This document sets out the requirements for writing patient information for the Cancer Research UK website. It covers requirements for documents in production and for finished documents.
- 1. The house style
- 2. Researching your writing
- 3. Documents in production
- 4. Bookmarks and jump links
- 5. Formatting
- 6. Layout of sections
- 7. Keywording and metadata
- 8. Glossary
- 9. Diagrams, illustrations, animations and video
- 10. Quick Guides
- 11. Standard statistics and outlook opening text
- 12. Standard screening opening text
- 13. Standard chemotherapy opening text
- 14. Standard radiotherapy text
- 15. Suggested coping opening text
- 16. Fact, opinion and uncertainty
- 17. Words and phrases we should not use - with alternatives
- 18. How to improve your writing
- 19. Style guide
- 20. Policy review date
This website was originally designed as a low literacy project. With this in mind, a few basic design and writing style rules were implemented. These form the basis of our house style
- Use of white space
- Use of the second person, rather than third
- Avoidance of passive voice
- Short sentences
- Plain English
- Medical terms secondary to plain English
- Friendly tone
- Short pages where possible
- Frequent diagrams and illustrations
The compilation of our style guide is ongoing and features at the end of this document. Entries are in alphabetical order.
1.1 White space
This gives a more accessible appearance and is easier for under-confident readers than dense text. We aim to present information in short paragraphs. Spacing is set by the style sheet governing the website content. The general appearance is that there is one line space between paragraphs. All sub headings are in bold. There should be 2 line spaces above a bold heading.
1.2 Second person and avoidance of passive voice
Use of ‘you’ is much easier for less confident readers to follow and relate to than ‘they’ or ‘patients’.
Similarly, try to avoid the passive voice. Passive means: 'The scan will be given to you in the X-ray department.' The active form of this is: ‘You will have the scan in the X-ray department’. If you work in ‘Word’, the grammar checker will pick up the passive voice. (Do not trust the grammar checker for anything else!)
Avoiding the passive voice will also help you to be more specific eg 'Sometimes a large area of skin has to be removed.' (passive) vs 'Sometimes the doctor has to remove a large area of skin.' (active).
Sometimes the passive is unavoidable eg 'This test is called...' so use your judgement.
1.3 Bullets and jump links
Bullet points break up text, making it more accessible. They also serve to highlight important facts. We begin every page that is more than one screen long with the following sentence:
This page tells you about ... You can find the following information
The exact phrasing can be varied as appropriate. The introductory sentence and bullets also serve as a descriptor for our meta-tagging description field, which is used by search engines to find out what information a page contains and for the display that comes up on the results of our cross-site search.
We follow the introductory sentences with a bullet list of all the sub sections of that page, so that readers can go straight to the information they are searching for if they choose to. To differentiate between other in-page bookmarks and these navigational aids, we call the introductory list of links 'jump links'. They should be used on all pages that are more than one screen long (ie pages that you have to scroll down on).
Also use bullet points whenever you have a list to present eg.
Early stage cervical cancer means cancer that is
- Stage 0
- Stage 1a or 1b
- Stage 2a
The example above breaks one basic rule of using bullets: if you have the same word beginning each bullet, elevate it to the preceding sentence. We haven't done this here because it would leave the bullets rather brief, stark and more difficult to read.
You should also use bullets if you have a choice to present eg
Your doctor may prefer you to have radiotherapy if
- You are not fit enough to have an operation
- Your doctor suspects you may need radiotherapy after surgery anyway
We do not put 'or' or 'and' at the end of bullets - this is indicated in the preceding wording if necessary and so taken as implicit. For example,
You will have one of the following chemotherapy drugs
Bullet text should ideally be less than one line in length or lose impact. Take further description out and present in paragraphs underneath the bullets.
Break up long bullet lists into groups if possible eg for side effects, by body system so that all digestive system sfx are together.
Graduating the length of bullets in a list makes them easier to read. However a logical order takes precedence for putting bullets in an order. Consider grouping if it isn't possible to graduate the length eg for a list of treatment options, we would put the most commonly used before those used more rarely. More helpfully, you can split into two lists of common and rare treatments and then order the bullets in each list according to length.
For ease of use, items in bullet lists may be bookmarked to the relevant paragraphs that follow (see links and bookmarks). Linking in this way is optional and does not have to be done for bullet lists of 2 bullets, or for bullets that are self explanatory and either have no following paragraphs, or are just single sentences.
1.4 Short sentences
These are easier for people with literacy problems to read and follow. Split sentences into 2 shorter ones whenever you can. It takes a while to get used to writing like this, but stick with it. It is a common misconception that it is grammatically incorrect to begin sentences with ‘And’ or ‘But’. It is perfectly acceptable, under the rules of English grammar, to begin a sentence with a conjunction. 'And' and 'But' are conjunctions that are particularly useful for creating short sentences in this way.
1.5 Plain English
This is the main stay of our house style. Whatever you are writing, think about whether you could simplify the wording. There is a list of words and phrases to avoid at the end of these writing guidelines.
Medical terms should be secondary in plain English text. We do include them because this furthers understanding between the public and their doctors. Medical terms should be presented in brackets immediately after the colloquial term. For complicated medical terms, we include a pronunciation guide eg 'Your doctor may call this haemostasis (heem-oh-stay-sis).'
Look at the style and phrasing of existing sections and feel free to base your writing on that.
1.6 General tone
We aim for a friendly tone, brevity and simplicity. Wordiness is less easy to follow than simple, plainly expressed short sentences.
We aim to keep a user focus at all times. Put yourself in the place of the reader. What would you want to know? What would you find confusing about what you’ve written? Have you left anything out that they’d need to know? For example, think about what would bother you most about having a particular medical test. This will usually include how long I’ll have to hang about, will it hurt and will I have to take my clothes off.
Be particularly aware of the impact of sensitive areas, such as prognosis. For example, it is better to talk about risk of developing a cancer rather than ‘risk of dying’ in context of a screening programme. Be mindful of when you introduce the concept of cancer spread and how you do it.
Our editorial policy contains a detailed section on research. This outlines the sources you are required to consult and to search as a basis for writing any clinical section. You need to consult UK medical information because practice can differ between countries. You may also find it helpful to look at other general and site specific cancer websites.
Please type in ‘Word’. Word documents are passed through NotePad prior to content mounting to remove formatting tags. To communicate changes and queries during the editing process, we use Word ‘tracked changes’.
You may need to leave notes to other team members about future developments or the placing of diagrams, for instance. Anything you put in that you do not want the site user to read should go in square brackets and be highlighted in yellow so that it is not missed when the content is put on the site e.g. 'LINK', 'BKMK' (short for bookmark - see below), 'DIAGRAM of..' or 'not sure this is right - please check'.
Documents must be searched for square brackets before content mounting and they, and their contents, removed.
Links can be internal to a section, eg from treatment to diagnosis; internal to the site eg from a specific cancer to 'about cancer tests' section or external, to another website altogether. Indicate link text in your Word document by colouring it blue.
Our site complies with accessibility criteria. For those using site reading software, the links may display as a list at the end of a page so please remember that link text should make sense in its own right and describe the content on the link destination. For example, 'tests' is less helpful as link text than 'tests for breast cancer'. For this reason, do not use 'Click here' or similar variations. Where relevant, the word 'section' should be part of the link text eg There is more information in our living with breast cancer section.
As above, when referring to another section, use lower case. The only exception is for the first word at the beginning of a sentence.
Indicate link destination by putting the destination url in square brackets. [LINK ct-scan] would instruct the content mounter to put in a link to the page on CT scans in the 'about cancer tests' section. You will have to consult the site frequently while you are writing. [LINK glossary-ct-scan] would instruct the content mounter to link to that term in the glossary. To link to a section, use the section name eg LINK Breast cancer]
Please feel free to suggest any links you think would be helpful. When you are writing, you need to bear in mind what is covered elsewhere in the section and elsewhere in the site so you do not write anything over again.
Useful links in other parts of the site include
- [LINK about-cancer-tests] covers major diagnostic tests: ultrasound, CT, MRI, PET, bone scan, bone marrow biopsy, endoscopy, barium X-ray, IVU, lumbar puncture. blood tests, etc
- [LINK the-cancer-cell#grade] - explanation of grade in the about cancer section on what cancer is
- [LINK what-cancer-is#primary] - explanation of primary and secondary cancer in 'what is cancer' in the 'about cancer' section
4.2 Bookmarks and jump links
These are links within a page. We use them to
- Help users move directly from the top of the page to what interests them - 'jump links'
- Provide an anchor to link to specific information from another page or from another place within the same page - bookmarks
Jump links are used to begin the page with a bulleted list of what is to follow and bookmark each of the bullet points to the heading of the relevant section on the page. The jump link text and the subsection heading must be identical as the content management system puts in the jump links automatically as each subsection heading is added. For example these jump links
- A quick guide to what's on this page [JL #quick]
- The bladder and urinary system [JL #bladder]
- The layers of the bladder [JL #layers]
indicate that there are 3 subsections on this page: headed 'A quick guide to what's on this page'; 'The bladder and urinary system'; and 'The layers of the bladder'.
Bookmarks and jump links are indicated in the admin system by ‘naming’ a particular paragraph or part of the page. To show where you want a bookmark, put [JL #primary] next to the appropriate heading in your contents list of what's on the page or [BKMK #primary] next to the text you want users to click on. You then put [NAME = primary] at the beginning of the section you want them to be taken to. NB Be consistent! If the link name you choose is different in any way between where you are linking from and too, the link will not work. For eg, if you put [JL #primary] next to the link heading and [NAME=prim] next to the section of text, the link will not work.
There are examples of bookmarks using the hash notation above. If you indicate a link as [LINK what-cancer-is#primary], the user will be taken straight to the paragraph on primary cancer on the 'what cancer is' page. This is particularly important, as users will not necessarily search for information after they have followed a link - they expect to be taken straight to it.
Headings should be in bold. No underlining should ever be used as this contravenes our accessibility standards - underlining is reserved for hyperlinks.
In your Word doc, put [H2] after each heading that should be a jump link as an instruction for the web editor mounting the content.
If there are headings within a jump link section, put [H3] after the heading to make clear for the web editor mounting the content.
5.2 Paragraph spacing
There should be one line space between paragraphs. There should be two line spaces above every bold heading.
5.3 Quick Guides
In your Word document, please type this content within a text box, to make clear for the web editor mounting the content where the text begins and ends. See Quick Guide section for more information.
Section layout is dictated by the subject being covered. Cancer type sections conform to a basic layout. The ordering of information within this layout will vary according to the cancer type being covered. For examples, compare the specific cancer sections on site. For instance, the bladder cancer section has a treatment section divided into 'treating early bladder cancer'; 'treating invasive bladder cancer' and 'treating advanced bladder cancer' because the treatment information is so different for early and invasive bladder cancers.
The basic layout of the specific cancer sections is indicated below.
There are 4 main sections: ‘about’, ‘diagnosing’, ‘treating’ and ‘living with’. Following these is a page on useful cancer organisations, a reading list and a page of sources (Where this X information comes from). Every section and subsection ends with ‘questions for your doctor’ - check out existing ‘questions’ pages on the site and copy relevant questions.
6.1 The "about" section
- A basic anatomy and physiology page
- Risks and causes
- Screening (include this even if there is no screening programme)
- Guidelines for seeing a specialist
- Questions for your doctor
There is standard text for screening pages (see below: section 11.0)
6.2 The "diagnosing" section
- Tests - basic diagnostic tests
- Further tests - covers tests used for cancer staging after initial diagnosis
- Questions for your doctor
6.3 The "treatment" section
Treatment sections vary depending on the cancer being covered. Main subsections, such as surgery, chemotherapy and radiotherapy can all be subdivided if you think it necessary. If you do subdivide content to make a subsection, it then needs its own ‘questions for your doctor’ at the end. Be aware of page length. It is better to split content over more than one page than to have one single long page.
Treatment sections generally contain
- The stages
- Statistics and prognosis
- Types of treatment - an overview of treatment, usually by stage, with links to the pages following in the section
- Biological therapies (including immunotherapy, monoclonal antibodies, vaccines, anti angiogenesis and growth factor inhibitors)
- Follow up
- Questions for your doctor
If a section is not applicable to the section you are writing, just leave it out.
Statistics and prognosis can be extremely difficult to write. There is standard text for opening a statistics page (see below: section 10.0). We try to provide statistics by stage of cancer, but these are not always available. You should have a feel for what is available after having researched your section. Check Cancer Research UK's CancerStats content to see if official statistics by stage are available.
If necessary, write this page leaving [xxx] where you are not sure about the statistics and we will ask the specialist reviewers to fill in the blanks. We should not be too specific when reporting stats by stage, unless there are official stage stats available. For example, do not say "84 out of every 100 people with stage..."but 'more than 8 out of every 10 people with stage..." We often have to look at a variety of statistical sources to pull together the final statistic we quote and being too specific is misleading. You must record precise references for every statistical source you use. You should also be aware of the country of origin of the statistics (ideally the UK, but for rare cancers, we have to resort to US trial stats at times). You should be aware of whether the statistic is absolute or relative and you cannot mix the two into a single statistic. If in any doubt, seek help from the Clinical Information Manager or Head of Cancer Web Content.
The surgery section can be split into surgery to cure and surgery to relieve symptoms, if applicable. If not, split into 'types of surgery' (information about the various operations that can be used) and ‘having your operation’, which covers what happens from going into hospital to leaving to go back home.
Chemotherapy can be split into basic information about chemotherapy and information about specific drugs and side effects, if applicable. There is standard text for the beginning of this section. Don’t forget to look in the cancer drugs section, which features major chemotherapy drugs and combinations. If your drug or combination is covered in this section, you can put a short bullet list of side effects and then link to the main page for that drug for more detailed information.
There is standard text for the end of the 'about chemotherapy' and 'about radiotherapy' pages, directing readers to the main treatment sections for more information. This is detailed below (sections 12.0 and 13.0). This text must go at the end, rather than the beginning of a page because it is confusing for the audience to direct them to another page when they have just reached the one they are on.
The ‘research’ section covers all patient research, not just the work of Cancer Research UK. It does not cover treatments in animal or laboratory research. The aim of this section is to provide information on the areas that people will most likely be searching the internet for e.g. vaccines, gene therapy etc. If the experimental treatments covered are not in trial or only in very early trial or not yet available in the UK, we say so. If we don't, our information nurse team may be asked for further information on clinical research and won't be able to track it down. Any information can provide an end point for someone searching, even if it seems like 'negative' information. You can point users to the clinical trials database from this section as appropriate.
6.4 The "living with" section
This section contains a page on coping, with standard text and links (see below - section 14.0). The remaining pages in this section vary according to the cancer. They may cover life after surgery or bone marrow transplant; diet after treatment (e.g. stomach); sex life, or living with an advanced cancer (e.g. pancreas). Only put in pages you think are relevant.
6.5 Useful organisations
This page should contain information on organisations specific to that type of cancer. There is a general organisations page that covers other helpful organisations. You can include providers of equipment etc. See bladder, bowel or breast cancer organisations for examples of this.
The organisations pages contain links to other websites. We provide links that provide additional information for site users. There is a site policy of limiting lists of links, as we believe that long lists are less useful than shorter more discriminating ones. However, we would not wish to exclude a useful link solely on the grounds of number featured. All sites we link to must be reputable and produce reliable, quality information that is regularly updated. Links are approved on an individual basis. Generally, we provide a link to the relevant section of the website of the US National Cancer Institute. Other links will vary, depending on the subject and resources available. The Clinical Information Manager will edit the list of links you provide. Suitable links to include are discussed at the team meetings, as are all ad hoc requests for links that we receive. The Head of Cancer Web Content has the final say on the inclusion of individual links. There is more information about our links policy in the editorial guide.
6.6 Reading list
This page should contain relevant books that are in print. We can include books that have relevant chapters on specific cancers. Search Amazon for easily available site-specific patient books. You can include lay accounts of having that type of cancer or any books relevant to living with that type of cancer (e.g. books on diet after bowel surgery etc). Ask colleagues, including the cancer information nurse team. We will also ask lay and specialist reviewers for suggestions when the section goes out for review.
All pages in the Cancer Research UK patient information website are keyworded. This means picking out words that describe the main contents of the page. These are then input into the admin system. Keywords enable search mechanisms (both in house and external, eg Google) to pull out appropriate pages when a subject is searched for. To keyword, you need to scan each page that you have written and pick out relevant search terms. These should be written on the metadata form that accompanies each page. You need to think about what people wanting the information on that page are likely to search for and the terms they would be most likely to use. If you are unsure, Google trends will compare usage stats for two or more search terms (http://www.google.com/trends/explore).
- Aim to pick out key phrases that describe the main content of the page. Think about terms that people are most likely to use for searching. You do not have to input all variations of a phrase if the words are essentially the same, ie you do not have to key 'radiotherapy for breast cancer' as well as 'breast cancer radiotherapy'
- Include the cancer type on all pages in the section, including alternative names if they are spelt differently, eg for uterine cancer, you would also keyword womb cancer, cancer of the uterus, endometrial cancer and cancer of the endometrium
- Do not include anything referred to in passing, eg a surgery page mentions having lung function tests before an operation. Do not key "lung" for this type of low-key mention
- Include major themes, eg section headings as appropriate, or any other important information that is not covered in greater detail elsewhere on the site
- There are synonyms entered into the system, including US spellings, eg estrogen, tumor so you do not have to keyword these separately
- You do not need to include plurals unless they are irregular. For eg, searching for 'trial' will also pick up 'trials'.
- You do not need to include punctuation variations, eg hyphens, apostrophes, as these are ignored by the search engines and internal search
Do not overdo keywording. Erring on the side of caution means that search results will be more specific and so more useful to site users. As a general rule, use around 10-15 keywords or phrases.
Other metadata fields are page title, page url (web address), meta description, comments and tags.
Page title must be unique. There cannot be any other page on the site with the same title. This includes the glossary. The page url derives from the page title. So, it is very important that you think carefully about page names. We do not have free license to change page titles once the page is mounted on the site.
Page urls are constructed from the page title with hyphens between words. For example, the page Biological therapies for breast cancer would have the url biological-therapies-for-breast-cancer
Meta description must be between 75 and 160 characters long. It is generally drawn from the opening sentence and bullets, but cut into a sentence that would read satisfactorily as a description in a page of search results. For example, the page opening: This page is about what cancer is. You can find the following information
- What cancer is
- Normal cells
- Genes and cancer
- Benign and malignant tumours
- Primary and secondary cancer
- Cancer symptoms
should be changed to This page is about what cancer is, with information on normal cells, genes and cancer, benign and malignant tumours, primary and secondary cancer and cancer symptoms.
Each section has a glossary. Any new technical or medical terms that are not in the current glossary must be defined in plain English. The easiest way to identify these terms is to keyword first, compile a list of keywords for your whole section, add in any technical terms you think are missing and then cross check this against the existing glossary on the site.
It is part of our house style to include diagrams and illustrations wherever possible. These help to explain difficult concepts, break up the text and make the page more appealing to look at. Try to think creatively about where you could include diagrams or illustrations. Look at the site for examples e.g. pancreatic cancer surgery pages or any anatomy and physiology page for a specific cancer (the first page in the 'about section': 'about the...').
As part of your role, you are required to produce sketches of suitable anatomical diagrams and diagrams detailing surgical procedures to include in specific cancer sections. We then commission a medical illustrator to create image files suitable for the web. If there is any reason why this is not appropriate or possible, please inform us as soon as possible. Where possible, diagram sketches should be produced at an early stage, as they can then be sent to specialist reviewers with the text.
Diagram sketches should be produced with explanatory labels in plain English.
All diagrams are reviewed by a relevant specialist reviewer. They are put on the website by the visual content assistant. Once on the website they are reviewed as part of the review process of the information on the page they are on.
9.2 Videos and animations
Commissioning videos and animations is through the same process as all other information. Videos and animations should be focused and short - preferably under 2 minutes. If a video is likely to be longer, think about ways to split it into a series of 2 or more.
After a topic for a video or animation has been decided a brief is created. There is an organisational video approval process and the brief needs to be signed off by the Digital and Brand teams. Users can watch videos and animations on the relevant page of the website. They are also available within Cancer Research UK’s YouTube channel. Videos and animations are reviewed as part of the review process of the relevant section on the website 18 monthly.
The videos and animations are scripted as a 'story board' with the individual scenes, voice over and captions detailed. As with our written information the subject is researched using the same resources as text information. The New Content manager produces a first draft of a script using the house style. This is a visual piece of information using pictures rather than text to inform people of the subject. Supporting voiceover should enhance what is happening on screen. The story board is checked by one of the cancer information nurses. Depending on the subject a relevant health professional may have input at this stage.
The animator or video producer also has input to make it engaging and creative. The final version of the script is then looked at by a relevant health professional and where possible a lay reviewer. For eg, specialist physiotherapist input was obtained for videos detailing post op exercising.
Filming, review and availability
If filming a video, consent forms must be signed before filming by anyone appearing in the video. The video producer or animator makes it. If filming a video the New Content Manager needs to be there to check the tone and style during filming.
Once the first version of the video or animation is available the New Content Manager reviews it and it is also reviewed again by the relevant health care professional. A patient or other lay reviewer is also asked to comment at this stage. Any changes are made before the final sign off by the New Content Manager.
The visual content assistant produces a transcript to go on the page with the video or animation. They also fill in a video submission form for the digital department to put it on to the website. Feedback is collected in the same way as it is with text information. A record of the number of views, audience retention as well as likes, shares and any comments are collected monthly and changes made where appropriate and possible. This feedback helps inform us of how to make future videos and animations.
Quick Guides are page summaries, providing a simpler overview of the content of each page in a section for those who require less detailed information.
10.2 Production and positioning
They should be written at the same time as a main section. When writing, the QG text must be placed within a text box in your Word doc. This indicates to the web editor where the QG content starts and stops.
On site, QGs are placed at the top of a page, just under the bulllet list within a collapsible field. This is to avoid confusion from duplication of content being visible.
Quick Guides contain a brief summary of the key information on a given page - and only that information. They do not contain any links, except to glossary terms. They should contain no statistics or other information that is likely to need ad hoc updating. They should be as short as possible and no longer than 300 words.
Quick Guides are grouped together where appropriate, to form a printable pdf. For example, the bowel cancer section has Quick Guides collected into 4 pdf's: About bowel cancer, Diagnosing bowel cancer, Treating bowel cancer and Living with bowel cancer.
The pdf's are linked to from each box on the main section landing page and from the bottom of each individual Quick Guide in their section.
11.1 Standard introductory text:
This page is about statistics and what they can tell us about the outlook for people with bladder cancer. You can find the following information
11.2 Quick Guide text
We do not include any detailed statistics in the Quick Guide to avoid users coming across them unexpectedly and to give added longevity to the content. The standard text for these is as follows
Statistics and outlook for X cancer
Outlook means the likely outcome of your disease and treatment. Doctors call this prognosis. With X cancer, the likely outcome depends on how advanced the cancer is when it is diagnosed (the stage). We have detailed information about the likely outcome of different stages of X cancer. The statistics we use are taken from a variety of sources, including the opinions and experience of the experts who check this section. They are intended as a general guide only. For information about the likely prognosis in your case, you need to speak to your own specialist.
We include statistics because people ask for them, but not everyone wants to read this type of information. Remember that you can skip this page if you don't want to read it. You can always come back to it later.
How reliable are cancer statistics?
No statistics can tell you exactly what will happen to you. Your cancer is unique. The same type of cancer can grow at different rates in different people. The statistics cannot tell you about the different treatments people may have had, or how that treatment may have affected their prognosis. There are many individual factors that will affect your treatment and your outlook.
You can view and print the quick guides for all the pages in the Treating Hodgkin lymphoma section [LINK to Quick Guide pdf].
11.3 What you need to know about the information on this page
The first jump link after the 'Quick guide' should read: What you need to know about the information on this page. The text is as follows:
On this page there is quite detailed information about the survival rates for different stages of X cancer. We have included it because people ask us for this. But not everyone who is diagnosed with a cancer wants to read this type of information. If you are not sure whether you want to know at the moment, you might like to skip this page [LINK X cancer treatment] for now. You can always come back to it.
Please note - There are no national UK statistics available for different stages of cancer or treatments that people may have had. The statistics we present here are pulled together from a variety of different sources, including the opinions and experience of the experts who check each section of our site. We provide statistics because people ask us for them. But they are only intended as a general guide and cannot be used to predict what will happen in your individual case.
11.4 Cancer statistics in general
The second jump link should read Cancer statistics in general and the text should be as follows:
Our cancer statistics section [LINK Cancer Statistics] has information about the different types of cancer statistics [LINK incidence-survival-and-mortality]. Unless you are very familiar with medical statistics, it might help to read this before you read the statistics below.
Remember - You may hear doctors use the term ‘5 year survival’. This does not mean you will only live 5 years. It relates to the number of people in research who are alive 5 years after diagnosis. Doctors follow what happens to people for at least 5 years after treatment in any research study. This is because there is only a small chance of the cancer coming back more than 5 years after treatment. Doctors do not like to say these people are cured because there is that small chance. So they use the term ‘5 year survival’ instead.
Not all screening pages will have jump links or Quick guides. It will depend on their length (which depends on whether there is any screening information for that cancer type). If there are jump links, the second after the Quick guide should be headed 'What we mean by screening' and followed by this text:
"Screening means looking for early signs of a particular disease in 'healthy' people who do not have any symptoms. Screening cannot prevent cancer; only find it as early as possible.
Before screening for any type of cancer can be carried out, doctors must have an accurate test to use. The test must be reliable in picking up cancers that are there. And it must not give a false result in people who do not have cancer."
If there is no screening for that cancer type, you are unlikely to need jump links. In this case, use only the text above, with no heading and follow with:
"At the moment, there is no screening test that is reliable enough to use for x cancer in the UK.
If screening is introduced for x cancer, the test must be simple, quick and not too expensive. It would probably be most cost effective to screen people who are thought to be at a higher risk [LINK X-cancer-risks-and-causes]. But first we must be sure we know who is definitely at a higher risk."
13.1 Standard opening
The bullet after the Quick guide should be 'What chemotherapy is' with the following text:
Chemotherapy uses anti-cancer or 'cytotoxic' drugs to destroy cancer cells. They work by disrupting the growth of cancer cells. The drugs circulate in the bloodstream around the body.
13.2 Standard ending on finding more information
Under a bullet and subtitle of 'Where to find out more general information on chemotherapy' (or similar):
For more about chemotherapy look at our main chemotherapy section [LINK Chemotherapy]. It explains the treatment in more detail including
- How it works [LINK how-chemotherapy-works]
- How chemo is planned [LINK Planning Chemotherapy]
- How you have chemo [LINK Having Chemotherapy]
- General chemo side effects [LINK Cancer Drug Side Effects]
- Living with chemotherapy [LINK Living With Chemotherapy]
14.1 Standard opening text
The bullet after the Quick guide should be 'What radiotherapy is' with the following text: Radiotherapy uses high energy rays to cure cancer.
14.2 Standard ending on finding more information
Under a bullet and subtitle of 'Where to find out more general information on radiotherapy' (or similar):
There is more information about radiotherapy in our main radiotherapy section [LINK Radiotherapy]. You can find information about
- What radiotherapy involves [LINK About Radiotherapy]
- How your radiotherapy treatment is planned [LINK Planning External Radiotherapy]
- Possible side effects [LINK Radiotherapy Side Effects]
15.1 These pages follow the format of the site coping section ie coping emotionally, physically and practically.
15.2 Coping with your diagnosis
It can be very difficult coping with a diagnosis of cancer both practically and emotionally. At first you are likely to feel very upset and confused, or that things are out of your control. It is very important to get the right information about your type of cancer. If you are well informed about your illness and treatment you are likely to be more able to make decisions and cope with what is happening to you.
15.3 How X cancer can affect you physically
X cancer and its treatment may cause physical changes in your body. These changes can be very difficult to cope with and may affect the way you feel about yourself. [Continue with relevant info re symptoms for type of cancer, referring to other coping pages in same section eg diet after bowel cancer or coping with breathlessness for lung cancer.]
Another problem you may have to cope with is feeling very tired and lethargic a lot of the time. You may feel very tired during and after treatment or if the cancer is advanced. There is information about fatigue and cancer [LINK fatigue section] and treating cancer fatigue [LINK] in our section about coping physically with cancer [LINK].
If you are having a sexual relationship, one or all of these changes may affect your sex life. There is information about how cancer can affect your sex life [LINK] in our section on coping with cancer [LINK].
15.4 Coping practically with X cancer
As well as coping with the fear and anxiety [LINK managing fear and anxiety] that a diagnosis of lung cancer brings, you may also have to work out how to manage practically. There may be money matters to sort out. You may need information about financial support [LINK], such as benefits, sick pay [LINK benefits#ssp] and grants [LINK charity grants].
Who do you tell that you have cancer? And how do you find the words? You may also have children to think about. We have information about talking to people about your cancer [LINK who to talk to] and how and what to tell children [LINK talking to children].
Just try to remember that you do not have to sort everything out at once. It may take some time to deal with each issue. Do ask for help if you need it though. It is likely that your doctor or specialist nurse will know who you can contact to get some help. They can put you in touch with people specially trained in supporting people with cancer. They are there to help and want you to feel that you have support. So use them if you feel you need to.
You may need to have access to support staff, such as a physiotherapist or dietician. Social workers can help you with information about your entitlement to sick pay and benefits. If you live alone, a social worker may be able to help by organising convalescence when you first come out of hospital.
15.5 More information about coping with X cancer
Our coping with cancer section [LINK Coping With Cancer] section has lots of information you may find helpful. There are sections on
- Your feelings [LINK About Your Emotions And Cancer]
- How you can help yourself [LINK what you can do]
- Who else can help you [LINK who can help]
- Money matters [LINK Money Matters] including financial support [LINK Financial Support] and travel insurance [LINK travel-insurance]
If you would like more detailed information about coping with X cancer, you could ring our cancer information nurses on 0808 800 4040. They will be happy to talk through any concerns you have. They will be able to advise you on how to find a local support group. Or discuss whether counselling may help you. If you want to find people to share experiences with on line, you could use CancerChat [LINK], our online forum.
It is important to be clear about whether medical information is
- Confirmed fact
- Widely held medical opinion
- One of two or more views held by medical specialists and a matter of debate
It is important for patient information services to be careful in representing uncertainty. It can be unsettling for people to realise that their doctors do not necessarily have all the answers. We should also aim to make clear where opposing claims are made by different sources and where the differing views are supported by research. This is common in the case of alternative therapies.
We make the difference between the above clear by use of appropriate wording.
To indicate confirmed fact, we may say 'We know from research that…'. Where appropriate, we may refer to published guidance, such as guidelines produced by NICE or a statement by the Cochrane Collaboration, or to published trial results. For example 'Biological therapies are drugs that help the body to control the growth of cancer cells. A biological therapy called cetuximab (Erbitux) is licensed in the UK for people who have bowel cancer that has spread. We know from research that it can help some people with advanced bowel cancer to live longer when added to standard chemotherapy treatment.'
Widely held opinion
To indicate widely held medical opinion, we may say 'Doctors believe…'; 'Many doctors believe…' or 'Some doctors believe…' depending on which is most appropriate. For example, 'Some scientists and doctors believe that antioxidant vitamins and minerals may help prevent cancer when included in a healthy, balanced diet. Vitamin A, C and E are antioxidants. We don't know for sure whether eating these can help prevent cancer. This is a very difficult thing to prove.'
Differing medical views
To indicate where there are differing views, alternative views should be given and where possible, information should be provided to support the views expressed. For example 'A Cochrane review in 2011 reviewed the research which compared different treatments for localised prostate cancer. This review found that after 5 years follow up internal radiotherapy worked equally as well as surgery to remove the prostate gland. There were differences in side effects. The men who had surgery were more likely to be incontinent and the men who had brachytherapy were more likely to have pain and the need to pass urine often. They say we need more research to find out which treatment is best for men with localised prostate cancer. There are some trials comparing active monitoring with giving surgery or radiotherapy for localised prostate cancer. There are details about the ProtecT trial on our clinical trials database. This trial has closed and we are waiting for the results.'
Directly opposing claims from different sources
It is common for manufacturers of alternative remedies to make claims about their efficacy. This is a sensitive area and we should aim to avoid making any unsubstantiated claims ourselves. For example, it is preferable to say that there is no research evidence that a ‘therapy’ works, rather than stating categorically that it doesn’t work. For example 'A number of companies on the internet claim that milk thistle can ...slow the growth of some types of cancer, including breast and prostate cancer. Although it is possible that milk thistle may play a part in treating liver disease and some types of cancer there is currently no evidence for this. We need a lot more research with reliable clinical trials before we can be sure that milk thistle will play any part in treating or preventing cancers.'
From experience of providing a cancer information service, we suspect that many people in the UK think that more medical practice is evidence based than is actually the case. Realising that areas of medical treatment are far from certain can be very unsettling. Sensitive wording can ameliorate this response. The clinical trials database is dealing with uncertainty by definition. Commonly used wording is ‘Doctors think that……..but they are not sure yet.’ Responses from site users during usability testing indicate that people generally find this way of representing the research situation acceptable.
- Affected (as in 'one affected lymph node') - cancer in one lymph node
- Aggressive - faster growing
- Anti coagulation clinic - blood clinic
- Arise from - come from, or develop from
- Attend - go to
- Chemotherapy regime - chemotherapy drug combination or combination of chemotherapy drugs
- Cosmetic result - appearance after
- Decrease / reduce - lower
- Defined as - means
- Discuss with - talk to
- Prior to - before
- Effective - works
- Experience (as in ‘side effects you may experience’) - have
- How effective it is - how well it works
- In combination with - with
- Inform - tell
- Initial - first
- In other words - so
- Insert - put
- In spite of the fact that - although
- Lymph nodes affected by cancer - lymph nodes containing cancer cells
- More effectively - better (or works better than)
- Most appropriate - best
- Occur - happen
- Positive lymph nodes - lymph nodes containing cancer cells
- Progress (as in 'your cancer will progress') - your cancer will grow...
- Proportion - number
- Receive treatment - have treatment
- Requires - needs
- Return - come back
- Sufficient - enough
- Suspicious - abnormal
- Tablet form - tablets
- The patient - ‘People with cancer’ or ‘you'
- Thereafter - after that
- The reason why this is - this is because
- Vast majority of - most
- What is the incidence of - How common is
- Whilst - while
- You will be followed up - your doctor will arrange follow up appointments for you
- Shorten your sentences
- Take out unnecessary words
- Make sentences active, not passive
- Make sentences positive, not negative
- Substitute simpler words and phrases
- Cut out any repetition
- Make sure you haven’t contradicted yourself
- Change the order of sentences and paragraphs to make your writing flow more naturally
- Make sure you have included all necessary information - put yourself in the reader’s shoes
Affected. This can be misinterpreted - people may not understand that when we say 'one lymph node is affected', we mean that cancer has spread to it. Say 'there is cancer in one lymph node' or 'one lymph node contains cancer cells'.
Americanisms. We are a UK site and do not use Americanisms, including American spellings. Verbs should end in -ise, not -ize eg recognise.
'A' or 'an'. We don't use 'an' before words beginning with 'h', unless the 'h' is silent eg 'a herb' not 'an herb'; 'a hospital', not 'an hospital'.
Abbreviations. We don't use abbreviations unless it is detrimental not to, preferring to write in full - for example, not eg. If we do, we don't use full stops between letters in abbreviations.
Accident and Emergency (A&E) rather than 'Casualty'. Most hospitals now refer to Accident and Emergency (A&E) or Emergency departments rather than Casualty.
Acronyms. Don't put full stops between letters eg NICE not N.I.C.E. Spell out in full on first use, with abbreviation in brackets following. Subsequently, use abbreviation. We do not use an apostrophe after a plural abbreviation eg GPs not GP's.
Adviser not advisor (eg financial adviser)
Bloodstream is all one word.
Bold text should be used for emphasis, not capitals. Bold only one or two words (eg do not take X...) rather than a whole sentence and certainly never a whole paragraph
B-RAF has a hyphen.
Breastfeeding is all one word.
CancerHelp UK is always written as seen here. NB we are no longer using the name in site content, but referring to 'our' information. The site should now be referred to as 'Cancer Research UK's patient information.
Cancer Research UK should be written as seen here and never abbreviated, except in internal communications.
Capitals. Do not overuse. Doctor, nurse etc do not have a capital letter. Professor has a capital if followed by a specific name eg Professor Nick James. Do not use capitals for emphasis - use bold (sparingly) instead.
Casualty department - see 'Accident and Emergency'.
Contact details. Put address first, followed by phone, website and email. Use Phone instead of Tel. Email does not have a hyphen. Website should be all one word. Do not include either the http:// at the front of the web address, nor any extra code at the end, such as index.html. If you are in any doubt about what will work, try loading the site. (In the link wizard, you will have to include the http:// but you don't need it on the live site's content. All external sites should be set to open in a new window.)
Dietician / Dietitian – we use 'dietitian' as this is the accepted version in the ~UK
Distinguish – use "tell the difference between".
Dropdown – all one word (ie as in dropdown menu)
Drug names. Brand names always take a capital letter and generic names don't eg Panadol, paracetamol. For drugs yet to be named eg ABC-1234, use a hyphen as easier to read while making sure the two 'parts' of the name are connected.
E-CMF has a hyphen.
Examples. Write 'for example' in full instead of using eg. For a comparison, use 'such as' not 'like'. Like means 'similar to'. It does not mean the 'same as', or 'for example'. So, 'you may have a different chemotherapy drug, such as epirubicin'.
Factsheet is all one word.
FEC-T has a hyphen.
Fewer – see Quantity.
Follow up. You can refer to 'follow up clinics' or 'follow up appointments' but don't use 'You will be followed up...'. This doesn't necessarily have any meaning for the lay public and it is better to say 'Your doctor will see you for regular check ups' or similar.
Food pipe is now our accepted colloquialism for oesophagus. Younger people are not familiar with 'gullet'. Also include oesophagus for clarity.
G-CSF and GM-CSF both have hyphens.
Gallbladder is all one word.
Government has a capital G if we are talking about 'the Government' (as in UK).
Hyphens. Accepted site practice is not to use hyphens. They clutter the text and make it more difficult for less able readers. Although we do not use hyphens, we don't combine the prefix with the rest of the word as this can be even more difficult to read. Eg anti angiogenic, not antiangiogenic; anti inflammatory, not antiinflammatory. Exceptions to this policy are acronyms with an accepted form that includes a hyphen: drug regimens (eg R-CHOP), genes (eg K-RAS) and some drugs or drug targets that are acronyms (eg G-CSF and PARP-1). All exceptions are listed under individual entries in this guide so please check for the particular term you are querying.
Intra peritoneal (IP) is 2 words.
K-RAS has a hyphen.
Less – see Quantity
Licensed – licence is a noun which means 'a permit to do something' (a driving licence), whereas license is a verb meaning 'give a permit to someone: allow something' (this drug is licensed for the treatment of cancer). In American English, both the noun and the verb are spelled license.
Long term does not have a hyphen.
Mouth care is 2 words.
MRI is an MRI but a magnetic resonance imaging scan.
Mucous or mucus. Mucus is a noun and mucous is an adjective. Therefore, the stuff that clogs up your nose when you have a cold is mucus. But the membranes that produce mucus are 'mucous membranes'.
Neo adjuvant should be written as 2 separate words as it makes it easier to read.
Numbers. We generally write all numbers in figures. You can use your discretion for 'one' and 'two' as these in figures can sometimes look odd. Avoid starting a sentence with a number. Percentages are always in figures eg 2%. Always use commas for numbers over 999 eg 1,000.
Online is one word.
Organisations are singular, not plural. So NICE has...not NICE have.
Outpatient is all one word.
Painkillers should be all one word.
PARP-1 has a hyphen.
Percentages. Many people don't understand these. Always express risk as 'x people out of every 100' and then put percentage afterwards in brackets eg '80 out of every 100 people (80%)
PET-CT has a hyphen (to avoid confusion with PET and CT).
Post menopausal is two words.
Pre cancerous is two words (as easier to read.)
Premenopausal does not have a hyphen and is all one word.
Pre paid is two words.
Pre surgery is two words.
Philadelphia chromosome should have a capital p and lower case c.
Pronunciation guide. As an aid to our site users, we give guidance on how to say difficult words, particularly medical ones that may be unfamiliar eg lymphocytic (pronounced lim-fo-sit-ik). Try not to use real words as part of the phonetic spelling as it can confuse eg 'in-juicy-bull' for inducible.
Quantity. There are grammatical rules about the use of 'less' and 'fewer'. If it is possible to count what you are describing, use 'fewer'. If not, use 'less'. For example, there are fewer people on the beach, but less sand.
Quotation marks. Always use single quote marks (') and not double quote marks (").
Radio waves is 2 words (not radiowaves).
Referencing style. We have a patient friendly referencing style for books, articles and guidelines.
Book title in bold
Principles and practice of oncology (8th edition)
De Vita VT, Hellman S and Rosenberg SA
Lippincott, Williams and Wilkins, 2008
Article title in bold. Authors (and others). Journal title, Date. Vol #, Issue #.
Ductal carcinoma in situ of the breast: a systematic review of incidence, treatment, and outcomes. Virnig and others. Journal of the National Cancer Institute, 2010. Vol 102, Issue 3.
Guidelines or official reports
Guideline or report title in bold. Organisation, date.
Overcoming barriers. NHS Breast Screening Programme Annual Review. NHS Cancer Screening Programmes, 2010.
R-CHOP has a hyphen.
R-DHAP has a hyphen.
R-ESHAP has a hyphen.
Risk communication. All risk information should be presented as '1 in X'. We also generally put the percentage in brackets in an appropriate place in the same sentence. For eg About 1 in 5 people (20%) are diagnosed with stage 4 XXX cancer.
Short sentences - we use conjunctions to start sentences, such as And and But. But this should only be done if there is a genuine need for the 'and' or the 'but', ie the second sentence is dependent on, or an extension of the first. Don't just put them in for the sake of it.
Short term does not have a hyphen.
Synthetic – use 'man made'.
Trans is a common medical prefix. We write this as two words, without hyphens eg trans rectal, trans dermal.
Voice box is 2 words.
X-ray has a hyphen and a capital X.
This guideline will be reviewed on or before October 2015.
Question about cancer? Contact our information nurse team