Consultant, Medical Oncology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi
Part 2 of 13 in From Detection to Recovery: Navigating the Future of Cancer Care
When to Suspect Cancer: A Symptom Checklist by Cancer Type
September 6, 2026
Before any test is ordered, recognising the pattern of symptoms that should prompt a cancer workup is the first and most important step, one that Dr. Nithin S.G. of Fortis Hospital, Vasant Kunj, spends the opening part of his masterclass walking through organ by organ.
The CAUTION Checklist
A simple mnemonic covers the symptoms common to most cancers: a Change in bowel or bladder habits, an Ulcer or sore that does not heal, Unusual bleeding or discharge from any site, Thickening or a lump anywhere in the body, Indigestion or difficulty swallowing, an Obvious change in a wart or mole, and a Nagging cough or hoarseness.
Symptoms by Organ System
Breast cancer does not always present as a lump: redness, skin dimpling, nipple retraction or nipple discharge can be the only sign. Oral cancer should be suspected with a mouth ulcer lasting more than a month, a lump in the throat or tongue, or dentures that suddenly stop fitting properly, especially in someone who smokes or chews tobacco or paan. Lower gastrointestinal cancers present with abdominal pain, weight loss, fatigue and blood in the stool, while upper gastrointestinal cancers cause difficulty swallowing food (though not liquids), repeated gastritis that will not respond to treatment, and early satiety. Liver and gallbladder cancers cause pain in the right upper abdomen and jaundice, especially in an elderly patient where no other cause is found, and pancreatic cancer classically causes abdominal pain radiating to the back. Bladder and kidney cancers present with blood in the urine, and prostate cancer causes urinary hesitancy, urgency and a sense of incomplete emptying. Cervical cancer causes bleeding, often after intercourse, and uterine cancer causes bleeding after menopause has already occurred. Lung cancer has four classic warning signs: a dry cough lasting more than three to four weeks with no infection, breathing difficulty, blood in the sputum, and a lump in the neck from spreading lymph nodes, particularly in a previous smoker. Skin cancer, especially melanoma, should be suspected when an existing mole changes rapidly in size, develops an asymmetrical border, changes colour, or starts to bleed or itch.
Two Symptoms That Cut Across Every Cancer Type
Beyond the organ-specific list, decreased appetite and unexplained weight loss (more than 10 kilograms over six months counts as significant), along with severe fatigue, are consistent enough across almost all cancers that they justify testing even when no other symptom is present.
What a Proper Examination Should Cover
Any patient presenting with one of these symptoms should be examined for a lump at the site itself, for lymph node swelling in the neck, and for lymph nodes in the armpit whenever there is breast pain or a breast lump, since the cancer's only visible sign can sometimes be a spread lymph node rather than the primary tumour. The mouth should be examined for ulcers, and the patient should be checked for signs of anaemia.
Series index | From Suspicion to Diagnosis: Blood Tests and Imaging Explained →
This article is based on a Jivo Masterclass session conducted by Dr. Nithin S.G., Consultant, Medical Oncology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Nithin S.G. taught doctors across Africa on May 11, 2025.
FROM THE LIVE Q&A
Dr. Isaia
How does mammography compare to MRI for diagnosing breast cancer?
Dr. Nithin S.G.
Neither is simply better in every case. MRI is the more definitive test to rule out cancer, but mammography, a form of X-ray, can miss a tumour hidden in fattier breast tissue, which is common in women under 30 to 35. In younger women, ultrasound or MRI is preferred; mammography becomes more effective after around 35 to 40, once fibrous tissue outweighs fat. MRI is more accurate but costlier and more involved for the patient, which is why mammography is offered first, with a PET-CT or a CT of the chest, abdomen and pelvis used for staging.
Frequently Asked Questions
How effective is immunotherapy compared to other cancer medications?▼
Immunotherapy is highly effective and carries far fewer side effects than standard chemotherapy. In cancers with a large initial tumour burden, such as lung cancer, it is usually combined with chemotherapy at first, since immunotherapy alone takes time to bring a heavy disease burden under control. Once the disease responds, treatment continues on immunotherapy alone to maintain that response.
What specific investigation should be used to diagnose testicular cancer?▼
Any scrotal swelling should first be evaluated with ultrasound, which will show a testicular mass or enlargement, but there is no test that gives a confirmed diagnosis before surgery, that only comes after radical orchiectomy. Of 100 patients presenting with a testicular swelling, roughly 80 to 90 percent will have cancer and about 10 percent tuberculosis, so for the large majority a biopsy is avoided, since it risks spreading the cancer, in favour of going directly to orchiectomy. Tumour markers such as AFP and beta-hCG, elevated in seminoma and yolk-sac tumours, can support the ultrasound finding, but the standard recommendation regardless of marker levels is orchiectomy rather than biopsy.
How specific is PSA for prostate cancer, given a case where PSA was over 100 but the biopsy showed only BPH?▼
PSA is not specific for prostate cancer at all, no tumour marker is specific for any single cancer. An elevated PSA in a patient with a prostatic mass could reflect BPH or cancer, and can rise even after a digital rectal exam or ejaculation. Very high values, such as over 100, are more suggestive of cancer, so if PSA is extremely elevated yet the biopsy shows only BPH, the biopsy may simply have missed the cancerous core, which does happen. In such suspicious cases, a gallium-68 PSMA PET scan, highly specific for prostate cancer, can help confirm or rule out malignancy before treating for BPH alone.
Should breast cancer be diagnosed with a core biopsy or an excisional biopsy?▼
Core needle biopsy is sufficient for breast cancer, and there is no need for excisional biopsy in most cases. For a small tumour such as a fibroadenoma, excisional biopsy is an option, but core needle biopsy is equally effective, and if the mass proves benign, surgery can be avoided altogether.
Can precision oncology or targeted therapy offer a drug for uterine fibroids, since they are so common?▼
Unfortunately there is no specific genetic mutation identified for uterine fibroids and no targeted drug role for them, since fibroids are benign tumours, not cancers. Treatment options remain limited to hormonal therapy or surgery.
What is the CAUTION checklist for cancer symptoms?▼
Change in bowel or bladder habits, an Ulcer that does not heal, Unusual bleeding or discharge, Thickening or a lump, Indigestion or difficulty swallowing, an Obvious change in a wart or mole, and a Nagging cough or hoarseness.
Does breast cancer always present as a lump?▼
No. Redness, skin dimpling, nipple retraction or nipple discharge can be the only sign, even without a palpable lump.
What weight loss should prompt cancer testing regardless of other symptoms?▼
Losing more than 10 kilograms in six months, combined with severe fatigue, is significant enough on its own to justify testing for an underlying cancer.
In This Series: From Detection to Recovery: Navigating the Future of Cancer Care
- 1.From Detection to Recovery
- 2.When to Suspect Cancer: A Symptom Checklist by Cancer Type
- 3.From Suspicion to Diagnosis: Blood Tests and Imaging Explained
- 4.Why Biopsy Beats FNAC in Cancer Diagnosis
- 5.Tumour Markers: What They Can and Cannot Tell You
- 6.Cancer Staging and Why It Decides the Treatment Plan
- 7.Precision Oncology: How Genetic Testing Is Changing Cancer Treatment
- 8.Immunotherapy: Retraining the Immune System to Fight Cancer
- 9.Breast Cancer: Subtypes, Diagnosis and Newer Targeted Treatments
- 10.Targeted Therapy for Advanced Cancer Patients with Poor Performance Status
- 11.Testicular Cancer, Prostate Cancer and PSA: Working Up Common Urologic Presentations
- 12.Liquid Biopsy: A Newer, Less Invasive Way to Detect and Monitor Cancer
- 13.Uterine Fibroids Are Not Cancer: Why Targeted Therapy Doesn't Apply