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Fifth of emergency bowel cancer cases had red flag symptoms

GPs doing a good job but need better access to tools to support timely cancer diagnosis

Louise Prime

Thursday, 29 September 2016

GPs are doing a good overall job of appropriately referring people suspected of having cancer but they need better access to tools to support timely diagnosis, warned GP leaders as UK research revealed that about a fifth of bowel cancer patients diagnosed as emergencies had had ‘red flag’ symptoms.

The study,* published in the British Journal of Cancer and funded by Cancer Research UK, found that – as might be expected – ‘red flag’ symptoms were much more common in patients who were diagnosed via non-emergency routes, and that patients diagnosed as an emergency often did not display these symptoms strongly associated with bowel cancer.

However, the ‘emergency presenters’ had a similar background consultation history as non-emergency presenters. And although their tumours were generally associated with less typical symptoms, 17.5% of colon cancer patients and 23% of rectal cancer patients diagnosed as an emergency had had red flag symptoms.

Cristina Renzi, lead researcher, Cancer Research UK scientist at University College London, pointed out that most emergency presenters visited their doctor for various reasons, multiple times during the months leading up to their diagnosis, which could mean there had been opportunities to diagnose the cancer earlier. She said: “It’s important to find ways to ensure these patients can be diagnosed at an early stage. And this study highlights the need to support GPs and give them the tools to diagnose and refer patients promptly when they feel it’s necessary.”

The Royal College of GPs’ cancer lead Dr Richard Roope said: “Bowel cancer can be difficult to diagnose in primary care, particularly as many of its symptoms can be quite vague and could also indicate more common conditions, or may not be visible or obviously related to the initial reason a patient might be visiting his or her GP. 

“Nevertheless, GPs are doing a good job of appropriately referring our patients that we suspect of having cancer – 75% of patients found to have cancer are referred after only one or two GP consultations.”

But he welcomed Cancer Research UK’s call for GPs to have better access to tools to enable them to make earlier diagnoses. He said: “This would mean we are able to refer even more patients appropriately, avoiding unnecessary distress for our patients and alleviating pressures on secondary care.” He pointed out that the College has already developed several comprehensive toolkits to support GPs and others to diagnose cancer earlier, and treat patients with cancer at all stages.

He added: “Many GPs are currently undertaking an audit of their cancer diagnoses, to establish any factors that may have contributed to a delay in diagnosis. In doing so it is hoped that we can improve further both the timeliness of referrals and the care we offer our patients.


* Renzi C, Lyratzopoulos G, Card T, et al. Do colorectal cancer patients diagnosed as an emergency differ from non-emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage study in England. Br J Cancer 2016; 115; 866–875. doi:10.1038/bjc.2016.250.

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