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Warning Signs and Symptoms of most common cancer

Breast Cancer


  • Patient of any age presenting with discrete, hard lump with fixation, with or without skin tethering.
  • Age < 30 years, enlarging lump associated with high risk familial history
  • Age > 30 years with discrete mass persisting after next period or presenting after menopause
  • Any of the following:
    • Spontaneous unilateral bloody nipple discharge
    • Unilateral nipple or skin eczema unresponsive to topical treatment
    • Recent onset Nipple distortion
  • Male > 50 yrs. old with unilateral firm subareolarmass with or without nipple distortion and associated skin changes.

Lung Cancer


  • Persistent haemoptysis in smokers or ex-smokers who are > 40 years old
  • Unexplained and/or persistent (> 3 weeks)
    • Chest / shoulder pain, Difficulty in breathing, Cough, Weight Loss, Hoarseness, Finger clubbing, Cervical / Supraclavicular Lymphadenopathy, Chest Signs
  • Normal Chest Xray but with a high index of clinical suspicion (exposure to asbestos, heavy current smoker or ex-smoker)
  • Chest Xray (with above symptoms) with slowly resolving / non resolving pneumonia or pleural effusion
  • Patients with underlying chronic respiratory problems (COPD, etc) with unexplained changes in existing symptoms.
  • Features suggestive of Metastasis from Lung Cancer (Brain, Bone, Liver, etc)

Gynaecological Cancers


  • Postmenopausal bleeding in a lady NOT on HRT or taking Tamoxifen
  • Persistent unexplained postmenopausal bleeding after having stopped HRT for 6 weeks
  • Persistent intermenstrual bleeding with a negative pelvic examination
  • Clinically suspicious features of possible malignancy on Pelvic examination
  • Palpable or radiological evidence of abdominal/Pelvic mass not obviously any fibroid or simple cyst.
  • Unexplained Vulval Lump
  • Vulval bleeding due to ulceration

Head & Neck Cancers


  • Hoarseness of Voice for> 3 weeks ( Chest Xray – Negative)
  • Unexplained red and white patches of the oral mucosa WITH pain, swelling or bleeding
  • Any of the following:
    • Recent onset Unexplained Lump in neck or change in existing Lump in neck over 3-6 weeks duration
    • Any unexplained ulceration or growth over the oral mucosa
    • Persistent swelling in parotid or submandibular gland
    • Persistent sore or painful throat with or without dysphagia
    • Unilateral head / neck pain >4 weeks with otalgia but normal otoscopy
  • Unexplained tooth mobility > 3 weeks ( via Dentist)
  • A thyroid swelling with any of the following:
    • Solitary nodule increasing in size
    • History of Neck Irradition
    • Family History of endocrine cancer
    • Unexplained Hoarseness
    • Cervical Lymphadenopathy
    • Pre-pubertal patient or Age > 65 years
  • Thyroid swelling with symptoms of tracheal compression (stridor)
    • Consider Urgent admission

Lower GI Cancers


  • Age > 40 years with Rectal bleedingAND Change of bowel habit (looser stools, and/or increased stool frequency) persisting for >6 weeks
  • Age > 60 years with Rectal bleeding OR Change of bowel habit (looser stools, and/or increased stool frequency) persisting for >6 weeks
  • Definite Palpable Rectal / Lower Abdominal Mass
  • Unexplained Iron Deficiency Anemia + (Hb< 11g% [Males], < 10g% [Females])

Upper GI Cancers


  • Age > 55 years with unexplained and persistent recent onset dyspepsia alone
  • Dyspepsia with any of the following :
    • Chronic Gastrointestinal bleeding
    • Dysphagia
    • Progressive non-intentional weight loss
    • Persistent vomiting
    • Iron deficiency Anemia
    • Epigastric mass
    • Suspicious Barium Meal
  • Without Dyspepsia but with any of the following
    • Unexplained weight loss
    • Iron deficiency Anemia
    • Persistent Vomiting & Weight loss
  • Unexplained worsening of Dyspepsia AND any of the following risk factors:
    • Known Dysplasia, Atrophic Gastritis or Intestinal Metaplasia
    • Barret’s Esophagus
    • Peptic Ulcer surgery > 20 years ago
  • Any of the following
    • Unexplained upper abdominal pain and weight loss, with/without Back pain
    • Upper abdominal mass
    • Obstructive Jaundice
    • Dysphagia

Urological Cancers


  • PROSTATE CANCER

    (exclude UTI before measuring PSA) Any of the following when unexplained: Erectile dysfunction, hematuria, lower back pain, bone pain, weight loss

    OR

    Symptoms suggesting Prostate cancer (Lower urinary tract symptoms)

    • DRE &PSA (exclude UTI before measuring PSA)
    • Hard irregular Prostate on DRE, High PSA (> 20 ng /ml),
    • Normal prostate on DRE, Rising PSA ( 6 weeks apart)
    • Elevated Age specific PSA with no significant comorbidities
  • BLADDER CANCER
    • Painless Macroscopic Hematuria or recurrent, persistent Cystitis
    • Age > 50 with unexplained microscopic hematuria
    • Age < 50 with microscopic hematuria ( Normal S.Creatinine, No Proteinuria)
  • RENAL CANCER
    • Palpable renal mass
    • Solid renal mass or complex cyst on Imaging
  • TESTICULAR CANCER
    • Swelling or mass in body of testis
  • PENILE CANCER
    • Growth or ulceration over the Glans or prepuce

Bone Tumours & Soft tissue Sarcoma


  • Bone Tumours
    • If Xray for suspected Spontaneous Fracture indicates possible cancer
    • Increasing, unexplained or Persistent Bone Pain or Tenderness (esp at night) or an unexplained Limp ( Consider Multiple myeloma, Lymphoma, Sarcoma, Mets)
  • Soft tissue Sarcoma
    • Palpable lump that is either:
      • > 5 cms
      • deep to fascia, fixed or immobile
      • Increasing in size
      • Painful
      • Recurred after a previous excision
    • If patient has HIV, consider Kaposi’s Sarcoma

Blood Cancers


  • Combinations of the following :
    • Fatigue, Night sweats, Fever, Weight Loss, Generalised Itching, Brusing, Breathlessnesss, Recurrent Infections, Bone Pain, Alcohol induced pain
  • Lymphadenopathy > 1 cm persisting for > 6 weeks
  • Hepatosplenomegaly
  • Full blood Count suggesting Leukemia
  • Bone X ray or Paraprotein studies (+/- renal failure) suggesting myeloma
  • Persistent Unexplained Splenomegaly
  • Bone pain with anemia and raised ESR

Melanoma & Skin Cancers


  • Melanoma- Pigmented lesions with:
    • Major Features (2 points): Change in Size, Irregular Shape, Irregular Colour
    • Minor Features (1 Point) : Diameter > 7mm, Inflammation, Oozing, Change in sensation.
    • Suspicion is greater if score ≥ 3 points
  • Skin cancers
    • Non healing lesions > 1cm with significant induration on palpation
    • Documented explansion over 8 weeks
    • Subcutaneous Component
    • Organ Transplant receipient with new or growing skin lesion
    • Clinically obvious lesion on sun exposed area (usually face) s/o BCC

Brain & CNS Tumours


  • CNS related Symptoms including:
    • Progressive Neurological Deficit
    • New Onset Seizures
    • Recurrent headaches
    • Cranial Nerve Palsy
    • Mental Changes
    • Unilateral Sensorineural Deafness
  • Recent Onset headaches accompanied by features suggesting Raised Intracranial Pressure i.e
    • Vomiting
    • Posture related Headaches
    • Drowsiness
    • Pulse synchronous Tinnitus
  • Focal / Non-Focal Neurological Symptoms (Blackout, change in personality or memory)
  • Patient with Rapid Progression of any of the following:
    • Subacute Focal Neurological Deficit
    • Unexplained Cognitive Impairment, Behavioural disturbances or slowness
    • Personality Changes confirmed by witnesses with no reasonable explanation.

What are the Top 10 Breast Cancer Myths


  • A lump in the breast is Breast Cancer

    A lump in the breast has a long list of differentials. More than 80% of lumps felt by women are benign, however this should be evaluated by a doctor who will perform an ultrasound, mammogram and at times a biopsy or FNA as deemed appropriate.

  • Women under 40 don't get breast cancer.

    Though the risk of breast cancer increases with age, women of all ages can develop breast cancer and statistically speaking it is uncommon for women under 25 to present with breast cancers.

  • A Mammogram detects all Breast cancers

    Mammogram is currently the gold standard screening investigation of choice, however it detects only 85% of all breast tumors, as it is harder to detect these tumours in women with dense glandular breast tissue. In these circumstances, an ultrasound and/or MRI Breasts may be useful in addition to Mammography

  • Breast cancer is a women’s disease

    This is not true as for every 100 breast cancers inflicting women, there is one male breast cancer detected. Paradoxically, breast cancer kills 25% of men who develop it, largely due to the fact there is a delay in diagnosis and the cancer goes untreated for a longer duration.

  • If I have no family history of breast cancer, and I exercise, eat right and don’t smoke, I probably wont get breast cancer

    Unfortunately this is not the case as 70 % of women have no identifiable risk factors. A healthy life style certainly helps with your general health in the long run, but this does not determine your risk of getting breast cancer or not.

  • Antiperspirants and deodorants can cause breast cancer.

    A decade back this was quite a common myth which fortunately is not true as substantiated by extensive research perfomed in studies.

  • Mammograms can spread cancer, or even cause it.

    There have been nearly a dozen trials all over the world over the last 3 decades which has consistently shown that the amount of radiation from mammography is so low, that it is outweighed by the benefits this test offers.

  • Underwire Bras can cause breast cancer

    A few years back few enthusiasts felt that an underwire bra potentially obstructed the lymphatic flow which possibly may have a link of causal association with breast cancers. The good thing is that this is not true as underwire Bras are absolutely safe as this finding has not been validated.

  • If my mother had breast cancer, I will also get Breast cancer.

    There is a genetic association of Breast cancer, and having one or two family members may put you at twice or thrice the risk of cancer. This implies that if your baseline risk of breast cancer was 1.5%, then with the presence of family history this risk increases to 3-4%

    However if the breast cancer is hereditary and a few known genes from your mother have been passed on to you like BRCA1 or BRCA2, then the risk of developing Breast cancer can be as high as 50-80% during life time. It is seen that only 5% of all familial breast cancer patients harbor the above mentioned genes.

  • Mastectomy is the only treatment for Breast cancer.

    As an alternative to mastectomy for Early Breast cancer and select cases of advanced breast cancers, it is now possible to preserve the breasts by performing a breast conserving operation which is followed by a course of radiotherapy treatment +/- chemotherapy. The results from over a dozen clinical trials comparing mastectomy Vs Breast conserving approach are identical, with of course the added benefit of preserving the body image for women by preservation of the breasts.

What are the Top 10 biggest causes of cancer


  • Growing Older

    The most important risk factor for cancer is growing older. In the western world most cancers occur in people over the age of 65, while in developing countries like our, this is around 50. There seems to be a complex interplay of genetic, environmental and life style changes which seem to be the root cause.

  • Tobacco Use

    This is the most preventable cause of cancer and death. Smoking has now been shown to be implicated in causation of not only Lung cancer, but also larynx (voice box), mouth, esophagus, bladder, kidney, throat, pancreas, and cervix. Smokeless Tobacco (Snuff and chewing Tobacco) along with second hand smokers are also at increase risk.

  • Sunlight

    Ultraviolet radiation from the sun, sunlamps and tanning booths are responsible for the resultant skin cancer.

  • Ionising Radiation

    This kind of radiation emanates from earths atmosphere in small quantities. Radioactive fallouts from accidents at nuclear power plants like the more recent incident at Fukushima in Japan, can increase the risk of cancer like and cancers of the thyroid, breast, lung, and stomach in the subsequent years to come.

    The risk of cancer from diagnostic and theraupeutic purposes is quite small and perhaps the benefits far outweigh the risks involved

  • Chemicals and Other substances

    People who have certain jobs (such as painters, construction workers, and those in the chemical industry) have an increased risk of cancer. Many studies have shown that exposure to asbestos, benzene, benzidine, cadmium, nickel, or vinyl chloride in the workplace can cause cancer.

  • Viruses and Bacteria

    It is now known that few viruses can cause cancers, for instance Human Papilloma virus (HPV) is now implicated as the main cause for cervical cancers and oropharyngeal cancers, Hepatitis B and C viruses with Liver cancers, HIV virus that causes AIDS with Lymphomas and a rare cancer called Kaposi sarcoma, Epstein Barr Virus (EBV) with Lymphomas and nasopharyngeal cancers and Helicobacter pylori with stomach cancer.

  • Hormones

    There have been a plethora of trials which implicate that estrogens and /or progestin used as contraceptive pills or advocated for management of menopausal symptoms may implicate a slight risk for breast cancer. Diethystilboestrol, a form of estrogen when taken by pregnant women in the 40s and 50s increased the risk of vaginal cancers in the daughters who were exposed to this drug before birth.

  • Family History of Cancer

    Most cancers are sporadic and due to the complex interpay of the genes with the environment and the life style there are sporadic mutations in the genes which are ultimately responsible for the genesis of cancers.

    A few cancers do run in families, where the faulty genes if passed from one generation to another would enhance the risk of cancer which is the case in breast, ovary, colorectal, prostate cancers and melanomas.

  • Alcohol

    Excessive alcohol consumption over a period of years may increase the chance of developing cancers of the mouth, throat, esophagus, larynx, liver, and breast.

  • Life style changes (Poor Diet, Lack of Physical Activity, or Being Overweight)

    People who have a poor diet, do not have enough physical activity, or are overweight may be at increased risk of several types of cancer. For example, studies suggest that people whose diet is high in fat have an increased risk of cancers of the colon, uterus, and prostate. Lack of physical activity and being overweight are risk factors for cancers of the breast, colon, esophagus, kidney, and uterus.

Cancer Prevention


2/3 of all cancers may be prevented by

  • Avoiding tobacco
  • Avoiding / limiting alcohol Consumption
  • Eating adequate fruits and vegetables daily
  • Knowing family history of cancer
  • Limiting exposure sun/radiation
  • Choosing healthy food reduces cancer risk by 30 – 40%
  • Eating a low fat diet
  • Regular exercising
  • Maintaining healthy weight throughout life

Screening for cancer


  • Early detection provides the best opportunity for successful treatment
  • Cancer screening examinations are medical tests performed when you’re healthy
  • Reliable screening tests are available for certain cancers Ex: Cervix, Breast, Colon etc.

Principles of Cancer Treatment


  • Chemotherapy - mainstay of therapy
  • Development of more Specific Targeted Agents
  • Increased anticancer agents Clinical trials
  • Refined Surgery and Radiation therapy as effective treatment for localized lesions
  • Considerable resources for Palliative care of cancer patients