1. Persistent cough, blood in sputum

For persistent cough, blood in sputum of recent origin in a middle-aged person, suspect cancer of the lungs (bronchogenic carcinoma). Another equally important cause is lung tubercu losis which should be suspected irrespective of age.

2. Unusual hoarseness

Unusually hoarse voice that does not completely respond to usual medical treatment may be a signal of some growth in the larynx which may be either benign (papilloma) or malig nant. However, tuberculosis of the larynx is another important cause of hoarseness and it is usually secondary to pulmonary tuberculosis which may remain unrecognized, i.e., the symptoms of laryngeal tuberculosis may precede the symptoms of lung tuberculosis. Under any circumstances, immediate services of an ENT specialist must be availed of for laryngos copy / precise diagnosis since laryngeal tuberculosis and carcinoma may simulate each other, both in signs and symptoms, and a delay in diagnosis may prove distressing.

3. Persistent indigestion

For persistent indigestion (dyspepsia) of a vague type (i.e. when the pain in abdomen has no relation to meals as in peptic ulcer discussed at serial 5), loss of appetite, loss of weight in a middle-aged person, suspect carcinoma of the stomach. It is generally between 3-6 months after the onset of symptoms that the patient seeks medical advice.

4. Difficulty in swallowing

For progressive difficulty in swallowing (dysphagia) in a middle-aged person, suspect carcinoma of the oesophagus (food-pipe). Or, there could be cancer of the pharynx. Some usual notable causes of dysphagia are anaemia, foreign body, inflammatory stricture, hysteria, especially in women.

5. Gastric/duodenal peptic ulcer

For pain in the upper part of the abdomen, half an hour to an hour after meals, suspect gastric peptic ulcer. If there is pain in the same region, 3-4 hours after meals, and it is relieved only when the patient eats something (said to be hunger pain), suspect duodenal peptic ulcer. In both, cancerous changes may occur if the disease is neglected. Cancer should be seriously considered if symptoms occur in a middle-aged person with associated loss of weight.

6. Inflamed gallbladder I gallstones

People who get an attack of acute cholecystitis (inflamed gallbladder) in which there is an acute pain in the right upper part of the abdomen should not delay surgical intervention for removing the gallbladder after the medicinal treatment is over, as such a gallbladder is always prone to malignant change. The prevention of the cancer of the gallbladder lies in the removal of the inflamed gallbladder after the acute episode is over.

In the same way, the gallbladder of patients who are suffering from chronic cholecystitis, i.e., long-standing inflammation of the gallbladder, should also be removed without delay. Similarly, in gallstones, the gallbladder should be removed as there is always associated chronic inflammation of the gallbladder.

7. Change in bowel habits

For recent/sudden change in bowel habits, i.e., alternating constipation and diarrhoea with the formation of a ball of wind or of a lump in the abdomen, passing of blood through the rectum or blood in stool, loss of appetite and weight, in a middle-aged person, suspect cancer of the colon or of the rectum. Sometimes, bleeding piles may alone be a signal of a malignant growth in a middle-aged person.

8. Lump / thickening in the breast or anywhere

A lump / thickening in the breast and/or bleeding or discharge from the nipple of a middle-aged female should immediately be got diagnosed and treated as it is always prone to malignant change (breast cancer). In general, the appearance of a painless swelling anywhere in the body, suspect malignancy

9. Blood in urine

One should be cautious whenever there is blood in urine (haematuria). Medical people know that it could be a symptom of carcinoma of the kidney, the urinary bladder, the prostate, papilloma (benign) of the urinary bladder or of the pelvis of the kidney, or tuberculosis of the kidney. A middle-aged person has to be cautious on all these accounts. In a child the carcinoma of the kidney usually presents itself as a lump in the abdomen, and blood in the urine is a late feature. Tuberculosis of the kidney may be curable with medicinal treatment in early cases. Later, surgery may be required.