From telegraph.co.uk
By Mary Comber
From persistent fatigue to a change in bowel habits, one doctor and cancer survivor reveals the red flags we should never ignore
“Nobody wants to think they’ll be affected by cancer,” says Dr Anisha Patel, GP. “Many people dismiss cancer symptoms as stress or ageing, or worry they’re wasting my time. Some have waited for months before coming to see me.”
Dr Patel, author of Everything You Hoped You’d Never Need to Know About Bowel Cancer, understands that instinct only too well. In 2018, she was diagnosed with stage-3 bowel cancer after a few months of subtle symptoms.
“Even with my medical knowledge, I could explain everything away,” she says. “I blamed constipation and tiredness on being a busy mum and GP. It was only when the symptoms became more persistent I realised I needed help.”
She’s far from alone. According to Cancer Research UK, around one in three people delay contacting their GP for six months after noticing a potential cancer symptom. That delay can have serious consequences. A study in The British Medical Journal found each four-week delay in intervention was associated with a 6 to 13 per cent increase in the risk of death, with the risk rising the longer treatment was delayed.
“A later diagnosis often means the cancer has had more time to grow or spread,” says Dr Patel. “That often leads to more intensive treatment and a worse prognosis.”
Following surgery and chemotherapy, Dr Patel made a full recovery and now works with Bowel Cancer UK to encourage more people to recognise the warning signs.
Here are the symptoms she says should never be ignored.
1. You’re more tired than usual
“Fatigue is a difficult symptom to catch because it’s so common,” says Dr Patel. “What’s key is whether it feels disproportionate to your activity level and distinctly different from your normal level of tiredness.”
Persistent fatigue can be a sign of many cancers but particularly bowel, kidney and blood cancers such as leukaemia and lymphoma.
As cancer cells grow, they consume more energy and nutrients which can leave the body depleted. Blood cancers and gastrointestinal cancers that cause slow, internal bleeding can lead to anaemia, resulting in weakness and fatigue.
Shortly before her diagnosis, Dr Patel was on holiday in Italy when she noticed she couldn’t manage her usual morning run. “I kept needing siestas and assumed it was because of the heat,” she says. “In reality, I was becoming increasingly anaemic because the bleeding was getting worse. I was relaxed, eating and sleeping well but the fatigue was pervasive.”
What to do
Book an appointment to see the GP if your fatigue lasts more than six weeks, is getting worse or significantly affecting everyday life, despite adequate rest, advises Dr Patel.
“It’s particularly important to seek help if fatigue is accompanied by another red-flag symptom, such as unexplained weight loss, bleeding, a lump or persistent pain,” she adds. “Don’t simply assume persistent tiredness is part of getting older.”
Your GP should check for anaemia and nutritional deficiencies, says Dr Patel. “They may also check thyroid function, diabetes and whether fatigue is caused by medication, an autoimmune condition or other illness,” she adds. “There may be an obvious explanation but, if it’s out of the ordinary, it needs investigating.”
2. Your bowel habits have changed
Whether it’s stress, anxiety or simply getting older, most of us experience changes in our bowel habits from time to time. Yet “people should never diagnose themselves with IBS (Irritable Bowel Syndrome) or assume it’s just stress affecting their bowels,” says Dr Patel. “We first need to rule out medical conditions including bowel cancer.”
A change in bowel habits doesn’t just mean diarrhoea or constipation. “Some people alternate between the two, the need to open their bowels more frequently or feel as though they’ve not emptied them properly,” says Dr Patel. “The shape of the stool can also change – mine became thin and ribbon-like because my tumour was in my rectum, narrowing the passage. I also had pain and a spasming sensation in my bottom.”
Other warning signs include abdominal pain and blood in the stool. “Shortly before my diagnosis, I began waking in the night with a sudden need to open my bowels,” adds Dr Patel. “That’s another red flag.”
What to do
If changes in bowel habits last more than three weeks or keep coming back, see your doctor.
“If a symptom clears up within a week or two, it’s less likely to be concerning,” says Dr Patel. “However, symptoms that persist or are clearly different from usual should always be checked.”
Around nine in 10 people with bowel cancer survive five years or more when diagnosed at the earliest stage, according to Bowel Cancer UK. At the latest stage, this falls to one in 10.
3. You’ve lost weight without trying
“Loss of appetite often goes hand in hand with unexplained weight loss, but either symptom can occur on its own,” says Dr Patel. “Unexplained weight loss is particularly associated with cancers of the digestive system, including bowel cancer, but can also occur with lung, liver, kidney and blood cancers.”
Cancer can trigger weight loss for several reasons. “Some cancers suppress appetite while others cause difficulty swallowing or nausea,” says Dr Patel. “Cancers affecting the digestive system may affect digestion and nutrient absorption while others trigger inflammatory changes that alter the body’s metabolism.”
What to do
Never ignore unexplained weight loss. If you’re not deliberately trying to lose weight, loss of appetite and weight need investigating, says Dr Patel.
“There are many non-cancer causes, including an overactive thyroid, diabetes, digestive disorders and certain medications,” she explains. “However, persistent, unexplained weight loss should always be checked, particularly if accompanied by other symptoms such as abdominal pain, bloating and problems swallowing.”
4. Your back pain won’t go away
“For me, the red flags are new back pain in someone over 50 who’s never had it before,” says Dr Patel. “The risk of cancer and other serious conditions increases with age so any new, persistent pain becomes more clinically significant.”
The type of pain is also key. “Muscle pain is usually related to movement,” she says. “You might have been digging in the garden or lifting something heavy and it hurts when you bend, twist or stand up. Cancer-related back pain is more likely to be constant whether you move or not.”
Backache is particularly concerning if combined with other symptoms such as a cough, changes in bowel habits or breast symptoms such as lumps or swelling. “Breast, prostate, lung, kidney and thyroid cancers, as well as myeloma, can all spread to the bones,” says Dr Patel.
What to do
Seek medical advice if you’re over 50 and start experiencing persistent back pain for the first time – especially if it’s not affected by movement and gets worse at night.
“Night pain is another important red flag,” says Dr Patel. “If your back pain is waking you up at night, it’s something to investigate.”
5. You’re feeling bloated
“Ordinary bloating comes and goes,” says Dr Patel. “If it doesn’t settle and feels like your tummy is getting bigger, that’s more concerning – particularly if accompanied by pelvic pain, feeling full more quickly or loss of appetite.”
Bloating that doesn’t go away can sometimes be an early warning sign of ovarian, bowel, liver, pancreatic or womb cancer.
Cancer-related bloating can be caused by a tumour pressing on nearby organs or by fluid building up in the belly (the medical term for this is ascites).
“You may notice you’re eating less because you feel full more quickly, need to urinate more often or see changes in your bowel habits,” says Dr Patel.
What to do
Arrange a GP appointment if bloating persists for more than three weeks, is getting worse or keeps coming back.
“It could be caused by IBS, coeliac disease or another non-cancer condition but it’s paramount we rule out ovarian and other cancers,” says Dr Patel. “These cancers are often diagnosed late because they start with non-specific symptoms.”
Your doctor may arrange blood tests and, depending on your symptoms, further investigations or referral to a specialist.
“The important thing is to know what’s normal for you,” says Dr Patel. “If something changes and doesn’t feel right, don’t keep putting it down to stress or getting older. Get it checked.”
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