The Lead Cancer Nurse (LCN) role was developed following the publication of the NHS Cancer Plan [Department of Health (2000) The NHS Cancer Plan. A Plan for Investment. A Plan for Reform. HMSO, London]. In collaboration with the Lead Cancer Clinician and Cancer Manager the role of the LCN is to contribute to the planning and delivery of cancer services in line with government guidance. However, there are significant variations in the remit and authority of the role between organizations, and limited research has been undertaken to evaluate the effectiveness of this senior nursing post. This article explores the complex and often ill-defined remit of the LCN role and compares this with Nurse Consultant and Advanced Nurse Practitioner roles. It explores the challenges that this presents both to the postholders and the organizations within which they work. Recommendations include on-going monitoring and evaluation of these posts, the development of local supportive frameworks and a review of the educational needs of these postholders.