Warning signs
Introduction
In this module, we consider situations that might prompt you to have a conversation with someone about the need for further investigation of possible cancer symptoms. These situations might involve a person using medicines in an unusual way or a person describing symptoms that you think need further investigation.
Warning signs
Repeated requests for, or use of, certain over-the-counter (OTC), Pharmacy-only (P) or General Sales List (GSL) medicines may be masking an early warning sign for cancer and should prompt a conversation. This is why your consultations with patients should include a conversation about medicines other than those on their prescription. Over-ordering of prescribed medicines may prompt similar concerns. See Table 1 for some examples – remember that some of these symptoms could indicate serious conditions other than cancer.
Cancer risk generally increases with age, so symptoms that may cause little concern in a younger person may need referral above a certain age. For example, a 25-year-old person presenting with a change in bowel habit is less likely to have a serious condition, but for someone aged 55 years, the risk of cancer is higher and referral is recommended. Some conditions are red flags regardless of age, for example, significant change in an existing mole (possible skin cancer symptom) or difficulty swallowing (possible oesophageal cancer symptom).
Common symptoms of acute, self-limiting viral illnesses can become red flag symptoms if they persist or are recurrent. Coughs due to viral illnesses often last up to three weeks, but if they persist for longer, they may need investigation – as would recurrent chest infections (both possible lung cancer symptoms). Persistent mouth ulcers should be investigated (possible symptom of oral cancer).
| Table 1: Medicines that could mask early warning signs of cancer | ||
| OTC/GSL/P medicine | Example of patient's symptom1 | Possible related cancer2 |
| Dry cough mixtures | Cough for three weeks or more | Lung cancer |
| Paracetamol/other analgesics | Abdominal pain | Stomach cancer/bowel cancer/ovarian cancer |
| Plasters for recurrent sores that do not heal | A sore or ucler that does not heal for three weeks or more | Skin cancer |
| Laxatives | Constipation for three weeks or more | Bowel cancer/ovarian cancer |
| Mouth ulcer treatments | Mouth ulcer that does not heal for three weeks or more | Oral cancers |