Department of Community Medicine, UiT The Arctic University of Norway, Norway.
Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Denmark.
Br J Gen Pract. 2018 May;68(670):e301-e310. doi: 10.3399/bjgp18X695777. Epub 2018 Apr 9.
Different abdominal symptoms may signal cancer, but their role is unclear.
To examine associations between abdominal symptoms and subsequent cancer diagnosed in the abdominal region.
Prospective cohort study comprising 493 GPs from surgeries in Norway, Denmark, Sweden, Scotland, Belgium, and the Netherlands.
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.
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 ( = 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.
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.
不同的腹部症状可能提示癌症，但它们的作用尚不清楚。
检查腹部症状与随后在腹部诊断出的癌症之间的关联。
这是一项包含来自挪威、丹麦、瑞典、苏格兰、比利时和荷兰的外科医生的 493 名全科医生的前瞻性队列研究。
在为期 10 天的时间里，全科医生记录了连续就诊的情况，并记录了：在登记表格上预先指定的出现腹部症状的患者；非特异性症状的其他数据；以及就诊的特点。8 个月后，向参与的全科医生请求了所有研究患者在参与的普通科室中所有癌症诊断的数据。
记录了 61802 次就诊，6264 名（10.1%）患者记录了腹部症状。随后在 511 名患者（0.8%）中诊断出恶性肿瘤，无论是腹部还是非腹部。在新诊断为腹部癌症的患者中（=251），175 名（69.7%）在就诊后 180 天内被诊断。在多变量模型中，单一症状直肠出血的性别和年龄调整后的最高危险比（HR）为 19.1（95%置信区间=8.7 至 41.7）。宏观血尿、直肠出血和非自愿体重减轻的阳性预测值>3%，且根据年龄和性别存在差异。与不规则出血相关的三个症状在结直肠癌、子宫癌和膀胱癌方面具有特别高的特异性。
未确诊癌症的患者可能出现症状或无症状。不规则出血必须始终得到解释。腹痛发生在所有类型的腹部癌症中，几种症状可能提示结直肠癌。这些发现很重要，因为它们会影响全科医生的思维和行为方式，以及他们如何为癌症的早期诊断做出贡献。
