The National Institute for Health and Care Excellence (NICE) have given doctors a symptom based approach to help improve early diagnosis of cancer. It is hoped that people with possible cancer symptoms will visit their GP more quickly for a check up and for any tests that may be needed.
Willie Hamilton, Professor of Primary Care Diagnostics at the University of Exeter Medical School said “This guideline is about getting the right patients to the right tests at the right time.”
In our earlier article we listed the possible signs and symptoms to be taken into consideration when seeking medical help and further investigation where necessary.
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Now we will take a further look at the symptoms and the tests that may be carried out to identify the cause of the problem.
Mouth, throat and neck cancer symptoms
If you have a lump in your neck, the GP may check for problems with your thyroid, larynx or lymph glands and you may be sent for blood tests or an x-ray.
If you have problems swallowing, your GP should organise an endoscopy whereby a doctor can look inside your throat and stomach for any signs of cancer.
If you are over 45 and your voice is raspy or strained your GP may want to check for cancer of the voice box (larynx).
If you have a red or red and white patch or lump or ulcer that has lasted for more than 3 weeks on the inside of your mouth, your GP may refer you to see a dentist.
Breast and armpit cancer symptoms
If you are 50 or over and have changes to a nipple such as discharge or inversion, you should be offered an appointment to see a cancer specialist within 2 weeks. The same timescale applies if you are 30 or over and have a lump in your breast or in your armpit.
If other lymph glands in different parts of your body are also swollen, you may be offered a blood test to check for leukaemia. If there is puckering or dimpling to the skin on the breast that the doctor doesn’t think is caused by any other factor, you should also be referred to a specialist.
Chest cancer symptoms
You should be offered a chest x-ray, which should be carried out within 2 weeks, if you are 40 or over and have 2 or more of the following:
- Shortness of breath
- Chest pain
- Weight loss
- Appetite loss
- If you have been exposed to asbestos
- If you have a recurrent chest infection
Abdomen, stomach, bowels and bottom symptoms
If you have a lump which your GP thinks may be caused by a swollen spleen, you may be referred to a specialist to check for non-Hodgkins lymphoma. If the lump is in the upper part of the abdomen, the doctor may want to check for stomach cancer.
A blood test (full blood count) may be offered to check for leukaemia if the GP feels the lump may be caused by a swelling of the liver and spleen. This should be carried out within 2 days. A scan may also identify signs of cancer in the liver or gall bladder.
If you have pain in the abdomen and weight loss that cannot be explained by anything else, you may be offered a scan to check for cancer of the pancreas. An endoscopy may also help to look inside your throat and stomach for signs of cancer.
You may also be offered a test to check for blood in your stools as this could be a sign of cancer of the colon or rectum. If you are a woman and have long-lasting pain and bloating in your abdomen, you should be offered a blood test (called a CA125 test) to check for cancer of the ovaries.
You should also be offered an endoscopy within 2 weeks if you have severe acid reflux, indigestion, weight loss or are vomiting blood.
Changes in your bowel movements such as diarrhoea, constipation, blood in stools, size and frequency may need investigating especially if you are 60 or over.
Back and bones symptoms
Back pain is common but if you are 60 or over and have lost weight, your GP may offer you a scan to check for cancer of the pancreas. If you have a fracture not caused by an accident, you should be offered blood tests to check for myeloma.
Groin and pelvis symptoms
If you have problems with urinating or blood in your urine and the GP eliminates other possible causes, you should be offered an appointment to check for kidney or bladder cancer. If you are a man with these symptoms you may be offered a blood test called a prostate specific antigen test (PSA) and a rectal examination to check for prostate cancer.
New developments in the diagnosis of prostate cancer have seen the use of prostate MRI scans to improve detection by pinpointing the exact location of suspicious areas to help guide targeted biopsies.
If you are a woman, especially if you are over 50, you should be offered a CA125 blood test to check for cancer of the ovaries. A lump in your groin needs investigating in the same way.
Swollen glands in the groin may also need checking for lymphoma which is a cancer of the lymphatic system. Other symptoms of this include night sweats, fever, breathlessness, itchy skin, weight loss and pain in your glands when you drink alcohol.
If you are over 55 and have vaginal bleeding more than 12 months after the menopause, the GP should send you to a specialist to check for endometrial cancer which is cancer of the lining of the womb.
If you have pain, a lump or bleeding from the vulva, you may be offered an appointment to check for cancer of the vulva or vagina. If your GP examines the cervix and thinks that cancer may be possible, you may be offered an appointment to see a specialist within 2 weeks.
If you are a man and have a long-lasting sore or lump on your penis or if your testicles are swollen or have changed in shape, you should be offered an appointment to check for cancer of the penis or testicles. A PSA blood test may be offered if you have problems getting an erection.
Skin and soft tissue symptoms
If you are 40 or over and show the yellowing signs of jaundice, you should be checked out for cancer of the pancreas. If you have bruising, a rash of red or purple spots or unusual paleness of the skin, you may be offered a blood test to check for leukaemia which is cancer of the white blood cells.
Skin lesions and unusual or changing moles may need to be checked out using a magnifying tool called a dermoscope. If the doctor suspects melanoma or squamous cell carcinoma, then they should refer you to a skin cancer specialist within 2 weeks. If the GP thinks it may be basal cell carcinoma the timescale may be longer as it is a slower developing condition.
If a lump occurs in the soft tissue especially the arms and legs, a scan will check for soft tissue carcinoma.
Some symptoms that may be caused by cancer are not specific to a body area. If weight loss, tiredness and appetite loss cannot be explained by any other cause, you should be offered an appointment to see a cancer specialist within 2 weeks. They may carry out blood tests, scans or x-rays to identify the nature of the problem.
In conclusion, it must be stressed that being referred to a specialist does not mean that you have cancer. Very few people who are referred to a specialist actually have cancer. However, it is important that you are checked quickly to find out. If you do have cancer, spotting it early can mean treatment is easier and more likely to be successful.
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