TTP1.06 Significance of Weight Loss in Lower GI Cancer Pathway: Diagnostic Yield and Investigative Burden

Aims Unintentional weight loss is a concerning symptom in suspected cancer pathways. This study evaluates its significance in patients referred via the Lower GI suspected cancer pathway, its association with cancer diagnoses, and the investigative burden. We also assess whether only "significant" weight-loss should warrant investigation. Methods We retrospectively analyzed 214 patients referred on the pathway with weight-loss as a presenting complaint. We selected 86 patients who did not have the weight-loss quantified and asked GP for information regarding any “significant weight-loss” which was defined as ≥5% of body weight over 6–12 months. Additional symptoms included abdominal pain, altered bowel habits, PR bleeding, or a positive FiT (present in 26 patients). Investigations included colonoscopy, OGD, CT colonography (CTC), and CT chest-abdomen-pelvis (CT-CAP). Results Of 86 patients with ages ranging from 32–93 years (mean=71.11), 43 (50%) had significant weight-loss. Malignancy was diagnosed in 3 patients (3.4%): one metastatic pancreatic cancer and two colorectal cancers. Additionally, one patient had a significant colonic polyp (now on surveillance), and one had abdominal lymphadenopathy pending further assessment. All these substantial clinical findings were diagnosed in the “significant weight-loss” patient cohort. Conclusions Significant weight loss has a good predictive value for malignancy; reserving comprehensive investigations for those with "significant" weight loss can be more efficient in diagnosing potential cancers. The high investigative burden underscores the need for refined triaging strategies to optimize resource allocation while ensuring timely cancer detection. Further studies are needed to assess the predictive value of weight-loss severity in guiding investigations.