Suspected Cancer: Recognition and Referral

Excerpt

Cancer is an important condition, both in terms of the number of people affected and the impacts on those people and the people close to them. Around one third of a million new cancers are diagnosed annually in the UK, across over 200 different cancer types. Each of these cancer types has different presenting features, though there may be overlap. More than one third of the population will develop a cancer in their lifetime. Although there have been large advances in treatment and survival, with a half of cancer sufferers now living at least ten years after diagnosis, it remains the case that more than a quarter of all people alive now will die of cancer.

It is generally believed that early diagnosis of cancer is beneficial. However, this is quite difficult to prove scientifically, in part because the natural course of cancer, and of its symptoms, is imperfectly understood. The benefit from earlier diagnosis is usually thought of in terms of survival - with most people considering the chance of surviving their cancer to be higher the earlier it is diagnosed, as the cancer will have had less time to spread. There may be other benefits from expediting diagnosis, such as relief of symptoms. These factors have underpinned many initiatives in the UK and other countries aimed at improving cancer diagnosis. These include awareness campaigns, cancer screening, and better diagnosis of symptomatic cancer. There is also unwarranted variation in referral rates, investigation rates and clinical outcomes. This guideline, on the symptoms of possible cancer, seeks to improve cancer diagnosis.

This guideline is about people with symptoms, rather than about people in whom cancer is already suspected. It is increasingly recognised that selection of patients whose symptoms suggest cancer should be considered a primary care task, as the large majority of such patients present to a primary care clinician. As consideration of possible cancer typically occurs in primary care, evidence from primary care must inform the identification process. Previous approaches have relied mostly on evidence from secondary care, partly because evidence from primary care was lacking. More primary care evidence is now available.