leads to peeling or blistering of the skin.

What does the DPD test involve?
Before you start treatment, your oncologist will arrange for you to have a genetic blood test. The blood test is sent to a genetic laboratory to look for changes in the DPYD gene. The result will be available in about five days and will be sent back to your oncologist.

Please be aware that your blood sample will only be tested for changes in the DPYD gene so you will not find out about your risk of any other genetic conditions.
What action is needed if I am found to have a DPD deficiency?
The team responsible for your treatment will discuss the results with you prior to starting any treatment. If your DPD gene is normal, you can have a standard dose of chemotherapy. This is because your body can break down the chemotherapy drugs.

If a change in the DPD gene is found, you may need lower doses of chemotherapy to reduce the chance of getting serious side effects. In some cases, it may be necessary to avoid using these drugs altogether. In this situation, alternative treatment options will be discussed with you.

The team will monitor you closely during treatment. If you do not develop any serious side effects after the first few cycles of treatment, they may consider whether it is safe to increase the dose of chemotherapy. This will only be done following a discussion with you about the benefits and risks of increasing the dose.
Will reducing the dose of the chemotherapy drugs affect how successful the cancer treatment is?
It is important that the risks of treatment are kept as low as possible, particularly as severe side effects may be life-threatening. Your DPD level does not in itself affect how successful the chemotherapy will be in killing cancer cells, but it will tell us how your body will cope with the drug and the dose that is given.
Is there anything I can do to increase the levels of DPD in my body?
There is no evidence that medications, dietary or lifestyle changes affect DPD levels. The only action you need to take is to seek medical attention if you develop side effects following chemotherapy treatment. In this situation you should inform the medical team that you are known to have a DPD deficiency. Contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
What does a diagnosis of DPD deficiency mean for my family?
DPD testing is only recommended for people being treated with 5FU or capecitabine chemotherapy. There is no need to test your blood relatives who do not have a cancer diagnosis. However other members of your family may also have a DPD deficiency. This is because you share your genetics with blood relatives. We would encourage you to share this information with your family in case they are treated for cancer in the future.
Contact telephone numbers Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night.

For more detailed information on DPD deficiency, please see below:

Cancer Research UK General Cancer Information on DPD deficiency https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/side-effects/dpd-deficiency

This information is also available in Welsh

This leaflet was written by health professionals. The information contained in this leaflet is evidence based.

It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

Originally prepared April 2020

Updated November 2022

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This leaflet provides information on dihydropyrimidine dehydrogenase (DPD) testing. If you are due to receive 5FU or capecitabine chemotherapy as part of your cancer treatment, it will be necessary to have genetic blood test prior to starting treatment. This is to check whether your body is able to breakdown the chemotherapy drugs safely or not.

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Information for patients receiving a blood
transfusion at Velindre Cancer Centre

This leaflet provides information for patients receiving a blood transfusion at Velindre Cancer Centre. It will explain why you're having a blood transfusion and where and how it will be given. It will also tell you about the care and services you will receive during your stay. Contact telephone numbers and details of how to obtain further information on blood transfusions are given at the end of the leaflet.
Why do I need to have a blood transfusion?
You need to have a blood transfusion because you are anaemic. This means that you do not have enough red blood cells in your body. This can make you feel very tired (lethargic) and that you have no energy. It may also make you feel breathless.

Having a blood transfusion will help to increase your red blood cells. This will alleviate the symptoms of anaemia. You should feel the benefits of the blood transfusion within 24 hours. However these benefits may be short lived so you may need further blood transfusions.

Where will I receive my blood transfusion?
You will receive your blood transfusion on the Ambulatory Unit. This is situated on the ground floor of Velindre Cancer Centre. You will be offered a comfortable reclining chair to sit in whilst you receive your blood transfusion.

What facilities are on Ambulatory Unit?
There are a selection of magazines and books available. DVDs are also available on request. There are toilets on the unit. Hot and cold drinks are provided.

How long will I need to stay?
The length of time you will need to stay depends on how many units of blood your doctor has prescribed. The first unit of blood is given slowly, it usually takes about 2 hours. Other units usually take about 1½ hours unless your doctor requests a slower rate.

When your doctor is arranging your appointment you will be told how many units of blood you will receive. This will help you to calculate how long you will stay.

Can somebody stay with me?
Currently due to the need to ensure 2m space between patients during COVID-19 we do not usually allow anyone to stay with you during your transfusion. If you have any concerns about this please speak to your team before your treatment starts. We may be able to make some exceptions but we will need to be aware of this before the day of treatment.

What should I wear?
You should wear comfortable clothing. Most patients wear their normal everyday clothes.

How will my blood transfusion be given?
Your blood transfusion will be given by a drip through a tiny tube directly into a vein in your arm. The
drip is connected to a pump fitted onto a drip stand. The pump regulates the rate that your blood transfusion is given. If you have a special line in place, for example a PICC or Hickman line, then your blood transfusion can usually be given through this.

The nurses will monitor you during your blood transfusion. They will regularly check your temperature, pulse and blood pressure and make sure that you are comfortable and that the drip is flowing at the correct rate.

Can I move around Ambulatory Unit whilst having my blood transfusion?
Yes, you can move around. Your drip stand has wheels so you can push this yourself, or ask a nurse to help you.

What about any tablets and medicines that I usually take?
It is important that you bring these in with you to show the nurses. You can continue taking these as usual unless you are advised not to.

What are the risks associated with having a blood transfusion?
All medical procedures and therapies involve some degree of risk. These need to be balanced against the risk to your health of not having a blood transfusion.

The biggest risk from a blood transfusion is being given the wrong blood. We will ask for your full name and date of birth and this identification will be used to check each bag of blood that is given.

The risks of getting an infection from a blood transfusion are very low. All blood products are carefully checked and tested for viruses or impurities to minimise any risk to you.

The risk of contracting HIV or HTLV (Human T-Cell Lymphotropic Virus) infection from a blood transfusion is about 1 in 5 million. The risk of contracting hepatitis is 1 in 500,000 for hepatitis B and 1 in 30 million for hepatitis C.

The risk of getting variant Creutzfeldt-Jakob disease (vCJD) from a single blood transfusion is very low, although this risk increases with additional blood transfusions. Each year approximately 2 million units of blood are transfused in England and there have been just a handful of cases where patients are known to have become infected with vCJD.

Are there any side effects?
Most people do not experience side effects whilst having a blood transfusion. However, it is important that you tell the nurses immediately if you feel unwell in any way. For example if you feel hot or feverish, notice any itching or rashes, feel sick or experience any lower back or loin pain.

What will happen when my blood transfusion is finished?
Your nurse will disconnect the drip and apply a dressing to your arm when your blood transfusion has finished. The nurses will give you any specific information or instructions before you go home.

If you have concerns you can contact us using the telephone numbers listed below.
Contact telephone numbers
Further information and advice is available from:

Rhosyn Day Unit 029 2061 5888 ext 6352
Monday - Friday 8am - 5pm

For booking enquiries 029 2061 5888 ext 6248

Macmillan Cancer Support 0808 808 0000 - www.macmillan.org.uk

National Blood Service- www.welsh-blood.org.uk

This leaflet was written by health professionals. Sources of information include the Handbook of Blood Transfusion Medicine, the Blood Component Transfusion Policy of Velindre NHS Trust and the Welsh Blood Service leaflet 'Will I need a blood transfusion?' The information contained in this leaflet is evidence based. The leaflet has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

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Information for patients receiving a blood transfusion at Velindre Cancer Centre This leaflet provides information for patients receiving a blood transfusion at Velindre Cancer Centre. It will explain why you're having a blood transfusion and where and how it will be given. It will also tell you about the care and services you will receive during your stay.

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What is a liver biopsy?
Liver biopsy is the biopsy (removal of a small sample of tissue) from the liver. It is a medical test that is done to aid diagnosis of liver disease, to assess the severity of known liver disease, and to monitor the progress of treatment. It is a routine procedure, which is done as a day case.

Who will be doing the percutaneous biopsy?
A specially trained doctor called a Radiologist. Radiologists have special expertise in using x-ray and scanning equipment, and also in interpreting the images produced. They need to look at these images while carrying out the biopsy.

Are you taking any medicines? We need to know all medication that you are taking, including anti-platelet drugs and anticoagulants. These are medicines that affect the way your blood clots. Listed below are some drugs that the doctor will need to be informed about if you have been prescribed them:

Warfarin, Asprin, Enoxaparin, Dalteparin, Tinzaparin, Bemiparin, Fondaparinux, Danaparoid, Apixaban, Coumarins, Acenocoumarol, Phenindione, Lepiridin, Bivalirudin, Argatroban, Dabigatran, Rivaroxaban, Clopidogrel, Dipyridamole, GPllb/lla inhibitors, Abciximab, Eptifibatide, Tirofiban and Plasugrel.

We would also need to know if you have a hereditary bleeding abnormality or abnormal bleeding history after minor procedures such as dental extraction and further tests to assess your blood may be needed.
Day before liver biopsy?

1. You will be asked to attend for a blood test. This blood test will check how well your blood clots. Normal blood clotting is important to prevent bleeding after the biopsy.

2. Please contact Velindre on Tel: 02920615888 and ask for the bed manager Pager 264 who will tell you which ward has allocated a bed for you.

Day of procedure:
Can I eat and drink before the biopsy?
No - you must not eat or drink for up to four hours before the procedure.

Where to go on arrival at Velindre
You will need to report to the ward on your appointment letter. A nurse will have been allocated to looking after you. He/she will check your temperature, pulse, respiration rate, blood pressure, and oxygen saturations (a probe will be placed on your finger and this will measure the oxygen levels in your blood). You will be given a gown to wear and will be asked to empty your bladder before you go to x-ray where the procedure will carried out.
The procedure:
The person performing the procedure will go through the process with you and explain the potential adverse effects. You will need to sign a consent form.

Your skin will be cleansed prior to the biopsy with an antiseptic fluid.

A local anaesthetic is injected into a small area of skin and tissues. This stings a little at first. Once the area is numb a needle is pushed through the anaesthetised skin into the liver to aspirate a sample of the liver tissue. The needle is then taken out and a dressing is put over the small wound.
After the procedure you will return to ward:
You will need to remain on bed rest for four hours.
The nurse looking after you will monitor your temperature, pulse, respiration rate, blood pressure, and oxygen saturations. The nurse will also check your wound site regularly. Bleeding can sometimes happen, as can a leak of bile from the liver or gallbladder.
Do I need to take special care when I go home?

* Someone should take you home as driving is not advised in first 24 hours.

Rest for 24hours after the biopsy

The biopsy site may feel uncomfortable for a day or two after the biopsy. You may wish to take painkillers for this in normal doses of up to two paracetamol tablets every six hours.

Avoid any heavy lifting or strenuous exercise for at least 48 hours.

Contact sports should be avoided for at least one week; this is to allow your liver to heal.

Please make sure that the dressing over your biopsy site remains in place for 24 hours, to prevent any infection. After the 24 hours you can bathe as normal, and change your dressing with the spare dressing provided.

Avoid Aspirin or Ibuprofen for the first week after the procedure. These medicines decrease blood clotting which is crucial for healing.

Contact your GP:

If you have pain at the biopsy site for longer than 4-5days and painkillers do not help.

Fever - raised temperature of more than 38.C

Feeling faint or dizzy, especially on standing

If you develop have any of the symptoms below:

Bleeding from biopsy

Severe pain around the site of the biopsy or elsewhere in the chest or abdomen.

Swelling or bloating in your abdomen

You should go directly to your local Accident and Emergency Department immediately. As Velindre Cancer Centre does not have an emergency department

Very rarely these complications may cause you to need surgery, this may be indicated if bleeding from the biopsy site is confirmed - this occurs in less than 2-3% of patients.

Take this information with you and give it to the receiving doctor in the accident and emergency department

Discharging nurse: ....................................................

Date of procedure: ....................................................

To: Accident and Emergency Department
This patient is experiencing symptoms after a liver biopsy. Please contact: SpR-on-call at Velindre for details on patient's current treatment plan

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What is a liver biopsy? Liver biopsy is the biopsy (removal of a small sample of tissue) from the liver. It is a medical test that is done to aid diagnosis of liver disease, to assess the severity of known liver disease, and to monitor the progress of treatment.

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ERCP stands for endoscopic retrograde cholangio pancreatography. This test can help to diagnose conditions of the liver, bile ducts, pancreas or gallbladder.

What is an ERCP?

Your doctor puts a tube called an endoscope down your throat to take x-rays of the pancreas, gallbladder and bile ducts. The endoscope is a long flexible tube with a small camera and light at the end.

The doctor can look down the endoscope or at pictures on a TV monitor. The test takes between 30 minutes and 2 hours.

Why you might have it

Your doctor might use an endoscopic retrograde cholangio pancreatography (ERCP) to check whether there is a growth or any abnormal looking area in your gallbladder. They can also look at the inside of your small bowel (duodenum) and take tissue samples (biopsies).

This test can also show a narrowing or blockage of the bile duct or pancreatic duct. So it can also help with planning surgery.

Preparing for an ERCP

Before the ERCP, you usually have a blood test to check how well your blood clots.

Let the hospital department where you are having the test know if you're taking medicine that changes how your blood clots. This includes:

aspirin

clopidogrel

arthritis medicines

warfarin or heparin

apixaban or rivaroxaban

You might need to stop taking this type of medicine a number of days before the ERCP. Your doctor or nurse will tell you when you should stop. They will also tell you if you need to stop taking any other medicines and when.

You can't eat for 6 to 8 hours before the test. This is so that your stomach and duodenum are empty. You might be able to drink sips of water up to 2 hours before your appointment. Your doctor or nurse gives you written instructions about this beforehand.

Talk to your doctor or nurse if not eating could be a problem for you. For example, if you have diabetes.

Because you have sedation for the test to make you drowsy, you will need someone with you to take you home and stay overnight. You shouldn't drive, drink alcohol, operate heavy machinery or sign any legally binding documents for 24 hours.

It's also a good idea to bring an overnight bag just in case you need to stay in hospital overnight.

How you have an ERCP

Just before the test

Your appointment letter tells you where to go. You usually go to the endoscopy department to have this test but you might have it in the x-ray department.

Before the procedure you see the doctor. They explain the procedure to you and ask you to sign a consent form. This is a good time to ask any questions you may have.

You usually change into a hospital gown and remove any jewellery or metal objects on your body. As this will interfere with the x-ray pictures they take.

You lie on the bed or x-ray couch. The nurse puts a small plastic tube (cannula) into the back of one of your hands. You may have antibiotics to prevent infection and fluids through a drip.

Your nurse gives you a plastic mouth guard to wear. This is to protect your teeth and gums during the test. They also give you oxygen through a tube that fits into your nose (nasal cannula).

During the test

You usually have an injection of sedation first to make you very drowsy. Your doctor might spray the back of your throat with a local anaesthetic to make it easier to swallow the endoscopy tube.

Once the sedative has worked, your doctor passes the endoscope tube through your mouth, down your throat into your stomach. They'll ask you to swallow as the tube goes down. You will be able to breathe normally, but you may gag slightly.

Once in the stomach, it then goes into your duodenum. This is where the pancreatic and bile ducts join. They might put a small amount of air into your stomach to help them see more clearly. This can make some people feel uncomfortable and like you want to burp.

They pass a thinner tube down through the endoscope which can fit into your bile duct. They then inject dye (contrast medium) through the tubes into the channels (ducts) of the biliary tree and pancreas so they can see them on x-ray pictures.

Your doctor can take samples of cells from the bile ducts using a brush (brush cytology). And they may also take pieces of tissue (biopsies). They send these samples to the laboratory for examination under a microscope. They may also take some photographs.

Your nurse checks your heart rate, breathing rate and oxygen levels throughout the test.

After the test

Your doctor removes the tube. You then need to rest for a while. You might need to stay in the department for a few hours.

You might not remember much (if anything) about the test when you wake up from the sedation.

After the test you might:

have a sore throat for a few days

have bloating and discomfort in your tummy (abdomen) for a day or two

feel sick or be sick after the sedation

Your nurse removes the cannula from your hand before you leave. You should be able to go home the same day. You won't be able to drive for the rest of the day and should have someone to go home with you and stay overnight.

Possible risks

There are possible risks with an ERCP and cholangioscopy. Some can be serious and life threatening. Your doctor makes sure the benefits of the test outweigh these risks. Your doctor or nurse will explain all the risks of having an ERCP and what to look out for.

Inflammation of the pancreas (pancreatitis)

You may have inflammation of the pancreas after this test. This can cause pain in your tummy (abdomen). Your doctor can give you painkillers to help control this. It's important to tell your nurse or doctor if you get pain in your abdomen.

Inflammation of the pancreas can also be severe. You might need to stay in hospital for some days if this happens.

Infection

There's a risk of infection with this test. If you get a temperature or generally feel unwell contact your doctor.

Bleeding

There may be some bleeding from having an ERCP which usually stops on its own. In some cases this can be severe and you will need medicine to stop it and maybe a blood transfusion.

Allergic reaction

There is a risk of having an allergic reaction to the sedation or dye. This can cause problems with your breathing, heart rate and blood pressure. If this happens, the staff will give you medicines to control the reaction.

Tear in your bowel

Very rarely there is a small tear (perforation) in the first part of your small bowel. If this happens it's likely you would need surgery to repair the tear.

Exposure to radiation

The amount of radiation you receive from the x-rays during the test is small and doesn't make you feel unwell. Talk to your doctor if this worries you.

When to contact a doctor

Contact the hospital where you had the ERCP or go the accident and emergency department (A&E) if you have:

ongoing or severe pain in your abdomen

a high temperature

yellowing of the skin (jaundice), if you didn't have it before

black poo (this can be a sign of blood in your poo)

being sick and are unable to stop

Getting your results

You should get your results within 1 or 2 weeks.

Waiting for results can make you anxious. Ask your doctor or nurse how long it will take to get them. Contact the doctor who arranged the test if you haven't heard anything after a couple of weeks.

You might have contact details for a specialist nurse who you can contact for information if you need to. It may help to talk to a close friend or relative about how you feel.

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ERCP stands for endoscopic retrograde cholangio pancreatography. This test can help to diagnose conditions of the liver, bile ducts, pancreas or gallbladder. Your doctor puts a tube called an endoscope down your throat to take x-rays of the pancreas, gallbladder and bile ducts.

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Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin.
This procedure is also known as keyhole surgery or minimally invasive surgery.

Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope.

This is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor.

The advantages of this technique over traditional open surgery include:

a shorter hospital stay and faster recovery time

less pain and bleeding after the operation

reduced scarring

When laparoscopy is used

Laparoscopy can be used to help diagnose a wide range of conditions that develop inside the abdomen or pelvis. It can also be used to carry out surgical procedures, such as removing a damaged or diseased organ, or removing a tissue sample for further testing ( biopsy).

Laparoscopy is most commonly used in:

gynaecology - the study and treatment of conditions affecting the female reproductive system

gastroenterology - the study and treatment of conditions affecting the digestive system

urology - the study and treatment of conditions affecting the urinary system

Read more about when laparoscopy is used.

How laparoscopy is carried out

Laparoscopy is carried out under general anaesthetic, so you won't feel any pain during the procedure.

During laparoscopy, the surgeon makes one or more small incisions in the abdomen. These allow the surgeon to insert the laparoscope, small surgical tools, and a tube used to pump gas into the abdomen. This makes it easier for the surgeon to look around and operate.

After the procedure, the gas is let out of your abdomen, the incisions are closed using stitches and a dressing is applied.

You can often go home on the same day of your laparoscopy, although you may need to stay in hospital overnight.

Read more about how laparoscopy is performed.

Safety

Laparoscopy is a commonly performed procedure and serious complications are rare.

Minor complications

Minor complications are estimated to occur in 1 or 2 out of every 100 cases following laparoscopy. They include:

infection

minor bleeding and bruising around the incision

feeling sick and vomiting

Serious complications

Serious complications after laparoscopy are estimated to occur in 1 out of every 1,000 cases. They include:

damage to an organ, such as your bowel or bladder, which could result in the loss of organ function

damage to a major artery

complications arising from the use of carbon dioxide during the procedure, such as the gas bubbles entering your veins or arteries

a serious allergic reaction to the general anaesthetic

a blood clot developing in a vein, usually in one of the legs (deep vein thrombosis or DVT), which can break off and block the blood flow in one of the blood vessels in the lungs (pulmonary embolism)

Further surgery is often required to treat many of these more serious complications.

Page last reviewed: 01 August 2018
Next review due: 01 August 2021

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Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. This procedure is also known as keyhole surgery or minimally invasive surgery. Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope.

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Chemotherapy is a cancer treatment where medicine is used to kill cancer cells.
There are many different types of chemotherapy medicine, but they all work in a similar way.

They stop cancer cells reproducing, which prevents them from growing and spreading in the body.

When chemotherapy is used

Chemotherapy may be used if cancer has spread or there's a risk it will.

It can be used to:

try to cure the cancer completely (curative chemotherapy)

make other treatments more effective - for example, it can be combined with radiotherapy (chemoradiation) or used before surgery (neo-adjuvant chemotherapy)

reduce the risk of the cancer coming back after radiotherapy or surgery (adjuvant chemotherapy)

relieve symptoms if a cure is not possible (palliative chemotherapy)

The effectiveness of chemotherapy varies significantly. Ask your doctors about the chances of treatment being successful for you.

Types of chemotherapy

Chemotherapy can be given in several ways. Your doctors will recommend the best type for you.

The most common types are:

chemotherapy given into a vein (intravenous chemotherapy) - this is usually done in hospital and involves medicine being given through a tube in a vein in your hand, arm or chest

chemotherapy tablets (oral chemotherapy) - this usually involves taking a course of medicine at home, with regular check-ups in hospital

You may be treated with one type of chemotherapy medicine or a combination of different types.

You'll usually have several treatment sessions, which will typically be spread over the course of a few months.

Side effects of chemotherapy

As well as killing cancer cells, chemotherapy can damage some healthy cells in your body, such as blood cells, skin cells and cells in the stomach.

This can cause a range of unpleasant side effects, such as:

feeling tired most of the time

feeling and being sick

an increased risk of getting infections

a sore mouth

dry, sore or itchy skin

diarrhoea or constipation

Many of these side effects can be treated or prevented and most, if not all, will pass after treatment stops.

Page last reviewed: 29 January 2020
Next review due: 29 January 2023

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Chemotherapy is a cancer treatment where medicine is used to kill cancer cells. There are many different types of chemotherapy medicine, but they all work in a similar way. They stop cancer cells reproducing, which prevents them from growing and spreading in the body.

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Chemotherapy Patient Education - Velindre Cancer Centre

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Information leaflet for patients having a PICC line (peripherally inserted central catheter) put in at
Velindre Cancer Centre

This leaflet provides information for patients having a PICC line. It will explain what a PICC line is, and what to expect on the day that the PICC line is placed. It will tell you how your PICC line is cared for and what you need to look out for. Contact telephone numbers are at the end of the leaflet.

What is a PICC line?

A PICC line is a long hollow tube that is inserted into a vein in your upper arm and travels along the vein in your shoulder and chest until it reaches the large vein above your heart. It is used to give treatments such as chemotherapy, antibiotics and intravenous fluids. It can also be used to take blood samples. A specially trained nurse will place the PICC in the X-ray department in Velindre or the Macmillan unit in Prince Charles hospital if you live in that area.

A PICC line is also called a central line.

Why do I need a PICC line?

You need a PICC line for one of the following reasons:

The type of treatment that your doctor has prescribed you can only be given through a central line

The PICC line can be used instead of placing needles into your arms which can be painful

You may need treatment which needs to be given to you at home through a special pump

The small veins in your arms or back of your hands may have become sore after previous treatments

How long does my PICC line stay in?

Your PICC line can stay in until your treatment has finished as long as it is free from complications.

Will I need any tests before the PICC line goes in?

We need to know if you take blood thinning drugs such as warfarin, clopidogrel or heparin injections such as Fragmin. If you take warfarin you will need to arrange an INR blood test the day before your PICC line is placed. If you take warfarin please ring 029 2061 5888 and ask for the PICC clinic in X-ray (all days except Tuesdays - on Tuesday please ask for the treatment helpline) at least two days before your PICC line appointment. If you take blood thinning injections we will need to advise you when to take it. We will ring you one or two days before the PICC - if we have not managed to contact you, please ring the above number.

We need to test you for MRSA (a bacteria that many people carry harmlessly on their skin) before your PICC line is placed. We will take a swab of your groin and nose. Most people will be negative. If you are positive we can give you creams and lotions to reduce the risk of your PICC becoming infected with MRSA. If an MRSA screen has not been taken, please ring 02920615888 and ask for the PICC clinic.

If you are unable to attend for your PICC appointment please telephone 0290 615888 and ask for the PICC clinic.

Can I eat and drink as normal?

You can eat breakfast or have a light lunch. You can drink normally.

What do I need to wear?

You can wear your normal, everyday clothes. You may be asked to change into a gown. We will ask you to remove any jewellery from your neck. Women will be asked to remove their bra if it is under-wired before the procedure - therefore try to wear a bra without under wires if possible.

What happens on the day of my appointment?

You can bring one relative to come into the room with you. We will give you information about the procedure and discuss possible complications. We will then ask you to sign a consent form.

The nurse will wear a mask, gown, hat and gloves when placing your PICC line to make sure that everything is kept as clean as possible. We will also use drapes to make sure that the surrounding area is kept clean.

We will give you an anaesthetic injection into a small area of your arm before the PICC line goes in, the procedure is not painful. Once the PICC is in, you will have an X-ray to make sure it is in the right place.

The appointment should take less than 2 hrs.

How does the PICC stay in place?

The PICC is not stitched in place. It is kept in place by a device called a securacath (see picture below). It anchors the PICC under the skin. The securacath will be placed when the PICC goes in and removed when the PICC comes out. A clear dressing will be placed over the PICC and the securacath device. A loose sleeve (tubigrip) will be placed over your arm to protect it.

Sometimes, you can feel some irritation from the securacath anchors which are beneath the skin for a few days after the PICC has gone in. This is normal and we expect a settling in period. If the area is painful, please ring Velindre for advice.

Can I drive home after the PICC has been put in?

You can drive home after having your PICC line placed as long as you feel fit and able to drive.
What problems could happen with the PICC line when I'm at home?
Your PICC nurse will discuss the possible complications in more detail before you sign your consent form. Possible complications include:

Infection

Blood clot in the vein (thrombosis)

Blocked line (occlusion)

Bleeding

What should I look out for whilst my PICC line is in?

If you notice any of the following please contact Velindre Cancer Centre without delay. The telephone number is at the end of the booklet.

Feeling 'shivery' or unwell after the PICC has been flushed

Any redness or pain at the site where the PICC goes into the skin

Swelling or redness of your arm, neck or shoulder

The PICC line looks longer or shorter than when it went in

Fluid or puss leaking around the skin where your PICC line enters your arm

Your skin feeling sore or uncomfortable under the dressing

The securacath (orange securing device) is painful under the skin

Who looks after my PICC line?

Your PICC line needs to be cleaned and flushed every week and this is shared between Velindre Cancer Centre and the community nurses. We also ask you to have some responsibilities. These are:

To check your PICC every day using the alert card and report any problems as soon as possible to Velindre Cancer Centre

To use your arm normally - this is important to reduce the risk of some complications.

To know when your PICC line has been flushed and dressed

To keep your PICC line dry at all times

If you are having daily radiotherapy treatment your dressing may be changed and your PICC line flushed in Velindre. Please tell your PICC nurse if you are to receive daily radiotherapy treatment.

Are there any activities that I shouldn't do with a PICC line in my arm?

You can carry on with your normal activities when you have a PICC line in place but there are some things you need to avoid. You should not swim, weight-lift, play golf, carry very heavy items or use heavy rucksacks.

What about showering or bathing?

You will need to keep your PICC line dry when you shower or bath. This is very important as it can cause the dressing to loosen or cause an infection. A waterproof sleeve will be given to you on the day of your appointment for the PICC

Contact telephone numbers

We hope that this leaflet has answered your questions.
If you have any further questions or problems with your PICC please contact:

Velindre Cancer Centre 029 2061 5888
If you are unwell at home or need to talk to anyone about your PICC ask for the treatment helpline or nurse in charge after 4.30 or weekends.

A short video can be found explaining the insertion procedure on the Macmillan website.

This leaflet was written by health professionals. The leaflet has been approved by doctors, nurses and patients. It is reviewed and updated annually.

Author: Meinir (Min) Hughes. Intravenous Access Specialist Nurse

Updated Jan 2018

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This leaflet provides information for patients having a PICC line. It will explain what a PICC line is, and what to expect on the day that the PICC line is placed. It will tell you how your PICC line is cared for and what you need to look out for.

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What happens when I come for my Picc line 

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What happens when I come for my Picc line 

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Patient Information video prior to the placement of a PICC line - Velindre Cancer Centre

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What is a Hickman line?
A Hickman line is a long, hollow tube that is inserted into a vein in your chest. It is used to give treatments such as chemotherapy, antibiotics and intravenous fluids. It can also be used to take blood samples.

A Hickman line can also be called a 'central line' a 'central venous catheter' or a 'tunnelled, cuffed catheter'.

Why do I need a Hickman line?
You need a Hickman line for one of the following reasons:

The type of treatment that your doctor has prescribed can only be given through a central line

The Hickman line can be used instead of placing needles into your arms which can be painful

Another type of line (PICC line) may not have been successfully placed

How long does my Hickman line stay in?
Your Hickman line can stay in until your treatment has finished.

Will I need any tests before the Hickman line goes in?
We need to know if you take warfarin or any blood thinning injections (heparin). If you are on warfarin, you will need a warfarin blood test the day you have your Hickman line placed. If you are on heparin, we need to make sure that there is plenty of time between the injection and the procedure. The x-ray department will let you know. If you take warfarin or heparin injections please ring the x-ray department on 029 2031 6252 at least four days before your Hickman line appointment.

We need to test you for MRSA before your Hickman line is placed. This is bacteria that live harmlessly on some peoples' skin. We will take a swab of your groin and nose. Most people will be negative. If you are positive we can give you creams and lotions to reduce the risk of infection with MRSA.

Who puts the Hickman line in?
A specially trained doctor will put in your Hickman line.

Where do I go to have my Hickman line placed?
Your Hickman line will be placed in the x-ray department. This is on the ground floor at Velindre Cancer Centre. We will send you a letter with the date and time of your appointment. We may also telephone you to confirm your appointment.
Please be on time for your appointment.
Will it hurt?
We will give you an anaesthetic injection to numb the area before the line is put in. You should not feel pain after this. You may feel some discomfort.

Can I eat and drink as normal?
You can eat breakfast as normal and have a light lunch. You can drink water throughout the day.

Can a relative or friend stay with me?
You can bring someone with you to the hospital but they will not be able to be with you when the line is put in. There is a waiting area in the x-ray department.

Can I drive home after the Hickman has been put in?
You can drive home after your Hickman line placed as long as you feel fit and able to drive.

How long will it take?
Your appointment will be approximately 4 hours. It usually takes about 45 minutes to an hour to place the Hickman line.

What happens on the day of my appointment?
You will be asked to go to Rhosyn Day Unit for your appointment time and they will take a blood test. You will then attend the x-ray department. We will give you information about the procedure and discuss any possible complications. We will ask you to sign a consent form.

The doctor will wear a mask, gown, hat and gloves when placing your Hickman line to make sure that everything is kept as clean as possible. We will also use drapes to make sure that the surrounding area is kept clean.

Your chest will be cleaned with an antiseptic solution, this will feel cold. Then you will have anaesthetic injections to numb the area. This may sting a little.

Your Hickman line will be placed with the help of an ultrasound machine. This gives the doctor a screen to look at to guide the Hickman line into the correct place.

How will you know that my Hickman line is in the right place?
You will have a chest x-ray after your Hickman line has been put in. This will tell us if your line is in the right place.

How does the Hickman stay in place?
A special dressing will be placed around the line to help keep it secure. Your Hickman line will be stitched to the dressing.

After about three weeks the tissues under your skin will grow around the Hickman line and hold it safely in place. The stitches will be taken out and the dressing will be removed. You will not need to have a dressing after the stitches have been taken out.

Are there any problems that could happen with the Hickman line when I'm at home?
Your radiographer or nurse will discuss the possible complications in more detail before you sign your consent form. Possible complications include:

Infection

Formation of a blood clot (thrombosis)

Blocked line (occlusion)

Movement of the line (migration)

Bleeding

Damage to the line

Air entering the vein

Allergic reaction to the dressing

What should I look out for whilst my Hickman line is in?
If you notice any of the following please contact Velindre Cancer Centre without delay. The telephone number is on page 10.

Any redness, pain or discharge around the exit site (the point where the Hickman line enters the body)

Feeling 'shivery' or unwell after your line has been flushed

Swelling of your arm, chest neck or shoulder

Pain in your chest, arm or neck

Fluid leaking around the skin at the exit site

If you accidentally cut your Hickman line you should cover the hole as best as you can and contact Velindre Cancer Centre immediately. The telephone number is on page 10.

Who looks after my Hickman line?
A District Nurse will come to your house once a week to care for your Hickman line. We will contact the District Nurse the day your line is inserted.

The District Nurse will flush and clean the exit site of your Hickman line every week.

If your District Nurse does not contact you within two weeks of the Hickman being placed, please telephone the chemotherapy pager to let us know that you need a District Nurse referral. The telephone number is on page 10.

Can I or a relative care for the line?
Please tell your radiographer or nurse if you want a relative or friend to flush the line. We will make arrangements to provide training and support.

Are there any activities that I shouldn't do with a Hickman line in place?
You can carry on with your normal activities when you have a Hickman line in place. The only things we ask you not to do are weight-lifting and playing golf. Activities such as these may cause your Hickman line to move into another vein in the chest. It is not advisable to go swimming because of the risk of infection.

What about showering or bathing?
For the first 3 weeks you should be careful to keep the dressing dry.

After the stitches have been removed you can bath or shower at home without a dressing. Pat the area dry with a clean towel.

If you are in hospital there is an increased risk of infections so you must cover the exit site with a dressing whilst bathing or showering.

How does my Hickman line come out?
We will give you an appointment for your line to be removed. A specially trained nurse will remove your Hickman line. You will have to lay flat on a bed for the procedure.

We will clean your skin with an antiseptic and give you anaesthetic injections to numb the area. The Hickman line will be taken out.

What happens if I go to another hospital?
If you are admitted to another hospital except Velindre or you visit a hospital where they use your Hickman line, please ring Velindre on the chemotherapy pager to tell us.
Contact telephone numbers
We hope that this leaflet has answered your questions. Please do not hesitate to contact us if you have further questions at any time.

Velindre Cancer Centre - 029 2061 5888
If you are unwell at home and need immediate attention at any time of the day or night ask for the chemotherapy pager

X-ray department - 029 2031 6252
Monday - Friday 8am - 5.30pm for queries or problems with your appointment

Tenovus cancer support line - 0808 808 1010
Monday - Friday 9am - 4.30 for general queries on cancer

This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients.

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What is a Hickman line? A Hickman line is a long, hollow tube that is inserted into a vein in your chest. It is used to give treatments such as chemotherapy, antibiotics and intravenous fluids. It can also be used to take blood samples.

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If you are on treatment and have any of the following;

Temperature above 37.5 degrees or below 36 degrees

Shaking/shivering episodes

Unusual bruising/bleeding/rashes

Flu like symptoms

Persistent feeling of sickness or vomiting

Diarrhoea-more than 4 episodes in 24hours

Mouth ulcers or a sore mouth

Concerns about your Picc or Hickman line

Please contact the hospital on 02920 615888 and ask for the Treatment Helpline. You may be asked to leave a message so please leave your name, contact telephone number, and hospital number, you will be contacted back as soon as possible.

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Read about what radiotherapy is, how it works, when's used, how it's given and what the possible side effects are.

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What to expect at your RT planning appointment 

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What to expect at your RT planning appointment 

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Radiotherapy Planning session Velindre Cancer Centre

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What to expect at your radiotherapy appointment 

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What to expect at your radiotherapy appointment 

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If you have any concerns or suffering from side effects from your radiotherapy treatment please contact the Radiotherapy Review team on 02920 615888 ext 6421

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Preparing for surgical  treatment (PREHAB)

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Preparing for surgical  treatment (PREHAB)

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The main operation used to treat oesophageal cancer is called an oesophagectomy. In this operation, the part of the oesophagus containing the cancer is removed.

If the cancer is at an early stage, you may have surgery with the aim of curing the cancer.

The main operation used to treat oesophageal cancer is called an oesophagectomy. In this operation, the part of the oesophagus containing the cancer is removed.

The part that is removed depends on the size and position of the cancer inside the oesophagus.

You may need to stay in hospital for a few weeks after surgery to the oesophagus.

Your cancer doctor will talk with you about the operation you are going to have. It is important to discuss the operation with them before it happens. It may help to make a list of questions you want to ask.

Surgery to the lymph nodes

During the oesophagectomy the surgeon removes a small area of healthy tissue around the oesophagus. This is called a margin. They also remove some of the nearby lymph nodes within the margin. This is called a lymphadenectomy.

A doctor who specialises in studying cells (pathologist) then looks at the lymph nodes under a microscope. This is to see if there are any cancer cells.

Removing the lymph nodes helps reduce the risk of the cancer coming back. It also helps the doctors know more about the stage of the cancer.

Depending on where the cancer is in the oesophagus, there are two main ways the surgeon can do your operation:

After an oesophagectomy, the stomach will be in a higher position in the body than it was before. It will be above, instead of below, the sheet of muscle (diaphragm) that divides the chest from the tummy. The stomach will also be smaller. This is because the surgeon has shaped it into a tube to replace the part of the oesophagus they removed. This will affect eating and drinking.

Sometimes, it is not possible to join the stomach to the remaining part of the oesophagus. In this case, the surgeon uses a part of the large bowel (colon) to replace the part of the oesophagus they removed. Your cancer doctor will explain this in more detail if they think they might use this type of surgery.

Sometimes during the operation, the surgeon finds that the tumour cannot be removed. This may be because the tumour has spread or gone through the wall of the oesophagus to nearby parts of the body. If this happens, your cancer doctor will talk to you about other treatment options.

Minimally invasive surgery (keyhole surgery)

The surgeon does this operation through a few small cuts in the tummy (abdomen), rather than one large opening. It is sometimes called keyhole surgery. The surgeon puts fine tubes with a camera and light on the end through the cuts. This lets them see and work inside the body.

If the surgeon does this surgery inside the chest to reach the oesophagus, this is called a thoracoscopy. If the surgeon does the surgery inside the tummy, it is called a laparoscopy.

You may be able to have part, or all, of your operation by keyhole surgery. Your surgeon can tell you whether this is suitable for you.

During the operation, the surgeon may decide keyhole surgery is not suitable. They will then do standard surgery instead. Keyhole surgery should only be done by experienced and specially trained surgical teams.

Your surgeon will explain the possible risks of oesophagectomy before you have the operation. You will have tests to check your heart and lungs, to make sure you are well enough to have it.

Some of the possible complications of surgery to the oesophagus may be life-threatening. You might need to stay in the intensive care unit for a while after surgery. Other possible risks include:

the join between the oesophagus and stomach leaking

a chest infection or pneumonia

bleeding

problems with the wound healing properly.

It is important to have the information you need about any possible risks before the operation. You can talk to your surgeon or specialist nurse if you have questions.

You will be in hospital for a few weeks with this type of operation. At first it may feel like you are improving quite quickly. But it may take a few months before you recover and can go back to your normal activities.

We have more information about having surgery for oesophageal cancer.

Before your operation, you will have tests to make sure you are well enough. These are usually done a few weeks before surgery at a pre-assessment clinic. They include tests on the heart and lungs.

Your surgeon and a specialist nurse will talk to you about the operation. You may see the doctor who gives you the anaesthetic (anaesthetist) when you are at a clinic or when you go into hospital for the operation.

If you think you might need help when you go home after your operation, tell your specialist nurse as soon as possible. For example, tell them if you might need help because you live alone or are a carer for someone else. Your healthcare team can help organise support before you go home.

You will usually go into hospital on the morning of your operation. Or you may go in the night before.

The nurses give you special elastic stockings (TED stockings) to wear during and after the operation. These help prevent blood clots in your legs.

Before surgery, it is important to make sure you have all the information you need. The operation can be complex so it is fine to ask lots of questions. Talk to your surgeon or specialist nurse if there is anything you do not understand.

Enhanced recovery programme

Many hospitals now have enhanced recovery programmes. This aims to reduce your time in hospital and speed up your recovery. It also involves you more in your own care. For example, you are given information about exercises you can do to help you get fitter before surgery, as well as exercises to do after your operation.

It also makes sure any arrangements needed for your return home are organised in advance.

Your cancer doctor will tell you if an enhanced recovery programme is suitable for you.

You will probably be cared for in the intensive care unit, or a high-dependency unit, for a few days after your operation. You may be kept asleep for longer using a machine called a ventilator. This is to help your heart and lungs recover after the operation. If you are woken up earlier, a ventilator may be used to help you to breathe for a few hours. You will probably feel quite tired, and may not remember much about the first day or two after your operation.

Drips and drains

You may have some drips and drains attached to your body for a few days after surgery. These include the following:

Reducing the risk of complications

The nurses will encourage you to get out of bed and move around as soon as possible. This helps reduce the risk of complications after surgery, such as blood clots and infections. The nurses can help you manage your drips and drains while walking.

A physiotherapist or nurse will teach you deep breathing exercises to help keep your lungs clear. They will also show you how to do regular leg movements to prevent blood clots forming in your legs.

A physiotherapist can also show you how to clear your lungs of any fluid that may have built up because of your operation.

Pain

You will probably have some pain and discomfort after the operation. Your cancer doctor or specialist nurse will explain how your pain will be controlled.

You may have painkillers in one of the following ways:

When you no longer need the epidural or PCA, you have painkillers as tablets or liquids.

It is important to tell your healthcare team if you are still in pain. Mild discomfort or pain in your chest can last for several weeks, so they will give you some painkillers to take home with you.

Your wound

You will probably have a dressing covering your wound, which might not be removed for the first few days.

How long the wound takes to heal depends on the operation you had. The surgeon may have closed your wound with glue or stitches that dissolve and do not need to be removed. If you do not have stitches that dissolve, they are usually removed about 7 to 10 days after your operation.

Tell a nurse or your cancer doctor straight away if your wound becomes:

Eating and drinking after surgery

You will not usually have anything to eat for the first 48 hours after surgery. When you are fully awake, you may have small sips of clear fluids. The amount of fluids you have is slowly increased. After a few days, when you can drink enough, you will start having small amounts of soft foods, and then normal food in smaller portions. This gives the new joins made during surgery some time to heal.

Feeding tube

You will usually go home with your feeding tube still in, to make sure you get enough food and nutrients and do not lose weight. Before leaving hospital, your nurse or dietitian will show you how to use your feeding tube. If you have a carer, they can learn how to use it too. You will see the dietitian regularly as an outpatient to check how well you are eating. When you are eating and drinking enough, the tube can be removed.

We have more information about feeding tubes and nutritional support.

You will still be recovering for some time after you go home. Try building up the amount you do slowly. Gentle exercise, such as regular walks, builds up your energy levels. You can increase the amount you do as you feel better. Everyone is different, and some people take longer than others to recover.

Avoid lifting heavy things like shopping, or doing vacuuming or gardening, for at least 8 weeks. This gives your wound time to heal.

Some insurance policies give specific time limits for not driving after surgery. Contact your insurance company to tell them you have had an operation. Most people are ready to drive about 4 to 6 weeks after their operation. Do not drive unless you feel in full control of the car.

We have more information about going home from hospital, which explains how to get support after you get home.

Outpatient appointment

Before you leave hospital, you will be given an appointment for your check-up at an outpatient clinic. The appointment is a good time to talk about any problems you have after your operation. If you have any problems before this appointment, you can contact your cancer doctor, specialist nurse or ward nurse for advice.

Eating

You probably will not feel like eating very much for a while, and it is common to lose some weight. You may feel full after eating small amounts. Some foods might make you feel sick, or give you indigestion or diarrhoea. It is important to try to eat, even if you do not feel like it. Over time, you will start to manage bigger portion sizes and different foods. If you continue to have problems, it can help to write down what is happening so you can limit or avoid certain foods. Talk to your cancer doctor or dietitian if you continue to have problems with food.

We have more information about eating after treatment for oesophageal cancer.

Indigestion

Indigestion or reflux (a backward flow of digestive juices into the oesophagus) can happen after stomach surgery. This can cause pain and inflammation of the lining of the oesophagus. Your GP or cancer doctor can prescribe antacid medicines to help with this.

Avoid fizzy drinks, alcohol and spicy foods, as these may make your symptoms worse. Lying down may also make symptoms worse. After eating and drinking, try to stay sitting up for at least an hour. When you lie down to sleep, try using pillows to raise your head slightly.

Indigestion can also be caused by wind trapped in the digestive system. You can reduce wind by drinking peppermint water or taking charcoal tablets. You can buy these from a pharmacy.

Preventing weight loss

To start with, you may find it hard to not to lose weight. Your body will use lots of calories to help it recover from surgery, but you may not be eating as much as you normally would. But in time, most people find they stop losing weight.

You will usually see a dietitian, who will talk with you about the effects of surgery on your diet. They will give you advice about eating a balanced diet and building up your weight. To gain weight, you need to add more energy (calories) and protein to your diet. You can do this by:

eating high-calorie foods, such as crisps, cakes, biscuits and pastries

adding more calories to your food by using things like cream, butter or cheese

having nutritious, high-calorie and protein food supplements - these are available on prescription as liquids or powders.

Dumping syndrome

The stomach normally stores food and releases it into the bowel in a controlled way. After an operation to remove part of the oesophagus, food can travel more quickly through the digestive system. This can cause symptoms called dumping syndrome.

We have more information about nutritional support and diet problems after surgery.

Macmillan Cancer Support Line

The Macmillan Support Line offers confidential support to people living with cancer and their loved ones. If you need to talk, we'll listen.

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Oesophagectomy - Macmillan Cancer Support

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The main operation used to treat oesophageal cancer is called an oesophagectomy. In this operation, the part of the oesophagus containing the cancer is removed. If the cancer is at an early stage, you may have surgery with the aim of curing the cancer. The main operation used to treat oesophageal cancer is called an oesophagectomy.

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A gastrectomy is a medical procedure where all or part of the stomach is surgically removed.

When a gastrectomy is needed

A gastrectomy is often used to treat stomach cancer.

Less commonly, it's used to treat:

Gastrectomy is usually an effective treatment for cancer and obesity.

How a gastrectomy is performed

There are 4 main types of gastrectomy, depending on which part of your stomach needs to be removed:

total gastrectomy - the whole stomach is removed

partial gastrectomy - the lower part of the stomach is removed

sleeve gastrectomy - the left side of the stomach is removed

oesophagogastrectomy - the top part of the stomach and part of the oesophagus (gullet), the tube connecting your throat to your stomach, is removed

After surgery, you'll still have a working digestive system although it will not function as well as it did before. If all or most of the stomach is removed, the gullet will be connected to the small intestine or the remaining section of the stomach.

All types of gastrectomy are carried out under general anaesthetic, so you'll be asleep during the operation.

Techniques for gastrectomy

2 different techniques can be used to carry out a gastrectomy:

open gastrectomy - where a large cut is made in your stomach or chest

keyhole surgery (laparoscopic gastrectomy) - where several smaller cuts are made and surgical instruments are used

People who have keyhole surgery usually recover faster and have less pain after the procedure than those who have an open gastrectomy. You may also be able to leave hospital a little sooner.

Complication rates after keyhole surgery are similar to those for open gastrectomies.

Open gastrectomies are usually more effective in treating advanced stomach cancer than keyhole surgery is. This is because it's usually easier to remove affected lymph nodes (small glands that are part of the immune system) during an open gastrectomy.

Before you decide which procedure to have, discuss the advantages and disadvantages with your surgeon.

Recovering after a gastrectomy

A gastrectomy is a major operation, so recovery can take a long time. You'll usually stay in hospital for 1 or 2 weeks after the procedure, where you may receive nutrition directly into a vein until you can eat and drink again.

You'll eventually be able to digest most foods and liquids. However, you may need to make changes to your diet, such as eating frequent small meals instead of 3 large meals a day. You may also need vitamin supplements to ensure you're getting the correct nutrition.
Read more about recovering from a gastrectomy

Complications

As with any type of surgery, a gastrectomy carries a risk of complications, such as infection, bleeding and leaking from the area that's been stitched together.

A gastrectomy may also lead to problems, such as anaemia or osteoporosis, caused by a reduction in your ability to absorb vitamins.
Read more about the possible complications of a gastrectomy

Page last reviewed: 19 April 2021
Next review due: 19 April 2024

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A gastrectomy is a medical procedure where all or part of the stomach is surgically removed. A gastrectomy is often used to treat stomach cancer. Less commonly, it's used to treat: Gastrectomy is usually an effective treatment for cancer and obesity.

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This leaflet provides information on dihydropyrimidine dehydrogenase (DPD) testing. If you are due to receive 5FU or capecitabine chemotherapy as part of your cancer treatment, it will be necessary to have genetic blood test prior to starting treatment. This is to check whether your body is able to breakdown the chemotherapy drugs safely or not. This leaflet will explain why the test is needed in more detail.
What is DPD?
DPD is an enzyme made by the liver. It helps break down certain chemotherapy drugs (such as 5FU and capecitabine) that are used to treat cancer.

DPYD is a gene. Genes are our cells' instruction manuals and tell our body how to work normally. The DPYD gene helps to control how much DPD enzyme is made. Changes in the DPYD gene can mean your body does not make enough (or any) of the DPD enzyme. This is called DPD deficiency.
Why am I being offered a DPD test?
If your body does not make enough DPD, the chemotherapy drugs can build up in the body. This can cause more severe side effects than usual and in some situations may be life-threatening. The side effects include:

a drop in the level of blood cells which may increase the risk of having infections, breathlessness and bleeding

diarrhoea, which can be severe

a sore mouth

feeling or being sick, which can cause dehydration

a severe skin reaction, which leads to peeling or blistering of the skin.

What does the DPD test involve?
Before you start treatment, your oncologist will arrange for you to have a genetic blood test. The blood test is sent to a genetic laboratory to look for changes in the DPYD gene. The result will be available in about five days and will be sent back to your oncologist.

Please be aware that your blood sample will only be tested for changes in the DPYD gene so you will not find out about your risk of any other genetic conditions.
What action is needed if I am found to have a DPD deficiency?
The team responsible for your treatment will discuss the results with you prior to starting any treatment. If your DPD gene is normal, you can have a standard dose of chemotherapy. This is because your body can break down the chemotherapy drugs.

If a change in the DPD gene is found, you may need lower doses of chemotherapy to reduce the chance of getting serious side effects. In some cases, it may be necessary to avoid using these drugs altogether. In this situation, alternative treatment options will be discussed with you.

The team will monitor you closely during treatment. If you do not develop any serious side effects after the first few cycles of treatment, they may consider whether it is safe to increase the dose of chemotherapy. This will only be done following a discussion with you about the benefits and risks of increasing the dose.
Will reducing the dose of the chemotherapy drugs affect how successful the cancer treatment is?
It is important that the risks of treatment are kept as low as possible, particularly as severe side effects may be life-threatening. Your DPD level does not in itself affect how successful the chemotherapy will be in killing cancer cells, but it will tell us how your body will cope with the drug and the dose that is given.
Is there anything I can do to increase the levels of DPD in my body?
There is no evidence that medications, dietary or lifestyle changes affect DPD levels. The only action you need to take is to seek medical attention if you develop side effects following chemotherapy treatment. In this situation you should inform the medical team that you are known to have a DPD deficiency. Contact Velindre Cancer Centre for advice. The telephone number is at the end of the leaflet.
What does a diagnosis of DPD deficiency mean for my family?
DPD testing is only recommended for people being treated with 5FU or capecitabine chemotherapy. There is no need to test your blood relatives who do not have a cancer diagnosis. However other members of your family may also have a DPD deficiency. This is because you share your genetics with blood relatives. We would encourage you to share this information with your family in case they are treated for cancer in the future.
Contact telephone numbers Velindre Cancer Centre 029 2061 5888
Ask for the treatment helpline if you are unwell at home and need immediate advice at any time of the day or night.

For more detailed information on DPD deficiency, please see below:

Cancer Research UK General Cancer Information on DPD deficiency https://www.cancerresearchuk.org/about-cancer/cancer-in-general/treatment/chemotherapy/side-effects/dpd-deficiency

This information is also available in Welsh

This leaflet was written by health professionals. The information contained in this leaflet is evidence based.

It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

Originally prepared April 2020

Updated November 2022

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This leaflet provides information on dihydropyrimidine dehydrogenase (DPD) testing. If you are due to receive 5FU or capecitabine chemotherapy as part of your cancer treatment, it will be necessary to have genetic blood test prior to starting treatment. This is to check whether your body is able to breakdown the chemotherapy drugs safely or not.

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Information for patients receiving a blood
transfusion at Velindre Cancer Centre

This leaflet provides information for patients receiving a blood transfusion at Velindre Cancer Centre. It will explain why you're having a blood transfusion and where and how it will be given. It will also tell you about the care and services you will receive during your stay. Contact telephone numbers and details of how to obtain further information on blood transfusions are given at the end of the leaflet.
Why do I need to have a blood transfusion?
You need to have a blood transfusion because you are anaemic. This means that you do not have enough red blood cells in your body. This can make you feel very tired (lethargic) and that you have no energy. It may also make you feel breathless.

Having a blood transfusion will help to increase your red blood cells. This will alleviate the symptoms of anaemia. You should feel the benefits of the blood transfusion within 24 hours. However these benefits may be short lived so you may need further blood transfusions.

Where will I receive my blood transfusion?
You will receive your blood transfusion on the Ambulatory Unit. This is situated on the ground floor of Velindre Cancer Centre. You will be offered a comfortable reclining chair to sit in whilst you receive your blood transfusion.

What facilities are on Ambulatory Unit?
There are a selection of magazines and books available. DVDs are also available on request. There are toilets on the unit. Hot and cold drinks are provided.

How long will I need to stay?
The length of time you will need to stay depends on how many units of blood your doctor has prescribed. The first unit of blood is given slowly, it usually takes about 2 hours. Other units usually take about 1½ hours unless your doctor requests a slower rate.

When your doctor is arranging your appointment you will be told how many units of blood you will receive. This will help you to calculate how long you will stay.

Can somebody stay with me?
Currently due to the need to ensure 2m space between patients during COVID-19 we do not usually allow anyone to stay with you during your transfusion. If you have any concerns about this please speak to your team before your treatment starts. We may be able to make some exceptions but we will need to be aware of this before the day of treatment.

What should I wear?
You should wear comfortable clothing. Most patients wear their normal everyday clothes.

How will my blood transfusion be given?
Your blood transfusion will be given by a drip through a tiny tube directly into a vein in your arm. The
drip is connected to a pump fitted onto a drip stand. The pump regulates the rate that your blood transfusion is given. If you have a special line in place, for example a PICC or Hickman line, then your blood transfusion can usually be given through this.

The nurses will monitor you during your blood transfusion. They will regularly check your temperature, pulse and blood pressure and make sure that you are comfortable and that the drip is flowing at the correct rate.

Can I move around Ambulatory Unit whilst having my blood transfusion?
Yes, you can move around. Your drip stand has wheels so you can push this yourself, or ask a nurse to help you.

What about any tablets and medicines that I usually take?
It is important that you bring these in with you to show the nurses. You can continue taking these as usual unless you are advised not to.

What are the risks associated with having a blood transfusion?
All medical procedures and therapies involve some degree of risk. These need to be balanced against the risk to your health of not having a blood transfusion.

The biggest risk from a blood transfusion is being given the wrong blood. We will ask for your full name and date of birth and this identification will be used to check each bag of blood that is given.

The risks of getting an infection from a blood transfusion are very low. All blood products are carefully checked and tested for viruses or impurities to minimise any risk to you.

The risk of contracting HIV or HTLV (Human T-Cell Lymphotropic Virus) infection from a blood transfusion is about 1 in 5 million. The risk of contracting hepatitis is 1 in 500,000 for hepatitis B and 1 in 30 million for hepatitis C.

The risk of getting variant Creutzfeldt-Jakob disease (vCJD) from a single blood transfusion is very low, although this risk increases with additional blood transfusions. Each year approximately 2 million units of blood are transfused in England and there have been just a handful of cases where patients are known to have become infected with vCJD.

Are there any side effects?
Most people do not experience side effects whilst having a blood transfusion. However, it is important that you tell the nurses immediately if you feel unwell in any way. For example if you feel hot or feverish, notice any itching or rashes, feel sick or experience any lower back or loin pain.

What will happen when my blood transfusion is finished?
Your nurse will disconnect the drip and apply a dressing to your arm when your blood transfusion has finished. The nurses will give you any specific information or instructions before you go home.

If you have concerns you can contact us using the telephone numbers listed below.
Contact telephone numbers
Further information and advice is available from:

Rhosyn Day Unit 029 2061 5888 ext 6352
Monday - Friday 8am - 5pm

For booking enquiries 029 2061 5888 ext 6248

Macmillan Cancer Support 0808 808 0000 - www.macmillan.org.uk

National Blood Service- www.welsh-blood.org.uk

This leaflet was written by health professionals. Sources of information include the Handbook of Blood Transfusion Medicine, the Blood Component Transfusion Policy of Velindre NHS Trust and the Welsh Blood Service leaflet 'Will I need a blood transfusion?' The information contained in this leaflet is evidence based. The leaflet has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

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Information for patients receiving a blood transfusion at Velindre Cancer Centre This leaflet provides information for patients receiving a blood transfusion at Velindre Cancer Centre. It will explain why you're having a blood transfusion and where and how it will be given. It will also tell you about the care and services you will receive during your stay.

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Nutrition is a vital part of your cancer treatment. Upper GI cancers can affect your ability to eat and drink. We know that having good nutrition can help you to tolerate your cancer treatment better and improve your general wellbeing.

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Help with eating when you have constipation

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Help with eating when you have constipation

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Help with eating when you have diarrhoea

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Help with eating when you have diarrhoea

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Help with eating when you have nausea or vomiting 

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Help with eating when you have nausea or vomiting 

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Help with eating when you have a sore mouth

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Help with eating when you have a sore mouth

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Help with eating when your taste changes

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Help with eating when your taste changes

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Many patients who are faced with a cancer diagnosis report a reduction in quality of life and limitations in carrying out basic activities of daily living (ADLs). These limitations in function may be due to the cancer itself, but many are actually a result of treatment-related side effects. Cancer-related disability arises from these limitations.  Occupational Therapy carries out a wide range of interventions following a comprehensive assessment.  These are available via face to face appointments, video call or telephone call. Some of these may include:

• Assessments to support day to day function

• Provision of aids / adaptations

• Seating and wheelchair assessment

• Cushion assessment for management of pain or discomfort in sitting

• Fatigue Management / Anxiety Management

• Support with memory and cognitive difficulties

• Vocational Rehabilitation (returning to work / accessing employment)

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Physiotherapists are experts in finding the best ways for cancer patients to be active, improve independence and enhance quality of life. This may involve exercise programmes or advice on everyday activities. With some cancers, research has shown that being active can reduce the risk of it coming back and increase your chances of surviving. Specialist physiotherapists can also help with problems and possible treatment side effects such as pain, fatigue and breathlessness. For cancer patients of working age, physiotherapy can help you gain enough strength and mobility to return to work.

Physiotherapists deal with human function and movement and help people to achieve their full physical potential. They use physical approaches to promote, maintain and restore wellbeing.

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Inpatient

We offer Physiotherapy to all inpatients. During this time we deliver individualised, patient centred rehabilitation programmes to optimise function and support discharge from hospital. We aim to encourage independence in order to assist individuals to manage their symptoms and side effects of cancer and its treatment such as:

Reduced mobility

Weakness & reduced function

Assisting with the management of symptoms such as pain, breathlessness, fatigue, anxiety

Assessing and treating problems of muscle weakness and decreased joint mobility

Assessing and treating functional problems caused by brain and spinal tumours, including balance and coordination problems

Monday - Friday 08.00 - 4.30pm

Saturday 08.30 - 12.30pm

Sunday 08.30 - 12.00pm

Outpatients

We offer an outpatient service to all tumour sites. We run one to one assessments and treatment intervention depending on your needs, these services may be face to face or by virtual means. In addition, we are currently able to offer a Physiotherapy input into multi-disciplinary clinics for Lung, Neurological and Gynaecology cancers. All referrals must be via a health care professional, please speak to your team if you feel you would benefit from a referral to the Physiotherapy service.

We also have a new dedicated physiotherapy service for any ladies having treatment for gynaecological cancer. This is aimed at trying to help and support ladies through their treatment and to give advice for any side effects they may experience. Please contact the physiotherapy department for more information.

What is Breathlessness?

Breathlessness is an unpleasant sensation of uncomfortable, rapid or difficult breathing. It may come on suddenly or gradually over a period of time. The reason for breathlessness is that your body needs more oxygen than it is getting so you breathe faster.

Breathlessness and Cancer

There are a number of possible causes of breathlessness. Following a diagnosis of cancer, fear, stress and anxiety are very common natural reactions. They can cause people to breathe too fast and to take shallow breaths from the top of your lungs, rather than your lower chest. This can sometimes make you feel more breathless, which can lead to a feeling of a panic attack.

Sometimes cancer affecting the lungs can be a cause of breathlessness, it may be a primary lung cancer (where the cancer has started in the lungs) or a secondary cancer that has spread to the lung from another part of the body. Treatments are available which may help shrink the tumour and relieve breathlessness caused by cancer.

A few other examples include chest infections where the phlegm in the airways can make you feel breathless. Weakened muscles and pain that is poorly controlled can make it difficult to breathe comfortably.

Breathlessness can be distressing and it can affect several areas of your life. However, there are many things that can relieve or help you manage breathlessness. Some people prefer some techniques over others - there is no right or wrong way of coping. The most important thing is to find what works best for you in each situation. Here are some ideas below:

1. Prioritise: Consider which activities are important to you each day and prioritise the activities for which you would like to conserve your energy. Try to cut out unnecessary tasks in order to conserve your energy and spread out activities in the day. For example, do five minutes of ironing six times a day, instead of 30 mins at one time.

2. Plan: Organize your activities as effectively as possible in order to conserve as much energy as possible. Try not to do too much in any one day and plan your activities for the week if at all possible.

3. Pace: It is important to balance periods of activity with periods of rest (i.e. take your time when walking and take frequent rests if you need to).

4. Position: Work out a position that is comfortable for you and practice doing this to help yourself.
Try these positions to see if they work for you:
High side lying Head and chest are supported by the arm and pillows Top leg is bent up
Lower arm is bent under the pillow Relaxed sitting position
Sit on a chair Elbows are rested on thighs Hands and wrists are relaxed
Relaxed standing Lean against a wall
Relaxed forward slightly, loosening neck, shoulders and arms NB. Do not lean too far forward and fall Forward leaning standing Lean forward against a banister
Relax forward slightly, loosening neck, shoulders and arms
NB. Do not lean too far forward and fall

5. Permission: Give yourself permission not to do activities which make you breathless and tired. Try and change your way of thinking, instead of 'I must' or 'I ought' try 'I choose to do' or 'I wish to do' instead. For example, "I should ring Sam" to "I could ring Sam".

6. Psychological - Breathlessness can often make you feel low in mood. You may feel guilty and feel that you don't want to be a burden. Maybe everything seems too much effort and that you can't be bothered to go out. However, have you considered some alternative thoughts such as what small successes you have achieved and what other people see as your strengths? It is important to be kind to yourself and reward yourself for your successes - however small they seem.

7. Relaxation - relaxation can help to calm the body down. There are a number of different skills you can use. For example, deep breathing, muscle relaxation exercises, listening to relaxing music or imagining yourself somewhere safe and calm. Some people find physical activity is more relaxing for them. Please refer to the physical activity booklet.

8. Practical - If you are finding your breathlessness is causing difficulties managing at home there may be equipment that can help you complete your activities more independently. Your GP can refer you to your local occupational therapist or you can speak to a member of your oncology team.

Sources of Support

If you would like further support for coping with your breathlessness you can find this from the following services:

Your GP (you may be referred to the surgery's counselling service).

Macmillan Cancer Support: www.macmillan.org.uk or 0808 808 0000.

Tenovus: www.tenovus.org.uk or 0808 808 1010.

Leigh Porter, Velindre Patient and Carer Information and Support Co-ordinator: For information on support services in your local area - 029 20196132.

Velindre has programmes aimed to help you to manage your breathlessness and live with feelings of uncertainty.

Your Consultant or Clinical Nurse Specialist can provide you information about the services available to you and request a referral to programmes or Clinical Psychology and Counselling team at Velindre Cancer Centre.

This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

Original version prepared 2014.

The Role of Physical Activity

This leaflet aims to provide you with some information about the importance of physical activity and ways of increasing your activity levels. In the past, adults with cancer were often told to rest during treatment. However, we now know
that being active will help you manage some of the side effects of cancer and / or its treatment(s).

There are lots of benefits to keeping active during and after cancer treatment, both for your body and your mind. Activity can help reduce fatigue, increase your appetite, build muscle and bone strength, help your heart, keep you fit and help you maintain a healthy weight. Activity can also help you manage stress, anxiety and low mood. There is some evidence that for some people being active can reduce the risk of cancer coming back in the future. However, the thought of becoming active can be overwhelming, particularly if you have not been active before or for some time. It can be difficult to know where to start or you may worry about your ability to return to your previous activity levels.
How Much Activity Should I Do?
It can be difficult to know how much and the type of activity you should be doing. It is suggested that all adults should try and do:
150 minutes (2 hours 30 minutes) of moderate intensity
activity every week.
This may sound like a lot; but the activity does not have to be done all at the same time. For example:
30 minutes of activity - 5 times per week.
If you are just starting to increase your activity levels or are having treatment, you may want to do shorter times and do them over the day. For example:
Three 10 minute sessions in one day
It can also be hard to know how intense your activity levels need to be. As a rule, moderate intensity activity should make you feel a little warmer, make your heart beat a little quicker and breathing a little faster, but you should still be able to hold a conversation.
Top Tips for Getting Active and Staying Active
There are many ways that you can become more active. Here are some ideas on how to be more active:

1. Try not to sit and lie down for a long time in the day - do small amounts of activity throughout the day.

2. Build activity into things you do every day, for example:

Do some housework.

Take the stairs rather than the lift.

Get off the bus a stop early and walk the rest of the journey home.

Play with your children, grandchildren or the dog.

Do some gardening.

Remember that these things count towards our daily amount of activity and can help our health in the same way as swimming, running and cycling. Can you think of other ways of building activity into your daily routine?

3. Make goals that you can achieve. If you have never run before or for a long time, start by running for five minutes, not trying to run a marathon. As the activity gets easier, set a new goal.

4. Write down when you do an activity in a diary. This will help you to remain motivated and see what you have achieved.

5. Gradually build up your activity levels. Start with small amounts of activity, slowly increasing it over days and weeks.

6. Do something that you enjoy. You are more likely to stick to your activity plan and achieve your goals if you do an activity that you enjoy.

7. Trying a new activity or changing your activities will help to keep your interest and enjoyment.

8. Don't be hard on yourself if you are having a bad day, or if you are not going as quickly as you would like. Reward yourself when you achieve your goal.

9. You don't have to do it alone - asking family or friends to do some activities with you can help to keep you motivated. You may also want to think about joining a sports club or group.

10. Remember that you can ask for advice from your key-worker or GP. The National Exercise Referral Scheme can help you make an activity plan that works for you. They are at your local leisure centre. Speak to your GP, specialist nurse or key-worker if you are interested in being referred.

Sources of Support
The following services can give you more information or
help on staying active:

Let's Walk Cymru 02920 646890 or www.ramblers.org.uk/letswalkcymru

National Exercise Referral Scheme - www.wlga.gov.uk/ners

Leigh Bodilly, Velindre Patient and Carer Information and Support Co-ordinator: For information on support services in your local area - 029 20196132.

Macmillan Cancer Support: www.macmillan.org.uk or 0808 808 00 00. For further physical activity information and resources - please visit www.macmillan.org.uk/movemore

This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

This leaflet offers tips and advice on how to maintain a healthy bladder and bowel

Aim to drink 1.5-2 litres of fluid everyday spread throughout the day

Do not restrict fluids as this will make your urine more concentrated which can irritate your bladder and make you want to go more frequently

Limit caffeine, alcohol and carbonated drinks

Aim to go to the toilet to pass urine every 2-3 hours

Take your time and try to relax when passing urine and ensure your bladder has emptied completely

Try to avoid 'just in case' visits to the toilet - your bladder may become lazy otherwise

If you wake frequently during the night to empty your bladder try to limit fluids 2-3 hours before going to bed

Do not delay opening your bowels when you have the urge to do so

Try to raise your feet on a step when you sit on the toilet to open your bowels

Eat a well-balanced diet with at least 5 daily portions of fruit and vegetables

Lead a positive lifestyle - stop smoking and aim to maintain a healthy weight with a BMI of 25 or less

NOTES:

Version 1.0 April 2020

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We offer Physiotherapy to all inpatients. During this time we deliver individualised, patient centred rehabilitation programmes to optimise function and support discharge from hospital.

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The ability to communicate and eat/drink without difficulty is something we often take for granted. Speech and language therapists support people experiencing difficulties swallowing, eating, drinking and/or communicating. These difficulties can arise from cancer, its treatment or a variety of other reasons.

Speech and language therapists at Velindre Cancer Centre work closely with people with cancer who experience difficulties with swallowing, eating, drinking and/or communication. We also support individuals with altered airways (i.e. tracheostomy tubes or laryngectomies). Common difficulties for individuals needing speech and language therapy input include:

Coughing or choking when eating and drinking

Feeling like food and drink is “getting stuck” in the throat or “going down the wrong way”

Difficulty chewing food or keeping food/drink in the mouth

Difficulty understanding what is said or losing the thread of conversations

Difficulty finding the right word or using the wrong word

Slurred, hesitant or stuttering speech

Voice problems, for example sounding hoarse, gruff, croaky or strained

Difficulty reading

Difficulty writing

We play an important role in the multidisciplinary team to ensure that care is tailored to individual needs and goals. This will include working with families, carers and third sector organisations, such as Macmillan or The Brain Tumour Charity. The overall aim of our input is to offer practical help with speech and language therapy needs and to enhance quality of life.

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Velindre Cancer Centre offers a range of supportive services that include individual and group sessions aimed at promoting your emotional and psychological wellbeing.  Our dedicated Supportive Care Team can also provide support for your family, in addition to help with financial, spiritual and religious needs. Please see tab below for further information and contact details.  If you feel that any of the services below would be helpful to you and want  to be referred or would like  more information please get in touch with Donna, Sue or Karen on telephone number 02920 615888 ext 4676.

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Supportive Care Team including Welfare Rights 

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Supportive Care Team including Welfare Rights 

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You may be asked if you would like to complete an eHNA by  a member of the team. This brief video will show you the benefits of completing one. If feel you would benefit from a eHNA please contact Karen on ext:4790.

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Fatigue is often described as overwhelming and constant tiredness making it hard to cope with everyday life. It has been identified as one of the most common symptoms of cancer, preventing people leading a full and active life.

The Fatigue Management Group course runs once every 2 months at the Maggie's Centre in Cardiff (located on the premises of Velindre hospital) the sessions run between 13:00-15:00 and are face-to-face.

Dates

Jan 17th 2024 ..... more dates to follow

You can self-refer by calling Maggie's on telephone number 02922 408024 or alternatively contacting Donna, Sue or Karen on 02920 615888 ext 4676 who can refer on your behalf.

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Living with uncertainty and cancer
A diagnosis and/or treatment of cancer can lead to a range of difficult feelings, which differ from person to person. You may worry about what will happen (uncertainty).
Even in the months and years following diagnosis and treatment, you may notice feeling unsure about many things: the future, how you will cope, your physical health and your loved ones.
This uncertainty can feel worrying and difficult to cope with. You may feel anxious and low. Sometimes we struggle with these feelings and things seem to get worse.

Who is the course for?
The course is for people who are coping with uncertainty following a diagnosis of cancer during treatment and afterwards.

For more information or to book a place please speak to your key worker (Clinical Nurse Specialist), consultant, review radiographer or Navigator.

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Following illness or stress, people will very often be left in a state of imbalance, short of vital energy which can prevent the body and all its complex individual systems from functioning effectively.
Complementary Therapies can help restore the body's natural equilibrium and balance and when people are relaxed it is very much easier to cope with the everyday stresses and strains life throws at us.
How Complementary Therapies may be helpful:

Encouraging relaxation

Relieve non-clinical levels of anxiety

Easing low mood

Improving sleep patterns

Easing stress

Improve well-being and quality of life

Live with an altered body image (massage)

Manage procedural anxiety

Easing symptoms such as breathlessness, constipation, diarrhoea, pain, nausea and fatigue.

What treatments are available?

Reflexology

Aromatherapy

Reiki/Healing

Massage

Indian Head massage

Therapeutic massage

Mindfulness/ Visualization

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We are so excited to share this brand new free app with you, which has been created by the Psychology team here at Velindre Cancer Centre and funded with the support of Michele Pengelly via the Welsh Carers Fund.

The App is deliberately non-cancer specific so that anyone can use mindfulness as a tool to manage stress and anxiety.

In particular, the App is really useful to help support patients through their cancer experience.  Listeners will be guided through mindfulness exercises to help improve mental health and wellbeing and can be used before, during or after hospital treatment. There is also a relaxation element to the App which has been provided courtesy of the Occupational Therapy team here at Velindre.

Velindre encourages everyone to use the Mindfulness App.

Download the app now:

Google Play: https://play.google.com/store/apps/details?id=com.velindrecc.mindfulness&hl=en_GB

App Store: https://itunes.apple.com/gb/app/velindre-mindfulness-app/id1450624693?mt=8

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Ray of Light Wales Cancer Support was set up in 2009, for and by people who are affected by cancer.

Ray of Light recognises and understands the uncertainty, fear and change that comes with a cancer diagnosis. Every year in Wales over 19,000 are diagnosed with cancer but the impact of this diagnosis is felt by far more.

We provide a confidential, safe and non-judgemental space to support people affected by cancer, and
through the turmoil of their loved one's diagnosis, whilst trying to cope with daily family life. For many this support can be a lifeline.

What we do:

We deliver a confidential service and a listening ear in a friendly, relaxed environment.

In the current COVID 19 crisis we have suspended all group gatherings and face to face support. However, thanks to National Lottery support we are now launching Just ASK! - Access Support and Kindness Project so that we can still deliver support sessions remotely, utilising digital platforms.

Sign up for virtual sessions in:

Art Therapy
Chair Yoga
Close Knit Group
Mindfulness
Whittling it Down Group
Can you Hear Us? Cancer Support for Deaf People
Light at the End of the Tunnel - Wellbeing Peer Support
Macmillan HOPE Programme
Little Steps - Programme

Please feel free to join us in this temporary virtual world and hopefully, before too long, we can get together in the real world.

We are planning more sessions and welcome any suggestions or ideas of activities you would like to see, just drop us a line or post on Facebook.

We're celebrating 10 years!!

We rely on volunteers to support our work. All our volunteers have first-hand experience of cancer themselves and have supported a loved one through difficult times.

A big thank you to our wonderful volunteers and group members.....We wouldn't be here without you!
We welcome new volunteers - Find out more...

Monthly meetings

An informal peer support group for carers, friends and family members, come and join us for a cuppa in a friendly and supportive environment.

We've had to adapt our services due to the Covid-19 pandemic but we're still here for you, more information in our Groups page or on our Facebook page.

The Warblers,
Our singing group

Open to anyone affected by cancer, no singing ability needed, just a sense of fun! For more information, upcoming concerts and how you can get involved.

Read More...

Latest News

And the winners are...

A huge thank you to everyone who entered our Easter Online Raffle. We are pleased to announce our winners are (drum roll...) First prize of Afternoon Tea for Two at Pettigrew Tea Rooms - SYBIL FOWLER Second prize of our Easter Egg and Chocolate Hamper - ELERI DAVIES Third prize of £20 B&Q Voucher - [...]

Read more...

Resources and links

We're all in this together! We have collected together a wide range of resources and links to support groups for all types of cancer.

Read more...

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Ray of Light Cancer Support provides free support to patients, carers, friends and families affected by cancer - Ray of Light Wales

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Ray of Light Wales Cancer Support was set up in 2009, for and by people who are affected by cancer. Ray of Light recognises and understands the uncertainty, fear and change that comes with a cancer diagnosis. Every year in Wales over 19,000 are diagnosed with cancer but the impact of this diagnosis is felt [...]

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Get off at Junction 37, take the slip road to Porthcawl and head to North Cornelly. Go through the village of North Cornelly, pass Llew’s Fish & Chip shop on the right, then pass the Green Acres Motel and Redrow housing development on the right. Come to a small cross roads and turn left, continue un…

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Do something Mighty in 2024

Take on a Mighty Hike to support people living with cancer. Choose from 15 routes and challenge yourself to a full or half marathon across some of the UK's most breathtaking landscapes! Sign up today and get 20% off with EARLYBIRD20.

Do something Mighty in 2024

Take on a Mighty Hike to support people living with cancer. Choose from 15 routes and challenge yourself to a full or half marathon across some of the UK's most breathtaking landscapes! Sign up today and get 20% off with EARLYBIRD20.

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Macmillan Cancer Support | The UK's leading cancer care charity

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Macmillan Cancer Support is here to listen, support you through treatment, and help with money. We fundraise so we can do whatever it takes.

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If you have cancer or you're close to someone who has, we can help. We bring treatment, emotional support and practical advice to where it matters the most; the heart of the community. Last year...

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Tenovus Cancer Care - giving help, hope, and a voice to everyone affected by cancer.

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Tenovus Cancer Care is a Wales-based charity giving help, hope, and a voice to everyone affected by cancer.

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OPA- Oesophageal and Gastric Cancer Charity

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OPA- Oesophageal and Gastric Cancer Charity

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Goodnight Acid Reflux, Hello Sleep! Bed Wedge special offer from the OPA

Welcome to the OPA Cancer Charity
The OPA has led the fight against oesophageal and gastric cancers for over 30 years. Their purpose is to support patients, families, carers and to raise awareness of these cancers and their prevention. Whatever stage you're at the OPA is here to help you.

With up to 20% of the population experiencing regular Reflux symptoms. Click here for the Eligibility & symptom checker.

Suffering from Gastro Oesophageal Reflux Disease? Click here for the Diagnosis tool questionnaire.

Did you know? LINX surgery can really help to improve life on a daily basis. Click here to read testimonials.

Our Patron Fiona Wade
Watch our patron Fiona Wade - best known for playing Priya Sharma in Emmerdale - talk about her involvement with the OPA.

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The Oesophageal Patients Association - Cancer Charity

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Goodnight Acid Reflux, Hello Sleep! Bed Wedge special offer from the OPA The OPA has led the fight against oesophageal and gastric cancers for over 30 years. Their purpose is to support patients, families, carers and to raise awareness of these cancers and their prevention.

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Medical Disclaimer
All information on AMMF's website is for guidance only. It is not a substitute for professional medical care by a qualified doctor or other health care professional. Always check with your doctor if you have any concerns about your condition or treatment. AMMF is not responsible or liable, directly or indirectly, for any form of damages resulting from the use (or misuse) of information contained in or implied by the information on this site.

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AMMF - The UK's only Cholangiocarcinoma Charity

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Medical Disclaimer All information on AMMF's website is for guidance only. It is not a substitute for professional medical care by a qualified doctor or other health care professional. Always check with your doctor if you have any concerns about your condition or treatment.

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Pancreatic Cancer UK - For Everyone Affected by Pancreatic Cancer

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Support Line Freephone: 0808 801 0707. Dedicated UK pancreatic cancer charity. Specialist support. Investment in research. Driving awareness and change.

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Your doctor has asked us to do a radioisotope ‘scan’. This is a test which uses a small amount of radioactivity to produce pictures of bones, organs and other parts of the body.

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contact other GIST patients, please either call us or email us at: admin@gistcancer.org.uk. You can be added to our Listserve Discussion Forum where you can exchange news and views with other members of the forum. We will also add you to our Membership List so that you will receive invitations to our meetings.

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Your doctor has asked us to do a radioisotope ‘scan’. This is a test which uses a small amount of radioactivity to produce pictures of bones, organs and other parts of the body.

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For the past 120 years, we've been making discoveries that have saved countless lives. But we have so much more to do. Our strategy sets out how we'll accelerate progress towards a better future.

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We save lives by preventing, controlling and curing cancer. We're working to beat all 200 cancers and rely completely on donations from people like you

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'Helping Hands' Rhymney Cancer Self help Group 

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'Helping Hands' Rhymney Cancer Self help Group 

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Helping Hands Rhymney | Cancer Self Help Group

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We operate a 'Home Comforts Lending Service'. With this service, we try to provide anything that will make the life of the patients more comfortable, and that of their carers easier. This service is open to anybody with a serious illness or disability. We can loan you anything from special mattresses, cushions, backrests to footstools.

We can also lend out electric reclining chairs, commodes and commode chairs, raised toilet seats and tables that go over chairs and beds, wheelchairs that fit into boots of cars, or even specialised equipment for the disabled like standing frames. This is only a small mention of over £180,000 worth of medical aids that we have in the community.

Equipment can be supplied directly from ourselves, or if you are getting help from Social Services we can supply equipment via them.

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OUR SERVICES - Helping Hands Rhymney | Cancer Self Help Group

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We operate a 'Home Comforts Lending Service'. With this service, we try to provide anything that will make the life of the patients more comfortable, and that of their carers easier. This service is open to anybody with a serious illness or disability. We can loan you anything from special mattresses, cushions, backrests to footstools.

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Hair loss during Cancer Treatment

This leaflet provides information for people who may lose their hair as a result of their cancer treatment. The leaflet explains how to care for your hair during your treatment and how chemotherapy, radiotherapy and hormone therapies may affect your hair. It gives information about headwear options such as scarves, turbans and hats. It also mentions wigs and tells you how to choose, purchase and care for your wig. Websites for further information and local wig suppliers are listed in the back of the leaflet.
Will my treatment cause hair loss?
Some chemotherapy treatments and radiotherapy to the scalp area will cause hair loss. This may vary from hair thinning to complete hair loss. Your doctor, nurse or radiographer will advise you if your treatment is likely to cause hair loss.
Looking after your hair
Even if your hair does not fall out, treatment can make it dry and brittle. There are some simple steps you can take to help look after your hair:

Use a mild shampoo (not baby shampoo)

Use lukewarm not hot water to wash your hair

Try not to wash your hair too often

Pat your hair dry gently with a soft towel

Be gentle when combing or brushing your hair

Avoid hot hairdryers, heated rollers and hair tongs

Avoid using chemicals such as perms or colours

Avoid tying your hair back tightly, use soft hair bobbles

Preparing for hair loss
If you have been told you may lose your hair, you may find it helpful to have your hair cut short before your treatment starts. This will reduce the weight of hair pulling on your scalp so it may minimise hair loss.

Chemotherapy, radiotherapy and hormone therapies affect your hair in different ways:
Hair loss with chemotherapy
You may experience hair thinning or complete hair loss. Occasionally the treatments may also affect eyebrows, eyelashes, nasal hair, beard, moustache and body hair. We will discuss with you what hair loss is usual with your treatment. However, the amount of hair loss varies for each person.

Scalp cooling can be used for some chemotherapy treatments to prevent or minimise hair loss. If scalp cooling can be used with your treatment we will discuss this with you. We also have a leaflet that tells you more about scalp cooling.

Hair loss usually starts 2 - 4 weeks after your first treatment. Occasionally it may be sooner, and for some people it will be later. Your hair will grow back after you have finished treatment. You may even notice some new growth during your treatment. Hair may grow back a slightly different colour and texture.

You should minimise exposure to the sun, and wear a hat and sunscreen if you go out in the sun. Use a mild moisturiser if your head becomes dry or tender.
Hair loss with radiotherapy
You will only lose hair in the area being treated. For example if you have treatment to your breast or chest you may lose some underarm or chest hair; if your head is being treated you will only lose hair on your head. The amount of hair loss depends on the strength of treatment.

Hair loss usually starts after 2 -3 weeks of treatment. Sometimes hair loss can be permanent, this will depend of the strength of the treatment. Your doctor, nurse or radiographer will discuss this with you.

If your hair does grow back it can take 2 - 3 months, and the re-growth may be patchy. Your hair may not be as thick as it was before your treatment.

You should not expose the treated area to the sun during your treatment and for a year afterwards. Please wear a hat and use SPF 30 sunscreen on the treated area.
Hair loss with other cancer treatment
Some other cancer treatments such as hormones may cause hair thinning, or make your hair dry and brittle. Your hair should start to thicken within a few weeks of finishing treatment.
How will my hair fall out?
You will notice an increase in hair loss when you brush or wash your hair. You will also notice hair on your pillow. If you have been told to expect complete hair loss, once this process has started the hair loss usually occurs quickly over a few days to weeks.
Will losing my hair be painful?
Some patients having chemotherapy experience tingling of the scalp or discomfort when the hair starts to fall out. Mild pain killers can help (whatever you normally take for a headache).

However with radiotherapy, tingling, discomfort and reddening of the scalp could be a side effect of treatment.
Hair loss and body image
Losing your hair can change how you think and feel about yourself (body image), and may affect your self-confidence. You can speak to your doctor, nurse or radiographers if this has affected you. Macmillan and Breast Cancer Care produce leaflets that you may find helpful. These are available from the Patient Information Centre or see page 8 for their website details and helpline numbers.
Head coverings
If you want to cover your head, there are lots of options available. Scarves, turbans and hats come in a variety of styles and colours and are widely available from department stores. The Velindre gift shop stocks a selection of turbans.
HeadStrong
Velindre Cancer Centre run HeadStrong sessions which offer practical information and support around hair loss. You will be given a private appointment with a trained advisor. They will show you how to make the most of scarves, hats and hairpieces. This service is available to anyone who is likely to lose their hair through treatment for cancer.

This service is currently unavailable due to covid restrictions. If you visit www.cancerhaircare.co.uk there are helpful advice and tips about headscarves.

HeadStrong is available at Chemotherapy Out-Patients every Wednesday between 10am - 3pm. Please phone 029 2019 6132 for more information or to book an appointment.
Eyebrows and eyelashes
Losing your eyebrows and eyelashes can change your appearance. You can use an eyebrow pencil to redraw your eyebrows. Beauty counters in department stores can show you how to do this. Some cosmetic salons tattoo new eyebrows. You can also buy false eyebrows and false eyelashes.

The Maggie's Centre run the Look Good ... Feel Better sessions which give expert advice on make up and skin care. They are free and you will receive a gift bag of products. This can boost your morale as well as allowing you to spend an enjoyable afternoon with other women who have either had or are having treatment. Please contact 029 2240 8024 for more information or to book a place.
Wigs
You may want to wear a wig or hairpiece. Wigs are available in many different styles and colours.

We usually talk about wigs during your out-patient appointment when first discussing your treatment. You will be given a leaflet with wig suppliers on page 9 of the leaflet. You can choose any wig supplier from the list.

Velindre Cancer Centre can, if needed, subsidise the cost of your wig up to £100.00. This covers the cost of most wigs. If the wig you choose costs more than £100 you will need to pay the difference. If you would like a wig referral request form please contact Leigh Porter on 029 2019 6132, this telephone has an answerphone so if unavailable, please leave a message.
How do I choose a wig?
Your wig supplier will show you a catalogue of styles and colours to help you choose. You can try them on to find the one that you feel most comfortable and happy with.

Your wig supplier will give you specific advice on caring for your wig. It can be cut and styled to your personal requirements. Some wig suppliers may charge for this. Or your usual hairdresser should be able to do this for you.
When your hair grows back
Your hair will grow back at the same rate as normal hair growth, which is about half an inch per month. It will be very fine at first but will become thicker. Your scalp may become scaly as your hair grows back. When it is very short you can use aqueous cream to wash your hair. It produces lather and will moisturise your scalp at the same time. As your hair becomes longer you should use a very mild shampoo for frequent use. These do not contain chemicals that dry the scalp and hair.

You should avoid perms, colouring and chemical straightening for at least 3 months after treatment. After this time your hairdresser will be able to assess the condition of your hair and advise you further.

Websites and helplines
Breast Cancer Care - www.breastcancercare.org.uk
0808 800 6000

Look Good ... Feel Better - www.lookgoodfeelbetter.co.uk

Macmillan - www.macmillan.org.uk
0808 808 0000

Tenovus - 0808 808 1010

Macmillan freephone Helpline - 0808 808 0000

Trevor Sorbie's my new hair - www.mynewhair.org

Wigbank - www.wigbank.com
07840 937 574 Dawn

You can recycle your wig when you no longer need it by donating it to Wig Bank or Velindre Cancer Centre. We sell donated wigs with proceeds benefitting the Velindre Cancer Centre charity.

Please note: The wig referral can only be used with the following suppliers.Please telephone the suppliers of your choice to make an appointment

Alternative Look @ Salon Wills
11-13 Castle Arcade Balcony, Cardiff, CF10 2BY
Phone: 029 2022 4475 salonwills@daxbourne.com
Cutting / alteration is available on all wigs.

Inspirations (covers South Wales and South West Wales)
6A Penybont Road, Pencoed, Bridgend CF35 5RA
Phone: 01656 859528 www.inspirationsbridgend.co.uk
Home visits available. Cutting/alteration is available on all wigs
Finalist Specialist Retailer, Bridgend Retail Awards 2014
Also hats and head scarves available.
Peruke
Phillip Mungeam, Holly House, Llancayo Court, Usk NP15 1HY Phone: 01291 672749 or 07768848926.

Email: mungeam902@btinternet.com

Peruke.co.uk

Awarded the prestigious 'Welsh Hall of Fame' for our outstanding work in the hair loss industry for cancer patients

Parking at the office

Disabled facilities

Choice of 500+wigs in over 200 colours

Free cuts on hair regrowth after treatments

Home visits available if eligible

The Wig & Beauty Company
Mobile wig fitting service covering all areas
Abi & Kerry

The Wig & Beauty Company

Allure Aesthetics

Commercial House

Commercial Street

Pontllanfraith

Blackwood

NP12 2JY

07956967260
Email: thewigandbeautycompany@gmail.com

This leaflet was written by health professionals. It has been approved by doctors, nurses and patients. It is reviewed and updated every 2 years.

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This leaflet provides information for people who may lose their hair as a result of their cancer treatment. The leaflet explains how to care for your hair during your treatment and how chemotherapy, radiotherapy and hormone therapies may affect your hair. It gives information about headwear options such as scarves, turbans and hats.

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Run by the Upper GI specialist nurses at University Hospital Wales this friendly group meet every 8 weeks at the Maggie's Centre Cardiff.

If you have any questions or would like more information regarding this support group, please contact

Tracy Parson, Lynsey Bullock on telephone number 02920 744409.

Dates;

November 28th Christmas Party to be held at Llandaff

Rowing Club 6pm - 9pm

2025 - Maggie's Centre

Jan 29th 4pm -6pm

March 26th 4pm - 6pm

May 28th 4pm - 6pm

July 30th 4pm -6pm

Sept 24th 4pm - 6pm

Nov 26th 4 pm - 6pm

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CISS - Cancer Information & Support Services South West Wales

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CISS - Cancer Information & Support Services South West Wales

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Cancer Information and Support Services - South West Wales

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Real Help... Right Now. For those with cancer, their carers, family and friends in South West Wales. CISS is a registered charity that was set up in 1993.

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https://cdn.macmillan.org.uk/dfsmedia/1a6f23537f7f4519bb0cf14c45b2a629/2968-10061/mac13614-e04-building-up-diet-pdf

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https://velindre.nhs.wales/velindrecc/outpatients/

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https://velindre.nhs.wales/velindrecc/inpatients/

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https://velindre.nhs.wales/velindrecc/outpatients/nantgarw-support-unit/

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Cancer and buying travel insurance - Macmillan Cancer Support

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Get advice about buying travel insurance if you have cancer. You will need to check your travel insurance policy covers pre-existing medical conditions.

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https://www.velindrefundraising.com

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https://be.macmillan.org.uk/Downloads/CancerInformation/LivingWithAndAfterCancer/MAC11688RecipesE0520150202.pdf

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Order Macmillan cancer information and fundraising resources

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Explore free cancer information and fundraising resources. Order easy-read booklets, customise posters, and get merchandise to support your activities.

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Welcome to Velindre Cancer Centre and the Upper GI team.

We take care of patients that have been diagnosed with an upper gastrointestinal cancer, this would include oesophageal, stomach, pancreatic and Bile duct (known as cholangiocarcinoma).

We have produced this Padlet as a resource of useful information that we hope you will find helpful.
To access all information fully  please use the scroll bars on the side of each column and the scroll bar at the bottom of the page.

Croeso i Ganolfan Ganser Felindre a’r tîm Gastroberfeddol Uchaf.

Rydym yn gofalu am gleifion sydd wedi cael diagnosis o ganser gastroberfeddol uchaf, byddai hyn yn cynnwys canser yr oesoffagws, stumog, canser y pancreas a dwythell y bustl (sydd yn cael ei alw’n cholangiocarcinoma).

Rydym wedi cynhyrchu'r Padlet hwn fel adnodd o wybodaeth ddefnyddiol yr ydym yn gobeithio y byddwch yn ei ystyried yn ddefnyddiol.
I gyrchu'r holl wybodaeth yn llawn, defnyddiwch y bariau sgrolio ar ochr pob colofn a'r bar sgrolio ar waelod y dudalen.

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Consultants

Professor Tom Crosby
Dr Carys Morgan

Dr Betsan Thomas
Secretary; Anastasia Jones

Telephone number 02920 615888 ext: 6827

Dr Seema Arif
Secretary;  Stacey Ross

Telephone number 02920 196184

Dr Kein Yim
Secretary; Rita Harding

Telephone number 029 20316219

Dr Alok Chand
Secretary; Anastasia Jones
Telephone number 02920 615888 ext: 6827

Dr Ahmed Essa
Secretary; Hayley Hayes
Telephone number 02920 615888 ext: 6325

Dr Rhiannon Evans

Secretary; Esther Oke

Telephone number 02920 615888 ext: 6181

Nursing Team

Donna Lee - Clinical Nurse Specialist

Sue Ballinger - Clinical Nurse Specialist

Telephone number 02920 615888 ext:4676

Karen Kendall - Cancer Support Navigator

(Tuesday, Wednesday & Friday)

Lisa Jones - Cancer Support Navigator

(Monday & Thursday)

Telephone number 02920 615888 ext:4790

Dietetic Team

Telephone number 02920 615888 ext: 2214

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Treatment Helpline - 02920 615888 and ask for the Treatment Helpline

Chemotherapy bookings - ext: 6363/4495

Pharmacy - ext: 6223

X-ray - ext: 6252

Radiotherapy reception - ext 6434

Radiotherapy bookings - ext: 6836

Radiotherapy review - ext:6421

Outpatient appointments - 029 2031 6234

Main Outpatients -ext: 6225

Macmillan Unit at PCH -  01685 728 415

Patient transport - 0300 1000 012

Velindre Ambulance Office - 02920 316974

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This leaflet provides information on scalp cooling. Scalp cooling is used to reduce hair loss from the head which can occur with some chemotherapy drugs. The leaflet will explain briefly why chemotherapy causes hair loss. It will explain what scalp cooling is, how it works, how long it takes and potential side effects or problems related to scalp cooling. Contact telephone numbers and useful websites are provided at the end of the leaflet if you would like further information.

Chemotherapy treatment works by killing cells in the body that are growing. Cancer cells are constantly dividing and that is why we use chemotherapy as a treatment for cancer. Your hair follicles are also made of constantly growing cells, and this is why some chemotherapy treatments can lead to hair loss.

Some people find that hair loss can be a distressing side effect of chemotherapy treatment. Scalp cooling is used to reduce or prevent hair loss caused by some chemotherapy drugs. Unfortunately it does not work for all types of chemotherapy drugs or all types of cancer. Your doctor or nurse can discuss this further with you.

Scalp cooling lowers the temperature of the scalp. This makes the blood vessels smaller so less blood flows through them. This means that the amount of drugs that can actually reach the hair roots is reduced. As a result the hair is not fully exposed to the effect of the chemotherapy drugs.

Scalp cooling only protects hair on your head. You may still lose body hair.

Paxman scalp cooler: uses a machine which pumps cooled gel around a snug fitting cap.

Your doctor or nurse will tell you about scalp cooling in your chemotherapy clinic.

For scalp cooling to work your scalp needs to be cold before, during and after your chemotherapy treatment. This means that your appointments for each treatment will be longer.

Scalp cooling will need to start 15-30 minutes before the chemotherapy treatment, stay on during the time of the chemotherapy and for up to 45 minutes after the treatment. These times may vary slightly with different types of chemotherapy. Your nurse can explain this in more detail.

You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.

It is recommended that you should not wash your hair for 24-48 hours before scalp cooling.

If you are using the Paxman it is recommended that you dampen and condition your hair at the hospital just before the cap is fitted. You may feel more comfortable if you have a hat or scarf to wear when you go home.

We will provide you with a starter pack including a head band, which you may want to use to prevent the cold to your forehead causing a headache. Also included are sachets of conditioner, and useful leaflets.

You should have been given a hair loss booklet with this information, if you have not got one of these booklets please ask your nurse. This leaflet contains detailed information on how to look after your hair.

Side effects from scalp cooling are very rare. However, some people experience headaches, dizziness, and nausea.

Although very rare, it has been reported that because scalp cooling prevents chemotherapy reaching all the blood vessels to the scalp, there may be a risk of cancer secondaries in the scalp. It is important to discuss any worries or concerns about this with your hospital doctor.

You may find the cap heavy to wear, or it may feel uncomfortable. You may feel cold during scalp cooling so you may need to wear a jumper. Please ask your nurse if you would like a blanket. Hot drinks will also help to make you feel warmer. The soft head band may help to protect your forehead and ears.

If you find scalp cooling too uncomfortable it can be stopped immediately. You may find it helpful to try it out before you start your chemotherapy, so that you know what to expect.

Scalp cooling can be very effective in reducing or preventing hair loss. However, many people who have scalp cooling still experience hair thinning or lose their hair. Unfortunately you will not know if it will work for you until you try it.

If you require any further information on scalp cooling please contact one of the following:

Tenovus freephone 0808 808 1010

cancer helpline

Macmillan 0808 808 0000

Cancer Research UK

This leaflet was written by health professionals. The information contained in this leaflet is evidence based.

It has been approved by a team of doctors, nurses and patients. It is reviewed every two years.

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This leaflet provides information on scalp cooling. Scalp cooling is used to reduce hair loss from the head which can occur with some chemotherapy drugs. The leaflet will explain briefly why chemotherapy causes hair loss. It will explain what scalp cooling is, how it works, how long it takes and potential side effects or problems related to scalp cooling.