When the Doctor Suspects Cancer

The word cancer is perhaps one of the most anxiety provoking words that one can hear from a physician.  Just the mention of the word often creates a feeling of fear, hopelessness or a certainty that death is near.  Imagery associated with the word cancer is often dramatic and one might envision someone who has lost their hair to chemotherapy or someone who is in unbearable pain because of cancer throughout their body.  The purpose of this article is to discuss the most common complaints or concerns that one may have when discussing the possibility of cancer with their doctor.

Patient Concern: One of the most common reasons that doctor might use the word cancer is to imply that he or she cannot say without certainty that a minor symptom does not represent cancer.    The reason for this is simple; doctors are not all-knowing entities and can only speak in terms of likelihood or statistics.  For example, a woman with a small lump on the arm or leg goes to her doctor for an examination.  The woman is concerned that the lump might be cancer.  The doctor examines the lump and says that it feels like a lipoma or benign fatty tumor that is most likely not cancer.  The woman still worried says is there a chance this could be cancer?  Well of course there is a chance – there’s a chance that someone can be struck be a meteor from space but the odds are low.

In this situation, the doctor offers options such as 1) re-examine in a few weeks to see if it is changing, 2) getting an x-ray or ultrasound to get more information, or 3) simply removing the lump if it is small and examine it under a microscope to prove the cell type definitively.  This situation is fairly straightforward and the “ruling out” process to prove the lump is not cancer and to set the woman’s mind at ease is not terribly risky.  Sometimes the cost of peace of mind is worth a few extra steps.

But consider an example where the woman now complains of breast pain and is convinced she has breast cancerNo reasonable doctor would recommend a major treatment for breast cancer such as chemotherapy or mastectomy without some evidence that a cancer exists.  Not everything can be driven by anxiety when the risk-benefit ratio is so small.  The key to dealing with these types of situations is open and honest discussion with your doctor about all of these concerns.  Some cultures and different regions of the world have a social taboo or frown upon discussing death or bad outcomes openly.  They may believe that if you talk about these things that may make them happen.  In some way we all may have at least an inkling of these types of feelings.  Open communication with a competent and knowledgeable physician can often alleviate many of these fears and help you determine which ones are realistic and which ones are driven more by anxiety of the unknown.

A “red flag” symptom:  There are certain symptoms that arise that demand an evaluation.  Some things cannot be ignored because if they are ignored there is a legitimate risk of missing a cancer.  Early detection and diagnosis of a cancer provides the best possible chance for cure and better outcomes with almost all cancers.  Some red flag symptoms that may prompt a physician to order a study to investigate for the possibility of cancer are things such as:

  • Rectal bleeding or blood in the stool
  • Bloody nipple discharge
  • Chronic cough or a pneumonia that will not resolve
  • Anemia in an older person
  • Bloody vaginal discharge in a post-menopausal woman

Things such as these symptoms should prompt a physician to order some additional study or imaging test to check for the presence of a cancer being responsible for the symptom.  The mention of the word cancer and the ordering of the study to look for it often create significant anxiety.  More worrisome would be ignoring the symptom or if it were overlooked by the physician and nothing was ordered.  The actual risk of cancer may be overstated or overestimated by the person undergoing these tests.  For example, about 5% of people with some blood in the stool may eventually be found to have a colon cancer.  This percent may change if you consider just younger people without risk factors but may be higher if you consider older people with weight loss and several close relatives with colon cancer.

Another example may be the woman with bloody nipple discharge.  Overall, also about 5% of women with this symptom may have a breast cancer as the cause.  This means that almost all women with this symptom will not have cancer and will experience fear and anxiety without merit.  The practical question however becomes how much risk is enough to worry?  For most people, being told that you only have a 5% chance of having cancer would still cause concern and a desire to have it investigated.  Think of how many people would buy lottery tickets if they had a 5% chance of winning compared with the standard lottery odds of one in millions.

The point of these examples is that you need information to keep these tests in perspective.  A person with weight loss and a brother who died of colon cancer at a younger age that now has blood in the stool themselves has a very real concern about the possibility of colon cancer.  Communication with your doctor about the sequence of testing and possible results of these tests in terms of what they might mean and the subsequent steps provides a sense of control in the situation and may alleviate some of the anxiety.

RERFERENCES:

  1. cancerdiagnosis.nci.nih.gov/
  2. www.cancer.gov/
  3. Curtis JR, Wenrich MD, Carline JD, et al. Understanding physicians’ skills at providing end-of-life care perspectives of patients, families, and health care workers. J Gen Intern Med 2001; 16:41.
  4. Quill TE, Arnold RM, Platt F. “I wish things were different”: expressing wishes in response to loss, futility, and unrealistic hopes. Ann Intern Med 2001; 135:551.
  5. Factors that influence cancer patients’ and relatives’ anxiety following a three-person medical consultation: impact of a communication skills training program for physicians. Lienard A – Psycho-oncology – 01-MAY-2008; 17(5): 488-96
  6. de Oliveira EP, Burini RC (September 2009). “The impact of physical exercise on the gastrointestinal tract”. CurrOpinClinNutrMetab Care 12 (5): 533–8.
  7. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.