Symptoms, signs, and tests: The general practitioner's comprehensive approach towards a cancer diagnosis

<i>Objective</i>. To study the relative importance of different tools a GP can use during the diagnostic process towards cancer detection. <i>Design</i>. Retrospective cohort study with prospective registration of cancer in general practice. <i>Setting and subjects</i>. One hundred and fifty-seven Norwegian general practitioners (GPs) reported 261 cancer patients. <i>Method</i>. During 10 consecutive days, 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 six to 11 months later. For each patient with new or recurrent cancer, the GP completed a questionnaire with medical-record-based information concerning the diagnostic procedure. <i>Results</i>. In 78% of cancer cases, symptoms, signs, or tests helped diagnose cancer. In 90 cases, there were 131 consultation-recorded WSC that seemed related to the cancer. Further symptoms were reported for another 74 cases. Different clinical signs were noted in 41 patients, 16 of whom had no previous recording of symptoms. 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. <i>Conclusion</i>. 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 7% of patients they were the only symptoms. Clinical findings and/or supplementary procedures were sometimes decisive for rapid referral.

<i>研究目标</i>：探究全科医生（General Practitioner, GP）在癌症诊断过程中可使用的各类工具对癌症检出的相对重要性。
<i>研究设计</i>：一项针对全科医疗场景下癌症的前瞻性登记的回顾性队列研究。
<i>研究场景与研究对象</i>：157名挪威全科医生（General Practitioner, GP）共报告261例经确诊的癌症患者。
<i>研究方法</i>：在连续10天内，全科医生对所有患者就诊情况进行登记，并记录7种局灶性症状与3种全身性症状的出现情况，上述症状通常被视为癌症预警征兆（Warning Signs of Cancer, WSC）。随访周期为就诊登记后6至11个月。针对每例新发或复发癌症患者，由接诊该患者的全科医生填写一份问卷，问卷内容为基于病历记录的诊断流程相关信息。
<i>研究结果</i>：78%的癌症病例可通过症状、体征或检测手段实现确诊。其中90例患者中共记录到131项与所患癌症相关的就诊时记录的癌症预警征兆（WSC）。另有74例患者报告了额外症状。41例患者出现了不同的临床体征，其中16例患者此前未记录任何症状。补充检测为59例患者提供了诊断所需的额外信息，其中25例患者此前未记录任何症状或体征。任意癌症相关症状或临床体征的诊断灵敏度范围为：子宫体癌患者达100%，肾癌患者为57%。
<i>研究结论</i>：癌症预警征兆（WSC）在启动癌症诊断流程中发挥了核心作用。低风险但非无风险症状同样具有重要价值，7%的患者仅表现出此类症状。临床体征与/或补充检查手段有时可成为快速转诊的决定性因素。