scholarly journals Symptoms and signs of colorectal cancer, with differences between proximal and distal colon cancer: a prospective cohort study of diagnostic accuracy in primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Knut Holtedahl ◽  
Lars Borgquist ◽  
Gé A. Donker ◽  
Frank Buntinx ◽  
David Weller ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Rectal Bleeding ◽  
Occult Blood ◽  
Distal Colon ◽  
Supplementary Information ◽  
Free Text ◽  
Persistent Symptoms ◽  
Abdominal Symptoms ◽  
Symptoms And Signs

Abstract Background In an abdominal symptom study in primary care in six European countries, 511 cases of cancer were recorded prospectively among 61,802 patients 16 years and older in Norway, Denmark, Sweden, Netherlands, Belgium and Scotland. Colorectal cancer is one of the main types of cancer associated with abdominal symptoms; hence, an in-depth subgroup analysis of the 94 colorectal cancers was carried out in order to study variation in symptom presentation among cancers in different anatomical locations. Method Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. Follow-up data were provided by the GP after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. Fisher’s exact test was used to analyse differences between groups. Results Almost all symptoms recorded could indicate colorectal cancer. ‘Rectal bleeding’ had a specificity of 99.4% and a PPV of 4.0%. Faecal occult blood in stool (FOBT) or anaemia may indicate gastrointestinal bleeding: when these symptoms and signs were combined, sensitivity reached 57.5%, with 69.2% for cancer in the distal colon. For proximal colon cancers, none of 18 patients had ‘Rectal bleeding’ at the initial consultation, but three of the 18 did so at a later consultation. ‘Abdominal pain, lower part’, ‘Constipation’ and ‘Distended abdomen, bloating’ were less specific and also less sensitive than ‘Rectal bleeding’, and with PPV between 0.7% and 1.9%. Conclusions Apart from rectal bleeding, single symptoms did not reach the PPV 3% NICE threshold. However, supplementary information such as a positive FOBT or persistent symptoms may revise the PPV upwards. If a colorectal cancer is suspected by the GP despite few symptoms, the total clinical picture may still reach the NICE PPV threshold of 3% and justify a specific referral.

scholarly journals Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study

2020 ◽  
Vol 35 (11) ◽  
pp. 2035-2040
Author(s):  
Cecilia Högberg ◽  
Ulf Gunnarsson ◽  
Olof Cronberg ◽  
Hans Thulesius ◽  
Mikael Lilja ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Rectal Bleeding ◽  
Predictive Value ◽  
Primary Care Physicians ◽  
Occult Blood ◽  
Health Records ◽  
Alarm Symptom ◽  
History Of ◽  
Patient’S History

Abstract Background Rectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC. Methods Results of all FITs requested in primary care for symptomatic patients in the Örebro region during 2015 were retrieved. Data on each patient’s history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden. Results A total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1–13.4) and negative predictive value 99.7% (95% CI 99.2–100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6–10.9) and 100% (95% CI 99.6–100). Conclusion The diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation.

Faecal immunochemical tests safely enhance rational use of resources during the assessment of suspected symptomatic colorectal cancer in primary care: systematic review and meta-analysis

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324856
Author(s):  
Noel Pin-Vieito ◽  
Coral Tejido-Sandoval ◽  
Natalia de Vicente-Bielza ◽  
Cristina Sánchez-Gómez ◽  
Joaquín Cubiella
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Primary Healthcare ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Use Of Resources ◽  
Abdominal Symptoms ◽  
Meta Regression Analysis ◽  
Reported Data ◽  
Triage Test

ObjectiveImplementation of faecal immunochemical tests (FIT) as a triage test in primary healthcare may improve the efficiency of referrals without missing cases of colorectal cancer (CRC). We aim to summarise the performance characteristics of FITs for CRC in symptomatic patients presenting to primary healthcare.DesignWe performed a systematic literature review of Medline and EMBASE databases from May 2018 to November 2020. Previous related systematic searches were also adapted to this aim and completed with reference screening. We identified studies performed on adult patients consulting for abdominal symptoms in primary care which reported data such that the FIT diagnostic performance parameters for CRC could be obtained. Bivariate models were used to synthesise available evidence. Meta-regression analysis was performed to evaluate the causes of heterogeneity.ResultsTwenty-three studies (69 536 participants) were included (CRC prevalence 0.3%–6.2%). Six studies (n=34 691) assessed FIT as rule in test (threshold of ≥150 µg Hb/g faeces) showing a sensitivity of 64.1% (95% CI 57.8% to 69.9%) and a specificity of 95.0% (95% CI 91.2% to 97.2%). A threshold of 10 µg/g (15 studies; n=48 872) resulted in a sensitivity of 87.2% (95% CI 81.0% to 91.6%) and a specificity of 84.4% (95% CI 79.4% to 88.3%) for CRC. At a 20 µg Hb/g faeces threshold (five studies; n=24 187) less than one additional CRC would be missed per 1000 patients investigated compared with 10 µg Hb/g faeces threshold (CRC prevalence 2%).ConclusionFIT is the test of choice to evaluate patients with new-onset lower gastrointestinal symptoms in primary healthcare.

scholarly journals Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer

2013 ◽  
Vol 31 (4) ◽  
pp. 209-214 ◽  
Author(s):  
Cecilia Högberg ◽  
Pontus Karling ◽  
Jörgen Rutegård ◽  
Mikael Lilja ◽  
Thomas Ljung
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Occult Blood ◽  
Faecal Occult Blood ◽  
Blood Tests ◽  
Faecal Occult

scholarly journals EXPRESS: Faecal haemoglobin concentration thresholds for reassurance and urgent investigation for colorectal cancer based on a faecal immunochemical test (FIT) in symptomatic patients in primary care.

2020 ◽  
pp. 000456322098554
Author(s):  
Craig Mowat ◽  
Jayne Digby ◽  
Judith A Strachan ◽  
Rebecca Katherine McCann ◽  
Francis A Carey ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Gastrointestinal Disease ◽  
Haemoglobin Concentration ◽  
Individual Risk ◽  
First Year ◽  
Faecal Immunochemical Test ◽  
Persistent Symptoms ◽  
Immunochemical Test ◽  
Hb Concentration

Background Faecal haemoglobin concentration (f-Hb), estimated using a faecal immunochemical test (FIT), can be safely implemented in primary care to assess risk of colorectal cancer (CRC). Clinical outcomes of patients presenting with symptoms of lower gastrointestinal disease were examined using an extensive range of f-Hb thresholds to decide on reassurance or referral for further investigation. Methods All patients who attended primary care and submitted a single faecal specimen FIT in the first year of the routine service had f-Hb estimated using HM-JACKarc: f-Hb thresholds from <2 to > 400 µg Hb/g faeces (µg/g) were examined. Results Low f-Hb thresholds of <2, <7, <10 and <20 µg/g gave respective CRC risks of 0.1, 0.3, 0.3 and 0.4%, numbers needed to scope (NNS) for one CRC of 871, 335, 300 and 249, and “false negative” rates of 2.9, 11.4, 13.3 and 17.1%. With thresholds of <2, <7, <10, and <20 µg/g, 48.6, 74.6, 78.1 and 83.2% respectively of symptomatic patients could be managed without further investigation. With reassurance thresholds of <2 µg/g, <7 µg/g and <10 µg/g, the thresholds for referral for urgent investigation would be >400 µg/g, >200 µg/g and >100 µg/g. However, patients with a f-Hb concentration of <10 or <20 µg/g with iron deficiency anaemia, or with severe or persistent symptoms, should not be denied further investigation. Conclusions In primary care, f-Hb, in conjunction with clinical assessment, can safely and objectively determine individual risk of CRC and decide on simple reassurance or urgent, or routine referral.

scholarly journals Colorectal cancer and rectal bleeding in primary care: Rectal bleeding needs attention in primary care

BMJ ◽  
2006 ◽  
Vol 333 (7560) ◽  
pp. 201.3
Author(s):  
Christopher M Newman ◽  
Guy F Nash ◽  
Tom Armstrong ◽  
Kieren Darcy
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Rectal Bleeding
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