Our key strategy in our battle against cancer and to win it is to nip it in the bud. In order to do so, we have to be aware of the symptoms cancer can present with.
Cancer symptoms usually depend on the site of disease, the extent of disease and how much of the nearby structures are affected. Sometimes, the cancer may show itself in unusual ways not related to the the site of the disease.
For example excessive urination in a case of lung cancer- a condition known as Syndrome of inappropriate antidiuretic hormone secretion(SIADH), or severe headache in a case of breast cancer due to brain metastases. Cancer can even cause symptoms due to its spreading at various sites or by secretion of certain substances.
Being aware of the symptoms of cancer is very important not only in the early detection of the disease, but also discussing these symptoms with the treating physician helps in putting the mind at ease.
As mentioned earlier, cancer symptoms may vary on a case to case basis, but there are some symptoms which are common to most cancers. Some of the symptoms will be discussed further:
Presence of a lump
It is known that out of all lumps or swellings seen externally only a few turn out to be malignant. Cancer lumps are usually hard, progressively(slowly) increasing in size and painless (unless it causes pressure on adjacent organs or involves the nerves).
Lumps shouldn’t be ignored and the patient must be considered for a workup as soon as possible.
Lumps can be confirmed as a malignancy after a biopsy or an aspiration cytology.
Bloating sensation within the abdomen is a common symptom, but if it is present for a period of more than two weeks then it is necessary to get yourself checked. Abdominal bloating is associated with a variety of malignancies such as ovarian, gastric and colonic malignancies. An upper GI scopy can tell if theres any lesion along the upper GI tract and if present can be confirmed on a biopsy.
Bloating needs to be evaluated further if it does not go away on changing diet or going to the bathroom. Bloating sensation assosciated with pain could sometimes be assosciated with some kind of obstruction. Nausea, vomiting and change in bowel habits are other symptoms that need to be looked out for.
Pain in malignancies is very unpredictable, sometimes being extremely severe and sometimes not being present at all. Pain associated with malignancies vary in characteristic- sometimes being neuropathic (sharp, pricking pain) due to nerve involvement, sometimes being dull aching.
If at all this pain is assosciated with weight loss, presence of a swelling that’s increasing in size or other symptoms such as fatigue then it is something to be concerned about.
Blood in stools or urine
Blood in stools especially in older individuals have a possibility of being associated with cancer. Cancers within the gastrointestinal tract tend to present with blood in stools. Cancers located in adjacent structures also have a chance of causing blood in stools if they happen to infiltrate the GI tract- For example, cancers of the cervix.
Blood loss assosciated with a change in bowel habits and appearence of stools are mostly assosciated with colonic malignancies.
Colonoscopy is the first test one must undergo followed by further evaluation.
Cancers present anywhere along the urinary tract (from kidneys to urethra) tend to present with blood in stools. Patients must undergo a urethroscopy and pelvic MRI to look for any lesion and its extent.
Difficulty in swallowing
Difficulty in swallowing lasting for a few days is not something we need to get afraid off, but long standing difficulty in swallowing associated with weight loss, weakness, anemia are a matter of concern and warrant an immediate checkup. Again an upper GI scopy is useful in detecting any lesions present along the upper digestive tract.
The development of a new skin lesion or changes in a pre existing one can be a sign of malignancy. Sudden discolouration of a mole, changes in its boundaries and ulceration could be a sign of melanoma.
Bleeding in between periods/ post menopausal bleeds
Vaginal bleeding mostly when its not supposed to occur, could point out to something malignant., usually within the cervix or uterus.
Oral changes may be in the form of premalignant changes or malignant changes.
Examples of premalinant changes are leukoplakia and erythroplakia. Any ulceration or growth within the oral cavity need to be taken seriously.
Leukoplakia is a condition where white spots form in the mouth. Erythroplakia is a condition in which a velvety, red patch develops in the oral cavity. This lesion is highly premalignant i.e they are highly likely to transform into a malignancy.
A biopsy from the lesion can confirm the malignancy.
Cough can have many causes but may point out towards something more sinister.
Long standing cough, especially in elderly smokers need a further workup. A CT scan and CT guided biopsy can help in the diagnosis of lung cancer if present.
In lung cancer cough can be associated with blood in sputum.
A burning sensation of the chest is often assosciated with excessive food consumption, alcohol and smoking. Heartburn can even be caused due to gastric malignancies, ovarian and throat malignancies.
Keep in mind that any sort of obstruction in the normal passage of food and acids can cause a reflux of acids giving rise to a burning sensation in the chest, called ‘heartburn’.
Fatigue is something we all experience at some point of time, but
long standing fatigue which does not go away even with rest and is associated with weight loss, paleness of skin can point towards a malignancy and shouldn’t be ignored.
One of the common causes of fatigue is blood loss which go unnoticed most of the time. Patient must be evaluated for blood loss in stools and other causes of blood loss to see if the cause is a malignancy.
One of the most common symptoms of a malignancy is weight loss. Weight loss in a malignancy may be due to a number of reasons. For example loss of appetite, difficulty in swallowing, excessive vomiting/regurgitation.
Weight loss that is seen in malignancy is not like the usual weight loss that takes place with diet and exercise. Cancer weight loss is usually accompanied with muscle wasting, fatigue, loss of appetite and decreased quality of life.
Weight loss is often seen as the first sign of a malignancy among cancer patients. It is usually assosciated with carcinomas within the GI tract.
Cancer cachexia is a wasting syndrome characterized by weight loss, anorexia, asthenia and anemia. It is caused due to a complex interaction between tumor and host and is often a sign of advanced disease.
Yellowish discolouration of the skin due to increased levels of bile pigments is seen mostly in gastrointestinal malignancies. For example malignancies of the head of pancreas, gall bladder obstruction and malignancies of the ampulla of vater.
An endoscopic retrograde cholangiopancreatography (ERCP) or Magnetic resonance cholangiopancreatography (MRCP) can be used to diagnose any growth along the biliary tract.
Jaundice associated with itching an weight loss can be associated with a malignancy.
Lymph Node swelling
The cervical, axillary and inguinal nodes are present more towards the surface and are more visible when involved.
Swelling at any of these sites requires an aspiration cytology or a biopsy to prove the diagnosis.
In lymphomas all three sites maybe involved.
Although fever can have many causes, long standing fever where there is no infectious cause can be assosciated with blood malignacies or lymphomas.
Causes of fever in malignancy may be due to either an underlying infection as chances of infection are higher in cancer patients. The other cause maybe due to the tumor itself. The tumor releases some pyrogens (fever inducing substances) that cause fever.
Cancer fever is often intermittent, which means that you can have fever for some time and then it subsides and reappears after a few days or weeks.
The above symptoms are the most common ones I have come across during my practice as an oncologist, and shouldn’t be ignored especially if the symptoms last long and are not relieved on medications. Symptoms can help in detecting cancer at an early stage, although some symptoms do not present in patients until late stages for example back pain in advanced pancreatic cancer.
Symptoms in cancer are very vague being present is some and absent in someone else even though the tumor may be the same.
Cancer is a sneaky and messy pest after all, and fighting it depends not just on the healthcare team but also on how shrewd the patient is in picking up early signs and symptoms.