Identifying Early Warning Signs of Cancer

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Identifying Early Warning Signs of Cancer

In 2020, there will be an estimated 1.8 million new cancer cases diagnosed and 606,520 cancer deaths in the United States. Detailed cancer facts and figures are available at:     

Although diagnosis and treatment may be out of the scope of practice of many healthcare providers, cancer screening is the best method for detecting cancer as early as possible.  It is imperative clinicians perform a thorough medical screen to rule out the possibility of serious or life threatening illnesses.  Many cancers do not display symptoms in the early stages.  Screening tools such as mammograms, colonoscopies, Pap smears, pelvic exams, prostate exams, and skin scans can provide insight into potential problems developing.  Clinicians should encourage patients to seek resources to obtain these screening tests.    

During the clinical examination, there are signs and symptoms which should be observed.  To assist in the systematic review of some important signs and symptoms, the American Cancer Society uses the acronym

Each of the letters describe a possible cancer sign or symptom that should not be ignored.   Although there is no data to support the use of this acronym, the signs and symptoms have been shown to be consistent with the diagnosis of various cancers.

C: Change in bowel or bladder habits

  • If an individual has a sudden change in bowel habits that last several days, it may be time to seek medical attention. Several days of diarrhea or constipation could be a sign of cancer in the abdomen, or colorectal cancer.  
  • As for bladder habits, sometimes the urine might be discolored. Dark yellow urine may be from dehydration but it might also indicate jaundice. Jaundice could be an indicator of cancer in the liver or pancreas.  Blood in the urine may signify cancer in the kidney or bladder. In men, difficulty in passing urine, or frequently feeling the urge to urinate could be a sign of an enlarged prostate, a marker of prostate cancer.

A: A sore that does not heal

  • If there is a wound that does not heal, and continues to pester, it might indicate cancer.
  • There are a variety of skin cancers that are beyond the scope of this blog. One should examine shape & irregularities discussed in letter “O” below.
  • Although a time frame is not specifically stated, one should use common sense regarding the time a wound in a given area should be expected to heal.
  • If a sore is present in the mouth, it could indicate oral cancer.

U: Unusual bleeding or discharge

  • Bloody discharge can occur from the nipples, it could be a sign of breast cancer.
  • Post-menopausal women who experience sudden bleeding could be a sign of uterine cancer.
  • Even if a woman has undergone a hysterectomy, bleeding could indicate a cancer in the vagina. 

T: Thickening or lump in the breast or elsewhere

  • The most common location of a lump is in the breasts.
  • Painful lumps are usually non-cancerous. It is a painless lump, people tend to ignore and take it lightly that is more likely to be problematic.
  • Ironically, as a thumb rule, most cancers have pain as the very last symptom. A painless lump in the breast is more dangerous than a painful one. Although only 1% of breast cancers are in men, this applies to both men and women.  Due to ignorance and stigma attached to breast cancer in men, they often get diagnosed late. 
  • Lumps in any other part of the body, extremities, head, axilla, that suddenly increasing in size should be explored. 

I: Indigestion or difficulty in swallowing

  • Difficulty swallowing can easily be passed off as a simple sore throat. However, if it does not resolve in a reasonable amount of time of does not respond to medications, one should seek help.   
  • Indigestion or difficulty swallowing may be a sign of esophageal or stomach cancer.

O: Obvious changes in warts or moles

  • The changes to a wart, mole, or freckle can be further expanded into 5 criteria:

  • If moles, warts, or freckles grow or bleed, it could be an indication of melanoma.

N: Nagging cough or hoarseness

  • This sign should be especially alarming in smokers.
  • Persistent cough could indicate lung or throat cancer. 
  • The presence of rust colored sputum should also be explored.


Please Note:  All these symptoms do not necessarily signify the presence of cancer.  They are signs of potential pathology that merit further exploration.  Rehabilitation professionals may be able to continue to treat a pathology within their scope of practice while exploring the above signs.  One should watch out for changes carefully and not delay in seeking medical help.                

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  • American Cancer Society.
  • Goodman, C, Snyder, T. Differential Diagnosis in Physical Therapy, WB Saunders Co, Phila, 3rd ed, 2000
  • Gulick DT. iOrtho+ Mobile App. DTG Enterprises LLC. 2020
  • Gulick, DT. OrthoNotes, 4th FA Davis Publishing, Philadelphia. 2018
  • Maranhao ET, Maranhao-Filho P, Lima MA, Vincent MB. Can Clinical Tests Detect Early Signs of Monohemispheric Brain Tumors? Journal of Neurologic Physical Therapy. 2010;34(3):145-149
  • Walsh Flanagan K & Cuppett M. Medical Conditions in the Athlete. 3rd ed, Human Kinetics, Champaign IL. 2017

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