Unfortunately, not unlike elsewhere in the world, patients with oesophageal tumours usually arrive at our clinic quite late, when they can no longer swallow, or they can only do so with great difficulty. In such cases, the possibilities for treatment are very limited. For this reason, I’ll mention the warning signs that could more or less indicate the early stages of damage to the oesophagus. The first would be supposed incidences of choking, which patients often write off as coincidental or accidental. However, if they repeat themselves without any apparent reason, then it’s best to visit a specialist and to frankly disclose all possible information related to these episodes. Secondly, you should be mindful of a sensation that a piece of food is moving along you’re your oesophagus when you eat, or is perhaps lodged inside. You normally wouldn’t have this sensation unless you swallowed a particularly large piece of food, perhaps in great haste. Thirdly, any pain you might feel behind your breastbone when eating. Even if the pain is minimal, you shouldn’t have any at all when eating. If you do, then you should definitely determine the cause. Fourthly, any frequent belching with just air or perhaps an unpleasant smell (like spoiled food). I’m often astonished to learn that after asking the patient about the duration of the problem, they reply that it’s been months, perhaps even a year. The patient hoped that the symptoms would subside on their own or that they weren’t serious enough to warrant a visit to the doctor. Once the patient has problems swallowing solid food (liquids are more often required to wash down food), significant weight loss begins. When it becomes difficult to swallow liquids, the illness has often progressed. Oesophageal cancer is usually successfully treated when caught in its early stages. If you have any of the aforementioned symptoms, make an appointment with your doctor and, if necessary, he’ll prescribe further expedited examinations as part of the so-called Green Corridor. The best method of examining the oesophagus is by esophagoscopy, when an endoscope is inserted into the oesophagus. This allows doctors to view the mucous membranes along the entire length of the oesophagus, but also allows them to take tissue samples, which can be examined under the microscope. In addition, an ultrasound and perhaps also a CT scan of the throat and neck may be prescribed to check whether the lymph nodes are enlarged or if a tumour has invaded any surrounding tissues.
Problems swallowing, painful swallowing, a swollen tongue, the feeling that your throat is full or contains a foreign body and increased salivation can all be symptoms that a tumour may have developed at the base of your tongue. If you have any of these, you should consult your doctor. You can visit your family doctor or an ear, nose and throat specialist. Sometimes it isn’t possible to see the tumour even when using a tongue depressor. Then special mirrors have to be used. If your doctor notices something suspicious, he’ll immediately prescribe further expedited examinations as part of the so-called Green Corridor or send you to a specialist.
Coughing and changes in its characteristics
Smokers most often underestimate this symptom, as coughing is often a common occurrence for them and usually doesn’t seem like a significant problem. Non-smokers who experience a persistent couch for over 3 weeks, especially if it doesn’t improve after treatment, should definitely consult a doctor. Smokers should visit their doctor if they (or their family members!) notice even the smallest changes in their coughing habits. For example, if a dry or barking cough has become wet, the amount of sputum has increased or the coughing occurs at an unusual hour of the day. Chest pain when breathing deeply, coughing or laughing is another significant symptom. On the other hand, red dots or streaks in your sputum or a rosy colour can indicate bleeding in the lungs, which could become life threatening if ignored. Sometimes a cough can also be accompanied by dyspnoea or shortness of breath, hoarseness and wheezing. In this case, a lung X-ray is the simplest diagnostic method and it is often the first to be performed as it is so easily accessible. A much more detailed picture can be attained by conducting a CT scan. If you have any of the aforementioned symptoms you should contact your family doctor or pulmonologist (respiratory illness specialist), who can prescribe the necessary tests.
You should be concerned about hoarseness if it lasts more than 2 weeks and doesn’t respond to any of the usual over the counter medications. Unfortunately, this symptom is common to both lung and laryngeal cancer patients. Hoarseness can be an early symptom of cancer in the general area of the vocal chords (laryngeal cancer) or a later symptom for other types of tumours, which have spread to the vocal chords (lung cancer, hypopharyngeal tumours). People often explain away these symptoms as the result of a cold or too much strain on the vocal chords, and therefore are in no hurry to visit a doctor. If, in addition to this symptom, you also have the sensation of having a foreign body in your throat or enlarged lymph nodes, you shouldn’t hesitate to visit a doctor. Make an appointment with your family doctor or an ear, nose and throat specialist. The health of a larynx is tested by performing a laryngoscopy (an endoscopic examination of the larynx, during which it’s also possible to take biopsies of suspicious areas). As people with laryngeal cancer often also have other malignant tumours of the head or neck, a specialist may also recommend an esophagoscopy and a bronchoscopy. A sample of the enlarged lymph node can be obtained through the skin for microscopic examination. Tumours of the larynx are usually treated by oncologists who are specialised in diagnosing and treating the diseases of the ears, throat and nose.
Changes in small moles or other suspicious spots of pigmentation
Melanoma is a malignant tumour of the melanocytes, which, when caught early, has a very good prognosis. However, it is a cancer of the skin, which often metastasises. Environmental factors (excessive sunbathing, not using or improperly using individual preventative measures, using tanning beds) play a large role in the development of a melanoma, especially in early childhood and in young adulthood. The majority of melanomas (nearly 90%) develop in the skin and very rarely in the eyes or mucous membranes. Melanoma can develop in perfectly healthy skin or on pigmented areas of the body that are often uncovered, as well as parts that rarely ever see daylight. Furthermore, melanomas occur in all age groups – including teenagers and young people. This is why special attention is paid to those pigmented growths, which differ from others (the ugly duckling symptom). Unfortunately, in many cases patients visit a doctor with an already localised tumour. In addition, after careful questioning the patient reveals that they had noticed the changes in their skin for quite some time – months, perhaps even years ago.
The farer your skin, especially in combination with freckles, blonde or red hair or light-coloured eyes (blue, green, grey), the larger the risk of melanoma. The risk is also greater for people who burn easily in the sun, or who develop a tan very slowly and unevenly. It’s important to take note if any moles change over time (grow larger, change in colour, become rough to the touch, become more sensitive, bleed or secrete liquid) or if any new and unusual spots of pigmentation have appeared on your skin. So-called amelanotic melanomas (lacking dark pigmentation) also exist and they usually begin as rough, wart-like growths that are sensitive and may bleed or secrete liquid.
Melanomas can form on any part of the body, but in Latvia they’re most commonly found on the back or legs for women and on the back for men. These areas are difficult to check on your own, which is why Latvia has already had its own free app for a year, WeCare Be Aware, which anyone can download to their smartphone. It’s a unique opportunity for Latvia’s residents to check their abnormal skin growths or the changes in their existing moles. It’s a kind of screening method that allows one to examine not only their own unusual pigmented growths or other changes in the skin, but also those of their loved ones – partners, parents, grandparents and friends. Follow the instructions and photograph the suspicious growth. Whatever you do, don’t enlarge the photo by using the zoom mode! A dermatologist or oncologist will later analyse the photo on a large screen. Within a few days you’ll receive the results by e-mail. The app does not offer a diagnosis. A microscopic examination is necessary to make a precise diagnosis. You will, however, receive an answer that will let you know whether you can breathe easy or whether you should make an appointment with a dermatologist or oncologist for further testing (dermatoscopy, a biopsy or complete excision of the tumour).
Lethargy, fatigue, fever, weight loss
These are non-specific symptoms, which could be related to any number of pathological processes. However, if these trouble you and don’t improve over time or return now and again, you should definitely visit a doctor. Begin with your family doctor who could, possibly, recommend additional tests and examinations. The root cause could be much more serious than chronic insomnia or overwork.
In any case, it’s better to be overcautious than to let a tumour spread, so don’t try to fool yourself that it’s nothing, that it can wait or that the doctor will think you’re exaggerating. After all, it’s your health and your safety.