You don’t need to panic, but you shouldn’t assume these signs are ‘nothing,’ either.
Article By Christina Boufis
WebMD Magazine – Feature
Reviewed by Nivin Todd, MD, FACOG
When Caryl Engstrom, 49, found a lump in her right breast, she knew something was wrong. Despite a normal mammogram 2 months earlier and recent breast exams by her internist and gynecologist, who found nothing amiss, Engstrom knew she needed to call her doctor right away. “I just had a gut feeling. It was a sizable lump and just didn’t feel right to me.”
Engstrom’s suspicions turned out to be correct when a biopsy revealed she had stage 2 breast cancer.
Although almost 65% of women over 40 have had a mammogram in the last 2 years, according to the CDC, cancer isn’t always caught by screening tests.
And when women do suspect something, fear sometimes prevents them from seeing a doctor right away, says Beth Y. Karlan, MD. She’s the director of the Women’s Cancer Research Program at Cedars-Sinai’s Samuel Oschin Comprehensive Cancer Institute in Los Angeles. Or women downplay or misinterpret symptoms that could point to cancer.
“They say, ‘Oh, this bloating is nothing. It can wait,’ ” Karlan says. “There’s this idea that if you look into it, if you acknowledge the symptoms, then something is going to change in your life, and you don’t want it to change.
“But warning signs do not mean cancer,” she adds. “Even if you have all of them. There are many other benign diagnoses or physiological changes that can also cause warning signs.” For instance, you can have bloating, low back pain, and pelvic pressure and just have fibroids, Karlan says.
But if your symptoms are “persistent and progressive,” she says, “meaning you wake up every morning and feel something and it has you worried — even for 2 weeks in a row — it really is worth calling your physician and having it checked out.”
Regular checkups and screening tests such as Pap smears and mammograms, as well as knowing your own body, are all crucial for good health, Karlan says.
Which changes are worth bringing to your doctor’s attention? We’ve asked experts about the symptoms you need to keep on your radar screen.
1. Breast Changes
“If you feel a lump, you shouldn’t ignore it, even if your mammogram is normal,” says Carolyn Runowicz, MD. She’s a breast cancer survivor and past president of the American Cancer Society. If your nipple gets scaly or starts flaking, that could indicate Paget’s disease of the nipple, which is linked to an underlying cancer in about 95% of cases. Any milky or bloody nipple discharge should also be checked out.
Dimpling of the skin over the breast, particularly if it looks like the skin on an orange, “is something to be worried about,” Karlan says. Such dimpling is most often linked to inflammatory breast cancer, a rare, usually aggressive cancer characterized also by swollen, hot, red breasts.
Expect your doctor to do a breast exam and medical history, followed by a mammogram and most likely a sonogram. Depending on the results of both tests, your doctor might do a biopsy.
2. Irregular Bleeding
Once you hit menopause (defined as 12 months without a period), any postmenopausal bleeding is a warning sign, says Runowicz. “Any bleeding, staining, little drops on your underwear, or big clots are abnormal and should be immediately investigated,” she says. Such bleeding could indicate something as benign as an endometrial polyp or something more serious like endometrial or cervical cancer.
Bleeding that is unusual for you — spotting outside of your normal menstrual cycle or heavier periods — should be looked into, Karlan says. Around menopause, abnormal bleeding is often tied to hormonal shifts, though more serious problems could be the cause, which is why all abnormal vaginal bleeding should be checked. Expect to receive a transvaginal sonogram and perhaps a biopsy.
3. Rectal Bleeding
Colon cancer is the third most common cancer in women. One of the hallmarks is rectal bleeding, which many people link to hemorrhoids, the most common cause. “But it’s not always that,” Karlan says. Red or dark blood in your stool warrants a visit to your doctor, she says.
Your doctor will likely do a rectal exam and order a colonoscopy if you’re 50 or older, and perhaps if you’re younger.
A foul or smelly vaginal discharge could be a symptom of cervical cancer, says Runowicz. The discharge may contain blood and may occur between periods or after menopause. It’s best not to self-treat a discharge with over-the-counter medications, she says.
An exam is necessary to determine if the discharge is due to an infection or something more serious.
“Ovarian cancer is the No. 1 killer of all the reproductive-organ cancers,” Karlan says. “For years it’s been known by the misnomer of the silent killer, and we really need to put that aside. Ovarian cancer clearly has symptoms.”
- The four most frequent are:
- feeling that you’re getting full earlier than you typically would when eating
- changing bowel or bladder habits, such as urinating more frequently
- low back or pelvic pain
It’s not unusual to have one or two of these symptoms occasionally, particularly after a big meal. But if you have two or more symptoms daily for more than 2 weeks, call your doctor.
Expect a pelvic exam, transvaginal sonogram, and perhaps a blood test to check for cancerous cells.
6. Unexplained Weight Gain or Loss
“If you suddenly put on 5 pounds, I wouldn’t worry,” Runowicz says. But gaining excess weight month to month — especially if you usually maintain a normal weight and watch what you eat — can be due to a buildup of fluid in the belly related to ovarian cancer and warrants a checkup with your doctor, she says.
Unexplained weight loss of 10 pounds or more “may be the first sign of cancer,” the American Cancer Society says, and is most often linked to pancreatic, stomach, esophagus, or lung cancer.
But weight loss in women is often caused by a hyperactive thyroid, Runowicz says. Expect your doctor to order a thyroid test first to check for this common disease.
7. Persistent Cough
Any persistent cough — one that lasts more than 2 or 3 weeks and is not due to an allergy or upper respiratory infection, or one that produces blood — needs to be checked by your doctor.
If your cough may be caused by smoking or being exposed to secondhand smoke, get it checked out. “Smoking is the number one cancer killer of women,” says Karlan.
You don’t have to be a smoker to be at risk. The majority of lung cancers that nonsmokers get also occur in women. Expect your doctor to order a chest X-ray and perhaps a CT scan.
8. Change in Lymph Nodes
“If you feel hard lymph nodes in your neck or under your arm, you should be seen by a doctor,” Runowicz says.
Swollen, firm lymph nodes are often caused by an infection.
But lymphoma or lung, breast, head, or neck cancer that has spread can also show up as an enlarged lymph node. Expect a physical exam and possibly a biopsy.
The American Cancer Society defines fatigue as “extreme tiredness that does not get better with rest.” So if you’re often fatigued, see your doctor. Leukemia, colon, or stomach cancer — which can cause blood loss — can result in fatigue.
“Fatigue can be a serious problem and it’s easy to ignore,” Runowicz says.
Your doctor will most likely do a physical exam and order blood tests to check your thyroid and rule out a thyroid condition, she says.
10. Skin Changes
Keep an eye on any changes you notice on your skin all over your body, and call your doctor right away if anything concerns you.
Sores in the mouth that don’t heal — especially if you smoke or drink alcohol — may be signs of oral cancer and should be checked by your doctor.
Note any sores or irritated skin in the vaginal area. “A non-healing vulvar lesion could be a sign of vulvar cancer,” Runowicz says.
Changes in moles or pigmented lesions on the vulva can also point to cancer. “Vulvar melanoma can frequently be overlooked and can have a very aggressive course,” Karlan says. A simple biopsy can be done in your doctor’s office if necessary.
The Bottom Line
Watch for all of these symptoms, but remember: While it’s important to be on the alert for physical changes, “we don’t want to [cause] too much alarm,” Karlan says.
If you notice something different about your body, get it checked out. Most likely it’s not cancer, but if it is, she says, “cancer is treatable, often it’s curable, and clearly having a diagnosis earlier will allow you to have the most benefit possible from current health care advances and to live as full a life as prior to a diagnosis.”
Caryl Engstrom agrees. “It’s all about early diagnosis. At the stage I was diagnosed, it was completely treatable,” she says. Getting confirmation she had breast cancer was “the worst part.” The treatment — a mastectomy, chemotherapy, and radiation — “wasn’t that difficult,” she says. “I found it all very manageable.”
Today, years after being diagnosed and treated, Engstrom is in remission, despite having what turned out to be a very fast-growing cancer. She still gets screening tests, too. For her, picking up the phone right away was the best thing she could do for her health — and her life.
3 Ways to Lower Your Cancer Risk
- Know thyself. Make a family health tree. “Know your family history,” Karlan says. “Know what you’re at risk for,” so you can focus on screening tests and prevention. Also, you’re just as likely to inherit your risk of breast and ovarian cancer from your father’s side of the family as from your mom’s, she says.
- Check your BMI. Make it a habit to know your body mass index, and keep it under 25 — the dividing line for being overweight, Karlan says. Regular exercise can lower blood estrogen levels, which helps cut your risk of breast cancer.
- Schedule screening tests. “Make sure you get a colonoscopy if you’re 50 or older,” Runowicz says. And schedule regular Pap smears (starting 3 years after first intercourse or no later than age 21) as well as mammograms after 40, according to the American Cancer Society.