CAUTION AND ACTION – 7 Warning Signals of Cancer


Recently I participated in a meeting of Cancer NGOs ‘Can India Conclave’.  There was a panel discussion conducted by Sanjay Pugalia of IBN 7.   I was asked to make the final comments on how to tackle the oncoming ‘Cancer Tsunami’ .  First of all let me assure you that it is not a  tsunami, a national disaster of high magnitude.  The increase in cancer incidence is the price we pay for development. As the lifespan and longevity increase, communicable diseases decrease, non-communicable disease like diabetes, cardiac disease and cancer will take the forefront.  We will have to obviously change our strategy, as earlier the focus of healthcare was mostly on controlling diarrheas and dysenteries and now it has to shift to control of diabetes, cancer and cardiac diseases, a similar lifestyle related issues. 

I asked the learned audience a simple question – how many  know the 7 warning signals of cancer ? Very few hands went up. That only shows our own lack of important knowledge.  The only thing I can stress is that every NGO, every work place and every organization should just get this simple message across. 7 warning signals of Cancer. 

It is not just enough to have the warning signals but we also need to act on them.   CAUTION is the acronym developed by American Cancer Society to list the 7 warning signals. I strongly advise that every point in CAUTION has to be followed by an ACTION. 

Here are the CAUTION  and ACTION  on the 7 warning signals of cancer. 


Symptom or Sign

Action to be taken

C hange in bowel or bladder habits

Ultrasononograhy and endoscopy

A sore that does not heal

Biopsy and oral and skin examination

nusual bleeding or discharge in stool

U nusual bleeding in between periods


Rectal exam and colonoscopy

Gynaec examination for cervix and biopsy

hickening or lump in the breast, testicles, or elsewhere


Ultrasonography and FNAC if abnormal

ndigestion or difficulty swallowing



bvious change in the size of mole, or mouth sore



agging cough or hoarseness


ENT examination and X ray chest


With this information I am sure many can benefit by early diagnosis.  I must emphasize that these symptoms may not mean cancer, may be something which is much less risky.  But when there is a symptom it is best to get checked and be reassured that there is no  malignancy. Early diagnosis has a high potential for cure and should not be missed.

 So  make note of these warning signals and the actions to be taken and pass it on to as many people as you can.

That is the best way to beat the Big C. Many lives can be saved.

Does Biopsy In Cancer lead to its spread ?


Anish, is a senior engineer in a private sector power company. His mother was recently suspected as having cancer of the gall bladder.  CT Scan was suggestive of malignancy but not 100% certain.

  For any cancer, it is important to have a biopsy and a confirmation of the diagnosis, to have a look at the tissue under a microscope and to make a pathological diagnosis.  This is the final proof that it is malignancy.  So many times benign conditions mimic malignancy and it is really not appropriate to treat any patient as cancer unless it is confirmed 100%.  So I had suggested a biopsy to Anish.  He  was ‘terrified’ and said, “No doctor, if biopsy is done, I believe that cancer is likely to spread faster”. 

This is a complete myth. A biopsy will never lead to spread of cancer.  Perhaps the reason for this myth is that many times the patients undergo what’s called exploratory surgery or laparotomy after the diagnosis of malignancy in which  we may find that the disease is advanced much more than even the CT Scan has shown.  In such situations, the surgeons are forced to abandon the surgery  and obviously the patient would deteriorate.  It has nothing to do with the surgery or the biopsy.  It is just a progression of the disease. 

That brings us to the question – are there situations where we do not need a biopsy?  The answer to that is Yes.  In some critical areas when some other tests are completely collaborative, we may not need a biopsy and sometimes we may not be able to get a biopsy because of the location of the lesion.  In such situations we are justified in planning treatment without a biopsy.  In most of the situations biopsy is also important because as I said earlier, cancer is not a single disease, there are many different types of cancers that need different treatment.  Similar to ‘Fever’, which is not a diagnosis eg. typhoid would be treated differently from malaria.  Likewise cancer is not a diagnosis, histological type is definitely important.  Some of the types of cancers respond dramatically to drug treatment and radiation, they do not need surgery.  So it is important for the cancer specialist to identify the type of cancer.

So Anish had to be convinced that Biopsy had to be done for his mother and as she was lucky that it was not a cancer and could undergo a surgery for removal of gall bladder.

Dont be scared if the doctor suggests a biopsy. It will make a difference and is essential.