Quick Self-Screen List for 10 common Cancers

It is good to have a handy sheet to check ourselves out for alarm triggers for cancer that might go off in our system! Here is a short list for a quick self-screen. This list is by no means exhaustive, though I will try to cover as much as I can; I will also keep adding any that are left out in the initial post!

Some general tips:

Cancer is basically an abnormal growth of cells in some part of the body that starts to prey on the body, depleting it of nutrition, energy and finally life. Most cancers are fast growing. Many non-cancerous conditions (like non-healing ulcers, lumps, etc) can transform into cancerous growth over a period of time.

Cancers have loss of weight and loss of appetite in common. Any sudden spurt in growth of an old lump or an old ulcer should also be treated with suspicion.

Some charachteristics specific to location are:

1. Any growth inside the skull will have a set of common pressure symptoms as well as symptoms more specific to its site within the cranium and its type. The common symptoms that can be expected are: Nagging headache that is not amenable to treatment, sudden disturbances in hearing, sight or balance, vomiting, change in behaviour.

2. Cancers of the skin can be either growths or ulcers. Among growth, the old mole transforming in color, shape and size should be regarded as highly suspicious. Long-standing ulcers that fail to heal are also notorious for cancerous transformation.

3. Cancers of the tongue can be caused by sharp tooth, smoking, tobacco chewing, alcohol. Other factors that can contribute are infections by herpes simplex virus, human papilloma virus, family history, immunodeficiency and dietary deficiencies.
These cancers can show up as an ulcer or growth.

4. Cancers of the cheek are common in India because of that age old habit of chewing paan and betel nuts and then securing it in the 'cheek pouch'! Smoking, alcohol, HSV and HPV viral infections may also contribute but paan takes the cake. This often tends to occur in areas where the inside of the cheek gets whitened (leucoplakia). Some conditions called 'pre-malignant' conditions (sub-mucosal fibrosis and lichen planus) can also become cancerous.

5. Cancer of the thyroid: Any swelling in the thyroid gland which is lumpy whether it is one single swelling or multiple swellings, should be removed for diagnosis. A smooth diffuse swelling alone is goitre anything else is suspicious.
The lump can be tested by inserting a needle and aspirating some cells. This test will only be valid if it shows cancerous cells. If the result is negative, the lump MUST be removed for diagnosis for the simple reason that the needle may have missed cancerous cells by even a few millimetres.
Of the 5 types of cancer that can occur in the thyroid gland, the Papillary and Follicular forms are the commonest. Of these, the only way to differentiate between a Follicular lump that is cancerous and a Follicular lump that is not cancerous is to remove the lump with its capsule intact and see if this capsule or covering has been breached anywhere by cancerous cells.

6. Breast cancer: Any lump in the breast must be checked out by a doctor and investigated especially if it is found to be hard, fast-growing and appears to be 'fixed' with limited or no mobility. Women with a family history need to be extra careful. Routine yearly check ups by a doctor, with mammograms for those above 40 years of age and a monthly self-screen are of help in early diagnosis should a problem arise.
This has been discussed in detail as a separate topic. You could refer to it.

7. Lung cancer: Cancer found in the lung could either arise from the lung itself or could have spread there from a cancer found elsewhere in the body, commonly from the kidneys, prostate, breast, bone, gastro-intestinal tract, cervix and ovary. Here we will only discuss cancers that arise from the lung itself.

Among the causative factors for lung cancer, none stands taller than cigarette smoking. This has adverse effects not only on the smoker but also on all others exposed to his/her smoke.

Lung cancer can also be caused by exposure to asbestos, arsenic, chromium, iron oxide, petroleum products and oils, coal tar, products of coal combustion and radiation. This is generally an occupational risk for those involved with these dust or fumes in their work place.

Lung cancer can silently lurk in the body for 8 to 15 years from the time the first malignant cells appear, depending on the type, before it becomes obvious by symptoms. Often cough can be present as the only symptom. Chest pain and discomfort when present can be perceived as "fullness" and "pressure" in the chest. If the tumor has invaded the lung capsule (called the pleura) or the ribs, it can cause sharp pain everytime the lung is moved, the most common movement being breathing. A tumor blocking a large airway can make the lung tissue below it collapse or get infected. There can also be fluid between the layers of the lung capsule which is often blood stained (any blood-stained pleural fluid should make us up the antennae!). A variety of other symptoms occur with the location of the tumor.

Cancer from the lungs usually spreads to the bone, liver and brain.

A variety of investigations are available to confirm the diagnosis of the primary lung tumor. These begin with the humble chest x-ray and go on to include CT scan (MRI can be used for staging as it gives better images of the soft tissues in the mediastinum which is the central compartment of the chest), Fibreoptic bronchoscopy and Transthoracic fine-needle aspiration biopsy under radiographic guidance. A complete set of baseline biochemistry analysis must be done as well as tests to look for spread in the commonly expected areas.

The treatment is long and hard involving surgery when possible and indicated, chemotherapy and radiotherapy. The most sensible thing to do is to avoid the risk factors as much as possible! Those with occupational hazards should go for regular checks like yearly chest x-rays and 4 monthly sputum cytology (unfortunately their success rates remain minimal) and take whatever preventive steps they can to cut down on the hazardous exposure.

Smokers, just throw that burning stick away before it burns you up! Imagine what a lot you will save in terms of life-years, treatment costs and cigarette costs!

If you are a smoker or live with a smoker, here are somethings you absolutely must know!!
1. "Low-tar-low-nicotine Filter cigarrates" may not really reduce the risks as people often tend to inhale more deeply to compensate the dilution.
2. "Side-stream" smoke - inhaled passively by those around the smoker, contains more poisons than "main-stream" smoke - inhaled actively by the smoker. The person inhaling Passive Smoke can end up inhaling upto 3 times more than what the smoker himself/herself inhales as the cause for side-stream smoke (burning of cigarette inbetween puffs) releases more toxins.
3. Children exposed to passive smoke show increased chest infections and lesser growth. Long term effects on children are not yet fully known.
4. It takes 5 to 9 years of abstinence from smoking for the risk of lung cancer to begin to decrease in an ex-smoker. It takes 14 years of abstinence for the risk level to come down to the level of the normal population.


8. Stomach cancer: This is another major cause of deaths due to cancer, world wide. Certain pockets in the world like Japan and a few places in China have an extremely high incidence compared to the rest of the world (70 per 100,000 in Japan as against 15 and 10 per 100,000 in the UK and US respectively). This is attributed mainly to their diet. Yet for this reason, they have the best results of treatment as they have a well-set and elaborate screening program to detect and cure early disease and advanced treatment options for more progressed disease.

Diet that can make one predisposed to stomach cancer is the kind that is salted, smoked and pickled for preservation. The advent of the Refridgerator has cut down on the need of such food, helping to bring down the incidence of stomach cancer. The famous Japanese sushi is the leading contender in Japan.

For some reason, people with Type A blood group are more prone as are men than women.

Cancer of the stomach can be either 'intestinal' or 'diffuse' the diffuse being more dificult to treat. It can also be divided as cancer in the upper part of the stomach or the lower part. The lower part is more common in the common man! The upper part is more common in the affluent and is associated to obesity (just being very fat).

We will look more into cancer of the lower part of the stomach. This is often associated with infection by the bacteria Helicobacter pylorii, an organism that usually causes gastritis and other changes in the mucosal lining of the stomach. For this reason, H pylorii is sought to be eradicated by treatment when it is found in patients with gastric symptoms.

Stomach cancer is eminently curable if it is caught very early, before it has spread to the nearby lymphnodes. The problem is, nobody usually suspects it at this stage as it hardly causes any problems except what we commonly call "dyspepsia" which can be called 'discomfort'. To avoid not detecting an early cancer, as a rule, it is good to first undergo a gastroscopy for any one who gets "dyspepsia" first after 40 years of age (i.e. even before starting treatment - treatment can hide the changes and we may miss H pylorii if they were there). It is also good for anyone else whose dyspeptic symptoms have not subsided with treatment to undergo a gastroscopy. Its eeeeeeeeeech! but it might just save your life!! When a gastroscopy is done, if suspicious spots are found, they are biopsied and the tissue also tested for H pylorii.

The cancer can also bleed silently which may be passed out un-noticed but can show up as unexplained anemia instead. This is one more way it can give away itself. So unexplained anemia should be adequately investigated (hemoglobin levels, a stool blood test and gastroscopy will be some of the investigations called for). Larger bleeds can present as black tarry stools (like after eating spinach or iron tablets).

There is also unexplained tiredness and weightloss like it can be in any form of cancer.

Stomach cancer has many causes, though H pylorii is the flag bearer in most cases (we are not considering special regions like Japan here). Closely following on its heals is cigarratte smoking and some industrial dust, excessive intake of alcohol (though that might do a person in due to other causes earlier), excessive salt intake, deficiency of antioxidants, exposure to N-nitroso compounds and some other conditions like 'Pernicious anemia', 'gastric polyps' and previous surgery for gastric ulcer.

Advanced stomach cancer will cause difficulty to take and keep the food down and a feeling of fullness. Sometimes thrombosis of the deep veins can also occur.

Stomach cancer is treated by surgery when it can be performed and by chemotherapy either with surgery of chemotherapy alone, if it has unfortunately passed the operating stage.

Well, this article is out here so that none of you who reads it or your family or friends ever need to worry about that. Keep the prevention aspects going, binge on red and yellow fruits and veggies like tomatoes, carrots and sweet potatoes that can have protective effects and always be alert for early tell-tale signs!

9. Liver cancer: A routine ultrasound of the abdomen that shows up a lesion (an abnormal growth) in the can be scary! These can be caused by simple tumors that are non-cancerous as well as cancerous growths. Lets see how to differentiate these.

The most common benign or non-cancerous growths in the liver is the haemangioma which is quite plainly speaking, a lump of small blood vessals that have grown abnormally. This can be distinguished by delayed contrast CT scanning from other kind of liver tumors. These haemangiomas may be single or multiple. A biopsy through the skin is NOT advised as the tumor can bleed heavily into the abdomen which is very dangerous. They hardly ever show cancerous change, so can be well left alone after the diagnosis.

The Hepatic Adenoma is another non-cancerous growth found in the liver. This one has potential to become cancerous and so surgical removal of the tumor is the treatment of choice. It has been found to be related to sex hormones including intake of oral contraceptives. In such instances, the tumor size decreased on stopping the hormonal medication.

Focal Nodular Hyperplasia is found more in middle-aged women with no underlying liver disease. This is the only benign or non-cancerous liver tumor that contains a type of cell called 'kupffer cells' which are also found in normal liver. We do not yet know what causes this tumor.

Cancerous tumor found in the liver can be either due to spread to the liver from a cancer in some other part of the body - we call this metastatic tumor; or cancer arising from the liver itself - we call this primary liver cancer. We will deal with both separately.

Cancer that has spread from a primary cancer in another part of the body - These are the more common ones. They usually come from cancers of the gastrointestinal tract, breast or lung. These can be surgically removed if it is possible and will need further treatment like chemotherapy depending on where it has originated from.

Primary cancer of the liver or Hepatocellular Carcinoma - This is a very dangerous cancer which rarely lets its victim survive beyond 6 months. Upto 80% of those with this cancer have cirrhosis associated to it. Livers with cirrhosis are usually fibrotic and shrunken. The most common causes of cirrhosis are viral infections like Hepatitis B and Hepatitis C infections, excessive alcohol consumption and a rare condition called haemochromatosis.
Other causes of Hepatocellular cancer are a fungus called 'aflatoxin' (commonly found in spoilt groundnuts - next time, dump those spoit groundnuts in the kitchen rubbish bin and not your tummy rubbish bin!) and androgenic steroids; a weak association has been found with oral contraceptive pills. This tumor is more common in men than women.
This tumor can spread to the lymph nodes, lung and bones.
The only possible treatment is resection of the tumor and liver transplantation if the tumor is small enough and transplantation is an available option.

Cholangiocarcinoma is cancer that arises out of the bile ducts (network of tubes which transport bile - the green stuff produced by the liver and used for digestion by the stomach). This can arise from tubes that are within or outside the liver. They are often diagnosed late and also have a scope of less than 6 months survival.
These are not associated with cirrhosis or hepatitis B. In the Far East, they are associated to infestation with some species like Clonorchis sinensis or Opisthorchis viverini.

10. Cervical and Uterine cancer: Any bleeding from the vagina that is not related to a period must alert you! By this we mean, any bleeding that occurs unexpectedly between 2 periods, bleeding after sexual intercourse or bleeding after a vaginal examination. Even bleeding after menopause (more likely for uterine cancer) and a heavier normal period will be well worth getting checked out.
Any unexplained persistent vaginal discharge, pelvic pain or pain during intercourse should also raise alarm.
Who is prone to cervical cancer?
The Human Papilloma Virus or the HPV virus infection puts a woman in a high risk category. This virus is transmitted by sexual contact and is more likely in women with multiple partners or women who have a relationship with a man who has multiple partners. This virus may or may not also cause genital warts. There is now a vaccine available against this virus.
Cervical cancer is more commom over the 40 year age group and in those who have had more children.
Cigarrate smoking also increases the risk of cervical cancer. So does long-term (more than 5 years) use of birth control pills.
Any condition that decreases the immunity of a person increases risk, like having a HIV infection.
Daughters of mothers who had been given Diethystilbesterol during pregnancy were found to develop cervical cancer. This drug is now contra-indicated in pregnancy.
Screening: The Pap Test or Pap Smear is a good way to screen, though it may not be perfect always (sometimes disease can be missed).
Pap Test is a simple out-patient procedure that does not require any anesthesia. Some cells from the cervix are taken on a swab through the vagina, put on a special slide and sent for testing. During testing, the pathologist will look out for pre-cancerous of cancer cells.
A Pap Test is advised to be taken no later that 3 years after the first sexual intercourse or the age of 21. For 48 hours before a Pap Test, do not have sexual intercourse, do not use vaginal douche or any form of vaginal medication.