Spotting cancer early: Watch out for these red flags or key symptoms of cancer that are often missed and other expert insights for early detection
Early diagnosis is the single most important prognostic factor for cancer outcomes as the quality of life of patients is maintained and moreover less financial burden as the treatment is definitely shorter and simpler. In other words, early diagnosis has a very huge impact because cancer survival depends on the stage hence, the ultimate goal is to catch the cancer early as it reduces the patient’s difficulty in treatment and it also greatly improves survival.
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Are there any symptoms that are commonly overlooked or misinterpreted which can lead to delay in diagnosis
In an interview with HT Lifestyle, Dr Venkat P, Senior Consultant Surgical Oncologist, Breast, Gynec and GI Cancers at Apollo Cancer Centre, shared, “Any changes in the breast skin, small lumps, changes in shape of breast are sometimes overlooked by many patients . Sudden decrease in appetite or loss of weight , early satiety or feeling full after eating little, low hemoglobin are important symptoms of cancer which should not be missed . Blood in stools or dark coloured blackish stools can be associated with gastrointestinal cancers and is often misdiagnosed as piles.”
He added, “As a general rule any symptom that does not subside in 6 weeks should be taken seriously and an oncologist should be consulted. Ovarian cancer many times presents with gastrointestinal symptoms like bloating, gastritis , early satiety, abdominal distension. Most of these patients continue to take medications for gastritis and the correct diagnosis gets delayed . Sometimes abdominal distension secondary to ovarian carcinoma is falsely attributed as weight gain by women.”
According to Dr Vineet Govinda Gupta, Senior Consultant and Unit Head Medical Oncology at Fortis Hospital in Shalimar Bagh, it is very important to know cancer can have very subtle symptoms. He said, “Everybody knows common symptoms of cancer, like somebody feels a lump in their breast or somebody feels a mass somewhere in the body. These are relatively common symptoms of cancer. People know these symptoms and people are more aware of these symptoms. But there are many symptoms which are more subtle. For example, weight loss. So, many times patients don’t think that weight loss is a symptom of cancer but weight loss is actually a very common symptom of cancer. Normally what we say is that if any patient has involuntary weight loss of more than 10% of their body weight, then it is a big red flag for cancer and they need to see their doctor.”
Another example of a subtle symptom is cough. Dr Vineet Govinda Gupta said, “Lung cancer is a very common cancer and what happens is that people get coughs, which remain for a long time and they ignore it. So generally a persistent cough, which lasts more than three weeks is a very important sign of cancer. So a lot of these subtle symptoms can be cancer. One more example is persistent weakness. Weakness can have many causes but one important cause of weakness is blood loss. Suppose some one is losing blood in their stools. What happens is they develop anemia, they become pale and develop weakness and actually the blood loss could be because of a cancer somewhere especially in the GI tract (Gastrointestinal tract). So persistent fatigue, which is not resolving, also requires a complete checkup by the doctor, and it is a relatively subtle sign of cancer.”
He highlighted, “The key thing to note is that the patient has persistent symptoms. Even if it is a non-specific symptom. Normally when we think of cancer we think that the patient will develop a mass somewhere. The problem is the mass can occur inside the body also and they’ll lead to very subtle symptoms, which you need to be careful of. Generally what we recommend for patients is if they have any persistent symptoms, it may or may not be cancer related, but if they have any persistent symptom lasting more than three weeks they should meet the doctor. Even if it is a nonspecific kind of symptom, like fatigue or weight loss or weakness, still meet a doctor to have looked at that”
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For those with a family history of cancer, are there any preventive tests like genetic tests that can help understand their risk?
Dr Venkat P answered, “Science has advanced multifold and now it is possible to know the genetic defects. Any patient with young age cancer or any individual with multiple family members with cancer are advised to undergo genetic testing after proper counselling.”
Bringing his expertise to the same, Dr Vineet Govinda Gupta said, “Familial cancer is a very important cause of cancer. Data indicates that almost 5% to 10% of cancer has some familial implication. Patients who have got a strong family history should undergo something called Genetic Counseling. In genetic counseling, the doctor sits with the patient and the family and they make a family tree to see which kind of cancer is there in the family and which genetic syndrome it is likely to be. There are different genetic syndromes and they have different kinds of cancers which are seen in the family, and accordingly the patient is ordered genetic testing. Genetic testing can confirm whether there is familial cancer.”
Nowadays it is much easier to do genetic counselling and testing and it is being done very commonly right now but it is important to note that genetic testing should be done after genetic counselling. Dr Vineet Govinda Gupta explained, “The reason being that there are a lot of different syndromes and you need to be very careful with the syndrome you are testing for. You can’t just order a large panel and just hope for the best. That testing has to be done in a careful manner. You have to do pre-test counseling just to see what kind of test should be done and to prepare the patient for the test result, and post test counseling to discuss what implications that test has.”
He elaborated, “If somebody is tested positive, they need to have a heightened surveillance and their other family members need to be tested. A lot of things need to be done after the genetic test. It’s not just that we do the test and we leave it. If the test is positive, then the patient’s lifestyle is going to change and they have to do a lot of things to prevent cancer. There is something called genetic counseling, pre-test counseling, genetic testing and post test counseling. But with that you can improve the outcome of these familial cancer.”
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What impact does early diagnosis have on cancer treatment and outcomes? Anything else that you would like to add?
Dr Venkat P assured, “Breast cancer diagnosed early in stages has cure rates as high as 100 percent. Diagnosis and treatment in early stages has advantages like high cure rate , shorter duration of treatment, lesser side effects as the treatment is shorter and fewer modalities of treatment are used.”
According to Dr Vineet Govinda Gupta, in the case of breast cancer, if one has stage one breast cancer, it has a long term survival of almost 95 to 99%. He revealed, “For stage two, it dips to around 85 to 90%, for stage three dips to around 70 to 80%. Similarly, suppose one has head and neck cancer, so stage one again, the long term cure rate is almost 90%. But for patients who come in stage three or stage four, the long term survival is 30, 40%.”
The expert pointed out, “If you catch the cancer early then there are many advantages. One is that the survival rate is better. Number two, treatment is easier. For example, suppose the patient has had neck cancer and it is caught in Stage 1, then it requires a smaller surgery. Patients may not have to undergo radiotherapy, patients can avoid the chemotherapy and still get a very good survival. On the other hand, if the patient comes to us in stage three, then the patient’s surgery will be bigger, radiation will be required, the patient may need chemotherapy also, and the relapse rate is higher.”
Q. Where do they find genetic counsellors? And in India, how does one go about getting?
Dr Vineet Govinda Gupta shared, “Genetic counselling is a developing field. In metro cities, there are dedicated genetic counselors but in many of the smaller cities, there are no dedicated genetic counselors. Therefore,it is usually done by medical oncologists. Genetic Counsellors will figure out the family tree, what kind of genetic mutation is likely to be there. They’ll do the pre-test counselling, the testing, and the post-test counselling.”
