Cancer symptoms worth acting on

Stage at diagnosis is the strongest determinant of cancer survival, and the largest component of delay in most health systems is the interval before a person first presents.

Why people delay

The reasons are consistent across studies.

Not recognising a symptom as significant, particularly where it is vague or intermittent.

Fear of what will be found.

Embarrassment, particularly for symptoms involving the bowel, bladder, breast or genitals.

Not wanting to waste a clinician's time, which is one of the most commonly cited and most misguided reasons.

Difficulty getting an appointment.

And attributing symptoms to something else — age, stress, diet, a known condition.

The symptoms that warrant an appointment

Not exhaustive, and covering the common presentations.

Any unexplained bleeding: rectal, in urine, coughing blood, vaginal bleeding between periods or after sex, and any bleeding after menopause.

A new lump anywhere, including breast, testicle, neck and armpit — in people of any sex.

Unexplained weight loss.

A change in bowel habit lasting more than a few weeks.

Persistent difficulty swallowing.

A cough lasting more than three weeks, or a change in a long-standing cough.

Persistent hoarseness.

A sore or ulcer that has not healed in three weeks, including in the mouth.

A mole that has changed in size, shape, colour or symmetry, or that is itching, bleeding or crusting.

Persistent bloating, particularly in women, which is a recognised and frequently missed ovarian cancer symptom.

Unexplained persistent pain.

Night sweats with weight loss.

And unexplained persistent fatigue in someone who was previously well.

What happens when you present

Which is less alarming than people imagine.

Most people with these symptoms do not have cancer, and the majority of urgent referrals result in a benign diagnosis.

Referral pathways with defined time targets exist in many countries for suspected cancer, and clinicians use specific criteria to decide.

Being referred is not a statement that cancer is likely — it is a statement that it needs excluding promptly.

Investigations vary by site and may include blood tests, imaging, endoscopy or biopsy.

And a negative result is a genuine reassurance rather than a wasted appointment.

Screening versus symptoms

An important distinction.

Screening applies to people without symptoms and is designed to detect disease before it declares itself.

Anyone with symptoms should be assessed regardless of when they last attended screening, and a normal screening result does not exclude a cancer that has developed since or that the programme does not cover.

Which means "I had my mammogram last year" is not a reason to ignore a new breast lump.

Risk factors worth knowing

Modifiable and otherwise.

Tobacco, which remains the largest single preventable cause.

Alcohol, which is causally linked to several cancers and where awareness of the link is low.

Obesity, which is associated with a substantial number of cancer types.

Physical inactivity.

Ultraviolet exposure, including sunbeds.

Infections including HPV, hepatitis B and C, and Helicobacter pylori, several of which are preventable or treatable.

Occupational and environmental exposures.

Age, which is the largest non-modifiable factor.

And family history, where a strong pattern warrants discussion of genetic assessment, since some inherited syndromes change screening entirely.

Family history

Where a conversation is genuinely worthwhile.

Features suggesting an inherited predisposition: several close relatives with the same or related cancers; cancers diagnosed at unusually young ages; bilateral disease; multiple primary cancers in one person; and certain specific combinations such as breast and ovarian, or bowel and endometrial.

Where these are present, genetic counselling and testing may be offered, and this changes screening intervals, preventive options and family members' care.

Collecting an accurate family history — who, what cancer, at what age — is a useful thing to do before an appointment.

The cost argument

Which reinforces the clinical one.

Early-stage disease is generally treated with less extensive surgery, less or no chemotherapy and shorter recovery, at substantially lower cost to any payer and with far less disruption to income and family life.

Late-stage disease is expensive in every dimension.

Which makes prompt presentation the single most economically significant action a patient can take, quite apart from its effect on survival.

The message to internalise

You are not wasting anyone's time.

Health systems are designed on the assumption that most people presenting with these symptoms will not have cancer, and the small proportion who do are the reason the pathway exists.

The appointment you are avoiding takes fifteen minutes; the consequence of avoiding it is measured in stages.

General information only, not medical advice. Consult a qualified clinician promptly about any of the symptoms listed — most will not be cancer, and early assessment matters.