Red Flags Of Cancer

Question 1

Progressive unexplained symptoms such as weight loss, sweating (particularly at night) fevers and poor appetite?

Answer 1

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Symps that gradually worsen rather than fluctuate over time are strongly suggestive of cancer.
* There is usually no need for urgent referral as this may only increase anxiety. Only consider it as urgent if you suspect rapid disease progression or if patient is already very anxious.
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Question 2

Unexplained lump >1cm in diameter. Characteristically hard, irregular, fixed and painless.

Answer 2

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Cancer lumps are usually fixed, irregular and painless unless they obstruct viscera (organs) cause pressure on other structures, grow into bones or nerve roots. Soft mobile lumps are more likely to be benign. Painful lumps are more likely to be inflammation or infection.
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Question 3

Unexplained lump >1cm in diameter. Characteristically hard, irregular, fixed and painless.

Answer 3

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Cancer lumps are usually fixed, irregular and painless unless they obstruct viscera (organs) cause pressure on other structures, grow into bones or nerve roots. Soft mobile lumps are more likely to be benign. Painful lumps are more likely to be inflammation or infection.
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Question 4

Unexplained bleeding either from the surface of the skin or emerging from an internal organ e.g the bowel bladder or uterus. (Blood in vomit, from vagina, in stools or urine.

Answer 4

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Cancerous tissue is poorly organised and so bleeding may occur from the surface of an epithelial tumour (breast, skin, lung, mouth, stomach, bowel, bladder, uterus)
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Question 5

Bone marrow failure: severe progressive anaemia, recurrent progressive infections or bruising purpura and bleeding.

Answer 5

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Secondary cancer of the blood cells can infiltrate the bone marrow and prevent it from performing its role of producing healthy red and white blood cells and platelets. Purpura is pin point bruising which often looks like a rash of flat purplish spots and is one of the signs of a low platelet count.
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Question 6

Multiple enlarged lymph nodes. >1cm in diameter. Painless with no other cause e.g glandular fever and lasting for more than 2 weeks.

Answer 6

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Groups of lymph nodes can be found in cervical region, arm pits (axillary nodes) and in the inguinal creases. The nodes are usually soft but can enlarge when active in fighting infection or if infiltrated by cancer cells. If a number are enlarged to >1cm diameter this may be a sign of infection e.g glandular fever, HIV. Also disseminated cancer, in particular cancers of the white blood cells e.g leukaemia and lymphoma. If multiple enlarged nodes are found it’s best to refer to enable swift diagnosis, and as a high priority if the patient is unwell with other symptoms.
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Question 7

A single markedly enlarged lymph node >2cms in diameter with no other symptoms?

Answer 7

Even with infection it is unusual for a node to become this enlarged. Cancerous infiltration can lead to firm enlarged nodes which may be painless. This is particularly typical of lymphoma.
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Question 8

Painless abdo bloating or swelling due to fluid accumulation (ascites)

Answer 8

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Abdo epithelial malignancies such as colon cancer, stomach cancer, and ovarian cancer may lead to the accumulation of fluid in the abdo cavity. This may initially be painless.
Ascites is usually a sign that the cancer has metastasised and has a poor prognosis. Other causes are chronic congestive cardiac failure, liver failure, and kidney disease. Bloating at the end of the day or after meals is not usually a serious sign and is a common feature of IBD. However progressive bloating over a few weeks may indicate tumour bulk (particularly with ovarian cancer) and merits referral.
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