Is It Cancer?

When to worry that a new lump or symptom may be a malignancy...

Anyone who’s had a sore throat has felt those large, painful lumps in their neck.  Or painful lumps in your armpit when you have an infected scratch on your arm.  Or in your groin if you have an infected cut on your leg.  These are lymph nodes responding to and fighting the nearby virus or bacterial infection.  That’s how the lymph nodes of your body, a critical part of your immune system, and the infected body tissues respond to non-cancerous insults.

  They produce the classic symptom (subjective feeling) of pain, plus some or all of the classic signs (objective physical findings) of tenderness, swelling, redness, and/or warmth.

But not cancer.  Cancer is tricky.  It doesn’t want you to know it’s there.  At least not until it’s got a good head start.

That’s why we physicians are much more concerned about a painless lymph node in your neck, under your chin, in your armpit, or in your groin.  Painless, “rubbery” lymph nodes are worrisome for lymphoma, a cancer originating in the lymphatic system.

As with lymphoma, the vast majority of malignancies do not present with pain, or with the surrounding swelling, redness, and warmth of other benign illnesses.  Rather, symptoms and signs usually appear only once a cancer has grown large enough to impact or damage surrounding healthy tissue structures.  This pattern is true for the five cancers which in 2015 will cause the most deaths.

Lung cancer will kill more than 158,000 Americans this year, once again leading the list in cancer mortality.  For those with a long smoking history, the symptoms of lung cancer may mimic those caused by non-malignant lung damage.  That said, a cough that does not go away after a few weeks, new or worsening shortness of breath, and/or recurrent infections (bronchitis and/or pneumonia) should lead you to seek medical evaluation, as these may indicate a tumor irritating or blocking normal lung tissues.

  And while lung tumors themselves are not painful, they often press on or invade nerves, leading to unremitting pain in the chest or shoulder with deep breathing or coughing.

Colorectal cancer, the second leading cause of cancer deaths in American adults, grows like a head of cauliflower within a large, flexible tube.  Only when a tumor attains a large size will it begin to obstruct the passing stool, finally causing chronic cramping pain and/or a new constipation and/or diarrhea.  And rectal tumors, which develop just above the anus, can painlessly grow quite large without causing blockage, thus hiding until eventually causing bleeding from surrounding tissue onto the stool or into the toilet.  (Unfortunately, patients and all-too-many physicians attribute such bright blood to hemorrhoids, so don’t accept “I’m sure it’s just hemorrhoids.”)  Whether or not you’ve been screened (which can prevent almost all cancers), if you develop such symptoms, immediately see your physician.

Unfortunately, the third leading cause of cancer deaths, because of its location, frequently fails to produce any signs or symptoms until it is quite large and, often, incurable.

  Pancreatic cancer develops within the long, thin gland that travels horizontally deep within your abdomen (crossing just in front of your spine).  The classic pancreatic cancer presentation is painless jaundice (yellowing of the whites of your eyes and/or your skin), as the large tumor finally blocks the duct (tube) draining bile into the intestinal tract.  Benign pancreatic conditions may also present with jaundice but are usually associated with pain and, sometimes, fever.  Some tumors compress or invade nearby nerves, causing deep-seated pain in the upper abdomen which may radiate to a point in the back.  If you develop jaundice or such pain, immediately seek medical evaluation.

Breast cancer, the fourth greatest cancer killer, has, fortunately, received significant attention over the last decades, leading to increased awareness of screening techniques.  Often presenting as a growing, painless “lump” (unlike most benign fluid collections, called cysts, which are tender when pressed), cancer can develop anywhere within the breast, both deep and below the nipple.  It can even present as a painless lymph node in the armpit, or as liquid discharge from the nipple.  Even if you undergo routine mammograms and breast examination, should you discover such a finding, head back to your physician’s office.

More than 220,000 American men will be diagnosed with prostate cancer this year, the fifth most common cause of cancer death.  These painless tumors can grow quite large within this gland before causing symptoms (emphasizing the need for annual screening).  Large tumors eventually cause symptoms by impacting the urethra as it carries urine out of the bladder through the penis, causing urinary frequency, hesitation, urgency, and/or repeated nighttime urination.  While these symptoms are often caused by benign prostate enlargement, if you develop one or more, see your physician.

Of note, any cancer can cause significant pain if it spreads to bones.  And cancers can also present as unexplained weight loss.  Some even present by causing blood clots.  Thus, if you develop these or other unexplained, persistent symptoms, see your physician.

And for lung, colorectal, prostate, and breast, get screened regularly!

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