The al­most-silent symp­toms that may point to can­cer

When her mother was di­ag­nosed with a lit­tle-known form of can­cer, health writer Maria Lally found her­self googling to find out about it. On World Can­cer Day, she in­ves­ti­gates the symp­toms you should take se­ri­ously

The Sunday Telegraph - Stella - - CONTENTS -

I have a black-and-white greet­ing card on my desk that al­ways used to make me smile. It’s shows a lit­tle old lady, sat on a park bench, head tilted back, fast asleep and snor­ing. In­side there’s a note from my mum, a pro­lific card-sender, that reads, ‘Saw this and thought, “Looks like me af­ter a day with the girls.” But worth it! Love Mum xx.’

The card makes me smile in a sad­der way now, be­cause a few months af­ter send­ing it my mother was di­ag­nosed with ter­mi­nal bile duct can­cer, a rare type that hadn’t shown any ob­vi­ous symp­toms. Her in­creas­ing tired­ness on the days af­ter look­ing af­ter my two daugh­ters, aged four and seven, was just one of the many silent, or ‘quiet’, ones we didn’t no­tice.

An oth­er­wise fit, healthy, size-10 67-year-old, Mum was do­ing Pi­lates the day

be­fore our fam­ily’s night­mare be­gan, when she was rushed to A&E with ab­dom­i­nal pain and jaun­dice.

A few weeks later we re­ceived the news that she had bile duct can­cer (or cholan­gio­car­ci­noma). I had never heard of it, but I soon dis­cov­ered that ob­vi­ous symp­toms typ­i­cally only show when it’s al­ready ad­vanced, by which point it’s of­ten in­op­er­a­ble – and there­fore ter­mi­nal.

But some­thing else I soon dis­cov­ered, dur­ing end­less Google ses­sions by Mum’s hospi­tal bed, is that bile duct can­cer, and many other so-called silent can­cers, do in fact have symp­toms. They’re just sub­tle at first and there isn’t much aware­ness sur­round­ing them. My mother put her per­sis­tent tired­ness down to get­ting old (she later ad­mit­ted she had started sleep­ing in the af­ter­noons) and changed her wash­ing pow­der a cou­ple of times think­ing it was to blame for the itch­ing in her lower legs (see symp­tom box). She put the yel­low tinge in the whites of her eyes down to a new light in her bath­room.

‘Bile duct can­cer isn’t one of the big four (breast, bowel, prostate and lung). Its symp­toms are vague, there are no lumps or pain, and it’s to­tally off peo­ple’s radar,’ says He­len More­mont, chair­man trustee of AMMF, the cholan­gio­car­ci­noma char­ity. ‘How­ever, it’s re­spon­si­ble for more deaths in the UK than cer­vi­cal can­cer. Yet no­body re­ally talks about it and it’s hard to find ro­bust data on it, which drives pol­icy, fund­ing for re­search and aware­ness.’

Al­though rel­a­tively rare com­pared to, say, breast can­cer (in the UK around 2,000 peo­ple a year are di­ag­nosed with bile duct can­cer com­pared to 54,800 with breast can­cer), cases have risen steeply over the past decade. ‘Cholan­gio­car­ci­noma is a dev­as­tat­ing can­cer. Rates seem to be in­creas­ing and we don’t know why,’ says Dr Shahid Khan, con­sul­tant physi­cian at Im­pe­rial Col­lege Lon­don. ‘It presents late in its course and is dif­fi­cult to di­ag­nose ac­cu­rately and early. Clearly there is a great need for on­go­ing re­search.’

When it comes to can­cer, some types have early, ob­vi­ous symp­toms and strong aware­ness cam­paigns so we know what to look for. Most of us know, for ex­am­ple, that a lump in our breast war­rants a trip to our GP, whereas other can­cers are less likely to cause alarm and can fly un­der the radar, ig­nored or mis­taken for some­thing else.

‘The key word is “nor­mal”,’ says Kather­ine Tay­lor, chief ex­ec­u­tive of Ovar­ian Can­cer Ac­tion. ‘Whether it’s tired­ness, men­strual bleed­ing or bowel habits, what’s nor­mal for you? Some of these qui­eter can­cers do have symp­toms, but they’re vague or eas­ily blamed on some­thing else. Are your symp­toms per­sis­tent and un­re­spon­sive to treat­ment or change? If so, keep a symp­tom diary and see your GP. And feel em­pow­ered to be per­sis­tent if you have a sense things aren’t right, or if things don’t im­prove.’

Tay­lor says ovar­ian can­cer used to be

thought of as silent, but char­i­ties are rais­ing aware­ness of symp­toms – such as uri­nary pain and bloat­ing – and how to spot them early. (See symp­tom box for more de­tail.)

‘Spot­ting it and treat­ing it ear­lier – that’s what changes out­comes,’ she says, ‘as does im­prov­ing gaps in GP knowl­edge. One in four cases of ovar­ian can­cer is di­ag­nosed in A&E, mean­ing it’s ad­vanced and harder to treat. We hear of women go­ing back and forth to their GP with symp­toms.’ Plus, a 2016 study found more than a quar­ter of women pri­ori­tise work over see­ing their GP, and 38 per cent say look­ing af­ter their fam­ily takes prece­dence.

‘The key thing to re­mem­ber is that in most cases these symp­toms aren’t due to can­cer,’ says Dr Jas­mine Just of Can­cer Re­search UK. ‘But re­mem­ber: you’re the ex­pert on what’s nor­mal for you.’

Maria’s hus­band, Dan, is run­ning this year’s Lon­don Marathon in aid of AMMF, the only bile duct can­cer char­ity in the UK. To do­nate, visit just­giv­ / fundrais­ing /maria-lally1

Mum put her tired­ness down to get­ting old, and blamed the yel­low tinge in her eyes on a new bath­room light

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