Cancer Diagnosis

  • Kimberly S. PeairsEmail author


Timeliness of a cancer diagnosis has been associated with better clinical and patient-reported outcomes. Primary care providers are often faced with a myriad of patient symptoms with the challenging expectation they will be able to discern those that require further evaluation with the appropriate diagnostic tests and referrals. While screening and surveillance efforts are aimed at identifying cancer when patients are asymptomatic, the majority of malignancies manifest with symptoms. This chapter will focus on the symptomatic presentations of malignancies and the diagnostic options for assessment.


Alarm symptoms Evaluation options Rectal bleeding Hemoptysis Hematuria Dysphagia Breast mass Postmenopausal bleeding 


  1. American College of Radiology: Accessed 16 May 2018.
  2. Expert Panel on Breast Imaging: Moy L, Heller SL, Bailey L, D'Orsi C, DiFlorio RM, Green ED, et al. ACR Appropriateness Criteria Palpable Breast Masses. J Am Coll Radiol. 2017;14(5S):S203–24.Google Scholar
  3. Fojo AT. Cancer screening: still a work in progress. Semin Oncol. 2017: 44(1).Google Scholar
  4. Hamilton W. The CAPER studies: five case-control studies aimed at identifying and quantifying the risk of cancer in symptomatic primary care patients. Br J Cancer 2009; 101: S80–S86.CrossRefGoogle Scholar
  5. Hamilton W, Walter F, Rubin G, Neal R. Improving early diagnosis of symptomatic cancer. Nat Rev Clin Oncol. December 2016;13:740–49.CrossRefGoogle Scholar
  6. Koo M, Hamilton W, Walter F, Rubin G, Lyratzopoulos G. Symptoms signatures and diagnostic timeliness in cancer patients: a review of current evidence. Neoplasia. 2018;20:165–74.CrossRefGoogle Scholar
  7. Martins T, Hamilton W. The influence of ethnicity on diagnosis of cancer. Fam Pract. 2016;33:325–6.CrossRefGoogle Scholar
  8. Nekhlyudov L, Latosinsky S. The interface of primary and oncology specialty care: from symptoms to diagnosis. J Natl Cancer Inst Monogr. 2010;40:11–7.CrossRefGoogle Scholar
  9. Peairs KS, Nekhlyudov L. Does my patient have cancer? Presenting symptoms. In: DeVita VT, Lawrence TS, Rosenberg SA, editors. Oncology in primary care. Philadelphia: Lippincott, Williams & Wilkins. 2013.Google Scholar
  10. Seigel R, Miller K, Jemal A. Cancer Statistics, 2017. CA Cancer J Clin. 2017;67:7–30.CrossRefGoogle Scholar
  11. Shapley M, Mansell G, Jordan JL, Jordan KP. Positive predictive values of ≥ 5% in primary care for cancer: systematic review. Br J Gen Pract. 2010;60(578):e366–77.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Division of General Internal MedicineJohns Hopkins University School of MedicineBaltimoreUSA

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