Intra-abdominal cancer risk with abdominal pain: a prospective cohort primary care study

Sarah J Price; Niamh Gibson; William T Hamilton; Angela King; Elizabeth A Shephard

doi:10.3399/BJGP.2021.0552

Article Figures & Data

Figures

Tables

Download figure
Open in new tab
Download powerpoint
Figure 1.
Flow chart of individuals included in the study with application of exclusion criteria. CPRD = Clinical Practice Research Datalink.

Tables

Figures

How this fits in

Abdominal pain is a non-specific symptom, which may portend serious disease, including intra-abdominal cancers. There is no unified pathway for investigation. This paper reports the 1-year cumulative incidence risk of intra-abdominal cancer with or without concurrent clinical features for men and women aged 40–59, 60–69 and ≥70 years. Results show that patient demographics and type of concurrent feature effects the cancer risk. These results will inform appropriate testing strategies and specialist referral.

View popup

Table 1.

Participant characteristics

Age group, years	Participants, n (% of total)	Men, n (% in age group)	≥1 additional feature,^a n (%)
40–59	59 864 (47.6)	29 944 (50.0)	10 132 (16.9)
60–69	29 461 (23.4)	14 506 (49.2)	6632 (22.5)
≥70	36 468 (29.0)	13 460 (36.9)	13 790 (37.8)
Total	125 793 (100)	57 910 (46.0)	30 554 (24.3)

↵a Additional feature = the signs, symptoms or abnormal test results, in addition to abdominal pain, that are listed in NG12 as possible presenting features of intra-abdominal cancers.

View popup

Table 2.

Numbers of participants with additional features, by age group and sex, and by feature–cancer combination

Cancer and additional feature	Women, n (%)				Men, n (%)

	Aged 40–59 years (n= 29 920)	Aged 60–69 years (n = 14 955)	Aged ≥70 years (n= 23 008)	Aged 40–59 years (n= 29 944)	Aged 60–69 years (n = 14 506)	Aged ≥70 years (n= 13 460)
Colorectal, ovary, oesophagogastric, liver
Abdominal mass	67 (0.2)	51 (0.3)	85 (0.4)	63 (0.2)	32 (0.2)	57 (0.4)

Colorectal, ovary
Change in bowel habit	281 (0.9)	201 (1.3)	330 (1.4)	n/a	n/a	n/a

Colorectal, pancreas
Constipation	810 (2.7)	586 (3.9)	1765 (7.7)	645 (2.2)	574 (4.0)	1118 (8.3)
Diarrhoea	988 (3.3)	648 (4.3)	1474 (6.4)	1065 (3.6)	578 (4.0)	644 (4.8)

Pancreas, oesophagogastric
Nausea and/or vomiting	833 (2.8)	567 (3.8)	1486 (6.5)	626 (2.1)	325 (2.2)	587 (4.4)

Colorectal, oesophagogastric, pancreas, ovary
Weight loss	108 (0.4)	91 (0.6)	316 (1.4)	158 (0.5)	116 (0.8)	222 (1.6)

Bladder, kidney
Haematuria	100 (0.3)	88 (0.6)	129 (0.6)	182 (0.6)	119 (0.8)	199 (1.5)
Urinary tract infection	1514 (5.1)	1013 (6.8)	2183 (9.5)	352 (1.2)	261 (1.8)	506 (3.8)

Uterus, oesophagogastric
Low haemoglobin	2145 (7.2)	1209 (8.1)	4069 (17.7)	n/a	n/a	n/a
Raised platelets	1001 (3.3)	636 (4.3)	1348 (5.9)	n/a	n/a	n/a

n/a = not applicable: included because people born of male sex cannot be diagnosed with uterine cancer or with ovarian cancer.

View popup

Table 3.

The 1-year incidence (%, 95% CI) of cancers in participants aged 60–69 years with abdominal pain plus another feature of possible cancer, stratified by sex^a

Additional feature and cancer	Women		Men

	1-year incidence (%)	95% CI	1-year incidence (%)	95% CI
Constipation
Colorectal or pancreatic	2.7^c	1.6 to 4.4^c	4.0^d	2.6 to 6.0^d
Colorectal	1.7^b	0.8 to 3.1^b	1.2^b	0.5 to 2.5^b
Pancreatic	1.0^b	0.4 to 2.2^b	2.8^c	1.6 to 4.5^c

Diarrhoea
Colorectal or pancreatic	1.5^b	0.7 to 2.8^b	3.1^d	1.9 to 4.9^d
Colorectal	1.1^b	0.4 to 2.2^b	2.2^c	1.2 to 3.8^c
Pancreatic	0.5	0.1 to 1.3	0.9	0.3 to 2.0

Change in bowel habit
Colorectal or ovarian	3^c	1 to 6^c	n/a^e	n/a
Colorectal	2^c	1 to 6^c
Ovarian	0.5	0.1 to 2.7	n/a	n/a

Nausea and/or vomiting
Pancreatic or oesophagogastric	1.4^b	0.6 to 2.8^b	4^d	2 to 7^d
Pancreatic	1.2^b	0.5 to 2.5^b	3.1^d	1.5 to 5.6^d
Oesophagogastric	0.2	0.1 to 1.0	0.9	0.2 to 2.7

Abdominal mass
Colorectal, ovarian, oesophagogastric, or liver	10^d	3 to 21^d	9^d	2 to 25^d
Colorectal	6^d	1 to 16^d	3^d	0 to16^d
Oesophagogastric	0	n/a	3^d	0 to 16^d
Ovarian	2^c	0 to 10^c	n/a
Liver	2^c	0 to 10^c	3^d	0 to 16^d

Weight loss
Colorectal, ovarian, pancreatic, or oesophagogastric	5^d	2 to 12^d	9^d	5 to 16^d
Colorectal	2^c	0 to 8^c	2^c	0 to 6^c
Oesophagogastric	0	n/a	2^c	0 to 6^c
Ovarian	0	n/a	n/a	n/a
Pancreatic	3^d	1 to 9^d	6^d	2 to 12^d

↵a For each feature, the total risk and that of contributing cancers is reported. Estimates are reported to the precision afforded by the standard errors, which varies with the cancer–feature combination.
↵b Cancer risk ≥1% and <2%.
↵c Cancer risk ≥2% and <3%.
↵d Cancer risk ≥3%.
↵e There are no data for men for change in bowel habit, as the composite outcome is not meaningful for male sex, who are not diagnosed with ovarian cancer. CI = confidence interval. n/a = not applicable.

View popup

Table 4.

The 1-year cumulative incidence of cancers in participants aged ≥70 years with abdominal pain plus another feature of possible cancer, stratified by sex^a

Additional feature and cancer	Women		Men

	1-year incidence (%)	95% CI	1-year incidence (%)	95% CI
Constipation
Colorectal or pancreatic	1.9^b	1.3 to 2.7^b	4.9^d	3.7 to 6.4^d
Colorectal	1.3^b	0.8 to 1.9^b	3.8^d	2.7 to 5.0^d
Pancreatic	0.6	0.3 to 1.1	1.2^b	0.6 to 2.0^b

Diarrhoea
Colorectal or pancreatic	2.0^c	1.4 to 2.9 ^c	3.6^d	2.3 to 5.3^d
Colorectal	1.7^b	1.1 to 2.5^b	3.3^d	2.0 to 4.9^d
Pancreatic	0.3	0.1 to 0.8	0.3	0.0 to 1.1

Change in bowel habit
Colorectal or ovarian	5^d	3 to 8^d	n/a	n/a
Colorectal	4^d	2 to 6^d	n/a	n/a
Ovarian	1.5^b	0.5 to 3.5^b	n/a	n/a

Nausea and/or vomiting
Pancreatic or oesophagogastric	1.1^b	0.7 to 1.8^b	3.6^d	2.2 to 5.4^d
Pancreatic	0.5	0.2 to 1.1	2.2^c	1.2 to 3.8^c
Oesophagogastric	0.6	0.3 to 1.1	1.4^b	0.6 to 2.7^b

Abdominal mass
Colorectal, ovarian, oesophagogastric, or liver	20^d	12 to 30^d	9^d	3 to 19^d
Colorectal	12^d	6 to 21^d	5^d	1 to 15^d
Oesophagogastric	0		4^d	0 to 12^d
Ovarian	7^d	3 to 15^d	n/a
Liver	1^b	0 to 6^b	0	–

Weight loss
Colorectal, ovarian, pancreatic or oesophagogastric	5^d	3 to 8^d	9^d	6 to 14^d
Colorectal	1.6^b	0.5 to 3.7^b	4^d	2 to 8^d
Ovarian	0.9	0.2 to 2.7	n/a
Pancreatic	1.3^b	0.3 to 3.2^b	3^d	1 to 6^d
Oesophagogastric	0.9	0.2 to 2.7	3^d	1 to 6^d

↵a For each feature, the total risk and that of individual cancers is reported.
↵b Cancer risk ≥1% and <2%.
↵c Cancer risk ≥ 2% and <3%.
↵d Cancer risk ≥3%. CI = confidence interval. n/a = not applicable.

Supplementary Data

Supplementary material is not copyedited or typeset, and is published as supplied by the author(s). The author(s) retain(s) responsibility for its accuracy.