Diagnosis of cancer as an emergency: a critical review of current evidence
Open accessAbstract
Many patients with cancer are diagnosed through an emergency presentation, which is associated with inferior clinical and patient-reported outcomes compared with those of patients who are diagnosed electively or through screening. Reducing the proportion of patients with cancer who are diagnosed as emergencies is, therefore, desirable; however, the optimal means of achieving this aim are uncertain owing to the involvement of different tumour, patient and health-care factors, often in combination. Most relevant evidence relates to patients with colorectal or lung cancer in a few economically developed countries, and defines emergency presentations contextually (that is, whether patients presented to emergency health-care services and/or received emergency treatment shortly before their diagnosis) as opposed to clinically (whether patients presented with life-threatening manifestations of their cancer). Consistent inequalities in the risk of emergency presentations by patient characteristics and cancer type have been described, but limited evidence is available on whether, and how, such presentations can be prevented. Evidence on patients' symptoms and health-care use before presentation as an emergency is sparse. In this Review, we describe the extent, causes and implications of a diagnosis of cancer following an emergency presentation, and provide recommendations for public health and health-care interventions, and research efforts aimed at addressing this under-researched aspect of cancer diagnosis.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Over half of patients in the UK are diagnosed with pancreatic ductal adenocarcinoma after a non-specific disease course leading to emergency hospital admission.
“over half of patients in the UK are diagnosed following a non-specific disease course leading to an emergency hospital admission.10–13”
From Early detection of pancreatic cancer (2020) · cites this paper as [11]
Up to 85% of patients with pancreatic ductal adenocarcinoma have cancers that are not surgically resectable when identified.
“Unfortunately, up to 85% of patients have cancers that are not surgically resectable when identified, and over half of patients in the UK are diagnosed following a non-specific disease course leading to an emergency hospital admission.10–13”
From Early detection of pancreatic cancer (2020) · cites this paper as [11]
Cites
Preventing overdiagnosis: how to stop harming the healthy
Moynihan, R., Doust, J., & Henry, D. (2012) · BMJ · doi:10.1136/bmj.e3502 · Cited by 675 · see citing works
Routes to diagnosis for cancer – determining the patient journey using multiple routine data sets
Elliss‐Brookes, L., McPhail, S., Ives, A., Greenslade, M., Shelton, J., Hiom, S., & Richards, M. (2012) · British Journal of Cancer · doi:10.1038/bjc.2012.408 · Cited by 522 · see citing works
Self-citationWalter, F. M., Webster, A., Scott, S. E., & Emery, J. D. (2011) · Journal of Health Services Research & Policy · doi:10.1258/jhsrp.2011.010113 · Cited by 517 · see citing works
Self-citationEmergency presentation of colorectal cancer is associated with poor 5-year survival
McArdle, C. S., & Hole, D. J. (2004) · British journal of surgery · doi:10.1002/bjs.4456 · Cited by 362 · see citing works
Public awareness of cancer in Britain: a population-based survey of adultsPreprint
Robb, K. A., Stubbings, S., Ramirez, A., Macleod, U., Austoker, J., Waller, J., Hiom, S., & Wardle, J. (2009) · Nature Precedings · doi:10.1038/sj.bjc.6605386 · Cited by 329 · see citing works
Emergency presentation of cancer and short-term mortality
McPhail, S., Elliss‐Brookes, L., Shelton, J., Ives, A., Greenslade, M., Vernon, S., Morris, E. J. A., & Richards, M. (2013) · British Journal of Cancer · doi:10.1038/bjc.2013.569 · Cited by 221 · see citing works
Self-citationthe International Cancer Benchmarking Partnership Module 2 Working Group, Forbes, L. J. L., Simon, A. E., Warburton, F. G., Boniface, D. R., Brain, K. E., Dessaix, A., Donnelly, D. W., Haynes, K., Hvidberg, L., et al. (2013) · British Journal of Cancer · doi:10.1038/bjc.2012.542 · Cited by 216 · see citing works
Preventability of emergent hospital readmission
Frankl, S. E., Breeling, J. L., & Goldman, L. (1991) · The American Journal of Medicine · doi:10.1016/s0002-9343(05)80053-1 · Cited by 164 · see citing works
Ironmonger, L., Ohuma, E., Ormiston‐Smith, N., Gildea, C., Thomson, C. S., & Peake, M. D. (2014) · British Journal of Cancer · doi:10.1038/bjc.2014.596 · Cited by 148 · see citing works
Raine, R., Wong, W., Scholes, S., Ashton, C., Obichere, A., & Ambler, G. (2010) · BMJ · doi:10.1136/bmj.b5479 · Cited by 121 · see citing works
Lyratzopoulos, G., Abel, G., McPhail, S., et al. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-002861 · Cited by 119 · see citing works
Self-citationAbel, G., Shelton, J., Johnson, S., Elliss‐Brookes, L., & Lyratzopoulos, G. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.52 · Cited by 117 · see citing works
Self-citationHow might healthcare systems influence speed of cancer diagnosis: A narrative review
Brown, S. R., Castelli, M., Hunter, D. J., Erskine, J., Vedsted, P., Foot, C., & Rubin, G. P. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.06.030 · Cited by 115 · see citing works
Cancer Fatalism: Deterring Early Presentation and Increasing Social Inequalities?
Beeken, R. J., Simon, A. E., von Wagner, C., Whitaker, K. L., & Wardle, J. (2011) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-11-0437 · Cited by 114 · see citing works
Cancer symptom awareness and barriers to symptomatic presentation in England—are we clear on cancer?
Nikšić, M., Rachet, B., Warburton, F. G., Wardle, J., Ramirez, A. J., & Forbes, L. J. L. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.164 · Cited by 111 · see citing works
Psychological factors related to delay in consultation for cancer symptoms
Ristvedt, S. L., & Trinkaus, K. M. (2004) · Psycho-Oncology · doi:10.1002/pon.850 · Cited by 105 · see citing works
Renzi, C., Lyratzopoulos, G., Card, T. R., Chu, T. P. C., Macleod, U., & Rachet, B. (2016) · British Journal of Cancer · doi:10.1038/bjc.2016.250 · Cited by 104 · see citing works
Self-citationResponding to symptoms suggestive of lung cancer: a qualitative interview study
Birt, L., Hall, N., Emery, J. D., Banks, J., Mills, K., Johnson, M., Hamilton, W. T., & Walter, F. M. (2014) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2014-000067 · Cited by 91 · see citing works
Self-citationHall, N. J., Birt, L., Banks, J., et al. (2015) · BMJ Open · doi:10.1136/bmjopen-2015-008448 · Cited by 86 · see citing works
Pathways to the diagnosis of lung cancer in the UK: a cohort study
Barrett, J., & Hamilton, W. T. (2008) · BMC Family Practice · doi:10.1186/1471-2296-9-31 · Cited by 82 · see citing works
Self-citationAssessing the preventability of emergency hospital admissions
Bigby, J., Dunn, J. J., Goldman, L., Adams, J., Jen, P., Landefeld, C. S., & Komaroff, A. L. (1987) · The American Journal of Medicine · doi:10.1016/0002-9343(87)90938-7 · Cited by 76 · see citing works
Shawihdi, M., Thompson, E., Kapoor, N., Powell, G., Sturgess, R. P., Stern, N., Roughton, M., Pearson, M. G., & Bodger, K. (2013) · Gut · doi:10.1136/gutjnl-2012-304202 · Cited by 73 · see citing works
Walter, F. M., Birt, L., Cavers, D., Scott, S. E., Emery, J. D., Burrows, N., Cavanagh, G., Mackie, R. M., Weller, D., & Campbell, C. (2014) · BMJ Open · doi:10.1136/bmjopen-2014-005566 · Cited by 72 · see citing works
Self-citationBooker, M. J., Simmonds, R., & Purdy, S. (2013) · Emergency Medicine Journal · doi:10.1136/emermed-2012-202124 · Cited by 70 · see citing works
Bottle, A., Tsang, C., Parsons, C. M., et al. (2012) · British Journal of Cancer · doi:10.1038/bjc.2012.320 · Cited by 70 · see citing works
Pathways to the diagnosis of colorectal cancer: an observational study in three UK cities
Barrett, J., Jiwa, M., Rose, P. W., et al. (2005) · Family Practice · doi:10.1093/fampra/cmi093 · Cited by 70 · see citing works
Pruitt, S. L., Davidson, N. O., Gupta, S. N., Yan, Y., & Schootman, M. (2014) · BMC Cancer · doi:10.1186/1471-2407-14-927 · Cited by 67 · see citing works
Management and prognosis of primary tracheal cancer: A national analysis
Nouraei, S. A. R., Middleton, S. E., Nouraei, S. A. R., et al. (2013) · The Laryngoscope · doi:10.1002/lary.24123 · Cited by 66 · see citing works
Risk factors for emergency presentation with lung and colorectal cancers: a systematic review
Mitchell, E., Pickwell-Smith, B. A., & Macleod, U. (2015) · BMJ Open · doi:10.1136/bmjopen-2014-006965 · Cited by 65 · see citing works
Rabeneck, L., Paszat, L. F., & Li, C. (2006) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2006.00488.x · Cited by 65 · see citing works
Preventability of emergent hospital readmission
Frankl, S. E., Breeling, J. L., & Goldman, L. (1991) · The American Journal of Medicine · doi:10.1016/0002-9343(91)90660-p · Cited by 64 · see citing works
The Association between Fatalistic Beliefs and Late Stage at Diagnosis of Lung and Colorectal Cancer
Lyratzopoulos, G., Liu, P.-H., Abel, G., Wardle, J., & Keating, N. L. (2015) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-14-0969 · Cited by 63 · see citing works
Self-citationIdentifying patients at risk of emergency admission for colorectal cancer
Wallace, D., Walker, K., Kuryba, A., et al. (2014) · British Journal of Cancer · doi:10.1038/bjc.2014.300 · Cited by 61 · see citing works
Emergency presentation and socioeconomic status in colon cancer
Gunnarsson, H., Ekholm, A., & Olsson, L. (2013) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2013.04.004 · Cited by 59 · see citing works
Suspected cancer (part 2--adults): reference tables from updated NICE guidance
Hamilton, W. T., Hajioff, S., Graham, J. D., et al. (2015) · BMJ · doi:10.1136/bmj.h3044 · Cited by 50 · see citing works
Self-citationBlack, G. B., Sheringham, J., Spencer-Hughes, V., et al. (2015) · PLoS ONE · doi:10.1371/journal.pone.0135027 · Cited by 50 · see citing works
Beckett, P., Tata, L. J., & Hubbard, R. (2013) · Lung Cancer · doi:10.1016/j.lungcan.2013.10.010 · Cited by 48 · see citing works
Dejardin, O., Bouvier, A., Herbert, C., et al. (2005) · British Journal of Cancer · doi:10.1038/sj.bjc.6602571 · Cited by 46 · see citing works
Mitchell, E., Rubin, G., Merriman, L., et al. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.42 · Cited by 45 · see citing works
Cleary, J., Peters, T. J., Sharp, D., et al. (2006) · Family Practice · doi:10.1093/fampra/cml059 · Cited by 45 · see citing works
Tsang, C., Bottle, A., Majeed, A., et al. (2013) · BMC Health Services Research · doi:10.1186/1472-6963-13-308 · Cited by 44 · see citing works
Mansouri, D., McMillan, D. C., Crearie, C., et al. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.230 · Cited by 39 · see citing works
Goodyear, S. J., Leung, E., Menon, A., et al. (2007) · Gut · doi:10.1136/gut.2007.120253 · Cited by 39 · see citing works
Pathways to the diagnosis of ovarian cancer in the UK: a cohort study in primary care
Barrett, J., Sharp, D., Stapley, S., et al. (2010) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2010.02499.x · Cited by 37 · see citing works
Sheringham, J., Georghiou, T., Chitnis, X. A., et al. (2014) · British Journal of Cancer · doi:10.1038/bjc.2014.424 · Cited by 36 · see citing works
Lyratzopoulos, G., Saunders, C. L., & Abel, G. (2014) · Future Oncology · doi:10.2217/fon.14.80 · Cited by 36 · see citing works
Self-citationHeterogeneity of Colon Cancer Patients Reported as Emergencies
Gunnarsson, H., Jennische, K., Forssell, S., et al. (2014) · World Journal of Surgery · doi:10.1007/s00268-014-2449-7 · Cited by 34 · see citing works
Accelerate, Coordinate, Evaluate Programme: a new approach to cancer diagnosis
Fuller, E., Fitzgerald, K. R., & Hiom, S. (2016) · British Journal of General Practice · doi:10.3399/bjgp16x684457 · Cited by 33 · see citing works
Emergency admissions of cancer as a marker of diagnostic delay
Hamilton, W. T. (2012) · British Journal of Cancer · doi:10.1038/bjc.2012.423 · Cited by 30 · see citing works
Self-citationCauses and outcomes of emergency presentation of rectal cancer
Comber, H., Sharp, L. A., Cancela, M. D. C., et al. (2016) · International Journal of Cancer · doi:10.1002/ijc.30149 · Cited by 27 · see citing works
Rabeneck, L., Paszat, L. F., Rothwell, D. M., et al. (2005) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2005.41228.x · Cited by 26 · see citing works
Factors Affecting Short-term Mortality in Women With Ovarian, Tubal, or Primary Peritoneal Cancer
Barclay, M., Gildea, C., Poole, J., Hirschowitz, L., Menon, U., & Nordin, A. J. (2015) · International Journal of Gynecological Cancer · doi:10.1097/igc.0000000000000562 · Cited by 21 · see citing works
Palser, T., Cromwell, D. A., Hardwick, R. H., et al. (2013) · BMJ Open · doi:10.1136/bmjopen-2012-002129 · Cited by 18 · see citing works
Tataru, D., Jack, R. H., Lind, M., et al. (2015) · Cancer Epidemiology · doi:10.1016/j.canep.2015.04.008 · Cited by 16 · see citing works
Assessing the impact of an English national initiative for early cancer diagnosis in primary care
Rubin, G. P., Gildea, C., Wild, S., et al. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.43 · Cited by 14 · see citing works
Diagnosing symptomatic cancer in the NHS
Hamilton, W. T. (2015) · BMJ · doi:10.1136/bmj.h5311 · Cited by 9 · see citing works
Self-citationthe International Cancer Benchmarking Partnership Module 2 Working Group, Forbes, L. J. L., Simon, A. E., et al. (2014) · British Journal of Cancer · doi:10.1038/bjc.2014.562 · Cited by 7 · see citing works
278: Cancer Diagnosis and Outcomes In Michigan Emergency Departments Versus Other Settings
Sikka, V. K. (2010) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2010.06.328 · Cited by 6 · see citing works
Emergency diagnosis of lung cancer: An international problem.
Newsom-Davis, T. E., Berardi, R., Cassidy, N., et al. (2015) · Journal of Clinical Oncology · doi:10.1200/jco.2015.33.15_suppl.6536 · Cited by 5 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Early detection of pancreatic cancer
Pereira, S. P., Oldfield, L., Ney, A., Hart, P. A., Keane, M. G., Pandol, S. J., Li, D., Greenhalf, W., Jeon, C. Y., Koay, E. J., et al. (2020) · The Lancet Gastroenterology & Hepatology · doi:10.1016/s2468-1253(19)30416-9 · Cited by 482 · see citing works
The economics of diagnostic safety
Slawomirski, L., Kelly, D., de Bienassis, K., Kallas, K.-A., & Klazinga, N. (2025) · OECD Health Working Papers · doi:10.1787/fc61057a-en · Cited by 20 · see citing works
- Authors
- Zhou, Y., Abel, G. A., Hamilton, W., Pritchard-Jones, K., Gross, C. P., Walter, F. M., Renzi, C., Johnson, S., McPhail, S., Elliss-Brookes, L., & Lyratzopoulos, G.
- Affiliations
- University of Cambridge (GB)
- University of Exeter (GB)
- Yale University (US)
- University College London (GB)
- Public Health England (GB)
- Corresponding author
- Lyratzopoulos, Georgios
- Venue
- Nature Reviews Clinical Oncology
- Published
- 2016-10-11
- Volume
- 14
- Issue
- 1
- Pages
- 45-56
- ISSN
- 1759-4774 (ISSN-L)
- 1759-4782
- OpenAlex
- W2531472381
- Cited by
- 214
- References
- 59
- Citations by year
- 2026: 15 · 2025: 20 · 2024: 31 · 2023: 22 · 2022: 32 · 2021: 32 · 2020: 16 · 2019: 16 · 2018: 21 · 2017: 9
- FWCI
- 1.54
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Nature Reviews Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion)
- Archivio Istituzionale della Ricerca - Università Vita-Salute San Raffaele (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Funders
- Cancer Research UK (18667, 18180)
- Medical Research Council (MR/K006584/1)
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- emergency department presentation, oncological outcomes, colorectal cancer, lung cancer, health disparities, cancer screening, emergency treatment, public health policy
- MeSH terms
- Adolescent, Adult, Age Factors, Child, Child, Preschool, Emergencies, Emergency Treatment, Humans, Infant, Infant, Newborn, Neoplasm Staging, Neoplasms, Patient Acceptance of Health Care, Primary Health Care, Risk Factors, Sex Factors, Socioeconomic Factors, Karnofsky Performance Status, Early Detection of Cancer, Young Adult, General Practice, Neoplasm Grading
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
