Recognizing Gynecological Cancer in Primary Care: Risk Factors,Red Flags,and Referrals

Early diagnosis of symptomatic gynecological cancer is likely to improve patient outcomes, including survival. The primary care practitioner has a key role to play in this—they must recognize the symptoms and signs of gynecological cancer and make prompt evidence-based decisions regarding further investigation and referral. However, this is often difficult as many of the symptoms of gynecological cancers are nonspecific and are more likely to be caused by benign rather than malignant disease. As primary care is generally the first point of patient contact, those working in this setting usually encounter cancer patients at an earlier, and possibly less symptomatic, stage than practitioners in secondary care. Despite these challenges, research has improved our understanding of the symptoms patients present to primary care with, and a range of tests and referral pathways now exist in the UK and other countries to aid early diagnosis. Primary care practitioners can also play a key role in gynecological cancer prevention. A significant proportion of gynecological cancer is preventable either through lifestyle changes such as weight loss, or, for cervical cancer, vaccination and/or engagement with screening programs. Primary care provides an excellent opportunity to discuss cancer risk with patients and to promote risk reduction strategies and lifestyle change. In this article, the first in a series discussing cancer detection in primary care, we concentrate on gynecological cancer and focus on the three most common forms that a primary care practitioner is likely to encounter: ovarian, endometrial, and cervical cancer. We outline key risk factors, briefly discuss prevention and screening strategies, and offer practical guidance on the recognition of symptoms and signs and the investigation and referral of women with suspected cancer. While this article is written from a UK primary care perspective, much of what is discussed will be of relevance to those working in other healthcare systems.     

Medical student perceptions of research and research-orientated careers: An international questionnaire study

Background: Engaging and inspiring the next generation of physician-scientists at an early stage is recognised as key to ensure the future of medical research. However, little is known about medical student perceptions of research.

Objectives: We attempted to ascertain perceptions of research and research-orientated careers from medical students studying in different countries.

Methods: An online questionnaire was developed, piloted, and promoted to medical students in various countries.

Results: 1625 responses were collected from 38 countries. Analysis was restricted to data collected from countries with >100 responses (n?=?890). Less than half the respondents felt their medical school provided adequate research training. Key perceived barriers to research participation as a student included lack of time and difficulty finding mentors or projects. A significant gender disparity existed in research ambitions of students with females desiring less research involvement. The importance of barriers and satisfaction with research training differed significantly between countries.

Conclusions: Students perceive a number of key barriers to research involvement and pursuit of research-orientated careers. Programmes designed to engage students with research should focus on overcoming identified barriers. Greater effort is needed to engage female students who report more significant barriers and less desire to follow research-orientated careers.     

Spontaneous renal hemorrhage

This report of 9 cases of spontaneous renal hemorrhage illustrates the wide variety of responsible conditions that may be found in a small series and the tendency for some of these conditions to coexist. In particular, all 3 patients with a bleeding diathesis had an associated anatomic lesion, and it was concluded that this group of patients required aggressive radiologic investigation. Three main clinical presentations were identified: sudden severe flank pain, symptomless hypertension, and a palpable mass with few or no symptoms. The radiologic signs are reviewed with emphasis on a recently described sign of streaky retroperitoneal fat. Treatment is discussed briefly.     

Reduction in renal size associated with complete ureteric duplication

Ureteric duplication, whether complicated or not, is usually associated with an increase in renal length. Two cases of renal duplex with nonfunction- of the upper moeity, exhibiting a reduction in renal size, are presented. The radiologic features and the cause of this reduction in size are discussed. The importance of the postmicturition radiographs in cases of urinary tract infection is stressed.     

The effectiveness of post-detoxication referrals: effects on later detoxication admissions, drunkenness and criminality.

This study concerned the effectiveness of post-detoxication referrals to a variety of treatment facilities. The purpose was to discover (i) the proportion of men accepting referrals who actually arrived, (ii) the differences in outcome for patients attending an out-patient clinic, a halfway house, and a long-stay farm, (iii) the differences in outcomes for patients treated in one of the above facilities compared with those for similar patients not receiving treatment. In all, 114 male detoxication admissions were included. However, only 60% arrived, even when firm referrals were made. Those arriving and not arriving did not differ in social or demographic characteristics, nor did those who were referred to the various treatment facilities. However, the referral group had more detoxication admissions in the post-detoxication period. There were no post-treatment overall differences between all treated and untreated patients in detoxication admissions, arrests for drunkenness or criminal convictions. Refusals were more often successes than the treated or untreated groups but this was due to their better prognosis at intake. In general, the data provide little cause for optimism about the value of post-detoxication referrals.