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
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 justgiving.com / fundraising /maria-lally1
Mum put her tiredness down to getting old, and blamed the yellow tinge in her eyes on a new bathroom light