When you’re worried that it’s asign of cancer

56 I have a lump in my breast. Is it cancer?

‘NINE out of ten lumps found in the breast are not cancerous and are completely harmless,’ says Tony Howell, a professor of medical oncology at the University of Manchester. ‘But a breast examination should always be carried out, so see your GP if you think you have found a lump.’

One of the most common causes of breast lumps in younger women are benign (fluidfilled) cysts that can range from a few millimetres to 3cm. These are more common in women who are pre-menopausal.

Cysts tend to increase in size just before a period and feel sore, then shrink: most disappear a few days after the period. (If causing pain, the fluid can be drained off with a needle, says Kelvin Chong, a consultant oncoplastic breast surgeon at the NHS West Herts Breast Care Unit.)

Or it might be a hard piece of fat that can appear and disappear spontaneously. Sometimes patients think they feel a lump when there isn’t one — it can be bits of tissue rubbing together, says Professor Howell.

‘Another common breast condition in women between the age of 40 and 50 is fibrocystic disease, which causes the breast to feel hard and lumpy,’ says Mr Chong. This is completely benign and doesn’t need treatment. ‘But because these changes occur at a period of a woman’s life when breast cancer becomes more prevalent, they can cause anxiety. We advise a referral to check them.’

57 Can you check me for ovarian cancer?

SYMPTOMS of ovarian cancer can include persistent bloating, abdominal pain, a change in bowel habits or unexplained weight loss. It is diagnosed with a blood test to check levels of CA125, a protein produced by ovarian cancer cells.

But as well as cancer, high levels of CA125 can be a sign of conditions such as endometriosis, for instance, and in pre-menopausal women CA125 levels may rise in the menstrual cycle. So your GP may also refer you for an ultrasound — which may be done externally or internally with an ultrasound wand.

‘Testing shouldn’t be carried out unless there are symptoms or a strong family history,’ says Gordon Jayson, a professor in medical oncology at The Christie NHS Foundation Trust. There’s no evidence that screening the general population improves life expectancy, he says.

‘ But if you’re over 50 and experience symptoms such as bloating, which are gradually getting worse, see your GP. Tell them you’re worried it might be ovarian cancer. The symptoms may be irritable bowel syndrome (IBS) too, but with IBS they usually come and go.’

‘If the tests are normal, but your symptoms persist, go back to your GP and express your concerns,’ adds Dr Marcia Hall, consultant medical oncologist at Mount Vernon Cancer Centre, Herts.

58 Must I do the bowel cancer test I’ve been sent?

THE faecal occult blood test (FOB) checks for microscopic traces of blood, which can be an early sign of colorectal cancer, explains Professor William Steward, a bowel cancer specialist at the University of Leicester. Bowel tumours are fragile with a rich blood supply and so can easily bleed.

Everyone aged 60 to 74 is invited to have a FOB test using a home kit sent in the post via the NHS screening programme.

You collect a stool sample and send it to a laboratory: the results should be back within two weeks. ‘It would be very foolish not to do the test, as it is a quick, easy and invaluable way to pick up bowel cancer at an early stage that might not otherwise be detected,’ says Professor Steward. ‘Early diagnosis gives a better chance of a cure.’ Note that the FOB test checks for an enzyme, peroxidase, found in blood including animal blood. So if you have eaten black pudding, steak tartare or vegetables that contain peroxidase — which include broccoli, parsnips and cauliflower — the night before, it could give a false positive result.

A newer test called bowel scope screening is now being rolled out for men and women aged 55 in England.

A thin flexible telescope (flexible sigmoidoscopy) is used to look for cancer or polyps (which can become cancerous).

If the latter are found, they can be removed by a tiny wire loop.

‘Polyps often don’t bleed so can’t be detected, but this can identify and remove them,’ says Professor Sue Clark, a consultant colorectal surgeon at St Mark’s Hospital in London.

60 Every night I have to get up to go to the loo. Is that normal?

‘WE Are wired to produce less urine at night,’ says Professor Christopher Eden, a consultant urological surgeon at The royal Surrey County Hospital in Guildford.

‘At night, an area in the base of our brain called the hypothalamus releases antidiuretic hormone (ADH), which causes the kidneys to produce less urine.

‘However, as part of the normal ageing process in both men and women the brain produces less ADH at night. This means the kidney doesn’t get the signal to stop producing urine. Added to this, our bladders become stiffer and less able to hold urine.’

But if you get up more than twice in the night to pass urine, see your GP, advises roger Kirby, professor of urology and medical director of the Prostate Centre in London.

One in eight men develops prostate cancer, which can cause frequent urination at night.

But in men over 60, typically the cause is an enlarged prostate, says Professor Eden. This is an age-related and benign condition — as well as getting up to pass urine several times a night, symptoms include reduced urine flow, urgency and inability to empty the bladder completely.

Professor Kirby says the first advice he gives to men suffering from an enlarged prostate is to reduce fluid after 5pm and to cut out tea, which contains theophylline, a diuretic, and coffee, which can stimulate the bladder.

Treatments include drugs to relax the bladder neck muscle and others, including finasteride, to shrink the prostate. ‘There is also a newer treatment called DDAVP which causes the kidneys to produce less urine if taken at night,’ says Professor Kirby.

Surgery to reduce the size of the prostate may be offered.

Women can also suffer from an overactive bladder, which may lead to them passing more urine at night, though the cause is not clear. Urinary tract infections can also cause problems. A lot of women with recurrent UTIs have to pass urine in the night, and may also have pain, blood in urine and high temperature.

61 Why ist here blood in my semen?

‘FOR a great majority of men, blood in semen has no serious cause,’ says urological surgeon Professor Christopher Eden.

‘In most men, especially those under 50, it is the equivalent of a nosebleed, caused by small fragile blood vessels which may have burst. In most cases the blood vessels immediately heal — it doesn’t need intervention.’

Another possible cause is a stone in the ejaculatory duct, which affects around 50 per cent of men, but is benign, says urological surgeon Professor roger Kirby. An ultrasound scan will usually confirm this.

For a minority of men over 50, blood in the semen could be a sign of a more serious problem and it ‘is always a symptom you should get checked out by your GP,’ says Professor Kirby.

62 Can I have a PSA test?

THE PSA test is a blood test that measures the amount of a protein, prostate specific antigen, made in the prostate gland.

It’s normal to have some PSA in your blood, but raised levels can be a sign of several conditions, including an enlarged prostate gland or prostate cancer.

On the NHS, men can have a PSA test from the age of 50. You won’t be offered it automatically — you have to ask for it.

‘However, emerging evidence suggests a PSA test should be available to men as young as 45,’ says urological surgeon Professor Christopher Eden. ‘Men are at low risk if they have a PSA of less than 0.5 at the age 45 so they can leave it for five to eight years before having another one. But if, at the age of 45, the PSA is over 1, your risk is ten times greater.’

‘I would recommend all men over 45 ask their GP for a PSA test. A raised level suggests you have a problem with your prostate, but not necessarily cancer. It could just be age, a urinary tract infection, an injury and even vigorous cycling.’

Professor Kirby suggests men should know their numbers for PSA like they do for cholesterol or blood pressure. ‘Ideally, if you have a test at around 40 you can use it as a baseline for comparison and there’s some evidence that if your PSA levels are low at 40 it suggests you’re at low risk of getting prostate cancer later on.’ All the information given here should be taken in a general context — always consult your own GP with any health worries.