Frequency and nature of presenting abdominal symptoms in cancer patients before diagnosis: evidence to inform the design and evaluation of generic symptom awareness campaigns


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Minjoung Monica Koo1,Christian von Wagner1,Gary Abel2,Sean McPhail3,Greg Rubin4,Georgios Lyratzopoulos1
1UCL,2University of Exeter,3NCRAS, Public Health England,4University of Durham



Traditionally, public health campaigns about possible cancer symptoms have focused on ‘red flag’ symptoms associated with common cancers (e.g. ‘blood in poo’ or ‘lump in the breast’). Currently there is great interest in ‘generic’ symptoms campaigns (e.g. ‘abdominal symptoms’). However, evidence about the frequency and nature of abdominal symptoms in patients with different cancers is limited.


We used data from the National Audit of Cancer Diagnosis in Primary Care 2009/10. Free-text information on presenting symptom(s) was coded in symptom categories. We described the frequencies of the following 8 ‘major’ abdominal symptoms: abdominal pain, change in bowel habit, bloating/distension, dyspepsia, rectal bleeding, dysphagia, reflux, and nausea/vomiting. Logistic regression was used to compare patients with abdominal symptoms vs non-abdominal symptoms. Subsequently, we described the ‘cancer signature’ of patients with any abdominal symptom (and each individual symptom).


23% (3,661/15,956) of all cancer patients in our population based sample presented with at least one abdominal symptom. Among those, abdominal pain (8%) and change in bowel habit (6%) were the most common, and bloating/distension (2%) and reflux (0.4%) the least common. Patients with abdominal symptoms were more likely to be older and experience 3+ pre-referral consultations more frequently compared to those without abdominal symptoms.  A total of 27 cancers were represented among the 3,661 patients with abdominal symptoms, with 47%, 13%, 7%, 6% and 5% having colorectal, oesophageal, ovarian, pancreatic, and stomach cancers, and 0.1% each having melanoma, mesothelioma, and thyroid cancers.


One in four cancer patients present with abdominal symptom(s). These patients tend to experience longer diagnostic journeys and are diagnosed with a range of common and rarer cancers. This evidence supports the development of abdominal symptom campaigns and can help to inform their design and evaluation. Further work will explore variation in diagnostic intervals between patients with abdominal symptoms.