Background
Methods
Initial registrations
Follow-up
Statistics
Results
All cancer (N = 511) | Urogenital cancer (N = 134) | Bladder (N = 30) | Renal (N = 16) | Prostate (N = 56) | Cervix uteri (N = 10) | Corpus uteri (N = 14) | Ovary (N = 8) | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
at consultation | at consultation | at consultation | after consultation 1 | at consultation | after consultation 1 | at consultation | after consultation 1 | at consultation | after consultation 1 | at consultation | after consultation 1 | at consultation | after consultation 1 | |
Patient sex (Male / Female) | 231 / 280 | 92/42 | 23/7 | 13/3 | 56/0 | 0 / 10 | 0 / 14 | 0 / 8 | ||||||
Patient age (Median / Mean / Range) | 71 / 69 / 28–96 | 71/69/28–94 | 76/73/42–88 | 64/63/42–89 | 75/73/53–94 | 44 / 50 / 28–73 | 71 / 69 /55–82 | 64 / 68 / 48–87 | ||||||
New < 180 days / New > 180 days / Recurrent | 307/ 134/ 70 | 80/34/20 | 17/8/5 | 12/2/2 | 33/17/6 | 6 / 1 / 3 | 8 / 3 / 3 | 4 / 3 / 1 | ||||||
Abdominal symptoms | ||||||||||||||
Abdominal pain, upper part | 45 | 6 | 2 | 2 | 2 | 1 | 1 | |||||||
Abdominal pain, lower part | 37 | 8 | 1 | 1 | 2 | 1 | 3 | 1 | 1 | 1 | ||||
Constipation | 22 | 3 | 1 | 1 | 2 | |||||||||
Diarrhoea | 16 | 2 | 1 | 1 | 1 | |||||||||
Distended abdomen, bloating | 27 | 4 | 1 | 1 | 2 | 3 | ||||||||
Increased belching, flatulence | 17 | 2 | 1 | 1 | ||||||||||
Acid regurgitation | 14 | 2 | 1 | 1 | ||||||||||
Rectal bleeding | 18 | 0 | ||||||||||||
Unexpected genital bleeding | 4 | 4 | 1 | 1 | 3 | 7 | ||||||||
Haematuria, macroscopic 2 | 7 | 6 | 4 | 5 | 1 | 3 | 0 | 2 | 1 | 1 | ||||
Increased urinary frequency | 14 | 6 | 2 | 2 * | 3 | 16 * | 1 | |||||||
Other abdominal problems | 34 | 5 | 1 | 3 | 1 ** | 1 ^ | 1 | |||||||
Only one abdominal symptom | 66 | 4 | 2 | 8 | 2 | 2 | 3 | |||||||
More than one abdominal symptom | 63 | 2 | 2 | 3 | 0 | 2 | 1 | |||||||
Any abdominal symptom | 129 (25%) | 6 (20%) | 4 (25%) | 11 (20%) | 2 (20%) | 4 (29%) | 4 (50%) | |||||||
No symptom recorded | 382 | 24 | 12 | 45 | 8 | 10 | 4 | |||||||
Non-specific symptoms (given at least one abdominal symptom) | ||||||||||||||
Lack of appetite | 26 | 3 | 1 | 1 | 1 | |||||||||
Unusual tiredness | 25 | 6 | 2 | 1 | 2 | 1 | ||||||||
Involuntary weight loss | 18 | 2 | 1 | 2 | 1 | |||||||||
Only one general symptom | 24 | 1 | 1 | 1 | 2 | |||||||||
More than one general symptom | 19 | 1 | 1 | 1 | ||||||||||
Any general symptom | 43 (33%) | 1 | 2 | 1 | 0 | 2 | 2 |
The most predominant abdominal symptoms recorded
N | Sensitivity (A) | PPV (A) | Sensitivity (B) | Sensitivity (C) | Sensitivity (D) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
All | Males | Females | All | 95% CI | All | 95% CI | Males | Females | All | 95% CI | All | 95% CI | All | 95% CI | |
Bladder or renal cancer combined | 46 | 36 | 10 | ||||||||||||
Macroscopic haematuria and cancer (A): | 5 | 4 | 1 | 10.9% | 4.7–23.0 | 3.4% | 1.5–7.7 | 4.9% | 1.5% | ||||||
Macroscopic haematuria and cancer (B): | 13 | 11 | 2 | 28.3% | 17.3–42.6 | 56.5% | 42.2–69.8 | 60.9% | 46.5–73.6 | ||||||
Bladder cancer | 30 | 23 | 7 | ||||||||||||
Macroscopic haematuria and cancer (A): | 4 | 3 | 1 | 13.3% | 5.3–29.7 | 2.7% | 1.1–7.0 | 3.8% | 1.5% | ||||||
Macroscopic haematuria and cancer (B): | 9 | 7 | 2 | 30.0% | 16.7–47.9 | 63.3% | 45.5–78.1 | 66.7% | 48.8–80.1 | ||||||
Increased urinary frequency (A) | 2 | 1 | 1 | 6.7% | 1.9–21.3 | < 0.1% | |||||||||
Increased urinary frequency (B) | 4 | 3 | 1 | 13.3% | 5.3–29.7 | ||||||||||
Renal cancer | 16 | 13 | 3 | ||||||||||||
Macroscopic haematuria and cancer (A) | 1 | 1 | 0 | 6.3% | 1.1–28.3 | 0.7% | 0.1–3.8 | 1.3% | |||||||
Macroscopic haematuria and cancer (B) | 4 | 4 | 0 | 25.0% | 10.2–49.5 | 43.8% | 23.1–66.8 | 50.0% | 28.0–72.0 | ||||||
Prostate cancer | 56 | ||||||||||||||
Macroscopic haematuria and cancer (A) | 0 | - | - | ||||||||||||
Macroscopic haematuria and cancer (B) | 2 | 3.6% | 1.0–12.1 | 5.4% | 1.8–14.6 | ||||||||||
Increased urinary frequency (A) | 2 | 3.6% | 1.0–12.1 | < 0.1% | |||||||||||
Increased urinary frequency (B) | 18 | 32.1% | 21.4–45.2 | ||||||||||||
Uterine body cancer | 14 | ||||||||||||||
Macroscopic haematuria and cancer (A) | 1 | 7.1% | 1.3–31.5 | 0.7% | 0.1–3.8 | 1.5% | |||||||||
Macroscopic haematuria and cancer (B) | 2 | 14.3% | 4.0–40.0 | ||||||||||||
'Increased urinary frequency' and cancer (A) | 1 | 7.1% | 1.3–31.5 | < 0.1% | |||||||||||
'Increased urinary frequency' and cancer (B) | 2 | 14.3% | 4.0–40.0 |
N | Sensitivity (A) | Specificity | PPV | Sensitivity (B) | |||||
---|---|---|---|---|---|---|---|---|---|
Females | All | 95% CI | 95% CI | All | 95% CI | All | 95% CI | ||
Cervical cancer | 10 | ||||||||
'Unexpected genital bleeding' and cancer (A): | 1 | 10.0% | 8.6–28,6 | < 0.1% | |||||
'Unexpected genital bleeding' and cancer (B): | 2 | 20.0% | 4.8–44.8 | ||||||
'Unexpected genital bleeding, without cancer: 195 patients | |||||||||
No 'Unexpected genital bleeding, no cancer: 60,967 patients | 99.7% | 99.6–99.7 | |||||||
Uterine body cancer | 14 | ||||||||
'Unexpected genital bleeding' and cancer (A): | 3 | 21.4% | < 0.1–42.9 | 1.5% | 0.2–3.1 | ||||
'Unexpected genital bleeding' and cancer (B): | 10 | 71.4% | 47.8–95.1 |
The initiation of the diagnostic process
Location | Symptomatic | Asymptomatic | ||||
---|---|---|---|---|---|---|
PC, ordinary referral | PC, fast track referral | PC, urgent referral | SC, no referral | Screening | Incidentally | |
Bladder, ureter, urethra (30) | 12 | 7 | 5 | 3 | 3 | |
Symptomatic 27, Asymptomatic 3 | ||||||
Renal Cancer (16) | 8 | 1 | 3 | 2 | 2 | |
Symptomatic 14, Asymptomatic 2 | ||||||
Prostate (56) | 26 | 12 | 1 | 2 | 6 | 9 |
Symptomatic 41, Asymptomatic 15 | ||||||
Cervix uteri (10) | ||||||
Symptomatic 7, Asymptomatic 3 | 2 | 2 | 3 | 3 | ||
Corpus uteri (14) | ||||||
Symptomatic 14, Asymptomatic 0 | 7 | 3 | 3 | 1 | ||
Ovary (8) | ||||||
Symptomatic 7, Asymptomatic 1 | 3 | 4 | 1 |
The seriousness of disease
Type of cancer, with location | Clinical status at follow-up | Status after Fast track | Status after Urgent referral | ||||||
---|---|---|---|---|---|---|---|---|---|
Feeling well or stable disease | Progressive disease or dead | Unknown | Feeling well or stable disease | Progressive disease or dead | Unknown | Feeling well or stable disease | Progressive disease or dead | Unknown | |
Bladder (N = 30) | |||||||||
Localised: 16 (53%) | 14 (88%) | 1 (6%) | 1 | 3 | 1 | 1 | 1 | ||
Not localised: 11 (37%) | 9 (82%) | 2 (18%) | 2 | 1 | 2 | ||||
Unknown: 3 | 1 | 2 | 1 | ||||||
Kidney (N = 16) | |||||||||
Localised: 7 (44%) | 5 (71%) | 0 | 2 | 1 | 1 | 2 | |||
Not localised: 8 (50%) | 3 (38%) | 5 (63%) | |||||||
Unknown | 1 | ||||||||
Prostate (N = 56) | |||||||||
Localised: 31 (55%) | 26 (84%) | 1 (3%) | 5 | ||||||
Not localised: 18(32%) | 14 (78%) | 4 (22%) | 6 | 1 | |||||
Unknown 7 | 5 | 1 | 1 | 1 | |||||
Cervix uteri (N = 10) | |||||||||
Localised: 4 (40%) | 4 (100%) | 0 | 1 | ||||||
Not localised: 5 (50%) | 3 (60%) | 2 (40%) | 1 | 1 | 1 | ||||
Unknown: 1 | 1 | ||||||||
Corpus uteri (N = 14) | |||||||||
Localised: 10 (71%) | 9 (90%) | 1 (10%) | 3 | 3 | |||||
Not localised: 2 (14%) | 2 (100%) | 0 | |||||||
Unknown: 2 | 2 | ||||||||
Ovary (N = 8) | |||||||||
Localised: 4 (50%) | 4 (100%) | 0 | 3 | ||||||
Not localised: 4 (50%) | 1 (25%) | 3 (75%) | 1 |
The diagnostic role of the clinical examination, laboratory tests and diagnostic procedures ordered by the GP
Cancer site | ||||||
---|---|---|---|---|---|---|
Bladder, ureter, urethra | Renal | Prostate | Cervix uteri | Corpus uteri | Ovary | |
Clinical examination | ||||||
Abdominal examination | 3 (3) | 1 (1) | 1 (1) | 1 (1) | 5 (5) | |
Digital rectal examination | 1 (1) | 2 (2) | 27 (23) | |||
Gynecological examination | 1 (1) | 5 (3) | 5 (5) | 1 (1) | ||
Proctoscopy/sigmoidoscopy | ||||||
Other examination, not specified | 9 (8) | 4 (4) | 5 (4) | 2 (2) | ||
No contribution from clinical examination | 16 (14) | 9 (7) | 20 (11) | 3 (2) | 6 (6) | 3 (2) |
Missing | 3 (3) | 1 (1) | 4 (3) | 1 (1) | ||
Laboratory tests | ||||||
Haemoglobin concentration | 2 (1) | 2 (2) | 2 (2) | 1 (1) | ||
Erythrocyte Sedimentation rate | 1 (0) | 2 (2) | 1 (1) | 1 (0) | ||
C-Reactive Protein | 1 (0) | 1 (1) | 1 (1) | 1 (1) | ||
Test for occult blood in stool | 1 (1) | 1 (3) | ||||
Cervical cytology | 3 (1) | 1 (1) | ||||
Prostate Specific Antigen | 45 (32) | |||||
Urinary examination | 14 (14) | 8 (7) | 1 (1) | 1 (1) | ||
Other | 4 (3) | 3 (3) | 1 (1) | 1 (0) | 1 (1) | 1 (1)^^ |
No diagnostic contribution from laboratory tests | 10 (9) | 5 (4) | 6 (4) | 3 (3) | 9 (9) | 5 (4) |
Missing | 2 (2) | 4 (4) | 2 (2) | 1 (1) | 1 (1) | |
Diagnostic procedures | ||||||
X-ray | 1 (1) | 3 (2) | 1 (1) | |||
Ultrasound | 7 (7) | 2 (2) | 10 (5) | 4 (4) | 3 (3) | |
Computer tomography | 7 (5) | 13 (11) | 5 (4) | 1 (1) | 4 (4) | 5 (4) |
Magnetic resonance | 3 (3) | 8 (5) | 1 (1) | 1 (1) | ||
Upper GI Endoscopy | 1 (1) | |||||
Colonscopy | 1 (1) | |||||
Cystoscopy | 21 (18) | 3 (3) | 5 (4) | 1 (1) | ||
Other | 13 (7)* | 3 (1)** | 3 (3)^ | |||
None of the above | 1 (1) | 16 (12) | 4 (3) | 2 (2) | 1 (0) | |
Missing | 2 (2) | 11 (10) | 2 (2) | 2 (2) | 1 (1) | |
Number of patients | 30 | 16 | 56 | 10 | 14 | 8 |