Departments and Service Areas

The Edinburgh Breast Unit is a nationally and internationally acclaimed unit, providing a supra-regional comprehensive breast service to a population which includes Edinburgh and the Lothian’s. We also treat women with impalpable breast cancer detected by the South East Scotland Breast Screening Service, and provide treatments for patients who opt to come here from out with Scotland for immediate breast reconstruction.

Within the ECC, the Breast Unit holds a unique position of having the breast clinic, the breast ward, operating theatres and mammography department all within the same area. This has been known to improve the patient experience through the department.

The Breast Unit treats over 800 breast cancer patients per year including patients from the breast screening service.  A majority of the patients come via GP referrals to our symptomatic clinic which operates each morning from Monday to Friday in our one stop service. This allows us to assess breast symptoms and with radiology support, offers same day imaging and reporting along with breast biopsy if required. This enables us to let the patients know on the day what the likely cause for their symptoms. 80% of patients seen each day in this clinic are discharged home with a benign or normal breast finding.

Once patients are diagnosed breast cancer, individualised treatment plans are formulated within the scope of Multidiciplinary meetings held on Monday and Tuesday mornings. Within these meetings there are representatives from Pathology, Clinical Oncology, Medical Oncology, Breast Surgeons, Clinical Nurse Specialists and Radiology ensuring the patients are at the forefront of this decision making.

Breast surgery is performed in our 2 operating theatres which operate Monday to Friday with over 80% of the patients admitted under day case within the Day Bed Unit. The surgeons work closely with their plastic surgery colleagues to provide up to date Oncoplastic procedures, including breast reconstruction.

Within the Breast Unit, there is the Mammogram department which has highly qualified Consultant Breast Radiologists who are supported by a team of radiographers to perform a number of patient services to support diagnosis of breast cancer, wire guided procedures prior to surgery, reporting of mammograms for breast cancer follow up and supporting the Multidisciplinary meetings with in depth interpretation of radiology findings from different imaging modalities.

The Breast Out- Patient Clinic is central to the breast unit with patients attending before and after surgery, for review by their breast surgeon, to attend our designated Pre Operative Service prior to surgery, see the Clinical Nurse Specialists for support and advice, be involved in trials and to attend Breast Cancer Annual Follow Up.

The Breast Unit at St John’s Hospital, Livingston, West Lothian also comes under the remit of the Edinburgh Breast Unit. This services offers patients in West Lothian the option of being treated closer to home where staff cross cover both sites.  

The South East Scotland Breast Screening Service is part of the National Breast Screening Programme (NHSBSP). We offer screening to around 71,500 women each year from Edinburgh, the Lothians, Borders, Fife, and Forth Valley. We provide a free breast screening service for women aged between 50 to 70, resident in our area.

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Clinical Oncologists are doctors trained in the use of both radiation and medications in the treatment of patients with cancer. Used together or alone there is a huge variety in delivery techniques and schedules. Although increasing amounts of drug therapies can be delivered in peripheral sites such as at the Borders General Hospital – Melrose, St John’s Hospital – Livingstone, the Dumfries and Galloway Royal Infirmary and Victoria Hospital – Kirkcaldy all radiotherapy in South East Scotland is given at the Edinburgh Cancer Centre – part of the Western General Hospital site.

Radiotherapy uses ionising radiation (high energy x-rays) to treat cancers. As the body has a limit to how much dose it can safely receive radiotherapy is often divided into smaller ‘fractions ’which are usually, but not always, given daily. Depending on the type of radiotherapy, site and origin of the cancer, and intent of treatment this can vary from a single treatment to eight weeks of Monday to Friday treatments.

Different types of radiotherapy include:

• External beam radiotherapy – similar to getting a CT scan the radiation beam passes straight through the body.
• The Edinburgh Cancer Centre can deliver all forms of modern advanced radiotherapy as well as Stereotactic Radio-Surgery/Ablative Radiotherapy (‘SRS’/’SABR’.)
• We do not have Proton therapy – this is only available in the UK at University College London Hospital and The Christie in Manchester.
• Brachytherapy – radioactive ‘seeds ’are inserted directly into thetumour or organ
• Radioisotope therapy – a radioactive molecule in liquidform that can be swallowed or injected

Uses of radiotherapy can vary:

• It can be used with the aim of cure and this is sometimes called ‘radical ’treatment; it is in this setting that it is occasionally given alongside drug treatment such as chemotherapy.
• It can be used before or after surgery to reduce risk of recurrence; what is described as ‘neo-adjuvant ’and ‘adjuvant ’respectively.
• If, unfortunately, a cancer cannot be cured radiotherapy may still be helpful to provide some local control and in doing so hopefully prolong life and prevent or alleviate symptoms. It may also be useful for specific sites of problematic disease; such as to treat pain or bleeding for example. In this setting treatment is referred to as ‘palliative’.

Clinical Oncologists work closely with the Multi-disciplinary Team (MDT) and your named Consultant may head up the entirety of your treatment or simply be asked to consider/deliver some radiotherapy as a small part of it.

The Edinburgh Cancer Centre plays an active role in innovation with engagement in regional, national and international research. It also a large training centre for the doctors, nurses and other allied healthcare professionals of the future.

Medical oncologists are specialist cancer doctors who prescribe medications to care for and treat patients with many different types of cancer.

 These medications might be used to:

• Shrink and/or control cancer
• Reduce the risk of future cancer recurrence (called “adjuvant” therapy)
• Improve survival
• Control symptoms of cancer and improve quality of life
• Treat complications associated with cancer treatments

You may be referred to see a Medical Oncologist at the Edinburgh Cancer Centre for:

• Chemotherapy
• Hormone-blocking therapy
• Immunotherapy or Targeted treatments
• Clinical trials

There is no one-size-fits-all treatment for cancer and often a patient will have a combination of treatments for the best outcome possible. Treatment for cancer may also include surgery, radiotherapy, haematological support and symptom management.

Usually, a medical oncologist would specifically specialise in only a small number of specific cancer types, for example breast cancer, and they work together in tumour type specific multi-disciplinary teams (MDT). Many of our medical oncologists also have a practice in one of the district general hospitals served by t, in Fife, St John’s Hospital, Borders General Hospital or Dumfries and Galloway.

If you are receiving treatment for cancer, you will usually be looked after by a named consultant who will co-ordinate your treatment plan, although you will likely receive care from a range of different experts. Your multidisciplinary team may also consist of:

• Clinical oncologists (oncologists who are also specialists in radiotherapy)
• Surgeons
• Haematologists
• Clinical Nurse Specialists
• Chemotherapy or treatment nurses
• Specialist radiographers
• Oncology pharmacists
• Allied health professionals such as dietitians, physiotherapists, occupational therapists, social workers, clinical psychologists and other support services
• Palliative Care nurses and doctors

Research and training our future cancer professionals are embedded in everything we do at the Edinburgh Cancer Centre, so you may also meet doctors, nurses and allied health professionals in training. There will likely also be an opportunity for you to be involved in clinical trials or other studies, if you choose to. 

See the section on Cancer Types (hyperlink) to find out more about the team and service specific to your cancer.

Haematology within the Western General Hospital is part of the Edinburgh Cancer Centre, which offers tertiary healthcare services including clinical oncology, radiation therapy, clinical haematology and palliative care. 

The new Edinburgh Haematology Centre opened in September 2021 offering inpatient and outpatient care for haematology patients. Ward 7, the Haematology Day Unit, delivers ambulatory care for haematology patients whereas Ward 8 is dedicated to inpatient haematology services encompassing diagnosis, treatment and ongoing care for blood cancers and non-malignant haematology conditions. 

The most common treated conditions are haematology malignancies such as leukaemias, lymphomas and myelomas and the range of treatments include chemotherapy, different options of targeted therapies and autologous stem cell transplants. 

The Edinburgh Haematology Centre is one of the very few centres JACIE accredited in Scotland for performing haematopoietic stem cell transplants and does this co-ordinately with the Scottish National Blood Transfusion Service (SNBTS) Stem Processing Facility in Edinburgh. 

Treatment Planning is one of the essential components of the radiotherapy treatment process. The whole Oncology team has a part in it, including Therapeutic Radiographers, Clinical Oncologists, Clinical Scientists and Clinical Technologists. The aim is to create a clinically acceptable plan, targeting the radiation dose to a specific – desirable area, with as much healthy organ sparing as possible. Highly complex planning software is used to create a treatment plan according to the requirements from the Clinical Oncologist, adhering to national legislation (IRMER) and our local quality system protocols. Once the plan is ready, numbers of checks are performed, by other Technologists, Oncologists and an independent treatment planning software, to ensure the plan is optimal and safe to be delivered.

The pathway and requirements for treatment planning:

• Radiographers perform a CT scan that is used by the Oncologist to define a treatment volume
• Oncologist outlines on the CT image, defining target volume and organs at risk according to IRMER guidelines and department protocols
• Clinical Technologists, Clinical Scientists or Radiographers create a high quality treatment plan that can involve ongoing discussions and reviews to ensure plan is optimal
• The final plan is checked by another qualified member of the team and is reviewed and accepted by the Oncologist

The accepted plan is ready to be treated and is sent to the Therapeutic Radiographers for further checks and treatment delivery.

Types of Radiotherapy

The following categories of External Beam Radiotherapy are currently delivered by the Department:

• 3D simple calculations (VSim)
• 3D conformal radiotherapy
• Intensity-modulated radiation therapy (IMRT)
• Volumetric modulated arc therapy (VMAT)
• Respiratory phase monitored and gated radiotherapy
• Stereotactic radiotherapy treatments (SRT)
• Stereotactic ablative body radiosurgery (SABR)

Further Info

In Radiotherapy, we are constantly looking for ways to improve and develop the service. We are often involved in implementing new techniques to make sure our patients have access to the most up to date and safest high quality radiotherapy treatment.

For example, in 2023 our department is going to develop a paper light workflow which will make the treatment planning process more efficient and will be developing our oligometastatic SABR service to include a wider range of anatomical sites.

The ECC is heavily involved in participation in clinical trials for a number of treatment sites and have developed our own in-house clinical trial for prostate SABR. The treatment planning team is a key component for implementing and maintaining participation in clinical trials.

Our team provide expert technical support to the Radiotherapy Equipment used at Edinburgh Cancer Centre. The major equipment supported are seven Medical Linear Accelerators used for radiotherapy treatments and two Radiotherapy Big Bore CT Scanners used in the planning of radiotherapy treatments.

Our service can be varied and complex and we contribute to all aspects of an installations entire lifecycle. Typically this can involve product selection/tendering, installation, commissioning, quality control, repair and maintenance then ultimately de-commissioning.

Quality control and safety are at the forefront of a modern radiotherapy department and our team play a major role in ensuring that the technology is in tip top condition and ready for use on a daily basis.

The daily demand for access to the full suite of radiotherapy equipment provides the Technology team with a challenging role making sure that maintenance and servicing is up to date and any faults and repairs are attended promptly.

The team also provide a technical service to all other sections within the radiotherapy department providing support for computer systems in treatment planning and the full range of equipment used within our Dosimetry and Brachytherapy sections.

Training and development of staff is incorporated into our Radiotherapy activities and we are an IPEM accredited training centre providing formal training of new Radiotherapy Technologists. We also provide training to staff from other areas of expertise to facilitate their training needs.

The mechanical engineering support team provide a pan-Lothian clinical design and manufacturing service producing bespoke devices for development purposes or where commercial solutions are not available. Novel technologies such as 3D printing are currently being developed alongside other technologies such as laser scanning and LFS (Low Force Stereolithography).

Types of Radiotherapy

The following categories of external beam Radiotherapy are currently delivered by the department:

• Volumetric Modulated Arc Therapy (VMAT)
• Respiratory phase monitored and gated Radiotherapy
• Stereotactic Radiotherapy treatments (SRT)
• Stereotactic Ablative Body Radiosurgery (SABR)

Development Projects

4D CBCT Motion phantom

Triggered imaging phantom

RGSC Beam gating analysis phantom

Patient engagement Radiotherapy Technology exhibit

The introduction of 3D printer technologies to facilitate bespoke clinical device manufacture.

This is the main Cancer outpatient department for the east. Divided into with two areas: oncology outpatient clinics and a radiotherapy unit.

We see approximately 150 patients a day in clinics and 250 patients a day through the radiotherapy floor.

• Clinics: consists of 16 clinic rooms and provide support and a caring environment for new patients, return and follow up appointments for all oncology specialities within the ECC catchment zones.
• Radiotherapy floor: offer radiotherapy for both adult and paediatric patients. This is managed by the therapeutic radiographer team but have a dedicated nursing team who work in tandem with them?

Visiting Hours

Department open hours 08.30-17:00hrs Monday to Friday

We ask where possible, as coming out of Covid restrictions, to have minimal number of accompaniments with patients when attending. Also where possible to attend on their own for radiotherapy within the department.

There is limited space within clinic rooms/waiting areas to accommodate large groups. Large numbers should be pre-arranged with their team.

The Team

We have 15 dedicated nursing staff within this area. (1 charge nurse, 1 deputy charge nurse, 4 Clinical support workers and 9 trained staff – full and part time).

Clinic staff – responsible or greeting the patients and accompanying visitor. Performing pre clinic checks and routine tests. Organising clinic allocations and the daily running of these.

Radiotherapy staff – responsible for weekly nurse led radiotherapy review clinics and supporting medical led radiotherapy review clinics. Staff are available for daily support of any on treatment patient issues or requirements.

What is Palliative Care?

‘Palliative Care’ is an approach that improves quality of life for people and their families, who are facing problems associated with a life-threatening illness1. There is frequently a misconception that Palliative Care involves focusing on death and dying, but this is not the case. It is about helping people make the most of life, even when time may be limited.

Palliative care teams work alongside teams from all specialties to provide supportive care for patients, at any stage, from diagnosis through active treatments until the end-of a person’s life. Palliative care aims to improve quality of life, and to enable people to live well within the limits of their illness. Some teams across the UK use the title ‘Supportive and Palliative Care’ as this can help people feel easier about referral to our services/ reflects the broader nature of the role of Palliative Care teams.

Who delivers Palliative Care?

General Palliative care is something that all doctors are trained to deliver, and is mostly delivered by non-specialists, who are trained to ensure that you receive the support you need. However, if your team feel that you would benefit from seeing a Palliative Care specialist, they may refer you to our Hospital Palliative Care Team.

What are Specialist Hospital Palliative Care Teams?

Specialist Hospital Palliative Care teams can help people with more complex symptoms and circumstances. These teams are based at each of the acute hospitals in NHS Lothian and include a range of professionals who will see you depending on your individual needs. Specialist Hospital Palliative Care Teams are multi-professional and include Doctors, Nurse Specialists, Social workers, Chaplains, specialist Pharmacists, Complementary Therapists and in some cases are supported by specialist Physio and Occupational Therapists. 

Why might I benefit from Palliative Care support?

We know that supporting patients physically, psychologically, socially and spiritually from early in their illness, helps improve wellbeing, quality of life, symptoms and even survival3-4. Good symptom control can help relieve some of the distressing physical and psychological impacts of your treatments such as chemotherapy and radiotherapy. There are now international guidelines which advocate that palliative care teams work alongside Oncologists to improve outcomes for patients with cancer5. This is why Palliative Care teams are often routinely involved in the care of patients with cancer and other life-threatening conditions from the early stages.

Future Care Planning

Palliative care teams can also help you to plan ahead, so you are aware of your options: whether this be complex discharge planning for home from hospital, or planning for the ‘what ifs’ (known as Future Care Planning) to make sure that your care is aligned with what matters most to you and your priorities

More Information

For more detailed information which can be downloaded and printed on symptom management, talking to people about your condition, practical help, planning for the future (Future Care Planning) and preparing for death and bereavement, the NHS inform website has a fantastic range of resources: https://www.nhsinform.scot/care-support-and-rights/palliative-care

Useful Links

Scottish Palliative Care Guidelines:- Scottish Palliative Care Guidelines – Home

Good life, Good death, Good grief :- Good Life, Good Death, Good Grief :: Welcome (goodlifedeathgrief.org.uk)

Lets talk about death and dying (Age UK) :- Let’s talk about death and dying | How to have difficult conversations | Age UK