cancer

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What are the signs and symptoms of cancer?

Signs of cancer

Signs of cancer

It’s important to be aware of any unexplained changes to your body, such as the sudden appearance of a lump, blood in your urine, or a change to your usual bowel habits.

These symptoms are often caused by other, non-cancerous illnesses, but it’s important to see your GP so they can investigate.

If your GP suspects cancer, they’ll refer you to a specialist – usually within two weeks.

The specialist will carry out further tests, such as a biopsy or X-ray, and plan any necessary treatment.

Read more about waiting times for cancer referrals and treatment.

Other potential signs and symptoms of cancer are outlined below.

Lump in your breast

See your GP if you notice a lump in your breast or if you have a lump that’s rapidly increasing in size elsewhere on your body.

Your GP will refer you to a specialist for tests if they think you may have cancer.

Coughing, chest pain and breathlessness

Visit your GP if you’ve had a cough for more than three weeks.

Symptoms such as shortness of breath or chest pain may be a sign of a severe (acute) condition, such as pneumonia. See your GP straight away if you experience these types of symptoms.

Changes in bowel habits

See your GP if you’ve experienced one of the changes listed below and it’s lasted for more than a few weeks:

blood in your stools

diarrhoea or constipation for no obvious reason

a feeling of not having fully emptied your bowels after going to the toilet

pain in your stomach (abdomen) or back passage (anus)

persistent bloating

Bleeding

You should also see your GP if you have any unexplained bleeding, such as:

blood in your urine

bleeding between periods

bleeding from your bottom

blood when you cough

blood in your vomit

Moles

See your GP if you have a mole that:

has an irregular or asymmetrical shape

has an irregular border with jagged edges

has more than one colour – it may be flecked with brown, black, red, pink or white

is bigger than 7mm in diameter

is itchy, crusting or bleeding

Any of the above changes means there’s a chance you have malignant melanoma, a form of skin cancer.

Unexplained weight loss

You should also see your GP if you’ve lost a lot of weight over the last couple of months that can’t be explained by changes to your diet, exercise or stress.

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Mouth cancer – what are the signs and symptoms you need to look out for?

Mouth cancer

Mouth cancer

Mouth cancer can develop in most parts of the mouth, including the lips, gums and occasionally the throat.

The most common symptoms of mouth cancer are:

sore mouth ulcers that don’t heal within several weeks

unexplained, persistent lumps in the mouth that don’t go away

unexplained, persistent lumps in the lymph glands in the neck that don’t go away

Other symptoms may include:

pain or difficulty when swallowing (dysphagia)

changes in your voice or speech problems

unexplained weight loss

bleeding or numbness in the mouth

a tooth, or teeth, that becomes loose for no obvious reason, or a tooth socket that doesn’t heal

difficulty moving your jaw

red or white patches on the lining of your mouth – these are common and are very rarely cancerous, but they can sometimes turn into cancer, so it’s worth seeing a specialist if you have them

When to seek medical advice

Many of the symptoms listed above can be caused by less serious conditions, such as minor infections.

However, it’s strongly recommended that you visit your GP or dentist if any of the above symptoms have lasted longer than three weeks. It’s particularly important to seek medical advice if you drink or smoke regularly.

Dental check-ups

Mouth cancer often doesn’t cause any noticeable symptoms during its initial stages.

This is why it’s important to have regular dental check-ups, particularly if you smoke, drink heavily or chew betel, a type of nut commonly consumed in Asia. Your dentist may be able to detect mouth cancer during an examination.

You should have a dental check-up at least once a year. More frequent check-ups may be recommended if you have a history of tooth decay or gum disease.

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High-precision radiotherapy for prostate cancer ‘shows promise’

Prostate cancer

Prostate cancer

“Targeted radiotherapy ‘cures’ prostate cancer that kills thousands,” reports The Times.

The news is based on a UK study of the use of high-precision radiotherapy to treat men with advanced localised prostate cancer.

Researchers wanted to see if they could safely target cancer cells that had spread outside the prostate to nearby lymph nodes without damaging nearby healthy cells, and reduce treatment side effects.

Prostate cancer is the most common cancer in men – more than 47,000 cases are diagnosed in the UK every year.

Some 447 men with locally advanced disease took part in the 10-year study, carried out by the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust.

The high-tech radiotherapy, called pelvic lymph node intensity modulated radiation therapy (PLN-IMRT), can modify the shape and strength of its beams to target cancerous cells more effectively.

The main aim of the study was to look at the side effects of the treatment, specifically on the bladder and bowels.

Five years after receiving treatment, up to 71% of patients were alive and disease-free. Only 8-16% of patients experienced bowel or bladder complications.

This is promising research that suggests PLN-IMRT should be studied further. Later-stage randomised controlled trials would be the best way of confirming the safety and potential benefit of this treatment for men with advanced localised prostate cancer and seeing how it compares with other treatment approaches.

Where did the story come from?

The study was carried out by researchers from the Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, both in London. It was funded by Cancer Research UK, the Department of Health, the National Institute for Health Research (NIHR) Cancer Research Network and the NHS.

It was published in the peer-reviewed International Journal of Radiation Oncology Biology Physics and is free to read online.

The media headlines talking of a “cure” are premature at this point. This early-stage study focused on the potential harms of PLN-IMRT.

While the number of men surviving without disease progression was an exciting finding that should prompt further research, it’s important to realise that the present study wasn’t designed to give us definitive answers on whether the treatment works or how it should be delivered.

What kind of research was this?

This was a phase I and phase II trial designed to see whether PLN-IMRT was a feasible treatment to use in men with advanced localised prostate cancer and to look at its side effects.

Locally advanced prostate cancer means the cancer has spread outside of the prostate to the nearby lymph nodes and tissues, such as the semen-carrying seminal vesicles.

There are a number of treatment options, one of which is radiotherapy – but this is often targeted at the prostate and seminal vesicles rather than directly at the lymph nodes.

This is an early-stage trial, so the participants were not randomised to the treatment they received and there was no comparison group receiving a different treatment.

This stage of trial is important for looking at side effects and seeing if the treatment approach is feasible, but it can’t provide good evidence for how effective the treatment is – that requires later-stage trials.

What did the research involve?

The researchers recruited 447 men with advanced localised prostate cancer. The men received radiotherapy to the prostate as well as to the prostate lymph nodes in one of five different dosage patterns.

The dosage pattern each person received was determined by the order in which they entered the study, rather than being allocated at random.

The dosages were:

group 1: 70-74 gray units of radiation (Gy) to the prostate and 50Gy to the prostate lymph nodes over 35-37 sessions

group 2: as group 1 but with 55Gy to the prostate lymph nodes

group 3: as group 1 but with 60Gy to the prostate lymph nodes

group 4: 60Gy to the prostate and 47Gy to the prostate lymph nodes, spread across 20 sessions over the course of four weeks

group 5: as group 4 but across 20 sessions over five weeks

Everyone in the study also received long-course androgen-deprivation therapy (the male hormone, androgen, helps the cancer to grow).

Men were not allowed to participate in the study if they were unsuitable for radical radiation therapy, or had a history of either pelvic surgery or inflammatory bowel disease.

The main aim was to look at side effects of the treatment, particularly toxic effects on the bladder and bowel within two years of treatment.

The researchers also got an indication of how effective the treatment was by measuring survival rates as the study progressed and how many men could be considered to be free of prostate cancer.

However, it should be noted that, as this wasn’t a randomised trial, the men in each treatment group were not necessarily directly comparable in terms of their risk factors at the start of the study.

What were the basic results?

The researchers found that acute bowel toxicity peaked between six and eight weeks after treatment in groups 1, 2 and 3, but it occurred earlier in group 4 (in weeks four to five) and group 5 (weeks five to six). Most cases of bladder toxicity occurred in the first few weeks following treatment.

Rates of both bowel and bladder toxicity stabilised over time and were similar in all groups 18 weeks after treatment.

The overall toxicity rates per group at two years after treatment were as follows:

group 1: bowel 8.3%, bladder 4.2%

group 2: bowel 8.9%, bladder 5.9%

group 3: bowel 13.2%, bladder 2.9%

group 4: bowel 16.4%, bladder 4.8%

group 5: bowel 12.2%, bladder 7.3%

Disease progression occurred in 169 of 426 men (40%). The disease-free survival and overall survival rates were:

group 1 (26 people allocated): 38% disease-free, 76% survival

group 2 (59): 61% disease-free, 88% survival

group 3 (157): 70% disease-free, 92% survival

group 4 (70): 80% disease-free, 97% survival

group 5 (135): 78% disease-free, 95% survival

How did the researchers interpret the results?

The researchers described the bladder- and bowel-related toxicity rates of the treatment to be “acceptable” both in the short and longer term. They described the long-term disease-free survival of some people in the study as being consistent with other research on the same type of treatment.

Conclusion

This study shows some promising results for targeted pelvic lymph node radiotherapy for men with advanced localised prostate cancer.

However, these results can only be treated as preliminary findings for now. This was an early-stage trial that aimed to investigate whether the treatment approach is safe and to get an idea of what doses may be suitable for assessment in further trials. Although it can give an indication of effectiveness, this was not the main aim of the study.

Men were not randomised to a treatment group, which means there may have been some differences in the cancers or patient characteristics of men who received the different radiation dosages. This could, in turn, have impacted how effective the treatment was and makes it hard to know at this stage what the optimal approach to delivering this treatment would be – which dose is the best, for example.

All men in the study also received some kind of pelvic lymph node radiotherapy, which means it’s not possible to say how effective PLN-IMRT is compared with more conventional treatment approaches.

This research gives us a potential new treatment to investigate for men with locally advanced prostate cancer. Further trials looking more precisely at the effectiveness of this treatment are already in progress.

However, it will be some time before it’s known whether this could become a standard treatment option in the future.

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How Cells Divide and How Chemotherapy Works

How Cells Divide and How Chemotherapy Works

How Cells Divide and How Chemotherapy Works

How Cells Divide and How Chemotherapy Works. Learn more about this cancer treatment in this important video! For more on radiotherapy as a cancer treatment please go here.

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Can tattoos give you cancer?

Tattoos and cancer

Tattoos and cancer

“Tattoos could give you cancer, new research suggests,” is the entirely unsupported claim from the Mail Online.

The news come from a study that found evidence particles from tattoo ink can spread into lymph nodes – but it hasn’t been proven that tattoo ink causes cancer.

Researchers used samples of skin and adjacent lymph nodes taken from six donors after autopsy.

Four of the donors had tattoos and were more likely to have substances like titanium in the lymph nodes. Lymph nodes are part of the lymphatic system, which in turn is part of the immune system.

The problem is the researchers didn’t include important information about whether any of the donors had cancer, or what caused their deaths. This means it’s not possible to claim that the tattoo ink particles found in lymph nodes cause cancer.

Tattoos have become far more popular in recent years, leading to concerns about their safety. The ink used in tattoos includes a mixture of organic and metal-based pigments and preservatives.

There’s been little study of their effects on human health. This is partly because animal experiments are thought to be unethical, as tattoos are a matter of choice, not medical necessity.

Most safety concerns have focused on the need to ensure tattoo artists use sterile needles to prevent the spread of blood-borne diseases, such as hepatitis C.

We don’t know whether the spread of ink particles into lymph nodes would have any significant impact on human health, let alone cause cancer.

Where did the story come from?

Researchers were from the German Federal Institute for Risk Assessment, Physikalisch-Technische Bundesanstalt, and the Institute of Forensic Medicine in Germany, and the Department of X-ray Spectrometry European Synchrotron Radiation Facility in France.

The research was published in the peer-reviewed journal Scientific Reports on an open access basis, so it’s free to read online.

The Guardian’s reporting is balanced and accurate. But the Mail Online’s coverage is less accurate, focusing on the “controversial” chemical titanium dioxide found in some tattoo inks, stating it’s been “linked to cancer”.

There’s no evidence titanium dioxide is linked to cancer except possibly when inhaled, which would usually only be a risk for people who work in manufacturing.

What sort of research was this?

This post-mortem research was carried out on tissue samples from people with and without tattoos.

The researchers used a variety of techniques, including X-ray fluorescence imaging, to measure levels of dyes and metals in skin and lymph nodes.

Lymph nodes are part of the body’s immune system, and are located in the neck, armpits and groin.

Tiny foreign bodies such as nanoparticles of pigment can be swept up by lymph fluid or blood cells and transported to the lymph nodes.

The research doesn’t tell us what effect these findings might have on people’s health.

What did the research involve?

Researchers took samples of tattooed skin and lymph nodes from four people with tattoos and two people without to act as a control sample.

They ran a series of experiments to identify the types of pigments and particles in the skin and lymph nodes to see whether ink particles travelled to the lymph nodes and persisted there.

They also looked at tissue surrounding ink particles to see whether it differed from tissue not close to ink particles.

Using a range of techniques, they set out to answer four questions:

Do organic pigments travel from the skin to the lymph nodes?

Do people with tattoos have more potentially toxic metals in their skin and lymph nodes?

What size are particles from pigments, and what size are the particles that travel to lymph nodes?

Do the particles affect surrounding tissue?

They used a number of advanced spectroscopy techniques to analyse the tissue.

Spectroscopy involves analysing a sample of organic matter by measuring the wavelength of the spectrum of light it produces – different elements produce distinct lines on the spectrum.

What were the basic results?

The researchers found:

Organic pigments in both skin and lymph nodes from two of four tattooed donors. Two donors had no organic pigments in their lymph nodes, possibly because they were at low levels or had degraded. The most common organic compound in tattoo ink, carbon black, was “not accessible” with the methods used in the study.

Higher levels of five “toxic” elements in the skin and lymph nodes of people with tattoos. The elements identified were aluminium, chromium, iron, nickel and copper.

Traces of the element titanium (probably from the white pigment titanium oxide) in the skin and lymph nodes of people with tattoos. Micro-X-ray absorption showed this was “mostly” present in its more stable, less toxic, “rutile” form.

Particle size varied a great deal depending on the type of pigment. Smaller pigments were more likely to be found in the lymph nodes, although relatively large titanium oxide particles were also found in lymph nodes.

“Biomolecular” changes to tissue around pigment particles in the skin and lymph nodes. The researchers say the tissue near particles had higher levels of lipids and lower levels of proteins than similar tissue without particles.

They also found protein in the tissue around particles had a changed structure in both the skin and lymph nodes.

How did the researchers interpret the results?

The researchers said they found “strong evidence for both migration and long-term deposition of toxic elements and tattoo pigments” from tattoos on the skin into the lymph nodes.

They added they have found evidence for “alterations of biomolecules” in the tissues of skin affected by pigment particles, which may contribute to skin inflammation “and other adversities” connected with tattooing.

Conclusion

If you already have a tattoo, there’s nothing in this study that should alarm you. It doesn’t show that people with tattoos are more likely to get cancer, despite the scaremongering headlines.

The researchers explain how tattoo pigments are picked up as “foreign bodies” by the body’s immune system and are then stored in the skin and lymph nodes.

But they can’t tell us what effects this process has on our health. The researchers weren’t told any medical information about the donor samples, such as any diseases they had (including cancer) or the cause of donors’ deaths.

The study also has other limitations. It looked at samples from a small number of people, and an even smaller number of controls.

And some of the findings might not be linked to tattoos – for example, higher levels of iron in the lymph nodes might come from blood within the samples, and aluminium in armpit lymph nodes could be from antiperspirants.

If you’re considering getting a tattoo, it might be worth thinking about whether you want to introduce pigments that include metals into your body unnecessarily.

While we don’t know much about the possible effects now, harmful long-term effects can’t be ruled out.

As well as asking a tattoo artist about the hygiene of their tattooing equipment, it may also be worth asking them about the types of pigments they plan to use and what’s in them.

Titanium dioxide, for example, is known to increase inflammation and can delay healing.