Abdominal symptoms and cancer in the abdomen: prospective cohort study in European primary care

Abstract

Background: Different abdominal symptoms may signal cancer, but their role is unclear.

Aim: To examine associations between abdominal symptoms and subsequent cancer diagnosed in the abdominal region.

Design and setting: Prospective cohort study comprising 493 GPs from surgeries in Norway, Denmark, Sweden, Scotland, Belgium, and the Netherlands.

Method: Over a 10-day period, the GPs recorded consecutive consultations and noted: patients who presented with abdominal symptoms pre-specified on the registration form; additional data on non-specific symptoms; and features of the consultation. Eight months later, data on all cancer diagnoses among all study patients in the participating general practices were requested from the GPs.

Results: Consultations with 61 802 patients were recorded and abdominal symptoms were documented in 6264 (10.1%) patients. Malignancy, both abdominal and non-abdominal, was subsequently diagnosed in 511 patients (0.8%). Among patients with a new cancer in the abdomen (n = 251), 175 (69.7%) were diagnosed within 180 days after consultation. In a multivariate model, the highest sex- and age-adjusted hazard ratio (HR) was for the single symptom of rectal bleeding (HR 19.1, 95% confidence interval = 8.7 to 41.7). Positive predictive values of >3% were found for macroscopic haematuria, rectal bleeding, and involuntary weight loss, with variations according to age and sex. The three symptoms relating to irregular bleeding had particularly high specificity in terms of colorectal, uterine, and bladder cancer.

Conclusions: A patient with undiagnosed cancer may present with symptoms or no symptoms. Irregular bleeding must always be explained. Abdominal pain occurs with all types of abdominal cancer and several symptoms may signal colorectal cancer. The findings are important as they influence how GPs think and act, and how they can contribute to an earlier diagnosis of cancer.

Keywords: cancer; early diagnosis; general practice; proportional hazard models; symptoms.

Figure 1.

Inclusion and exclusion of patients with cancer. ^aMost patients had a histological verification. The few remaining patients had other convincing evidence of cancer. ^bOne patient had two new cancers, colon cancer (counted here), plus squamous cell carcinoma of lung discovered in hospital. Lung cancer discovered incidentally during work-up. ^cOne patient had one new (prostate) and one recurrent (bladder) cancer. The prostate cancer has been counted here, because this was the new cancer.