Pathways to the diagnosis of colorectal cancer: an observational study in three UK cities.
BACKGROUND
Colorectal cancer can present in a variety of ways, and with any of several symptoms. Different referral routes from primary to secondary care cater for these different presentations. The route that has received most investment in the UK National Health Service is the 2-week clinic, but the proportions of patients taking this and other routes to diagnosis are largely unknown.


METHODS
We designed an observational audit in Exeter, Oxford and Sheffield, UK. Colorectal cancers diagnosed in 2002 from participating practices were identified and the presence and timing of seven important clinical features noted: diarrhoea, constipation, rectal bleeding, abdominal pain, the finding of an abdominal or rectal mass on examination, anaemia and positive faecal occult blood tests. The referral pathways to secondary care were identified.


RESULTS
Of the 151 patients studied, 112 (74%) were referred with at least one clinical feature of colorectal cancer to a specialist. Only 43 of these (28% of the total) were referred to a 2-week clinic; 39 patients (26% of the total) had an emergency admission, of whom 10 (7%) had their emergency admission after referral to a specialist for investigation but before a diagnosis had been established. The time intervals between the first consultation with a symptom of cancer and referral were mostly short.


CONCLUSIONS
Patients with colorectal cancer travel several different pathways to diagnosis. The pathway with the most resources-the 2-week clinic-is used by a minority of patients.
Barrett
Jacqueline
J
Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, The Grange, 1 Woodland Road, Bristol BS8 1AU, UK.
Jiwa
Moyez
M
Rose
Peter
P
Hamilton
William
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D019091:Critical Pathways / Q000458:organization & administration*; D003938:Diagnostic Techniques, Digestive System; D005194:Family Practice / Q000592:standards* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009313:National Health Programs / Q000592:standards* / Q000639:trends; D009367:Neoplasm Staging; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies; D018570:Risk Assessment; D017749:Total Quality Management; D006113:United Kingdom; D014505:Urban Population