Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer : a prospective cohort study of diagnostic accuracy in primary care

Autor: Tonje Braaten, Lars Borgquist, Jörgen Månsson, Christine Campbell, David Weller, Gé Donker, Knut Holtedahl, Victoria Hammersley, Frank Buntinx, Ranjan Parajuli
Přispěvatelé: RS: CAPHRI - R5 - Optimising Patient Care, Family Medicine
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Neoplasms
Colorectal cancer
Early diagnosis
Diagnostic accuracy
General practice
Family medicine
Primary Health Care
Abdominal pain
Medicine (General)
Constipation
FEATURES
General Practice
0302 clinical medicine
Prospective Studies
030212 general & internal medicine
Prospective cohort study
Medisinske Fag: 700::Klinisk medisinske fag: 750::Onkologi: 762 [VDP]
ASSOCIATION
medicine.anatomical_structure
Occult Blood
030220 oncology & carcinogenesis
Colonic Neoplasms
TESTS
medicine.symptom
Colorectal Neoplasms
Family Practice
Life Sciences & Biomedicine
Gastrointestinal bleeding
medicine.medical_specialty
REFERRALS
03 medical and health sciences
Medicine
General & Internal
Bloating
R5-920
General & Internal Medicine
Internal medicine
GENERAL-PRACTICE
medicine
Humans
VDP::Medisinske Fag: 700
Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806 [VDP]
Science & Technology
business.industry
Research
Cancer
medicine.disease
Allmänmedicin
VDP::Medical disciplines: 700
Abdomen
business
Zdroj: BMC Family Practice
BMC Family Practice, 22(1):148. BioMed Central Ltd
BMC Family Practice, Vol 22, Iss 1, Pp 1-13 (2021)
Holtedahl, K, Borgquist, L, Donker, G A, Buntinx, F, Weller, D, Campbell, C, Månsson, J, Hammersley, V, Braaten, T & Parajuli, R 2021, ' Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer : a prospective cohort study of diagnostic accuracy in primary care ', BMC Family Practice, vol. 22, no. 1, pp. 148 . https://doi.org/10.1186/s12875-021-01452-6
ISSN: 1471-2296
DOI: 10.1186/s12875-021-01452-6
Popis: Background In an abdominal symptom study in primary care in six European countries, 511 cases of cancer were recorded prospectively among 61,802 patients 16 years and older in Norway, Denmark, Sweden, Netherlands, Belgium and Scotland. Colorectal cancer is one of the main types of cancer associated with abdominal symptoms; hence, an in-depth subgroup analysis of the 94 colorectal cancers was carried out in order to study variation in symptom presentation among cancers in different anatomical locations. Method Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. Follow-up data were provided by the GP after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. Fisher’s exact test was used to analyse differences between groups. Results Almost all symptoms recorded could indicate colorectal cancer. ‘Rectal bleeding’ had a specificity of 99.4% and a PPV of 4.0%. Faecal occult blood in stool (FOBT) or anaemia may indicate gastrointestinal bleeding: when these symptoms and signs were combined, sensitivity reached 57.5%, with 69.2% for cancer in the distal colon. For proximal colon cancers, none of 18 patients had ‘Rectal bleeding’ at the initial consultation, but three of the 18 did so at a later consultation. ‘Abdominal pain, lower part’, ‘Constipation’ and ‘Distended abdomen, bloating’ were less specific and also less sensitive than ‘Rectal bleeding’, and with PPV between 0.7% and 1.9%. Conclusions Apart from rectal bleeding, single symptoms did not reach the PPV 3% NICE threshold. However, supplementary information such as a positive FOBT or persistent symptoms may revise the PPV upwards. If a colorectal cancer is suspected by the GP despite few symptoms, the total clinical picture may still reach the NICE PPV threshold of 3% and justify a specific referral.
Databáze: OpenAIRE
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