General and Specific Cancer Symptoms

This article introduces the basic concepts about symptoms of common cancers.  In general terms, a medical symptom is a bothersome or unusual sensation, movement, discomfort or growth that causes a person to recognize that something is different or uncomfortable.  This usually prompts that person to bring the symptom to the attention of a doctor, assuming they are sufficiently worried about it or that it is causing enough discomfort to warrant action to try and relieve it.  This is in contrast to a sign which is generally able to be observed such as the appearance of a rash that is easily seen.  A symptom such as a severe headache cannot be readily seen by an observer.  Cancer symptoms will be discussed in subsequent articles in detail for specific cancer types.  Although there are thousands of possible symptoms that may either point to the presence of a cancer or be the result of a cancer, we will review the commonest symptoms as a broad introduction to symptom assessment.

Common symptoms of many cancers include: 

  • Fatigue
  • Weight loss (unintended)
  • Fevers (either a persistent fever or a cyclical fever that occurs once a week over several months for example)
  • Pain
  • A new “lump” or “bump”
  • Skin changes such as rash, ulcer, bleeding, change in previous moles, etc.
  • Cough (dry cough or cough with blood)
  • Poor healing of a wound or an old wound that starts to grow
  • Gastrointestinal changes
    • Diarrhea
    • Constipation
    • Blood in the stool
    • Difficulty swallowing
    • Pain with eating or bowel movements

Cancer symptoms can be roughly divided into those that are systemic (i.e. affecting the entire body) or regional (i.e. affecting the tissues or area directly around the tumor itself).  An example of a systemic symptom would be fatigue and weight loss from pancreatic cancer.  An example of a regional symptom would be a bleeding ulcer from a skin cancer.  Some cancers can directly cause both types of problems.  For example, a colon tumor may cause pain and blood in the stool from ulceration of the intestine.  The bleeding from the ulcerated tumor and blood loss over time will cause anemia resulting in fatigue – thus causing problems at the site of the tumor and problems affecting the entire body at the same time.

Although there are many types of symptoms, some cause intense anxiety or discomfort.  Most cancer symptoms are quite nonspecific and can be caused by many things that are not cancer.  For example, a simple common cold can cause a nagging cough just as a lung cancer can.  One of the challenges facing physicians is recognizing which minor symptoms do not require any further investigation and which ones are a potential red flag to indicate the presence of a cancer.  An additional challenge for a person with a minor symptom is knowing when to be concerned about it and when to ignore it.  A hypochondriac may be defined as a person who is very anxious about their health and demands frequent invasive (and often risky) testing or continually believes they have some dreadful illness.  The irony for hypochondriacs is that eventually we all get sick and die of something so their worry will one day be validated.

Pain:  Pain can arise from the tumor itself compressing nerves, from pressure on surrounding structures, or from destruction of areas where the tumor is growing.  An example of this would be breast or prostate cancer that has spread to the back causing pain in the spine and possibly fracture.  Pain is a very common fear and concern of someone who is diagnosed with cancer.  Even if there is no pain at the time of diagnosis of cancer, most people wonder if they will get pain at some point or die with severe pain.  Fortunately, the treatment and control of pain is something that is greatly emphasized in medical training and there are even pain specialists that have multiple types of pain relieving /prevention strategies.

Weight loss: Loss of weight with cancer can be caused by numerous factors.  Some of the commonest causes of weight loss from a cancer include; high metabolism of the cancer, loss of appetite from cancer hormones, blockage of the intestine, difficult swallowing, and changes in the taste of food.  An unintentional weight loss is often the first clue that a cancer may be present.  For example, a 65 year old man with a long history of smoking that loses 25 pounds over 6 weeks “for no obvious reason” and goes to his physician with back pain would be very suspicious of pancreatic cancer.  Unintentional weight loss also occurs with several non-cancer conditions, notably depression and endocrine disorders such as hyperthyroidism.  Depression and cancer frequently occur together and it may not be possible to fully define the precise cause of the weight loss – often many factors contribute together.

Nausea and Vomiting: Stomach upset and nausea is common with cancer and especially so with many cancer treatments such as chemotherapy or radiation.  When unrelenting, nausea can be a very disabling symptom that interferes with a normal life.  Fortunately, there are many different types of treatment for nausea.

Skin changes: There are hundreds of different skin diseases that are not cancer, however some changes in the skin are characteristic of cancer and can be recognized early.  Problems of the skin caused by cancer can include bleeding, ulcers, rash, redness, purple spots (or hemangiomas), pinpoint bleeding areas (such as petechiae or hematoma), and abnormal growth of the skin as might occur with a skin cancer.

Swelling: Swelling of a leg or arm can occur for several reasons with cancer.  The cancer may block the lymph nodes causing impaired drainage of lymph fluid from that extremity resulting in lymphedema.  A cancer may cause a growth or tumor of a limb.  Another mechanism for limb swelling might be blockage of a draining vein either by tumor within the vein (as with renal cell cancer), blockage of the vein by compression of the vein (as with a sarcoma of the thigh), or clot within the vein as a side effect of many cancers.

Fatigue: Many cancers cause a tired feeling or lack of energy.  This feeling is primarily attributed to cancer hormones such as TNF-alpha or interleukins 1 and 6.  These chemical messengers are also known as cytokines or cellular messengers and are increased with many severe illnesses.  Some of these cytokines are even elevated during a bout of the common cold explaining why someone feels weak or tired with a “simple” viral cold.

REFERENCES:

  1. Most bowel cancer symptoms do not indicate colorectal cancer and polyps: a systematic review. Adelstein BA, Macaskill P, Chan SF, Katelaris PH, Irwig L. BMC Gastroenterol. 2011 May 30;11:65. PMID: 21624112
  2. Goldman, L ;  Schafer A.I.  (2011). Goldman: Goldman’s Cecil Medicine, 24th ed. Chapter 183. New York, NY: Elsevier Saunders.
  3. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.