Eight key signs of cancer, say experts

Eight key signs of cancer which should be investigated immediately have been identified by scientists.

The symptoms predict the risk of cancer with such accuracy in certain age groups that patients should be referred to a specialist straight away unless there is a plausible explanation.

They are:

* Bleeding from the rectum (indicative of colon cancer in older age groups)

* Iron deficiency anaemia (indicative of colon cancer)

* Breast lump (possible breast cancer)

* A rectal examination which suggests cancer may be present (possible prostate cancer)

* Blood in the urine (indicative of cancers related to urology)

* Coughing up blood (potential lung cancer)

* Post-menopausal bleeding (possible cancers related to gynaecology)

* Difficulties with swallowing (indicative of oesophageal cancer)

The research, led by Mark Shapley and colleagues from Keele University, was published in the British Journal of General Practice (BJGP).

Identifying these symptoms has the potential to improve the number of cancers diagnosed early, when people have the best chance of responding to treatment.

The team said GPs should be given better computer systems to arm them with the tools to identify cancers much earlier.

They should also look closely at the ages of patients and see if they fall into risk groups for specific male or female cancers.

Dr Shapley said the eight symptoms had been identified following careful analysis of 25 studies from the UK, US, Netherlands, Belgium, Australia, Denmark and Germany.

"We recommend research and development of general practice computer systems to produce effective warning flags when the symptoms, signs or test results with a risk of 5% or more... are entered for patients within the specified sex and age groups.

"GPs should audit their management and reflect upon these cases as part of their appraisal to improve quality of care.

"There should be more open public debate on the level of risk that triggers a recommendation for referral by a GP."

In an accompanying editorial, Dr Kevin Barraclough, a GP from Stroud, said iron deficiency anaemia in a 21-year old female was extremely unlikely to be bowel cancer but more likely if the test results were for a 60-year-old man.

"More research in primary care is urgently needed to inform cancer referral guidelines," he said.

Professor Amanda Howe, honorary secretary of the Royal College of GPs, said: "It's useful to see these well known 'red flag' symptoms and signs validated in primary care research, and reinforces the importance of encouraging patients to discuss worrying symptoms early with their GP.

"Access and thorough examinations will help early diagnosis while further research gives us more detailed epidemiological thresholds for referral."