Which Patients with Unexpected Weight Loss Should Be Evaluated for Cancer?

[Argirios Argiriou]

August 16, 2020

Which Patients with Unexpected Weight Loss Should Be Evaluated for Cancer?
By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Cancer risk is generally low in primary care patients with unexpected weight loss, but for some, weight loss should trigger an "intensive" evaluation for cancer, according to a study in The BMJ.

Using U.K. primary care records, researchers identified nearly 64,000 adults with unexpected weight loss (mean loss of 5% or more in 6 months) during a 12-year period. Overall, 1.4% were diagnosed with cancer within 6 months; 97% of these patients were aged 50 or older. Lung cancer was most common (24% of diagnoses), followed by colorectal, gastroesophageal, and pancreatic cancers.

In men aged 50 and older with weight loss who'd ever smoked, however, the probability of a cancer diagnosis was above 3% — i.e., the threshold at which U.K. health experts recommend urgent cancer investigation. In addition, the following symptoms or findings were associated with a cancer probability above 3% when they occurred along with weight loss:

In men and women: abdominal mass or pain, chest signs, iron-deficiency anemia, jaundice, loss of appetite, lymphadenopathy, low albumin levels, and elevated white cell counts, calcium, platelets, and inflammatory markers

In men: dysphagia, hemoptysis, and noncardiac chest pain

In women: back pain, bowel habit changes, dyspepsia, and venous thromboembolism

The researchers suggest revised guidelines on cancer evaluation based on their findings.

LINK(S):
The BMJ article (Free)

Background: NEJM Journal Watch General Medicine coverage of red-flag questions in evaluation of back pain (Your NEJM Journal Watch subscription required)

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