A lump in the breast, sudden weight loss and blood in the stools. We think we know the signs of cancer. Except we don’t – and now experts are encouraging people to be more aware of less-known symptoms that could signal early disease and report them to their GPs.
In the UK, one in two people will be diagnosed with cancer in their lifetime.
Research from the London School of Hygiene and Tropical Medicine shows England has some of the poorest survival rates in the Western world for common cancers such as colon, breast, lung, ovarian and stomach. In the UK, one in two people will be diagnosed with cancer in their lifetime and the disease is responsible for a quarter of all deaths. According to the National Institute of Clinical Excellence (Nice), about 5,000 lives a year could be saved by making earlier diagnoses.
But what are we looking for? “A lot of the early symptoms of cancer will be vague and non-specific,” says Peter Johnson, professor of medical oncology at Southampton University and lead clinician for Cancer Research UK. “It’s these that people need to be aware of and report to their doctors. But we’re not good at paying attention to our own bodies, to what’s normal for us, so we ignore minor symptoms which occasionally can be caused by early cancer.”
The good news is that most cancers are curable if caught in the early stages, says Dr David Bloomfield, clinical oncologist at the Sussex Cancer Centre, Royal Sussex County Hospital, and medical director for the Royal College of Radiologists. “Be aware of the red flags [see box below], but if something else is unexplained and unusual for you and doesn’t get better in a couple of weeks, get it checked out,” he says.
Together we have worked with Cancer Research UK and Britain’s leading oncologists to come up with a list of vague symptoms that shouldn’t be ignored.
Hoarseness or a croaky voice
Being croaky or hoarse is common with a cold, but if it doesn’t get better within two or three weeks, it needs checking out. “Persistent hoarseness can indicate an early, curable head or neck cancer such as one of the vocal cords,” says Dr Bloomfield. Today’s surgery techniques usually mean minimally invasive removal of the cancer so your voice remains intact – if it’s caught early enough.
A stubborn cough should also be checked out with a chest X-ray, especially if it has lasted more than three weeks, as it could also indicate lung cancer, says Prof Johnson.
Heavy night sweats
It’s more than likely your duvet or the menopause if you’re a woman, but heavy night sweats could also be a sign of lymphoma, a tumour developing in the lymph cells. “People with lymphoma have high metabolisms because lymphoma cells use a lot of energy, so they get severe, drenching night sweats where they need to change their pyjamas and sometimes the bedding,” says Dr Shankara Paneesha, consultant haematologist at Spire Parkway Hospital in Birmingham. Other symptoms may include a lump around two centimetres or more in diameter in the armpit, groin or side of the neck.
Persistent heartburn
It’s not unusual to feel pain or discomfort after a fatty or spicy meal, but if this has lasted more than two or three weeks and you need to take antacids regularly, it could signal cancer of the stomach or oesophagus, says Prof Johnson. Occasionally, it may also be a sign of pancreatic or ovarian cancer, he says.
Middle back pain
In the UK, about 2.5 million people suffer with back pain. “For around 99 per cent, it’s going to be musculoskeletal, but back pain is also one of the more common symptoms of pancreatic cancer,” says Prof Pippa Corrie, consultant and associate lecturer in medical oncology at Cambridge University Hospitals NHS Foundation Trust.
“The classic symptom is pain in the upper abdomen that spreads out across the back,” she says. The pancreas sits at the back of the abdomen and, as it grows, it starts to invade the nerves that signal pain in the back.
“While most musculoskeletal back pain will occur in the lower back, that associated with pancreatic cancer is about a hand’s breadth above that and may also come with other symptoms, such as people being off their food, tiredness and weight loss.”
Pink discharge after menopause
Pink discharge from subtle bleeding – or any kind of vaginal bleeding after menopause – should be reported to your doctor as it can be an early sign of endometrial cancer, says Dr Bloomfield. Endometrial cancer is on the rise in the UK because it’s associated with being overweight, and as a nation we’re getting fatter. The earliest sign is a bit of bleeding and this is a highly treatable cancer if caught early.
Problems urinating
As a man ages, his prostate gland grows, which can cause more frequent urination, especially at night. “If you can’t go for a few hours without peeing, or you’re having difficulty starting to pass urine, this could indicate an obstruction, such as a prostate cancer,” says Prof Johnson. Your doctor can refer you for tests and a biopsy. ‘If the test is positive, most men won’t need treatment as their cancer may not be harmful, but it needs to be tested to see if it’s aggressive,’ says Dr Bloomfield.
Difficulty swallowing
Strokes, brain injuries and other medical conditions can cause difficulty swallowing but occasionally, it may be a key early symptom of a head and neck cancer such as of the vocal cords, oesophagus, mouth or tongue. ‘Caught early, these are often curable,’ says Dr Bloomfield. Other symptoms include pain at the back of the mouth. Though more common inn those that drink or smoke heavily, such cancers are on the increase in young people, believed to be caused by transmission of the Human Papilloma Virus (HPV), through unprotected oral sex, explains Prof. Johnson.
Looser stools
You know about blood in your stools but anything significantly different to what’s normal for you – colour, texture, frequency or pain – that lasts for two weeks or more should be reported. ‘Any sudden changes in your bowel habits including constipation, looser than usual or pain with a strange dragging sensation or dull ache, should be looked into,’ says Prof. Johnson. ‘It may indicate bowel cancer or in rare cases ovarian or pancreatic cancers.’
A sore that won’t heal
Most people know to look for changes to moles such as bleeding, itching or irregularity. ‘But other signs of skin cancer can include small lumps on the skin that get bigger, sometimes with an ulcer on top that doesn’t heal for 2-4 weeks,’ says Prof. Johnson. ‘Often they’re painless but they may bleed or be itchy.’ Good news he explains, is that GPs are good at recognising and referring skin cancers quickly.
Mouth or tongue ulcers
Lots of people get mouth ulcers from viral infections, but these usually clear up within a few days and are quite painful when you have them, says Prof. Johnson. ‘But a mouth ulcer that is there 3-4 weeks – with or without pain – needs looking at because it could be a cancer on the tongue or around the mouth,’ he says. ‘White marks on the tongue as well as thick, white patches on the tongue also need to be checked out because they can indicate changes in the lining of the mouth which can lead onto cancer.’
