The achievements of research and improvements in service delivery mean that more people survive cancer than ever before. Nevertheless, the number of people diagnosed with cancer in Wales continues to steadily increase, with just over 19,000 new cases diagnosed in 2015.

The increased incidence of cancer stresses the need for people to be aware of the signs and symptoms of cancer where possible. However the symptoms of cancer can be multiple, vague, and non-specific as they are shared with many other unrelated and less serious conditions. Therefore, it is imperative that we provide effective diagnostic tests that can help detect cancers earlier within the primary care setting.

As Wales’ leading cancer research charity, Cancer Research Wales is committed to diagnosing cancers earlier and improving cancer treatments to significantly improve the outlook for those who will develop cancer. By working together we can really reduce the impact that cancer has on the Welsh population.

The latest data released by the Wales Cancer Intelligence Surveillance Unit show the six most commonly diagnosed malignancies in Wales are cancers of the breast (women), prostate (men), lung, bowel, melanoma, and Head and Neck.

In this article we pull together some information readily made available by various healthcare providers on the signs and symptoms of the six most common cancers in Wales, which together account for over 50% of all cancers.

Breast Cancer

Breast cancer is the most commonly diagnosed cancer in Wales with over 2802 new cases in 2015. However, early diagnosis and adherence to national breast screening programmes means that over 85% of women diagnosed with breast cancer now live longer than 5 years

Signs and Symptoms of breast cancer include:

A change in the size, shape or outline of one or both breasts
A lump in the breast. Although most lumps in the breast are not malignant it is important to get any checked, especially if the lump is new
Unexplained alterations to the appearance and shape of the nipple, which may include bleeding, a rash, inversion (sunken nipple), and unexpected discharge
Dimpling on the skin of the breasts, similar to the appearance of ‘orange skin’
Easily detected lumps and swellings (lymph glands) in the armpits that are firm and rubbery to touch.

Prostate Cancer

Just over 2,500 cases of prostate cancer are diagnosed every year in Wales. Symptoms of prostate cancer are very similar to those of an enlarged prostate. The latter is a more common benign condition that effects many older men. However, it is advisable to get any symptoms checked, especially if occurring for the first time or increasing in severity.

Signs and Symptoms of prostate cancer include:

Needing to urinate more frequently, that also occurs at night.
Difficulty in starting to urinate
Weak flow of urine
Straining and taking time to urinate
A feeling that your bladder hasn’t fully emptied
An increased urge to urinate and rush to the toilet
Symptoms associated with advanced prostate cancer may include, blood in urine or semen, pain in the back, hip and pelvis, erectile dysfunction and unexplained weight loss.

While the risk factors for prostate cancer are not fully understood, it is thought that certain genetic factors, family history, and African-Caribbean ethnicity increase the risk of developing prostate cancer.

Lung Cancer

Lung Cancer is third most common cancer in Wales, the leading cause of cancer-related mortality, with almost 2,500 new cases and over 2000 deaths occurring annually. Most, but not all lung cancers are caused by smoking.

Signs and Symptoms of lung cancer include:

A persistent cough that lasts for more than two or three weeks
A long-standing cough that increases in severity or becomes painful
Repeated chest infections
Coughing up blood and signs of blood in phlegm(sputum)
Persistent tiredness (fatigue)
Loss of appetite and/or unexplained weight loss
Persistent breathlessness
Other less common symptoms may also include persistent shoulder and chest pain, wheezing and hoarseness of voice, fever, swelling of face or neck

Colorectal Cancer (Bowel Cancer)

Colorectal cancer is a term used to refer to tumours that occur in the bowel and/or rectum. They represent the fourth most common cause of cancer in Wales, but the second leading cause of cancer death. The national bowel screening programme helps to detect pre-cancerous polyps or early stage cancers when they are easier to treat. When diagnosed at the earliest stage, 5-year survival rates for bowel cancer exceed 90%.

Symptoms of bowel cancer are common to several other conditions and while most people with some of the symptoms highlighted below won’t have bowel cancer, if symptoms are new and persistent then advice from a GP should be sought.

Signs and Symptoms of colorectal cancer include:

A change in bowel habits that last more than two or three weeks. This may include alternating bouts of constipation and diarrhoea
Unexplained persistent tiredness or fatigue (resulting from anaemia due to blood loss)
Blood in the stools (poo) without confirmed piles (haemorrhoids)
Unexpected tenderness or pain in the back passage or abdomen
Other symptoms may include bloating and tummy swelling, unintentional weight loss, and vomiting, especially if these are accompanied with abdominal pain and discomfort

Although a minority of bowel cancers are inherited, most are not. Healthy life style choices are important in mitigating risk. A diet rich in fruit and vegetables, high in fibre, low in red and processed meats, exercise, quitting smoking cessation, and reduced alcohol intake, all help reduce the risk of developing bowel cancer.

Melanoma

Melanoma is an aggressive form of skin cancer that if caught early enough can be successfully treated. Melanoma is the fifth most commonly diagnosed cancer Wales, with 786 new cases in 2015. However, it represents the second fastest growing cancer in Wales, just behind liver cancer.

Typically, melanomas appear as new moles or changes to an already existing mole. The most common cause of melanoma is overexposure to intense UV sunlight that leads to sunburn. As a result they more frequently arise on areas of the skin that are most exposed to sunlight, such as the back and legs, although they can occur anywhere. A rare form of melanoma, known as ocular melanoma can sometimes occur within the eye.

Signs and Symptoms of skin melanoma include:

A new mole or an existing mole that is growing in size. Melanomas are often greater than 6mm in diameter, which about the size of a pencil rubber
A mole that has developed an irregular border
A mole that has changed shape, often with two non-identical halves
A mole that has changed in colour, or has developed more than one colour (blue, black, tan, brown, etc.)
A mole that is itching, bleeding, or has become crusty and/or inflamed

An ABCDE checklist has been developed to help people and doctors determine the likelihood that a mole could be melanoma. A = Asymmetrical Shape; B = Border; C = Colour; D = Diameter; E = Evolution (knowing what is normal for you and what is not, is key to helping diagnose melanoma. Any change or one that is ongoing requires prompt action).

Some people are at more risk of developing melanoma than others. These include people who have fair, or pale skin that is prone to burning easily, people with lots of moles and freckles, and those with a close family member that has been affected by melanoma.

While not all melanoma can be prevented, we can reduce the risk through the use of sunscreen and dressing sensibly in the sun. Also the use of sunbeds and sunlamps should be avoided as there is evidence that some melanomas may be caused by their use.

Head and Neck Cancer

Head and neck cancer is a collective term to describe a group of tumours that arise in different regions of the mouth, throat and nose, and together they form the sixth most common diagnosed cancer, with just under 700 new cases confirmed annually in Wales.

Head and neck cancers can be split into cancers of the mouth (oral cancer), voice box (laryngeal cancer), the soft palate at the back of the mouth and throat (oropharyngeal cancer), nose and sinus, and the part of the throat that connects the nose to the back of the throat (nasopharyngeal cancer).

Due to the anatomical complexity of the head and region and the diverse cancer types that can affect it, symptoms can be very varied. It is important to note that these symptoms are not exhaustive and are also very common to other non-cancerous conditions or infections prevalent in the population,that are unlikely to be cancer-related.

If in doubt or you have any concerns then it is important to get any symptoms checked, especially if they are new, unexplained or causing problems.

Further information and guidance on the symptoms of head and neck cancers can be found on the NHS choices website and includes the following:

A persistent lump or non-healing mouth ulcer that occurs on the lips, tongue, inside of cheeks, gums, and on the floor or roof of the mouth
Lumps or swellings in the mouth, jaw and neck regions that may cause pain and difficulty in moving the jaw or swallowing
Persistent sore throat
A change in the voice, persistent hoarseness, persistent cough, noisy breathing and shortness of breath,
persistent blocked nose or congestion, a decreased sense of smell, mucus running down the back of nose, mouth and throat, with no obvious cause such as a cold, sinusitis, or other type of infection
Frequent nose bleeds, blood in saliva or phlegm, or unusual nasal discharge
Unexplained weight loss
Persistent fatigue and tiredness with no obvious reason
Ear pain or changes in hearing (ringing or hearing loss)
A white or red patch that occurs in the mouth or throat – this can be a sign of cancer or precancerous changes
Other symptoms may also include dentures that no longer fit, unexplained loosening of teeth, foul mouth odour not explained by poor oral hygiene, and double vision

Risk factors for cancers of the Head and Neck include tobacco and alcohol use, certain infections with HPV and Epstein-Barr virus, exposure to ionising radiation and a previous history of cancer.

We would finally like to stress that if people are uncertain or concerned about any of the above cancers and related symptoms, that they contact their GP where they can receive the right advice and guidance.