Background
Methods
Initial registrations
Follow-up
Statistics
Results
The most predominant abdominal symptoms recorded
All cancer (N = 511) | Colorectal cancer (N = 94) | Colon (N = 65) | Proximal part of colon (N = 18) | Distal part of colon (N = 26) | Rectum (N = 29) | |||||
---|---|---|---|---|---|---|---|---|---|---|
at consultation | at consultation | at consultation | after consultationa | at consultation | after consultationa | at consultation | after consultationa | at consultation | after consultationa | |
Patient sex (Male / Female) | 231/280 | 35/59 | 22/43 | 5/13 | 9/16 | 13/16 | ||||
Patient age (Median / Mean / Range) | 71/69/28–96 | 75/71/39–92 | 73/71/39–92 | 75/70/49–86 | ||||||
New < 180 days / New > 180 days / Recurrent | 307/134/ 70 | 55/25/14 | 37/20/8 | 18/5/6 | ||||||
Abdominal symptoms | ||||||||||
Abdominal pain, upper part | 45 | 14 | 9 | 13 | 3 | 5 | 3 | 6 | 5 | |
Abdominal pain, lower part | 37 | 14 | 9 | 15 | 3 | 5 | 3 | 8 | 5 | |
Constipation | 22 | 13 | 7 | 6 | 2 | 1 | 2 | 2 | 6 | 2 |
Diarrhea | 16 | 10 | 5 | 4 | 4 | 2 | 5 | 3 | ||
Distended abdomen, bloating | 27 | 12 | 7 | 4 | 5 | |||||
Increased belching, flatulence | 17 | 6 | 3 | 1 | 1 | 3 | ||||
Acid regurgitation | 14 | 5 | 1 | 1 | 4 | |||||
Rectal bleeding | 18 | 16 | 8 | 13 | 3 | 6 | 6 | 8 | 8 | |
Unexpected genital bleeding | 4 | |||||||||
Haematuria, macroscopic | 7 | |||||||||
Increased urinary frequency | 14 | 2 | 1 | 1 | 1 | |||||
Other abdominal problems | 34 | 6 | 5 | 2 | 2 | 2 | 1 | |||
Only one abdominal symptom | 66 | 21 | 13 | 11 | 2 | 3 | 7 | 2 | 8 | 5 |
More than one abdominal symptom | 63 | 23 | 13 | 17 | 3 | 5 | 7 | 8 | 10 | 2 |
Any abdominal symptom | 129 (25%) | 44 (47%) | 26 (40%) | 28 | 5 | 8 | 14 | 10 | 18 (62%) | 7 |
No symptom recorded | 382 | 50 | 39 | 11 | 13b | 5 | 11b | 1 | 11 | 4 |
Non-specific symptoms (given at least one abdominal symptom) | ||||||||||
Lack of appetite | 26 | 10 | 7 | 3 | 1 | 1 | 3 | 1 | 3 | |
Unusual tiredness | 25 | 9 | 6 | 3 | 1 | 1 | 2 | 1 | 3 | 1 |
Involuntary weight loss | 18 | 6 | 3 | 7 | 3 | 3 | 2 | 3 | 3 | |
Only one general symptom | 24 | 5 | 4 | 6 | 1 | 3 | 1 | 1 | 1 | 2 |
More than one general symptom | 19 | 9 | 6 | 3 | 1 | 1 | 4 | 1 | 3 | 1 |
Any general symptom | 43 (33%) | 14 (32%) | 10 (38%) | 9 | 2 | 4 | 5 | 2 | 4 (22%) | 3 |
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 | |
Colorectal cancer | 94 | 35 | 59 | 17.0% | 10.8–25.9 | 4.0% | 2.5–6.4 | 2.0% | 5.1% | 39.4% | 30.1–49.5 | 47.9% | 38.1–57.9 | 57.5% | 47.4–67.0% |
A | 16 | 3 | 13 | ||||||||||||
B | 37 | 13 | 24 | ||||||||||||
Colon cancer | 65 | 22 | 43 | 12.3% | 6.4–22.5 | 2.0% | 1.0–4.0 | 0.7% | 2.8% | 32.3% | 22.2–44.4 | 41.5% | 30.4–53.7 | 55.4% | 43.3–66.8 |
A | 8 | 1 | 7 | ||||||||||||
B | 21 | 6 | 15 | ||||||||||||
Colon, proximal cancer | 18 | - | - | 16.7% | 5.8–39.2 | 22.2% | 9.0–45.2 | 38.9% | 20.3–61.4 | ||||||
A | 0 | ||||||||||||||
B | 3 | 1 | 2 | ||||||||||||
Colon, distal cancer | 26 | 23.1% | 11.0–42.1 | 1.5% | 0.7–3.3 | - | 2.4% | 46.2% | 28.8–64.5 | 57.7% | 39.0–74.5 | 69.2% | 50.0–83.5 | ||
A | 6 | 0 | 6 | ||||||||||||
B | 12 | 1 | 11 | ||||||||||||
Rectal cancer | 29 | 13 | 16 | 27.6% | 14.7–25.7 | 2.0% | 1.0–4.0 | 1.3% | 2.4% | 55.2% | 37.6–71.6 | 62.1% | 44.0–77.3 | 62.1% | 44.0–77.3 |
A | 8 | 2 | 6 | ||||||||||||
B | 16 | 7 | 9 | ||||||||||||
Colorectal cancer (A), specificity: | Specificity 99.4% (95% CI 99.3–99.4), based on 385 patients with 'Rectal bleeding' without cancer, and 60,777 patients with no 'Rectal bleeding' and no cancer |
Colorectal cancer | A | B | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N | Sensitivity | Specificity | PPV | Sensitivity | |||||||
All | Males | Females | All | 95% CI | 95% CI | All | 95% CI | All | 95% CI/Location | ||
Abdominal pain, lower part' | 94 | 35 | 59 | 14.9% | 9.1–23.5 | 96.6% | 96.4–96.7 | 0.7% | 0.4–1.1 | 30.9% | 22.4–40.8 |
'Abdominal pain, lower part' and cancer (A): | 14 | 6 | 8 | ||||||||
'Abdominal pain, lower part' and cancer (B): | 29 | 13 | 16 | 8 proximal, 11 distal, 5 unspecified, 5 rectal | |||||||
'Abdominal pain, lower part', without cancer: 2084 patients | |||||||||||
No abdominal pain, lower part, no cancer: 59,078 patients | |||||||||||
'Constipation' | 13.8% | 8.3–22.2 | 98.9% | 98.8–99.0 | 1.9% | 1.1–3.2 | 22.3% | 15.1–31.8 | |||
'Constipation' and cancer (A): | 13 | 5 | 8 | ||||||||
'Constipation' and cancer (B): | 21 | 7 | 14 | 3 proximal, 4 distal, 6 unspecified, 8 rectal | |||||||
'Constipation', without cancer: 676 patients | |||||||||||
No constipation, no cancer: 60,486 patients | |||||||||||
'Distended abdomen, bloating' | 12.8% | 7.5–21.0 | 98.4% | 98.3–98.5 | 1.2% | 0.7–2.0 | 12.8% | 7.5–21.0 | |||
'Distended abdomen, bloating', and cancer (A): | 12 | 6 | 6 | ||||||||
'Distended abdomen, bloating', and cancer (B): | 12 | 6 | 6 | 1 proximal, 4 distal, 2 unspecified, 5 rectal | |||||||
'Distended abdomen, bloating', without cancer: 1011 patients | |||||||||||
No distended abdomen, bloating, no cancer: 60,151 patients |
The initiation of the diagnostic process
Type of referral / Location of cancer | Colon Cancer | Rectal cancer | ||
---|---|---|---|---|
Proximal (n = 18) | Distal (n = 26) | Unspecified (n = 21) | (n = 29) | |
A. Symptomatic patients (Colon 57, rectum 28) | ||||
PC, ordinary referral (Colon 24, Rectum 13) | 5 | 12 | 7 | 13 |
PC, fast track referral (Colon 17, Rectum 11) | 4 | 7 | 6 | 11 |
PC, urgent referral (Colon 12, Rectum 3) | 5 | 2 | 5 | 3 |
SC, no referral (Colon 4, Rectum 1)) | 2 | 2 | 1 | |
B. Asymptomatic patients (Colon 8, Rectum 1) | ||||
Screening (Colon 2, Rectum 1) | 2 | 1 | ||
Incidentally (Colon 5) | 2 | 1 | 2 | |
Do not know (Colon 1) | 1 |
The diagnostic role of the GP’s clinical examination, laboratory tests and diagnostic procedures, performed or ordered by the GP, and the seriousness of disease
Colon cancer (n = 65) | Proximal location (n = 18) | Distal location (n = 26) | Unspecified (n = 21) | Rectal cancer (n = 29) | |
---|---|---|---|---|---|
Clinical examination | |||||
Abdominal examination | 19 (29.2%) | 4 (22.2%) | 7 (26.9%) | 8 (38.1%) | 10 (34.5%) |
Digital rectal examination | 13 (20.0%) | 1 (5.6%) | 7 (26.9%) | 5 (23.8%) | 11 (37.9%) |
Gynecological examination | 1 | 1 | 1 | ||
Proctoscopy/sigmoidoscopy | 10 (15.4%) | 1 (5.6%) | 6 (23.1%) | 3 (14.3%) | 5 (17.2%) |
Other examination | 5 | 3 | 2 | 2 | |
No diagnostic contribution from clinical examination | 29 (44.6%) | 11 (61.1%) | 10 (38.5%) | 8 (38.1%) | 10 (34.5%) |
Missing | 4 | 2 | 1 | 1 | 1 |
Laboratory tests | |||||
Haemoglobin concentration | 17 (26.2%) | 5 (27.8%) | 5 (19.2%) | 7 (33.3%) | 2 (6.9%) |
Erythrocyte Sedimentation rate | 5 | 2 | 3 | 1 | |
C-Reactive Protein | 7 | 2 | 2 | 3 | 2 |
Test for occult blood in stool | 17 (26.2%) | 1 (5.6%) | 8 (30.8%) | 8 (38.1%) | 4 (13.8%) |
Cervical cytology | 0 | 0 | |||
Prostate Specific Antigen | 0 | 0 | |||
Urinary examination | 0 | 0 | |||
Other | 3 | 3 | 2 | ||
No diagnostic contribution from laboratory tests | 29 (44.6%) | 10 (55.6%) | 13 (50.0%) | 6 (28.6%) | 18 (62.1%) |
Missing | 5 | 1 | 2 | 2 | 3 |
Diagnostic procedures | |||||
X-ray | 4 | 1 | 2 | 1 | 1 |
Ultrasound | 2 | 2 | 1 | ||
Computer tomography | 20 (30.8%) | 7 (38.9%) | 6 (23.1%) | 7 (33.3%) | 5 (17.2%) |
Magnetic resonance | 1 | 1 | 4 | ||
Upper GI Endoscopy | 0 | 0 | |||
Coloscopy | 47 (72.3%) | 13 (72.2%) | 19 (73.1%) | 15 (71.4%) | 20 (69.0%) |
Cystoscopy | 0 | 0 | |||
Other | 2 | 1 | 1 | 3 | |
None of the above procedures | 6 (9.2%) | 2 (11.1%) | 3 (11.5%) | 1 (4.8%) | 1 (3.4%) |
Missing | 2 | 1 | 1 | 1 |
Colon cancer (n = 65) | Stage | ||||
At consultation | After consultation | Localised(n = 29) | Locally advanced(n = 18) | Distant metastases (n = 10) | Unknown or Missing(n = 8) |
No symptoms | No symptoms | 3 | 2 | 2 | 4 |
No symptoms | 1–2 symptoms | 13 | 9 | 2 | 3 |
1–2 symptoms | No symptoms | 6 | 3 | 2 | 1 |
1–2 symptoms | 1–2 symptoms | 1 | 1 | ||
3 + symptoms | No symptoms | 4 | 4 | 3 | |
3 + symptoms | 1–2 symptoms | 2 | |||
Rectal cancer (n = 29) | Stage | ||||
At consultation | After consultaton | Localised(n = 10) | Locally advanced(n = 8) | Distant metastases (n = 9) | Unknown or Missing(n = 2) |
No symptoms | No symptoms | 1 | 1 | 2 | 1 |
No symptoms | 1–2 symptoms | 3 | 1 | 2 | 1 |
1–2 symptoms | No symptoms | 2 | 3 | 2 | |
1–2 symptoms | 1–2 symptoms | 1 | 1 | ||
3 + symptoms | No symptoms | 2 | 2 | 2 | |
3 + symptoms | 1–2 symptoms | 1 | 1 |