General awareness about cancers

Why and when to see your Doctor


Knowing how your body normally looks and feels can help you spot early any changes that could be caused by a cancer. Having any of the following symptoms doesn’t necessarily mean you have cancer, but it’s sensible to get them checked out by your GP.
• A lump anywhere on your body.
• Changes on your skin or to an existing mole (such as itching, bleeding, or a change in shape or colour).
• A cough or hoarseness that lasts for more than three weeks.
• A change in bowel habit that lasts for more than six weeks.
• Any abnormal bleeding from your vagina or back passage, in your urine or when being sick (vomiting).
• Unexplained, significant weight loss (5kg over a couple of months).
• Coughing up blood.

Some cancers have very specific symptoms, but not all cancers will have symptoms in the early stages. Some cancers are diagnosed by accident, while someone is being investigated or treated for another condition.
Cancer can’t be diagnosed based on symptoms alone. Investigations, such as x-rays, scans and biopsies, are nearly always needed to make a diagnosis.


General signs and symptoms
The following are the most common signs and symptoms of cancer.
Lumps
You should see your doctor if you notice a lump or swelling anywhere on your body.
Coughing and breathlessness If you have a cough or feel breathless for more than three weeks, you should see your GP. Tell them if you have any blood in your sputum (phlegm) when you cough.
Change in bowel habit
Blood in your stools (bowel motions) can be a symptom of bowel cancer. The blood is usually dark but can be bright red in colour.
You may notice a change in your normal bowel pattern, such as diarrhoea or constipation, for no obvious reason. Some people may have alternating episodes of diarrhoea and constipation. You may have a feeling of not having emptied your bowel properly after a bowel motion. Some people have pain in the tummy (abdomen) or back passage.
If any changes in bowel habit last for more than six weeks, you should check them out with your GP.
Abnormal bleeding
Unexplained bleeding should always be checked out by your GP.
Any unexplained bleeding is a sign that something might be wrong and should always be checked out.
• Bleeding between periods or after sex may be caused by cancer of the womb orcervix. Women who have any vaginal bleeding after they have had their menopause should always see their GP.
• Blood in your urine may be caused by bladder or kidney cancer.
• Coughing up blood in your sputum (phlegm) can sometimes be a sign of lung cancer.
• Vomiting blood can be a sign of stomach cancer, although it can also be due to a stomach ulcer.
• Bruising and nosebleeds are rarely signs of cancer, but can in some cases be caused by leukaemia. However, people with leukaemia usually have other symptoms too.
Unexplained weight loss
If you’ve lost a lot of weight over a short period of time (a couple of months or less) that can’t be explained by changes in your diet, increased exercise or stress, it’s important to tell your GP.
Suspicious moles or skin changes
Malignant melanoma is a type of skin cancer that often starts with a change in the appearance of normal skin. This can look like an abnormal new mole. Fewer than one third of melanomas develop in existing moles. Any of the following changes should always be checked out.
• Asymmetry - Melanomas are likely to be irregular or asymmetrical. Ordinary moles are usually symmetrical (both halves look the same).
• Border - Melanomas are more likely to have an irregular border with jagged edges. Ordinary moles usually have a well-defined, regular border.
• Colour - Moles tend to be one shade of brown. Melanomas often have more than one colour.
• Diameter (width) - Melanomas are usually more than 7mm in diameter. Moles are normally no bigger than the blunt end of a pencil (about 6mm across).
• Evolving (changing) - Look for changes in the size, shape or colour of a mole.

It’s important to see your GP if you have any unusual marks on the skin that last for more than a few weeks, or if you have a mole that shows any of the above signs.
Hoarseness
A hoarse voice may be a sign of cancer of the larynx. Hoarseness can occasionally be a symptom of other cancers, such as thyroid cancer, cancer of the oesophagus or lung cancer. If hoarseness continues for longer than two weeks, you should tell your GP.
Pain
People often think that pain is a symptom of cancer, but many people with cancer have no pain in the early stages. Some people with cancer will never have pain.

Lung cancer symptoms
Lung cancer is common in both men and women. Smoking cigarettes is known to be the cause of most lung cancers.
The symptoms of lung cancer may include any of the following:
• continued coughing for three weeks or longer, or a change in a long-standing cough
• a chest infection that doesn’t get better
• increasing breathlessness and wheezing
• coughing up blood in your sputum (phlegm)
• a hoarse voice
• a dull ache or a sharp pain when you cough or take a deep breath
• loss of appetite or loss of weight
• difficulty swallowing
• excessive tiredness (fatigue) and lethargy.
It’s important to have any of these symptoms checked by your GP as early as possible.


Large bowel cancer symptoms
The large bowel is made up of the colon and the rectum, and is part of the digestive system. Most cancers of the large bowel develop in the colon.
The following can all be symptoms of large bowel cancer:
• dark or bright red blood in or on your stools
• a change in your normal bowel habit, such as diarrhoea or constipation, for no obvious reason that lasts for longer than six weeks
• unexplained weight loss
• pain in the tummy (abdomen) or back passage
• a feeling of not having emptied your bowel properly after a bowel motion
• general discomfort, such as gas, bloating or cramps, in the tummy (abdomen).
Sometimes tiredness (fatigue) is a symptom of a bowel cancer. This can happen if the cancer has been bleeding, which means that the number of red blood cells in your body is reduced (anaemia). Anaemia may also make you feel breathless.
Sometimes a cancer can cause a blockage (obstruction) in the bowel. The symptoms of this are being sick (vomiting), constipation, pain in the abdomen or a bloated feeling.
Although these symptoms can be caused by conditions other than large bowel cancer, it’s important to get them checked by your doctor.


Prostate cancer symptoms
The prostate is a small gland found only in men. It‘s about the size of a walnut and surrounds the first part of the tube (urethra) that carries urine from the bladder to the penis.
Many men with early prostate cancer are unlikely to have any symptoms, as these only occur when the cancer is large enough to put pressure on the urethra.
In men over the age of 50, the prostate gland often gets larger due to a noncancerous condition known as benign prostatic hyperplasia or benign prostatic hypertrophy (BPH). The symptoms of both benign enlargement of the prostate gland and a malignant tumour (cancer) are similar and can include any of the following:
• difficulty in starting to pass urine
• a poor or weak flow of urine
• urgently needing to pass water
• passing urine more frequently than usual, especially at night
• blood in the urine, although this is uncommon.
If you have any of these symptoms, you should discuss them with your GP.


Bladder cancer symptoms
The bladder is a hollow, muscular, balloon-like organ that collects and stores urine. The most common symptoms of bladder cancer are:
• Blood in the urine - This usually happens suddenly and may come and go. It’s not usually painful. Sometimes the blood in your urine can’t be seen and is picked up by a urine test.
• Bladder changes - You may have a burning feeling when you pass urine, or need to pass urine more often or urgently than usual. These are all symptoms of bladder irritation and are more likely to be due to an infection than cancer. Your GP may want to investigate further if you have repeated infections.
If you have any worrying symptoms, getting them checked out with your GP is the best way to find out the cause.


Breast cancer symptoms
Breast cancer mainly affects women, but in rare cases can affect men too. In most cases, the first symptom of breast cancer is a painless lump. You should visit your doctor straight away if you notice a lump or other changes in your breast(s). Although most breast lumps are not cancerous (benign), they still need to be checked carefully to rule out the possibility of cancer.
Other, less common signs of breast cancer may include:
• a change in the size or shape of a breast
• dimpling of the skin on the breast
• a thickening in the breast tissue
• a nipple becoming inverted (turned in)
• a lump or thickening behind the nipple
• a rash (like eczema) affecting the nipple
• a swelling or lump in the armpit
• blood in discharge from the nipple.
Pain in the breast is not usually a symptom of breast cancer, but it can occur.


Ovarian cancer symptoms
Symptoms of ovarian cancer can be quite vague and may not occur until the cancer is at a late stage. When symptoms occur, they can include any of the following:
• loss of appetite
• feeling sick (nausea)
• excessive gas (wind)
• a bloated, full feeling
• unexplained weight gain
• swelling in the abdomen – this may be due to a build up of fluid (ascites), which can also cause shortness of breath
• pain in the lower abdomen
• changes in bowel or bladder habits, such as constipation, diarrhoea or needing to pass urine more often than usual
• lower back pain
• pain during sex
• abnormal vaginal bleeding.
If you have any of the above symptoms, it’s important to have them checked by your doctor.


Screening
Screening is a way of testing healthy people, either to see if a cancer can be found early or to detect changes that may develop into cancer at a later date.
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References
This section has been complied using information from a number of reliable sources including;
• Cancer Research UK. http://info.cancerresearchuk.org/
cancerstats/incidence/commoncancers/ (accessed August 2011).
• Clinical Guidelines CG027: Referral for Suspected Cancer. June 2005. National Institute for Health and Clinical Excellence (NICE).
• Clinical Guideline 121. Lung cancer: The diagnosis and treatment of lung cancer. April 2011. National Insitute for Health and Clinical Excellence.
• Tobias & Hochhauser. Cancer and its Management (6th edition). 2005. Wiley-Blackwell, Oxford.



How is cancer treated?


There are several different types of cancer treatment.

• Surgery
• Radiotherapy
• Chemotherapy
• Hormonal therapy
• Biological therapy
Some are used to treat cancer in a particular (local) area of the body. These are called local treatments. They include surgery and radiotherapy. Other treatments can treat cancer in more than one part of the body at a time. These are called systemic treatments. Chemotherapy, hormonal therapy and biological therapy generally work in this way.
The main types of treatment for cancer are described here. It’s quite common for a combination of treatments to be used.


Surgery
An operation to remove the tumour is the main treatment for many types of cancer.
Surgery is most likely to be used if the cancer is only in one area of the body and has not spread. It can sometimes be used to remove a cancer that has spread to another area of the body, but this is less common.


Radiotherapy
Radiotherapy uses high energy x-rays to destroy cancer cells. The radiation is targeted at the area affected by cancer so that it does as little harm as possible to normal cells. One of the most common side effects is tiredness. Other side effects depend on the part of the body being treated.


Chemotherapy
Chemotherapy uses anti-cancer (cytotoxic) drugs to destroy cancer cells.
There are more than 50 different chemotherapy drugs. Sometimes treatment is with just one chemotherapy drug but often two or more drugs are given together. This is known as combination chemotherapy. The type of chemotherapy treatment you are given depends on the type of cancer you have.
Chemotherapy can cause various side effects depending on which drug (or combination of drugs) is used. However, there are many ways of preventing or reducing the side effects of chemotherapy.


Hormonal therapy
Hormones are natural substances made by the body that control the growth and activity of certain cells. Some cancers depend on particular hormones in order to grow. Hormonal therapies reduce the levels of these hormones in the body or block the hormones from reaching cancer cells. This shrinks the cancer and stops it growing.


Biological therapy
Biological therapies work in various ways to destroy cancer cells. They can:
• stimulate the body’s defences (immune system) to attack the cancer
• attach to particular types of cells (including cancer cells) in the body so that they die
• interfere with a cancer’s ability to grow
• stop a tumour from making its own blood supply so it can’t get the oxygen and nutrients it needs.
Some biological therapies will do just one of these things while others may use two or more of these methods to attack the cancer.
Biological therapies can be given different names according to how they work. Some of the main types of biological therapies used to treat cancer are monoclonal antibodies,cancer growth inhibitors and angiogenesis inhibitors. Research is trying to discover whether other types of biological therapy such as vaccines and gene therapy can be used to treat cancer. This type of research is in the very early stages.
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