About cancer

Signs and symptoms of cancer

Cancer can often be managed more easily when it is diagnosed in the early stages. Being aware of your body and what is 'normal' for you, and reporting symptoms to your GP, can help to make sure that, if you do have cancer, it is diagnosed as early as possible.

There are some common signs and symptoms that may alert you to the fact that something is new or different. You should contact your doctor if you have any of the following:

Lumps

Knowing how your body normally looks and feels can help you spot any early changes that could be caused by cancer. You should see your GP if you notice a lump anywhere in your body. It can be useful to tell them how long it’s been there and whether it is getting bigger, or causes discomfort. Cancerous lumps are often (but not always) painless.

It can be difficult to tell what a lump is just by feeling it, but if your GP suspects that you might have a cancer, they will refer you to the appropriate specialist for further tests.

It is important to remember that lumps and bumps often occur in the body, and most of these will not be cancer.

Coughing, breathlessness and hoarseness

There are many medical conditions that can cause 'chesty' symptoms like coughing and breathlessness (for example, infections and inflammations), but in some cases these symptoms may be a sign of lung cancer. If you have a cough or feel breathless for more than two weeks you should see your GP. You should also tell your GP if you have any blood in your sputum (phlegm) when you cough.

Laryngitis (inflammation of the larynx) is common and can cause a hoarse voice. In a small number of people, a hoarse voice may be a sign of cancer of the larynx (voice box). If hoarseness continues for longer than two weeks, you should tell your GP.

Changes in bowel habit

Symptoms of bowel cancer may include blood in your stools (bowel motion). The blood would usually be dark but can be bright red in colour. Fresh, bright red blood is usually a sign of piles (haemorrhoids).

You may notice a change in your normal bowel pattern (such as diarrhoea or constipation) for no obvious reason. You might have a feeling of not having emptied your bowel properly after a bowel motion. Some people also notice that they have pain in the abdomen or back passage.

Remember that altered bowel habits aren't always caused by cancer, but can be caused by changes in diet, some medicines, anxiety, and other medical conditions. If any changes last for more than a few weeks it's important to rule out cancer as a possible cause, so you should see your GP.

Bleeding

Any unexplained bleeding is a sign that there is something wrong and should always be checked out by your GP.

As previously mentioned, bleeding from the back passage is most commonly caused by piles, but can sometimes be due to cancer of the bowel or rectum.

Cancer of the womb or cervix can cause women to bleed between periods or after sex. Women who have any vaginal bleeding after they have had their menopause should see their GP. If necessary your GP will refer you to a gynaecologist.

Blood in your urine may be caused by bladder or kidney cancer. It can also be caused by infection. If you notice blood in your urine it is important to see your GP for a check-up.

Coughing up blood in your sputum may be caused by serious chest infections, but 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. Therefore, it is important to have this checked out by your GP.

Bruising and nosebleeds are rarely signs of cancer, but can in some cases be caused by leukaemia. However, people with leukaemia often have other troublesome symptoms too.

Moles

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. Less than a third of melanomas develop in existing moles. It can be difficult to tell the difference between a mole and a melanoma, but any of the following changes should be checked out:

Asymmetry Moles are usually regular and symmetrical in shape. Melanomas are likely to be irregular or asymmetrical.

Border Moles usually have a well-defined regular border. Melanomas are more likely to have an irregular border with jagged edges.

Colour Moles tend to be a single brown. Melanomas often have more than one colour. They may be varying shades of brown mixed with black, red, pink, white or a bluish tint.

Size Moles are normally no bigger than the blunt end of a pencil (about 6mm (½ inch) across). Melanomas are usually more than 7mm (½ inch) in diameter.

Itching, crusting or bleeding may also occur in melanomas – these are less common signs but should not be ignored.

It is important to see your GP if you have any unusual marks on the skin that last more than a few weeks, or an existing mole which shows any of the above signs. If necessary they will arrange for you to see a doctor who specialises in skin conditions (a dermatologist) or a surgeon.

Unexplained weight loss

If you have lost a lot of weight over a short period of time (a couple of months), that cannot be explained by changes in your diet, increased exercise or stress, it is important to tell your GP. Other symptoms, such as sickness, pain and fatigue also tend to occur when a person experiences weight loss due to cancer.

What to do if you have worrying symptoms

You usually begin by seeing your GP who will examine you, ask questions about your symptoms, and might ask you to have some tests, such as a blood test or x-ray.

If your GP suspects that you may have cancer, an urgent referral will be made to a specialist. There are guidelines produced by the National Institute for Health and Clinical Excellence (NICE) to help GPs identify when symptoms could be due to cancer or some other condition. An urgent referral usually means that the specialist will see you within two weeks. The specialist can carry out other investigations, such as a biopsy or various scans, to find the cause of your symptoms and plan any treatment necessary.

If your GP thinks your symptoms are not caused by cancer they may still refer you to a specialist for advice, but the referral is likely to be non-urgent and it will take longer for you to be seen.

Remember – in most cases, your symptoms will turn out to be caused by something other than cancer, but they can still be signs of illness and so you won't be wasting your doctor's time by getting them checked out.

References

This section has been complied using information from a number of reliable sources including;

Clinical Guidelines CG027: Referral for Suspected Cancer. National Institute for Clinical Excellence (NICE). June 2005.
Souhami and Tobias. Cancer and its Management (5th edition). Blackwell Scientific Publications. Oxford. 2005.
Souhami et al. Oxford Textbook of Oncology (2nd edition). Oxford University Press. Oxford. 2002.
DeVita, Vincent T. et al. Cancer: Principles and Practice of Oncology (6th edition). Lippincott. Philadelphia. 2001.

Types of cancer

Carcinomas

The majority of cancers, about 85% (85 in a 100), are carcinomas. They start in the epithelium, which is the covering (or lining) of organs and of the body (the skin). The common forms of breast, lung, prostate and bowel cancer are all carcinomas.

Carcinomas are named after the type of epithelial cell that they started in and the part of the body that is affected. There are four different types of epithelial cells:

squamous cells - that line different parts of the body, such as the mouth, gullet (oesophagus), and the airways
adeno cells - form the lining of all the glands in the body and can be found in organs such as the stomach, ovaries, kidneys and prostate
transitional cells - are only found in the lining of the bladder and parts of the urinary system
basal cells - that are found in one of the layers of the skin.

A cancer that starts in squamous cells is called a squamous cell carcinoma. A cancer that starts in glandular cells is called an adenocarcinoma. Cancers that start in transitional cells are transitional cell carcinomas, and those that start in basal cells are basal cell carcinomas.

Leukaemias and lymphomas

These occur in the tissues where white blood cells (which fight infection in the body) are formed, i.e. the bone marrow and lymphatic system. Leukaemia and lymphoma are quite rare and make up about 6.5% (6.5 in 100) of all cancers.

Sarcomas

Sarcomas are very rare. They are a group of cancers that form in the connective or supportive tissues of the body such as muscle, bone and fatty tissue. They account for less than 1% (1 in 100) of cancers.

Sarcomas are split into two main types:

bone sarcomas - that are found in the bones
soft tissue sarcomas - that develop in the other supportive tissues of the body.

Others forms of cancer

Brain tumours and other very rare forms of cancer make up the remainder of cancers.

What is cancer?

The organs and tissues of the body are made up of tiny building blocks called cells. Cancer is a disease of these cells.

Cells in different parts of the body may look and work differently but most reproduce themselves in the same way. Cells are constantly becoming old and dying, and new cells are produced to replace them. Normally, cells divide in an orderly and controlled manner. If for some reason the process gets out of control, the cells carry on dividing, developing into a lump which is called a tumour.

Two diagrams, one showing normal cells and the second showing cells forming a tumour.

Tumours can be either benign or malignant. Cancer is the name given to a malignant tumour. Doctors can tell if a tumour is benign or malignant by examining a small sample of cells under a microscope. This is called a biopsy.

In a benign tumour the cells do not spread to other parts of the body and so are not cancerous. However, if they continue to grow at the original site, they may cause a problem by pressing on the surrounding organs.

A malignant tumour consists of cancer cells that have the ability to spread beyond the original area. If the tumour is left untreated, it may spread into and destroy surrounding tissue. Sometimes cells break away from the original (primary) cancer. They may spread to other organs in the body through the bloodstream or lymphatic system.

The lymphatic system is part of the immune system - the body's natural defence against infection and disease. It is a complex system made up of organs, such as bone marrow, the thymus, the spleen, and lymph nodes. The lymph nodes (or glands) throughout the body are connected by a network of tiny lymphatic ducts.

When the cancer cells reach a new area they may go on dividing and form a new tumour. This is known as a secondary cancer or metastasis.

It is important to realise that cancer is not a single disease with a single type of treatment. There are more than 200 different kinds of cancer, each with its own name and treatment.

Bart's Mesothelioma Research

Bart’s Mesothelioma Research is a group of doctors, nurses and laboratory researchers aiming to improve the treatment and increase our understanding of mesothelioma and lung cancer. Mesothelioma is the main type of cancer caused by asbestos poisoning. Mesothelioma and other asbestos-related illnesses such as lung cancer and pleural plaques are increasing in incidence even though asbestos was little used after 1980. The problem is that there is a delay of between 30 and 50 years from the exposure to asbestos dust and the development of one of the diseases.

Britain is currently facing an epidemic of asbestos-related illness. Unfortunately there is very little research going on into mesothelioma in the UK. Bart’s Mesothelioma Research is aiming to raise the profile of this neglected group of diseases by offering our patients the best possible treatment and by conducting first-rate clinical and laboratory research.

At Bart’s we have one of the largest outpatient clinics in the UK for patients with mesothelioma. Typically our doctors see two or three new patients weekly. We also see a large number of patients who have completed treatment and are being followed up. We take a very positive view of treatment for mesothelioma and our patients are treated as individuals with treatment tailored accordingly. Treatments that we use include chemotherapy, radiotherapy and surgery. All patients are assessed in detail for symptoms by our team which also includes cancer specialist nurses.

Mesothelioma is cancer of the lung pleura or the abdominal peritoneum. The cancer arises in the membranous coverings of the lungs or bowels. Eventually the membrane becomes thickened and rubbery. Problems with breathlessness, chest pain and cough occur in many patients, though modern treatments can be very effective at abolishing these symptoms. Other symptoms that we see include weight loss, low energy levels and night-time sweating. Surgery to remove the cancer can be done in a few patients but most patients are treated with chemotherapy, radiotherapy and supportive treatments such as painkillers and appetite-boosting tablets. No patient is identical to another and, as discussed above, all patients are treated as individuals.

Research is central to our approach. It is imperative that we learn more about mesothelioma so that we can help current patients as well as patients of the future. What we learn about mesothelioma will help us understand other types of cancer such as breast, bowel and conventional lung cancer. Research at Bart’s takes two forms:

Clinical Trials

We have a programme of clinical trials which was initiated in the mid 1990s. Treatments pioneered at Bart’s have become accepted around the world. We cannot afford to stop where we are however, and much more progress is needed. We always have clinical trials available for patients. We also offer the standard best available treatments for patients who prefer not to be included in research trials. Some patients prefer a ‘watch-and-wait’ approach and we are supportive of this. Mesothelioma cancers tend to vary in their speed of growth and a period of observation is often very appropriate.