Symptoms and Cancer

            Most cancers eventually cause symptoms, but usually only when the cancer has been there a long time, and often when the optimal time for treatment has passed. This has led to the recommendation behind many “screening tests,” tests done in people with no symptoms.

            Colonoscopy, Pap smears (often combined with HPV virus testing), mammograms and low-dose chest CT are among the recommended tests done routinely in people with no relevant symptoms.

            Do symptoms have any role in cancer detection? Yes, in both directions.

            Let’s start with men. Many men worry they may have prostate cancer when they begin noting urinary urgency and frequency and feel that if they have no urinary symptoms cancer is unlikely. In fact, urinary symptoms reflect growth of the central part of the prostate, which surrounds the urinary passage out of the bladder, while most cancers begin in the outer part of the gland. So, counting on symptoms to prompt a search for prostate cancer is unwise.

            Whether screening for prostate cancer saves lives remains controversial, but if you want to find it early, get tested regardless of any symptoms.

            For both men and women, both kidney and bladder cancers are usually heralded by blood in the urine, though this may be small enough to only be seen when the urine is checked by a lab. Since a small amount of blood in the urine is common, and most often due to something else (infection and stones lead the list), there is tendency to overlook it. Don’t.

            If your patient portal shows you that you have any amount of blood in your urine, be sure your doctor stays on top of it. At a minimum, get this rechecked. If it is still there, the next test is usually an ultrasound – both safe and harmless, so not to be feared.

            Uterine cancer is becoming more common, for reasons not entirely clear. This cancer almost always announces itself early, with abnormal bleeding. If caught early, uterine cancer should be nearly 100% curable, but diagnosis is too often delayed because the bleeding is attributed to something else. Don’t accept a diagnosis of fibroids or endometriosis or hormone imbalance without at least discussing having a sampling biopsy. If you have been through menopause and then bleed, demand a biopsy.

            Finally, for women, is ovarian cancer. This, like pancreatic cancer, is often found only after it has spread. It has been taught that early ovarian cancers do not cause symptoms, but a recent study found that 72% of women with early-stage cancer had one or more symptoms. The leading symptoms were abdominal and/or pelvic pain, fullness or bloating and urinary frequency. Most often these symptoms are not due to ovarian cancer, but do not ignore them.

            You know your body, and if these symptoms are new, persist and do not have another explanation, push your doctor to check for ovarian cancer, typically with a pelvic ultrasound. Catching it early may save your life.

            Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.

What Does The Doctor Say?

By Dr. Edward Hoffer

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