Asymptomatic Cancer

This article describes how some cancers may not cause symptoms and list the most common cancers with a “quiet” presentation.  The challenges of screening for common cancers are also reviewed. Eviction Lawyer reviewed.

All cancers cause some type of symptom when they are very advanced or end-stage.  The hallmark of cancer is disordered growth with abnormal invasion.  This type of behavior can be expected to cause some combination of pain, blockage, bleeding or swelling at the site of invasion.  Some types of cancer are recognized early on because they tend to cause symptoms early in their growth.  An example of this might be a tumor of the esophagus that causes immediate problems with swallowing.

Some types of cancer have a reputation for not causing any symptoms early on thus being hard to detect their presence.  A cancer that is difficult to detect will grow unchecked and may even spread before it is noticed.  A cancer that has spread to other locations (i.e. metastatic) are generally very difficult to treat and also very difficult to cure (although not impossible).

The primary emphasis for asymptomatic cancers is to focus on screening and early detection.  Although some  cancers can remain asymptomatic long periods of time, almost all cancers cause little to no symptoms in the earliest stages of disease.

Examples of cancers that may cause few or no symptoms include:

  • Ovarian cancer
  • Cancer of the tail of the pancreas
  • Lung cancer
  • Kidney Cancer
  • Early stage breast cancer
  • Early stage colon cancer

Ovarian cancer is notorious for having an indolent disease course and causing little symptoms.  Ovarian cancer can remain present for several years without the woman having many clues to its presence.  Ovarian cancer is also challenging because there is not a readily available, easily accessible and accurate way to identify it early as compared with breast or colon cancers.  Screening mammograms are started usually at age 40 to help detect breast cancer.

Screening colonoscopy are started around age 50 to help detect colon cancer.  There is not a good screening test for ovarian cancer making its detection difficult.  About 1 in 70 women will get cancer of the ovary with those of European descent being at a higher risk.  About 75% of women found to have ovarian cancer are diagnosed at a late stage (i.e. stage III or IV).  About 60% of women with cancer of the ovary will die from the disease within 5 years.  When cancer of the ovaries causes symptoms they can be quite vague and may not point immediately to a problem in the ovaries.

This is in contrast to the examples given with esophageal cancer where swallowing difficulty will point to the area of the problem early on.  Symptoms of cancer of the ovary might include mild abdominal pain, a feeling of bloating, a sensation of a mass in the pelvis, frequent urination or difficulty eating with loss of appetite.  Any combination of these symptoms might easily be attributed to many other things such as “stomach flu”, irritable bowels, gas, pre-menstrual syndrome, bladder infection, etc.  A similar and often unfortunate situation can arise with a tumor growing in the tail of the pancreas.  In this location a tumor might cause very few symptoms only causing pain or a sense of fullness when it has grown to an advanced stage and usually spread into neighboring tissues.

Identifying people at risk for asymptomatic cancers is an effective but costly strategy and is not practical for trying to screen a large group of people for the disease.  For example, there is a well-known cancer gene called BRCA-1 which predisposes a woman to get ovarian cancer.  A woman who carries this gene (BRCA-1) has up to a 40% chance of getting ovarian cancer at a young age.  If the presence of this gene is known, removal of the ovaries can be undertaken early in life to avoid development of ovarian cancer.  This would be referred to as a prophylactic surgery.  The situation becomes very complicated when you consider that there are different kinds of BRCA-1 mutations and it is not possible to test all women for these genes.  The testing is usually done when either a family member is found to have it or an unusual pattern of cancer is found that prompts consideration of a genetic family defect such as BRCA-1.

The other type of tool that can used to help find the presence of a cancer is termed a tumor marker.  Tumor markers are usually very poor tools for trying to diagnose a cancer but better at confirming the presence of a cancer and looking for recurrence of a cancer after treatment.  Most tumor markers are small proteins that are secreted or made by the cancer that can be found in the blood.  Common tumor markers used in modern medicine include:  (2)

  • CEA
  • PSA
  • CA-125
  • CA 19-9
  • CA 15-3
  • AFP

There are many others but these are among the most common markers used.  An example of how this might be used would be measurement of CEA level after diagnosis of a colon cancer.  If the value of this test is 80 and drops to 1 after removal of the tumor, then this information is useful.  In 6 or 12 months’ time if the CEA is re-measured and is now 25 (up from 1), this might indicate recurrence of the tumor.  A colon tumor early in growth and development might little or no symptoms.  A commonly quote rule of thumb (although there are notable exceptions) is that by the time a tumor is able to be felt, it has probably been growing for about 5 years.   This emphasizes the importance of screening for common cancers when appropriate.  It also emphasizes the difficulty a physician might face when evaluating a patient with a common complaint such as bloating or mild stomach pain.  Every minor symptom cannot be investigated with costly or dangerous testing to check for cancer – however things cannot be dismissed when it may represent a cancer.

This dilemma and practical considerations of the cost of health care have lead to the development of screening guidelines so physicians can hopefully target detection of the most common cancers that may early on have few symptoms.  This is why most average risk woman are encouraged to begin mammograms at age 40 or colonoscopies at age 50.

Knowledge of what cancers are more common can help direct invasive testing.  For example, a man with some stomach pain inJapan will likely receive a video endoscope inspection of his stomach (upper endoscopy) because stomach cancer is much more common inJapan.    Likewise, a young person with swallowing difficulty inEast Africa should receive early endoscopy to look for esophageal cancer because it is much more common in that area of the world.

REFERENCES:

  1. Ovarian cancer. Chobanian N, Dietrich CS 3rd.  SurgClin North Am. 2008 Apr;88(2):285-99, vi. Review.  PMID: 18381114
  2. www.cancer.gov/cancertopics/factsheet/detection/tumor-markers
  3. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.
  4.  This article is not to be construed as legal or medical advice and was last reviewed by John C. Feely from www.evictionlaw.org on June, 29th, 2016