Emergency diagnosis more common for cancers of ‘unknown origin’

In collaboration with the Press Association

Cancers with an undefined origin are twice as likely to be diagnosed in A&E than cancers where the initial tumour site is known, according to research by The National Cancer Intelligence Network (NCIN).

“Not knowing the specific cancer type limits the treatment options so more work is needed to improve diagnosis to give patients the most appropriate care." Sara Hiom, Cancer Research UK

More than half (57 per cent) of newly diagnosed cases of ‘cancer of unknown primary’ were identified either in A&E or via emergency referral from a GP compared to under a quarter (23 per cent) for all types of cancer, the study shows.

This accounted for around 25,000 cancer cases in England between 2006 and 2010.

Cancers for which the initial origin of the tumour cannot be found or when the tumour has been registered without specifying where it started are classed as a cancer of unknown primary.

Such cancers are often identified at a later stage when the cancer has spread to other parts of the body.

Dr Mick Peake, clinical lead at Public Health England’s NCIN, said: “There are many reasons why it is difficult to prove the source of the primary cancer, sometimes it is just too difficult to get a piece of tissue for analysis, but there are some cancers where despite every test, it is not possible to be sure where the cancer started.” 

Only 16 per cent of patients with a cancer of unknown primary in the study were alive for one year or more after diagnosis, which is low compared to other types of cancer.

The study revealed that people diagnosed via emergency routes had the lowest survival rates compared with those diagnosed through other routes, such as via a two-week wait system of referral employed by GPs.

Sean Duffy, national clinical director for cancer at NHS England, said: “Currently referral systems for generic investigation of this rarer form of cancer are poorly developed, which is why we’ve broadened the range of symptoms and enabled more patients to be referred with non-specific symptoms to help increase earlier diagnosis.”

The research also makes a link between how old someone is when they present their symptoms and their chances of survival. Nearly 40 per cent of the cancers of unknown primary diagnosed in England during the study affected people aged 80 years and over. 

Sara Hiom, Cancer Research UK’s director of early diagnosis, said: “Being diagnosed with cancer but not knowing where that cancer started remains a serious problem for almost 10,000 people in the UK every year. These data highlight the scale of the problem, and the importance of accurately diagnosing what type of cancer a person might have.

“Not knowing the specific cancer type limits the treatment options so more work is needed to improve diagnosis to give patients the most appropriate care.

“This study also provides another great example of how data routinely collected in our health system can be analysed and used to better understand cancer and suggest how improvements can and must be made to benefit patients. Such work is crucial to making consistent improvement to patients’ results and improving the care for those people with cancer.”

Copyright Press Association 2014