What are symptoms? What are the symptoms of cancer?

Symptoms as warning signs: For symptoms to function as warning signs of undiagnosed, site-specific cancers, well-documented, established symptoms and symptom clusters or profiles must be well publicized, using a range of methods that are understandable and palatable to an increasingly diverse American population. Public information should make it easy for people to receive timely medical attention, consisting of a diagnostic workup, definitive medical or surgical recommendations, and timely intervention. Public education regarding signs and symptoms of cancer is vital to promote early diagnosis, not only to promote cure and survival but also to minimize disability and health care costs. Several reliable Internet sites deliver information regarding early symptoms and warning signs for a range of cancer diagnoses. The fact that this information can be accessed in a private, confidential manner may facilitate action among individuals who would otherwise be hesitant to seek medical advice in a timely manner. Nevertheless, attention needs to be paid to recognizing and addressing common psychological issues such as depression, fear, and anxiety that prevent some people from seeking medical attention even when they are aware of symptoms.

Cancer symptoms: The following symptoms may be early warning signs for site-specific cancers and, if experienced, are reason to seek medical attention for a definitive diagnosis:

• Bladder cancer: Blood in the urine, pain or burning upon urination, frequent urination, or cloudy urine





• Bone cancer: Pain in the bone or swelling around the affected site, fractures in bones, weakness, fatigue, weight loss, repeated infections, nausea, vomiting, constipation, problems with urination, weakness or numbness in the legs, bumps and bruises that persist





• Brain cancer: Dizziness; drowsiness; abnormal eye movements or changes in vision; weakness or loss of feeling in arms or legs or difficulties in walking; fits or convulsions; changes in personality, memory, or speech; headaches that tend to be worse in the morning and ease during the day, which may be accompanied by nausea or vomiting





• Breast cancer: A lump or thickening of the breast, discharge from the nipple, change in the skin of the breast, a feeling of heat, enlarged lymph nodes under the arm





• Colorectal cancer: Rectal bleeding (red blood in stools or black stools), abdominal cramps, constipation alternating with diarrhea, weight loss, loss of appetite, weakness, pallid complexion





• Kidney cancer: Blood in urine; dull ache or pain in the back or side; lump in kidney area, sometimes accompanied by high blood pressure or abnormality in red blood cell count





• Leukemia: Weakness; paleness; fever and flulike symptoms; bruising and prolonged bleeding; enlarged lymph nodes, spleen, or liver; pain in bones and joints; frequent infections; weight loss; night sweats





• Lung cancer: Wheezing; persistent cough for months; blood-streaked sputum; persistent ache in chest; congestion in lungs; enlarged lymph nodes in the neck





• Melanoma: Change in mole or other bump on the skin, including bleeding or change in size, shape, color, or texture





• Non-Hodgkin lymphoma: Painless swelling in the lymph nodes in the neck, underarm, or groin; persistent fever; feeling of fatigue; unexplained weight loss; itchy skin and rashes; small lumps in skin; bone pain; swelling in the abdomen; liver or spleen enlargement





• Oral cancer: A lump in the mouth; ulceration of the lip, tongue or inside of the mouth that does not heal within a couple of weeks; dentures that no longer fit well; oral pain or bleeding; foul breath; loose teeth; changes in speech





• Ovarian cancer: Abdominal swelling; in rare cases, abnormal vaginal bleeding; digestive discomfort





• Pancreatic cancer: Upper abdominal pain, unexplained weight loss, pain near the center of the back, intolerance of fatty foods, yellowing of the skin, abdominal masses, enlargement of liver and spleen





• Prostate cancer: Urination difficulties due to blockage of the urethra; bladder retains urine, creating frequent feelings of urgency to urinate, especially at night; bladder not emptying completely; burning or painful urination; bloody urine; tenderness over the bladder; dull ache in the pelvis or back





• Stomach cancer: Indigestion or heartburn, discomfort or pain in the abdomen, nausea and vomiting, diarrhea or constipation, bloating after meals, appetite loss, weakness or fatigue, vomiting blood, or blood in the stool





• Uterine cancer: Abnormal vaginal bleeding, a watery bloody discharge in postmenopausal women, painful urination, pain during intercourse, pain in pelvic area

Symptoms after cancer diagnosis: Identification and treatment of distressing symptoms that occur as a result of cancer or its treatment are paramount so that quality of life and comfort are optimized for the cancer patient. As people live longer following cancer diagnosis, symptom management is an increasingly important aspect of treatment. However, many factors interfere with prompt recognition and treatment of these symptoms.

The period between diagnosis and the start of treatment is marked by medical evaluation, the development of new relationships with unfamiliar medical personnel, and the need to integrate a barrage of information that, at best, is frightening and confusing. Patients and families experience heightened responsibility, concern, and isolation during this period. They are particularly anxious and fearful when receiving initial information regarding diagnosis and treatment. Consequently, care should be taken by professionals to repeat information over several sessions and to inquire about patients’ and families’ understanding of facts and options. Early assessment by clinicians can help identify individuals at risk for medical or psychological adjustment problems and particularly those who are in the greatest need of ongoing psychosocial support and symptom management. Patients who have ongoing involvement with medical personnel and repeatedly receive accurate and consistent information about what to expect will have less uncertainty and be less likely to develop maladaptive coping strategies based on erroneous beliefs.

Although many studies document the devastating emotional impact of a cancer diagnosis, many individuals cope effectively, experience minimal distress, and have a high quality of life throughout most aspects of the cancer experience. Effective coping strategies, such as taking action and finding favorable aspects of the situation, have been associated with positive treatment experiences. Contrary to the beliefs of many clinicians, denial has been found to assist patients to cope effectively, unless sustained and used to the point that it interferes with obtaining recommended treatment.

Health care providers play a vital role in monitoring physical comfort and psychosocial adjustment and managing problems as they arise. As cancer progresses, patients often report an upsetting scenario that includes frequent pain, disability, increased dependence on others, and diminished functional ability, which often results in psychological symptoms. Investigators studying quality of life in cancer patients have demonstrated a clear relationship between the presence of discomfort and a patient’s perception of quality of life. As uncomfortable symptoms increase, perceived quality of life diminishes. Therefore, an important goal in the psychosocial treatment of patients with advanced cancer focuses on symptom control.

Patients who are diagnosed with late-stage disease or have aggressive illnesses with no hope for cure are often the most vulnerable to psychological distress, particularly anxiety, depression, and family problems, and physical discomfort, including pain, fatigue, shortness of breath, and confusion. When physicians cannot offer patients hope for cure, helping them maintain comfort and control promotes adaptation and improved quality of life. One of the highest levels of psychological distress, with an increase in depression, anxiety, and thoughts of suicide, occurs in patients who have a recurrence of their cancer, which is often associated with a negative outcome or advanced disease.

The patient’s culture has a significant influence on perception of distressing symptoms such as pain. Some researchers have found that the best predictors of pain intensity are ethnic affiliation and locus of control style. For example, an individual’s stoic attitude, which serves to minimize or negate discomfort, may be related to a cultural value learned and reinforced through years of family experiences. Similarly, an individual’s highly emotional response to routine events may become exaggerated during the terminal phase of illness and not necessarily signal maladjustment but rather a cultural norm.

Knowledge of an individual’s response to illness and symptom expression is enhanced through awareness of the person’s family traditions and culture. Understanding a patient’s cultural, religious, ethnic, and socioeconomic underpinnings is key to understanding that person’s beliefs, attitudes, practices, and behaviors related to illness and death. Cultural patterns play a significant role in determining how patients cope with terminal stages of cancer when symptoms such as delirium, depression, thoughts of suicide, and severe anxiety are common. When severe, these symptoms require aggressive treatment using up-to-date pharmacological and psychotherapeutic treatment strategies.

In spite of the seemingly overwhelming nature of physical discomfort and psychosocial stress associated with cancer, most patients can be relatively symptom free and cope effectively throughout the experience. Differentiating psychiatric complications from adaptive coping and differentiating normal from pathological emotional distress can be challenging. For example, anxiety and depression are normal responses to traumatic events such as a cancer diagnosis or progression of a life-threatening illness and are typical and expected at transitions throughout the cancer experience. Clinicians can distinguish between patients who need aggressive psychiatric intervention and those needing routine support and information by looking at factors such as whether the patient has a prior psychiatric history including hospitalization and has used or is using psychopharmacologic treatments, and the intensity and duration of symptoms and how much they diminish functioning. These factors can also help clinicians determine whether the patient has a lasting psychiatric disorder or transient psychological symptoms that will dissipate without specific treatment.

Psychological symptoms may also emerge when physical discomfort escalates or is not well controlled and diminish following treatment of physical discomfort. Health professionals and family and friends can monitor the patient’s symptoms to determine what is normal for the patient and what indicates the need for intervention. They can also observe whether the patient’s usual patterns of coping remain effective. In general, when psychological stress worsens over time and does not respond favorably to the usual supports, aggressive psychiatric assessment and management should be instituted.

Groenwald, Susan L., et al. Cancer Symptom Mangement. Boston: Jones and Bartlett, 1996.

Kelvin, Joanne Frankel, and Leslie B. Tyson. One Hundred Questions and Answers About Cancer Symptoms and Cancer Side Effects. Sudbury, Mass.: Jones and Bartlett, 2005.

Lyman, Gary H., and Jeffrey Crawford, eds. Cancer Supportive Care: Advances in Therapeutic Strategies. New York: Informa Healthcare USA, 2008.

New England Medical Center EPC. Management of Cancer Symptoms: Pain, Depression, and Fatigue. Rockville, Md.: U.S. Department of Health and Human Services, Public Health Service, Agency for Healthcare Research and Quality, 2002.