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Table 2 Symptoms, comorbidities, and clinical characteristics relevant to liver cancer

From: Development and validation of personalised risk prediction models for early detection and diagnosis of primary liver cancer among the English primary care population using the QResearch® database: research protocol and statistical analysis plan

Symptoms (GP records)

 Appetite and upper gastrointestinal symptoms

Change in taste, loss of taste, dry mouth/thirst, dysphagia, loss of appetite or feeling full after eating small amounts, heartburn/gastro-oesophageal reflux (GOR), indigestion, nausea, vomiting, hematemesis, stomach pain/discomfort/cramp

 Abdominal and bowel symptoms

Abdominal pain (right upper quadrant), abdominal lump on the right side, abdominal distension, abdominal mass, swollen abdomen/flatulence/bloating, ascites, change in bowel habits, diarrhoea, constipation, melaena

 Non-specific and systemic symptoms

Weight loss, fatigue/tiredness/lethargy (lack of energy), nausea, confusion (may suggest hepatic encephalopathy), fever, shivering, jaundice (yellow skin), pruritis (itchy skin), rash, dark urine, pale stools, night sweats, right shoulder pain, back pain, peripheral oedema, unexplained bruising

Comorbidities (GP and HES records)

 Liver diseases

Cirrhosis, hepatitis B infection, hepatitis C infection, non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease, autoimmune hepatitis, liver adenoma, any other chronic liver diseases

 Cardiorespiratory diseases

Hypertension, coronary heart disease, heart failure, chronic obstructive pulmonary disease (COPD), venous thromboembolism

 Metabolic disorders

Type 1 and type 2 diabetes mellitus, electrolyte disorders, dyslipidaemia, obesity, gout

 Other GI and systemic diseases

Chronic pancreatitis, hepatic cyst, renal cyst, pancreatic cyst, hemochromatosis, cholangitis, gallbladder stones, gastrointestinal haemorrhage, peptic ulcer disease, anaemia, thrombocytopenia

 Others

Heroin use or other drug addiction, alcoholism, HIV/AIDS

Clinical and family history (GP records)

 Family history

Liver cancer, (any) gastrointestinal cancers (gastric, bowel, liver, pancreas)

 Personal history

Previous cancers

Investigation and patient management (logged) in primary care records

 Blood tests

Haemoglobin, HBV (antibody/antigen/DNA), ALT, AST, PLT, BR, GGT, ESR, CRP

 Medications

Furosemide, spironolactone, propranolol, carvedilol, lactulose, rifaximin, tenofovir, entecavir, lamivudine, antiretroviral therapy; statins, aspirin and metformin

  1. HES hospital episode statistics, HBV hepatitis B virus, HCV hepatitis C virus, HEV hepatitis E virus, ALT alanine transaminase, AST aspartate aminotransferase, PLT platelet count, BR bilirubin, GGT gamma-glutamyl transferase, ESR erythrocyte sedimentation rate, CRP C-reactive protein