General Practitioner - First Line Diagnosis

From the patient perspective, there is a danger that we learn to 'live with our symptoms'. We convince ourselves, from our interpretation of the data, that there is nothing really wrong; and that we do not want to bother our overworked GP. Early diagnosis is important. See Cancer Research UK for cancer signs and symptoms.

Through their scientific expertise and experience good GPs develop a "nose" for a presentation that may be cancer which requires further investigation but we should recognise that:

  • Many of the Less Common Cancers such as CUP lead to only very vague and generalised symptoms which can easily be confused with other conditions.
  • On average a GP will only see a few cases of cancer every year. He or she may never experience a Less Common Cancer such as CUP. The current (2005) NICE referral guidelines for GPs do not mention CUP or metastatic cancer in the Quick Reference Guide.
  • The Algorithms, or Decision Trees, often used by doctors to make a diagnosis, work best when applied to people who have straight-forward presentations. They work less well for generic or non-specific symptoms.

In a book, called How Doctors Think, published in 2007, Jerome Groopman suggests that doctors make up their minds too quickly (implying that when dealing with uncertainty they may settle on the first piece of data presented).

Research by Cancer 52 (July 2010) into symptom awareness for less common cancers suggests that Patients and GPs should look out for:

  • Severe tiredness, pesistent pain, lumps, unexplained weight loss
  • A combination of two or three symptoms
  • Key words: unexplained, persistent, recurrent, severe.

You may not know what it is, but you will know if there is something wrong with your body:

  • Do not delay, book an appointment today. With regard to cancer, early and accurate diagnosis is critical.To use a military maxim: make sure that the enemy diversion you are ignoring is not the main offensive!
  • Before seeing the doctor it may help reflect on the way both you and doctors think and behave to make the most of your time with the doctor.(See also "Help the doctor to achieve the correct diagnosis.")

Referral

If he or she is concerned about possible cancer, the GP will refer you to a specialist. The specialist you see first will depend on the symptoms you have (there are no CUP specialists). If you have mostly:

  • Digestive tract, bowel or stomach symptoms - Gastroenterologist
  • Chest/Lung symptoms - Respiratory specialist
  • Enlarged lymph gland - You’ll often be seen by a surgeon first. If the gland is in the head and neck area you may be referred to a head and neck specialist or an ear nose and throat (ENT) specialist. If the enlarged gland is under your arm you may be referred to a breast specialist
  • Symptoms of the vagina, cervix, womb or ovaries (female reproductive system) - Gynaecologist.  Women who have fluid collecting in the abdomen (ascites) are usually seen by a gynaecologist 
  • Urinary or kidney symptoms; disorders of the male reproductive system - Urologist
  • Symptoms to do with your blood cells -  Haematologist

 

Message board

We do not offer medical advice. We offer information & support which is intended to help patients, their carers, families and friends.

If you have any medical queries you should direct them at a qualified medical practitioner.

Endorsements

 

Thanks for your help. My family, son is also a doctor, have found it an invaluable resource from day 1 [of my husband’s CUP diagnosis]. Gillian (UK GP)

 

When teaching junior oncologists I have encouraged them to look at your effective website. Dr Simon Grumett, Consultant & Honorary Senior Lecturer in Medical Oncology

 

This website is a fantastic resource.
Dr Maurice Slevin, Medical Oncologist

 

Not only is the website an essential resource but the Foundation has been instrumental in bringing together experts from across the world and encouraging the development of research to improve the outcomes of patients with CUP. Dr Andrew Fowell, Macmillan Consultant in Palliative Medicine

 

Your website is such a good way of providing information that empowers the patient/carer.

Anne (former CUP patient)

 

Many congratulations on establishing such a superb website. Dr Robert H Phillips, Consultant Radiotherapist and Physician in Medical Oncology

 

A valuable patient support organisation that advocates much needed research and change for this neglected group.

Prof. Orest Mulka (former GP)

 

This site provides much needed and accessible help for CUP patients and their loved ones - I'm very, very impressed.

Nicola James

Macmillan Nurse Consultant

 

Your website and John were my life line when I was diagnosed with CUP in 2009.  Jane, Australia.

 

You have established an important island in the UK which I hope grows with support from many.

Dr Tony Greco, Director of the Sarah Cannon Cancer Center

 

This is an excellent resource for patients and relatives.  Keep up the good work!

Dr. David Farrugia. Consultant Medical Oncologist

 

 

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