Overall 5-year survival in both tumours is less than 4%.2 3 Despite advances in diagnostic technology and the identification of a number of promising biomarkers, impact on survival has been limited and novel diagnostic strategies are therefore urgently needed.4 Recently prediagnostic symptom profiles have been investigated as a method of enabling earlier selleck chemical diagnosis, in a number of common cancers including PDAC.5 6–8 The diagnosis of PDAC is heralded by the insidious onset of a heterogeneous collection of symptoms. Although symptom profiles are recognised to vary between patients with PDAC, certain symptoms

appear to occur with sufficient frequency to be useful as early diagnostic markers of the disease. To date, prediagnostic symptom profiles for PDAC have largely been defined through postdiagnosis retrospective interview studies of secondary care patients8 and through the interrogation of large primary care databases with predefined symptom lists.6 7 Almost no studies have explored the symptom profile of BTC. Defining the early symptom profiles of PDAC has enabled the development of symptom-based cancer decision support tools (CDSTs). Recently these tools have been introduced into primary care practices across 15 cancer networks, throughout the UK.6 Their impact on referral practice is subject

to an ongoing audit.9 CDSTs for PDAC have been validated independently within other primary care data sets. Initial results suggest that although they can effectively discriminate patients with PDAC, they may overestimate cancer risk in certain groups, in particular in older patients.10 Future modification of existing tools to improve their overall diagnostic accuracy is therefore likely to be required. Patients with PDAC frequently encounter a number of delays during their route to diagnosis.11 Although PDAC is no longer considered to be a symptomatically

silent disease, debate exists about how long patients are symptomatic for and if symptoms occur simultaneously or sequentially. A recent qualitative interview study suggested very early symptoms might actually be intermittent and therefore reassuring to patients leading them to ignore them until they increase in severity or other symptoms arise.12 Once symptomatic, large primary care database studies and patient surveys indicate that patients with PDAC visit their general practitioner Anacetrapib (GP) frequently with alarm symptoms in the months and years prior to diagnosis.6 7 11 13 However, almost half of patients are still diagnosed as a result of an emergency presentation to hospital.11 Reasons why the disease is not identified earlier are complex. The average GP will only see one new case of PDAC every 5 years and alarm symptoms overlap with a number of other more common benign and malignant conditions, as a result it is recognised as a very challenging disease to identify at an early stage.