Programme no. 236-OP
Professional Development
Symptoms, signs and tests: The general practitioner’s comprehensive approach towards a cancer diagnosis. Retrospective cohort study with prospective registration of cancer in general practice
Professor Knut Holtedahl1, Benedicte Iversen Scheel*2
1Department of General Practice, Institute of Community Medicine,UiT The Arctic University of Norway,Tromsø,Norway, 2Department of General Practice, Institute of Community Medicine,UiT The Arctic University of Norway,Tromsø,Norway
* = Presenting author
Objectives: To study the relative importance of different tools a GP can use during the diagnostic process towards cancer detection.
Background: Early diagnosis of cancer is an important challenge in general practice. Some common symptoms are known to be alarm symptoms for cancer, but information from further clinical work is necessary to strengthen or weaken a suspicion about cancer.
Results: In 78% of 263 cancer cases, symptoms, signs or tests helped diagnose cancer. In 90 cases there were 131 consultation-recorded WSC that seemed related to the cancer. Another 74 cases had additional symptoms before diagnosis, 74 WSC and 33 lower risk symptoms. Different clinical signs were noted in 41 patients, 16 of whom had no previous recording of symptom. Supplementary tests added information in 59 cases, in 25 of these there were no recordings of symptoms or signs. Sensitivity of any cancer relevant symptom or clinical finding ranged from 100% for patients with uterine body cancer to 57% for patients with renal cancer.
Material/Methods:

Retrospective cohort study with prospective registration of cancer in general practice. During ten consecutive days, 157 Norwegian GPs registered all patient consultations and recorded any presence of seven focal symptoms and three general symptoms, commonly considered as warning signs of cancer (WSC). Follow-up was done 6 to 11 months later. For each patient with new or recurrent cancer, the GP completed a questionnaire with medical record-based information about the diagnostic procedure.

Conclusion:

WSC had a major role as initiator of a cancer diagnostic procedure. Low-risk-but-not-no-risk symptoms also played an important role, and in seven percent of patients they were the only symptoms. Clinical findings and/or supplementary procedures were sometimes decisive for rapid referral.

Points for discussion: From your point of view as a GP, what are the most important elements in a diagnostic process/pathway towards the cancer?