Symptoms and signs of urogenital cancer in primary care.
Bladder cancer
Cervical cancer
General practice
Neoplasms
Ovarian cancer
Primary health care
Prostate cancer
Renal cancer
Urogenital cancer
Uterine body cancer
Journal
BMC primary care
ISSN: 2731-4553
Titre abrégé: BMC Prim Care
Pays: England
ID NLM: 9918300889006676
Informations de publication
Date de publication:
26 04 2023
26 04 2023
Historique:
received:
11
07
2022
accepted:
14
04
2023
medline:
28
4
2023
pubmed:
27
4
2023
entrez:
26
4
2023
Statut:
epublish
Résumé
Urogenital cancers are common, accounting for approximately 20% of cancer incidence globally. Cancers belonging to the same organ system often present with similar symptoms, making initial management challenging. In this study, 511 cases of cancer were recorded after the date of consultation among 61,802 randomly selected patients presenting in primary care in six European countries: a subgroup analysis of urogenital cancers was carried out in order to study variation in symptom presentation. Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. The general practitioner (GP) provided follow-up data after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients. The most common symptoms were mainly associated with one or two specific types of cancer: 'Macroscopic haematuria' with bladder or renal cancer (combined sensitivity 28.3%), 'Increased urinary frequency' with bladder (sensitivity 13.3%) or prostatic (sensitivity 32.1%) cancer, or to uterine body (sensitivity 14.3%) cancer, 'Unexpected genital bleeding' with uterine cancer (cervix, sensitivity 20.0%, uterine body, sensitivity 71.4%). 'Distended abdomen, bloating' had sensitivity 62.5% (based on eight cases of ovarian cancer). In ovarian cancer, increased abdominal circumference and a palpable tumour also were important diagnostic elements. Specificity for 'Macroscopic haematuria' was 99.8% (99.7-99.8). PPV > 3% was noted for 'Macroscopic haematuria' and bladder or renal cancer combined, for bladder cancer in male patients. In males aged 55-74, PPV = 7.1% for 'Macroscopic haematuria' and bladder cancer. Abdominal pain was an infrequent symptom in urogenital cancers. Most types of urogenital cancer present with rather specific symptoms. If the GP considers ovarian cancer, increased abdominal circumference should be actively determined. Several cases were clarified through the GP's clinical examination, or laboratory investigations.
Sections du résumé
BACKGROUND
Urogenital cancers are common, accounting for approximately 20% of cancer incidence globally. Cancers belonging to the same organ system often present with similar symptoms, making initial management challenging. In this study, 511 cases of cancer were recorded after the date of consultation among 61,802 randomly selected patients presenting in primary care in six European countries: a subgroup analysis of urogenital cancers was carried out in order to study variation in symptom presentation.
METHODS
Initial data capture was by completion of standardised forms containing closed questions about symptoms recorded during the consultation. The general practitioner (GP) provided follow-up data after diagnosis, based on medical record data made after the consultation. GPs also provided free text comments about the diagnostic procedure for individual patients.
RESULTS
The most common symptoms were mainly associated with one or two specific types of cancer: 'Macroscopic haematuria' with bladder or renal cancer (combined sensitivity 28.3%), 'Increased urinary frequency' with bladder (sensitivity 13.3%) or prostatic (sensitivity 32.1%) cancer, or to uterine body (sensitivity 14.3%) cancer, 'Unexpected genital bleeding' with uterine cancer (cervix, sensitivity 20.0%, uterine body, sensitivity 71.4%). 'Distended abdomen, bloating' had sensitivity 62.5% (based on eight cases of ovarian cancer). In ovarian cancer, increased abdominal circumference and a palpable tumour also were important diagnostic elements. Specificity for 'Macroscopic haematuria' was 99.8% (99.7-99.8). PPV > 3% was noted for 'Macroscopic haematuria' and bladder or renal cancer combined, for bladder cancer in male patients. In males aged 55-74, PPV = 7.1% for 'Macroscopic haematuria' and bladder cancer. Abdominal pain was an infrequent symptom in urogenital cancers.
CONCLUSIONS
Most types of urogenital cancer present with rather specific symptoms. If the GP considers ovarian cancer, increased abdominal circumference should be actively determined. Several cases were clarified through the GP's clinical examination, or laboratory investigations.
Identifiants
pubmed: 37101110
doi: 10.1186/s12875-023-02063-z
pii: 10.1186/s12875-023-02063-z
pmc: PMC10131418
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
107Informations de copyright
© 2023. The Author(s).
Références
Br J Gen Pract. 2007 May;57(538):371-6
pubmed: 17504587
Scand J Prim Health Care. 2015;33(3):170-7
pubmed: 26375323
BMJ. 2016 Nov 10;355:i5124
pubmed: 27834274
Lancet. 2016 Mar 12;387(10023):1094-1108
pubmed: 26354523
Scand J Prim Health Care. 2021 Dec;39(4):486-497
pubmed: 34889704
Adv Ther. 2019 Jul;36(7):1778-1785
pubmed: 31102201
Br J Gen Pract. 2011 Jan;61(582):43-6
pubmed: 21401991
Scand J Prim Health Care. 2021 Jun;39(2):230-239
pubmed: 34092179
Fam Pract. 1997 Feb;14(1):63-8
pubmed: 9061347
Br J Gen Pract. 2021 Dec 31;72(714):e19-e25
pubmed: 34903517
Fam Pract. 2013 Apr;30(2):153-60
pubmed: 23097250
Clin Chem. 2015 Dec;61(12):1446-52
pubmed: 26510957
Lancet. 2016 Jan 2;387(10013):70-82
pubmed: 26074382
BMJ. 2015 Sep 01;351:h4443
pubmed: 26328593
Br J Gen Pract. 2013 Sep;63(614):e643-8
pubmed: 23998845
Lancet Oncol. 2015 Sep;16(12):1231-72
pubmed: 26431866
CA Cancer J Clin. 2021 May;71(3):209-249
pubmed: 33538338
BMJ. 2011 Jul 06;343:d3954
pubmed: 21734165
Fam Pract. 2011 Dec;28(6):592-8
pubmed: 21632969
South Asian J Cancer. 2019 Oct-Dec;8(4):221-225
pubmed: 31807481
BMC Cancer. 2014 Mar 10;14:171
pubmed: 24612526
Eur J Cancer. 2013 Jun;49(9):2187-98
pubmed: 23453935
PLoS Med. 2021 Aug 2;18(8):e1003708
pubmed: 34339405
BMJ. 2014 Aug 14;349:g4474
pubmed: 25125424
BMC Fam Pract. 2021 Jul 8;22(1):148
pubmed: 34238248
Adv Ther. 2018 Apr;35(4):577-589
pubmed: 29516408
Heliyon. 2017 Jun 22;3(6):e00328
pubmed: 28707001
Br J Gen Pract. 2012 Sep;62(602):e598-604
pubmed: 22947580
Br J Gen Pract. 2015 Nov;65(640):e769-75
pubmed: 26500325
BMC Cancer. 2015 Apr 23;15:308
pubmed: 25900050
Br J Gen Pract. 2003 Jan;53(486):31-5
pubmed: 12564274
Br J Gen Pract. 2018 May;68(670):e301-e310
pubmed: 29632003
BMC Res Notes. 2009 Sep 29;2:200
pubmed: 19788721
World J Urol. 2020 Apr;38(4):1001-1007
pubmed: 31177305
Arch Intern Med. 1969 May;123(5):571-90
pubmed: 5780702
Br J Gen Pract. 2010 Sep;60(578):e366-77
pubmed: 20849687
Heliyon. 2020 Nov 04;6(11):e05372
pubmed: 33204876
Scand J Prim Health Care. 2020 Sep;38(3):251-252
pubmed: 32791936
BMJ. 2020 Nov 4;371:m4261
pubmed: 33148613
Br J Gen Pract. 2010 Feb;60(571):121-8
pubmed: 20132704
Adv Ther. 2018 Sep;35(9):1285-1294
pubmed: 30097885
Br J Cancer. 2009 Dec 3;101 Suppl 2:S80-6
pubmed: 19956169
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
BMJ. 2014 Mar 31;348:g2171
pubmed: 24687312
Lancet. 2016 Feb 27;387(10021):894-906
pubmed: 26318520