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Study identifies key cancer symptoms

Haemoptysis and dysphagia are particularly powerful alarm symptoms for cancer and need to be given strong weight when making decisions on referral, a study concludes.

Among older patients, odds ratios with the symptoms were 'strikingly high', the UK research team concluded.In patients aged 75 to 84, haemoptysis indicated cancer with a positive predictive value of 17.1%, and dysphagia had a predictive value of 9% in men aged 65 to 74.The study, published online by the BMJ, found the likelihood ratios for a diagnosis of cancer after haematuria, haemoptysis, dysphagia and rectal bleeding were particularly high in the six months after presentation.The researchers found 11,108 first occurrences of blood in urine were associated with 472 new diagnoses of urinary tract cancers in men and 162 in women, giving three-year positive predictive values of 7.4% and 3.4% respectively.After 4,812 new episodes of coughing up blood, there were 220 diagnoses of respiratory tract cancer in men (positive predictive value 7.5%) and 81 in women (4.3%).Study leader Professor Roger Jones, professor of general practice at King's College London, said: 'What our study shows is that with some symptoms, the chance of having cancer is particularly high.'

Key recommendations

• In haemoptysis unexplained by respiratory infection or other local factors, imaging studies should be done quickly to rule out underlying neoplastic cause• Dysphagia unexplained by non-neoplastic diseases such as reflux oesophagitis should be investigated promptly• Haematuria unexplained by UTI should be investigated by physical examination, fibre-optic cytoscopy and imaging of upper renal tract

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