Patel K, Doulias T, Hoad T, Lee C, Alberts J C
West Suffolk NHS Foundation Trust , UK.
Ann R Coll Surg Engl. 2016 May;98(5):308-13. doi: 10.1308/rcsann.2016.0123. Epub 2016 Mar 29.
Colorectal cancer in patients younger than 50 years of age is increasing steadily in the UK with limited guidelines available indicating need for secondary care referral. The aims of this study were to report the cancer incidence in those aged under 50 years referred to secondary care with suspected colorectal malignancy and also to analyse the quality of those referrals.
A total of 197 primary care referrals made between 2008 and 2014 to a UK district general hospital for suspected colorectal malignancy were analysed. All confirmed cancers were further evaluated regarding presenting symptoms, tumour characteristics and clinical outcomes. Each referral was given a referral performance score (out of 9) dependant on relevant information documented.
The overall malignancy rate was 9.1% (11 male and 7 female patients). The median age in this cohort was 41.5 years (interquartile range [IQR]: 37-49 years). Abdominal pain was the only presenting symptom to differ significantly when comparing malignant with non-malignant patients (44.4% vs 21.8% respectively, p=0.042). The median time period between referral date and colorectal specialist consultation was 11 days (IQR: 7-13 days) and the median referral performance score was 5 (range: 3-9).
Malignancy is prevalent in patients under 50 years of age who are referred to secondary care for suspected colorectal cancer. Those referred with abdominal pain in the presence of other high risk lower gastrointestinal symptoms are at significant risk of having a malignancy. Major deficiencies are apparent in urgent primary care referrals, highlighting the need for further national guidance to aid early diagnosis of colorectal cancer in the young.
在英国，50岁以下患者的结直肠癌发病率正在稳步上升，但可用的指南有限，这表明需要进行二级护理转诊。本研究的目的是报告因疑似结直肠恶性肿瘤而转诊至二级护理的50岁以下患者的癌症发病率，并分析这些转诊的质量。
对2008年至2014年间转诊至英国一家地区综合医院疑似结直肠恶性肿瘤的197例初级护理转诊病例进行了分析。对所有确诊的癌症患者进一步评估其症状表现、肿瘤特征和临床结果。根据记录的相关信息，为每次转诊给出一个转诊表现评分（满分9分）。
总体恶性肿瘤发生率为9.1%（11例男性患者和7例女性患者）。该队列的中位年龄为41.5岁（四分位间距[IQR]：37 - 49岁）。在比较恶性肿瘤患者和非恶性肿瘤患者时，腹痛是唯一有显著差异的症状表现（分别为44.4%和21.8%，p = 0.042）。从转诊日期到结直肠专科会诊的中位时间为11天（IQR：7 - 13天），转诊表现评分的中位数为5分（范围：3 - 9分）。
因疑似结直肠癌转诊至二级护理的50岁以下患者中，恶性肿瘤较为普遍。伴有腹痛及其他高危下消化道症状的转诊患者患恶性肿瘤的风险显著增加。紧急初级护理转诊中存在明显不足，这凸显了需要进一步的国家指南来帮助早期诊断年轻人的结直肠癌。
