Do colorectal cancer patients diagnosed as an emergency differ from non-emergency patients in their consultation patterns and symptoms? A longitudinal data-linkage study in England

Br J Cancer. 2016 Sep 27;115(7):866-75. doi: 10.1038/bjc.2016.250. Epub 2016 Aug 18.


Background: More than 20% of colorectal cancers are diagnosed following an emergency presentation. We aimed to examine pre-diagnostic primary-care consultations and related symptoms comparing patients diagnosed as emergencies with those diagnosed through non-emergency routes.

Methods: Cohort study of colorectal cancers diagnosed in England 2005 and 2006 using cancer registration data individually linked to primary-care data (CPRD/GPRD), allowing a detailed analysis of clinical information referring to the 5-year pre-diagnostic period.

Results: Emergency diagnosis occurred in 35% and 15% of the 1029 colon and 577 rectal cancers. 'Background' primary-care consultations (2-5 years before diagnosis) were similar for either group. In the year before diagnosis, >95% of emergency and non-emergency presenters had consulted their doctor, but emergency presenters had less frequently relevant symptoms (colon cancer: 48% vs 71% (P<0.001); rectal cancer: 49% vs 61% (P=0.043)). 'Alarm' symptoms were recorded less frequently in emergency presenters (e.g., rectal bleeding: 9 vs 24% (P=0.002)). However, about 1/5 of emergency presenters (18 and 23% for colon and rectal cancers) had 'alarm' symptoms the year before diagnosis.

Conclusions: Emergency presenters have similar 'background' consultation history as non-emergency presenters. Their tumours seem associated with less typical symptoms, however opportunities for earlier diagnosis might be present in a fifth of them.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdominal Pain / etiology
  • Adenocarcinoma / complications
  • Adenocarcinoma / diagnosis*
  • Adenocarcinoma / therapy
  • Aged
  • Anemia / etiology
  • Colorectal Neoplasms / complications
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / therapy
  • Delayed Diagnosis
  • Early Detection of Cancer*
  • Emergencies*
  • England / epidemiology
  • Female
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Male
  • Middle Aged
  • Organ Specificity
  • Primary Health Care
  • Referral and Consultation / statistics & numerical data*
  • Registries
  • Symptom Assessment