Signs and symptoms of cancer that can’t wait

Information for primary care and healthcare providers

You have probably heard the news reports and may have even had your own experiences of patients presenting with later stages of cancer during the COVID pandemic.

Our centre and others have seen a significant decrease in referrals of patients. We are concerned that these patients will eventually present with more advanced disease. Below you will find concerning signs and symptoms of common cancers, along with suggested first line management recommendations.

If a patient has an abnormal test result and/or ongoing suspicion of cancer, refer to the appropriate specialist or program for diagnostic assessment.

Specialist physicians have been and will continue to assess patients who have signs and symptoms suspicious for cancer during COVID-19.

Colorectal Cancer

Signs and Symptoms

  • Palpable rectal or abdominal mass
  • Anemia especially with iron deficiency 
  • Rectal bleeding, especially if dark blood or combined with weight loss, blood mixed with stool, absence of perianal symptoms, change in bowel habits, diarrhea and/or age 60-75 years
  • Change in bowel habit or diarrhea

Management Recommendation

  • Refer for diagnostic colonoscopy
  • DO NOT order FIT

Breast Cancer

Signs and symptoms

  • Palpable Mass                                                  
  • Concerning nipple discharge                   
  • New nipple retraction                 
  • Skin changes of the nipple or breast       
  • Asymmetrical thickening/nodularity

Management Recommendations

  • If <30 years of age and/or breastfeeding or pregnant: Ultrasound
  • If >30 years of age: Ultrasound and mammogram (consider galactography if clinically indicated)

Lung Cancer

Signs and symptoms
(especially if risk factors e.g. smoker/ex-smoker, occupational exposure)

  • Shortness of breath

  • Cough

  • Hemoptysis

  • Weight loss/ anorexia

  • Chest or shoulder pain

  • New wheezing/ crackles

  • Hoarseness

  • Lymphadenopathy

  • Horner’s syndrome

  • New finger clubbing

Management Recommendation

  • Chest x-ray (Chest CT if available and ongoing suspicion)

Prostate Cancer

Signs and Symptoms

  • Male over the age of 40 presenting lower urinary tract symptoms (LUTS) (irritative and obstructive voiding symptoms)

Management Recommendations

  • Do a DRE
  • Rule out UTI
  • Do a PSA (wait at least one month to order PSA if UTI)

Incidental elevated age-based PSA value (upper limit of normal, ng/mL):

  • 40–50 years: 2.5            
  • 50–60 years: 3.5            
  • 60–70 years: 4.5            
  • 70 years and over: 6.5

Management Recommendation

  • DRE and PSA

Bladder Cancer

Signs and Symptoms

  • Hematuria (persistent microscopic or single episode gross hematuria)
  • Storage/Irritative Bladder Symptoms, e.g. increased urinary frequency, urgency, incontinence and nocturia
  • Voiding/Obstructive Symptoms, e.g. dysuria
  • Palpable mass on physical exam
  • Pelvic or bone pain (sign of metastases)

Or:

  • Bladder lesion on abdominal/pelvic imaging

Management Recommendations

  • Urinalysis
  • Urine Cytology
  • Blood work
  • Consider abdominal/pelvic imaging
  • Cystoscopy referral if persistent hematuria despite treatment

Leukemia

Signs and Symptoms

  • Pallor                                             
  • Persistent fatigue                                        
  • Unexplained fever
  • Unexplained bruising             
  • Unexplained bleeding                                
  • Unexplained petechiae
  • Hepatosplenomegaly             
  • Generalized lymphadenopathy
  • Unexplained persistent or recurrent infection

Management Recommendation

  • CBC
      

Esophageal Cancer

Signs and Symptoms

  • Dysphagia
  • Odynophagia
  • Recurrent vomiting of solid food

Age 55 years and over with weight loss and any of the following:

  • upper abdominal pain
  • reflux
  • dyspepsia

Patient aged > 55 and one or more of the following unexplained symptoms for > 2-4 weeks

  • Chest pain (non-cardiac)
  • Hoarseness
  • Foamy stringy saliva
  • Positive for low grade GI blood loss / anemia
  • Treatment-resistant dyspepsia
  • Upper abdominal pain with low hemoglobin levels
  • Raised platelet count with any of the following:
  • Nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain

Nausea or vomiting with any of the following:

  • Weight loss, reflux, dyspepsia, upper abdominal pain

Management Recommendation

  • Refer for gastroscopy

For more information, visit the Ontario Health (Cancer Care Ontario) Pathway Maps and search by cancer type.