Solid Tumours

A new breast or underarm lump, focal thickening, skin dimpling, persistent redness, a newly inverted nipple, spontaneous bloody discharge, or a change in breast shape should be assessed. Breast pain alone is rarely caused by cancer, but persistent focal pain also deserves review. Men can develop breast cancer and should report a new lump or nipple change. Many breast symptoms are benign; examination and appropriate imaging are needed rather than self-diagnosis.

Assessment usually combines clinical examination, breast imaging and tissue sampling. Mammography and ultrasound are commonly used; MRI is helpful in selected situations. A core-needle biopsy usually confirms the type and grade. In invasive cancer, pathology commonly tests oestrogen receptor, progesterone receptor and HER2 because these results guide treatment. Suspicious underarm lymph nodes may also be sampled. A scan alone cannot reliably establish the full diagnosis.

Stage considers tumour size and local extent, regional lymph nodes and distant spread. The pathology also describes type, grade, hormone-receptor status and HER2 status; these biological features are as important as anatomy when planning treatment. Some early cancers need no whole-body scan, while symptoms or higher-risk findings may justify CT, bone imaging or PET-CT. Genomic-expression tests may help selected patients decide whether chemotherapy adds useful benefit, but they are not required for everyone.

Treatment may include breast-conserving surgery or mastectomy, lymph-node assessment, radiotherapy, endocrine therapy, chemotherapy, HER2-directed therapy and other targeted or immune treatments. The sequence varies: drug treatment may be given before surgery to shrink the tumour or afterwards to reduce recurrence risk. Some very early cancers need limited treatment; metastatic breast cancer is usually treated mainly with medicines, with radiotherapy or surgery used for selected symptoms or sites.

Outlook depends on stage, lymph nodes, grade, receptor status, response to preoperative therapy, general health and available treatments. Statistics describe groups and cannot predict one individual precisely. Follow-up usually includes clinical review and mammography of remaining breast tissue. Routine CT or PET-CT and broad tumour-marker testing are not automatically helpful after curative treatment when there are no symptoms. Report a persistent new lump, bone pain, breathlessness, neurological symptoms or unexplained weight loss.

Most breast cancers are not caused by a single inherited variant. Genetic counselling is more likely to help when cancer occurred young, affected both breasts, was triple-negative at a younger age, included male breast cancer, or clustered with ovarian, pancreatic or aggressive prostate cancer. Relatives should not copy the patient’s follow-up plan. Their screening should be based on age, their own history, a formal family-risk assessment and, where indicated, a confirmed familial genetic result.

A cough that persists or changes, blood in sputum, unexplained breathlessness, chest pain, hoarseness, repeated chest infections, weight loss or marked fatigue should be assessed. Lung cancer can occur without symptoms and in people who have never smoked, although tobacco remains the major preventable risk. Coughing up more than a small streak of blood, severe breathlessness or chest pain requires urgent care. Symptoms alone cannot distinguish cancer from infection or other lung disease.

A chest X-ray may be the first test, but contrast CT usually defines the abnormality better. Tissue can be obtained by bronchoscopy, image-guided needle biopsy, endobronchial ultrasound or sampling another accessible site. Pathology distinguishes small-cell from non-small-cell lung cancer and identifies the exact subtype. In advanced non-small-cell cancer, molecular testing and PD-L1 testing can be essential before choosing treatment. The biopsy method should obtain enough tissue while limiting risk.

Non-small-cell lung cancer is staged using the primary tumour, lymph nodes and distant spread. CT, PET-CT, brain MRI and lymph-node sampling may be used according to the planned treatment. Small-cell lung cancer is often described as limited or extensive stage, although TNM information may also be recorded. A PET-active area is not automatically cancer; infection and inflammation can also be active, and suspicious findings may need biopsy if they would change treatment.

Early non-small-cell cancer may be treated with surgery or, for patients who cannot have surgery, stereotactic radiotherapy. Chemotherapy, immunotherapy or targeted therapy may be given before or after surgery in selected cases. Locally advanced disease often needs combined treatments. Metastatic disease is treated according to subtype, molecular alterations, PD-L1, symptoms and health. Small-cell cancer commonly uses chemotherapy with immunotherapy and radiotherapy in appropriate settings. Stopping smoking remains beneficial after diagnosis.

Stage, cancer subtype, molecular features, general fitness and response to treatment all influence outlook. Some advanced cancers with targetable alterations can be controlled for years, while other tumours behave more aggressively. After curative-intent treatment, planned chest imaging is commonly used, but the interval depends on treatment and local guidance. New breathlessness, coughing blood, persistent focal pain, headaches, weakness or weight loss should be reported between visits.

Routine screening is based mainly on age and substantial smoking exposure, not simply on having one relative with lung cancer. Eligible high-risk people may benefit from annual low-dose CT through a structured programme; chest X-rays and tumour-marker tests are not substitutes. A strong family pattern or lung cancer at unusually young ages can justify individual risk assessment, although a single inherited cause is uncommon. All relatives should avoid tobacco and reduce second-hand smoke and occupational exposures.

Blood in the stool, a persistent change in bowel habit, unexplained iron-deficiency anaemia, abdominal pain or swelling, weight loss, or a feeling of incomplete emptying should be assessed. These symptoms commonly have non-cancerous causes, but visible bleeding should not be attributed to piles without evaluation. Black stools, heavy bleeding, severe abdominal pain, vomiting or inability to pass stool or gas may indicate an emergency. Screening can detect disease before symptoms develop.

Colonoscopy allows the bowel lining to be inspected, suspicious areas to be biopsied and many polyps to be removed. CT helps evaluate spread. Rectal cancer usually also needs pelvic MRI, and sometimes endorectal imaging, for precise local planning. The pathology report identifies type and grade. Mismatch-repair or microsatellite-instability testing is recommended in colorectal cancer because it may indicate Lynch syndrome, inform prognosis and influence immunotherapy decisions. Additional tumour biomarkers are tested when relevant to systemic treatment.

Staging describes how deeply the tumour has grown through the bowel wall, whether regional lymph nodes are involved and whether disease has spread, commonly to the liver, lungs or peritoneum. Colon and rectal cancers use related TNM systems, but pelvic anatomy makes rectal MRI especially important. A raised CEA can support baseline and follow-up assessment in some patients, but a normal CEA does not exclude cancer and an elevated result is not diagnostic by itself.

Localised colon cancer is usually treated with surgery, with adjuvant chemotherapy for selected stages and risk features. Rectal cancer often requires a carefully sequenced combination of radiotherapy, chemotherapy and surgery; in selected patients with an excellent response, organ-preserving surveillance may be considered only within an experienced programme. Metastatic disease may use chemotherapy, targeted therapy, immunotherapy for suitable biomarkers, and surgery or ablation for selected limited metastases. A stoma is not required for every patient.

Stage, number of involved lymph nodes, tumour biology, margins, response to treatment and whether metastases can be completely treated affect outlook. Follow-up after curative treatment may include visits, CEA, periodic CT and colonoscopy, with timing tailored to stage and local guidance. Bowel function can remain altered, particularly after rectal treatment, and pelvic-floor, nutrition or stoma support may help. New bleeding, persistent bowel change, abdominal swelling or unexplained weight loss should be reported.

Family history can change colorectal screening. Earlier or more frequent colonoscopy may be advised when a close relative was diagnosed young, several relatives are affected, or an inherited syndrome such as Lynch syndrome or familial adenomatous polyposis is suspected. Genetic testing should ideally begin with an affected family member when possible. Relatives with a known familial pathogenic variant need a syndrome-specific plan; relatives without such a variant may follow a different schedule determined by their residual family risk.

Early prostate cancer often causes no symptoms. Difficulty passing urine, a weak stream or frequent night-time urination is more often due to benign prostate enlargement, but still merits assessment. Blood in urine or semen, persistent pelvic discomfort, unexplained bone pain, weakness or weight loss can occur in more advanced disease. Symptoms cannot confirm prostate cancer. Sudden inability to urinate, new leg weakness or loss of bladder or bowel control requires urgent assessment.

Assessment may include PSA, examination, prostate MRI and biopsy. PSA is prostate-specific but not cancer-specific; enlargement, infection, ejaculation and procedures can affect it. MRI helps identify suspicious areas and guide biopsy but cannot rule out every clinically important cancer. Pathology provides the Gleason score and Grade Group. In selected older or frail patients, the team may individualise whether biopsy would meaningfully change care.

Planning combines TNM stage, PSA level, Grade Group, biopsy extent and imaging. Patients may be grouped as low, intermediate, high or very high risk, while metastatic disease is classified by where and how extensively it has spread. PSMA PET-CT is increasingly used in selected staging and recurrence settings, but availability and indications vary. Risk group often guides treatment more usefully than one PSA value alone.

Low-risk localised cancer may be monitored with active surveillance rather than treated immediately. Other options include prostatectomy, external-beam radiotherapy and brachytherapy. Hormone therapy may be combined with radiotherapy for higher-risk disease and is central in metastatic disease. Additional medicines include androgen-receptor pathway drugs, chemotherapy, radiopharmaceuticals and targeted treatment for selected biomarkers. Urinary, sexual, bowel, bone and metabolic effects should be discussed before choosing among medically reasonable options.

A father, brother or son with prostate cancer---especially at a younger age or with aggressive disease---can increase risk. Families with breast, ovarian, pancreatic or prostate cancer may have an inherited syndrome involving genes such as BRCA2 or mismatch-repair genes. Male relatives should discuss an individual PSA-based early-detection plan rather than adopting the patient’s surveillance schedule. Genetic counselling is appropriate when the pattern or the patient’s tumour features suggest inherited risk.

Persistent abdominal bloating, early fullness, pelvic or abdominal pain, urinary frequency or unexplained weight change can occur with ovarian cancer. Abnormal vaginal bleeding---especially bleeding after menopause---is the key warning sign for endometrial cancer. These symptoms often have benign causes, but persistence or postmenopausal bleeding needs assessment. Severe abdominal pain, vomiting and swelling may require urgent care. A normal cervical screening test does not rule out ovarian or endometrial cancer.

Ovarian assessment may include pelvic examination, ultrasound and CT; CA-125 can support evaluation but is neither a stand-alone screening nor diagnostic test. Tissue is obtained through surgery or biopsy when appropriate. Endometrial cancer is usually confirmed by endometrial biopsy or hysteroscopy, often after ultrasound. Pathology defines subtype, grade and biomarkers. Mismatch-repair testing is important in endometrial cancer, and genetic or tumour testing is commonly relevant in epithelial ovarian cancer.

Surgery is central for many patients. Ovarian cancer commonly uses platinum-based chemotherapy, with maintenance targeted therapy such as PARP inhibition or anti-angiogenic therapy for selected patients. Endometrial treatment may include surgery, radiotherapy, chemotherapy, hormonal therapy, immunotherapy or targeted combinations according to stage and biomarkers. Fertility-sparing hormonal treatment is possible only for carefully selected early endometrial cancers under close specialist surveillance. Treatment should be planned by a gynaecologic oncology team where available.

Epithelial ovarian cancer and some endometrial cancers can be associated with inherited BRCA-related or Lynch syndromes. Genetic evaluation is commonly recommended for epithelial ovarian cancer and for endometrial cancer when age, tumour testing or family history suggests risk. There is no reliable routine ovarian screening test for average-risk relatives. A confirmed familial variant may lead to earlier surveillance or risk-reducing options, while relatives should continue ordinary cervical and other age-appropriate screening.

Bleeding after sex, bleeding between periods, postmenopausal bleeding, persistent watery or blood-stained discharge, pelvic pain or pain during sex should be assessed. Early cervical changes often cause no symptoms, which is why screening matters. Abnormal bleeding is not automatically cancer, but it requires diagnostic evaluation rather than waiting for the next screening invitation. Heavy bleeding, dizziness, severe pain or inability to pass urine requires urgent care.

A clinician examines the cervix and may perform colposcopy with biopsy. Screening tests such as HPV testing and cervical cytology identify risk or precancer; they do not by themselves diagnose invasive cancer. If cancer is confirmed, pelvic examination under appropriate conditions and imaging---often MRI, CT or PET-CT---help plan treatment. Pathology usually identifies squamous-cell carcinoma or adenocarcinoma. A biopsy is necessary before definitive cancer treatment in almost all cases.

Stage reflects tumour size, extension into nearby tissues, lymph nodes and distant spread. Examination, MRI, CT, PET-CT and selected procedures may contribute. Kidney function and urinary obstruction are also important in advanced pelvic disease. Stage is used with tumour type, lymph-node status, health and fertility priorities to guide treatment. The same symptoms or abnormal screening result can occur across very different stages, so only complete evaluation can define the situation.

Very early cancers may be treated with a fertility-preserving cone procedure or trachelectomy in selected patients. Other early cancers may need hysterectomy and lymph-node assessment. Locally advanced disease is commonly treated with external-beam radiotherapy, concurrent chemotherapy and brachytherapy; completing the planned course without avoidable delay is important. Recurrent or metastatic disease may use chemotherapy, immunotherapy, targeted therapy, radiotherapy or surgery in selected circumstances.

Cervical cancer is usually related to persistent high-risk HPV infection, not a hereditary cancer syndrome, so relatives do not need extra screening merely because a family member was affected. Everyone eligible should receive HPV vaccination and follow the national cervical screening programme. Vaccination does not treat an existing infection and does not remove the need for screening. Smoking cessation and follow-up of abnormal cervical results reduce risk.

Progressive difficulty swallowing, pain on swallowing, persistent indigestion, early fullness, vomiting, unexplained weight loss, anaemia, black stools or vomiting blood should be assessed. Reflux and indigestion are common and usually benign, but new, persistent or worsening symptoms---especially with weight loss or swallowing difficulty---need investigation. Inability to swallow liquids, significant bleeding, dizziness or severe dehydration requires urgent care. Early disease can be silent.

Upper gastrointestinal endoscopy allows direct inspection and biopsy. Pathology identifies the type, most often adenocarcinoma or squamous-cell carcinoma. CT is commonly used for staging; endoscopic ultrasound can assess depth and nearby nodes, and PET-CT or staging laparoscopy is helpful in selected patients. HER2, PD-L1, mismatch-repair status and other biomarkers may guide treatment in advanced adenocarcinoma. Nutrition and swallowing should be assessed from the beginning.

Stage considers how deeply the tumour invades the wall, regional lymph nodes and distant spread. The exact lymph-node groups and staging details differ by tumour location. Doctors also assess whether the tumour can be removed safely, its relation to nearby structures and whether microscopic abdominal spread is present. A multidisciplinary review is valuable because the junction between oesophagus and stomach can be classified and treated differently depending on its precise position.

Most stomach and oesophageal cancers are not caused by a single inherited variant. Genetic counselling may be appropriate with diffuse stomach cancer at a young age, several relatives with diffuse stomach or lobular breast cancer, Lynch-associated cancers, polyposis, or another striking family pattern. Screening of relatives depends on the suspected syndrome and may involve endoscopy in specialised programmes. Relatives should also address tobacco, alcohol, obesity, reflux and Helicobacter pylori risk with their clinicians.

Jaundice, dark urine, pale stools, persistent upper abdominal or back pain, loss of appetite, unexplained weight loss, increasing abdominal swelling, itching or a newly palpable mass should be assessed. Gallbladder cancer is sometimes discovered unexpectedly after surgery for stones. Liver cancer may arise during surveillance for cirrhosis before symptoms appear. New jaundice with fever, chills, confusion, severe pain or vomiting can represent biliary infection or obstruction and requires urgent care.

Pancreas-protocol CT, liver MRI, ultrasound and endoscopic ultrasound are used according to the suspected site. Blood tests assess liver function and obstruction. CA 19-9 and AFP can support evaluation or monitoring in selected settings but cannot diagnose or exclude cancer alone. Biopsy is usually required before drug treatment, while some clearly resectable pancreatic or characteristic liver cancers may be managed without preoperative biopsy. The safest approach depends on imaging, liver disease and the treatment plan.

Chronic hepatitis B or C, cirrhosis and certain metabolic liver diseases increase liver-cancer risk; relatives do not inherit the cancer itself, but family members should know their hepatitis B vaccination and testing status when relevant. A strong pancreatic-cancer family history or a related inherited syndrome can justify genetic counselling and specialist pancreatic surveillance. Routine ultrasound, CT or CA 19-9 screening is not recommended for average-risk relatives. Gallbladder stones are common and do not mean cancer is inevitable.

A mouth ulcer lasting more than about three weeks, a persistent neck lump, unexplained hoarseness, difficulty or pain with swallowing, one-sided ear pain, coughing blood, nasal blockage or bleeding, or a red or white oral patch should be assessed. Dental problems and infections are more common causes, but persistent change needs examination. Breathing difficulty, significant bleeding or inability to swallow saliva requires urgent care. Tobacco, areca nut, alcohol and HPV are important risk factors for different sites.

An ear, nose and throat or head-and-neck specialist examines the mouth, throat and neck, often using a flexible scope. Ultrasound-guided sampling of a neck node, endoscopic biopsy or biopsy of the primary lesion confirms diagnosis. CT, MRI and PET-CT are selected for local and distant staging. HPV-related testing is important for oropharyngeal squamous cancer, and EBV-related testing may help in nasopharyngeal cancer. Dental, nutrition, speech and swallowing assessments are often needed before treatment.

Visible blood in urine should be assessed even if painless or present only once. Flank pain, a mass, persistent urinary irritation, repeated unexplained urinary infections, weight loss or fatigue can occur. Most urinary symptoms are due to stones, infection or benign conditions, but urine colour alone cannot identify the cause. Heavy bleeding with clots, inability to pass urine, fever with flank pain or severe weakness requires urgent assessment.

Kidney-cancer stage considers tumour size and extension beyond the kidney, lymph nodes and distant spread. Bladder cancer is first divided into non-muscle-invasive and muscle-invasive disease, then staged by depth, nodes and metastases. This distinction strongly affects treatment. Pathology grade is also important. Chest and abdominal imaging are selected by risk. A small kidney mass and a high-grade bladder tumour require very different discussions despite both involving the urinary system.

New seizures, progressive one-sided weakness, persistent personality or cognitive change, worsening headaches with vomiting, new speech or vision problems, or loss of balance should be assessed. Headaches alone are very common and rarely indicate a tumour; pattern, progression, neurological findings and associated symptoms matter. A first seizure, sudden weakness, severe confusion, reduced consciousness or a rapidly worsening headache requires emergency assessment.

MRI with contrast is the main imaging test, while CT is useful in emergencies and for some tumour features. A neurosurgeon may remove the tumour or obtain a stereotactic biopsy. Modern diagnosis combines microscopic appearance with molecular features, which can redefine tumour type and guide treatment. Some lesions can be monitored radiologically or diagnosed without biopsy when procedure risk outweighs benefit, but imaging alone cannot reliably identify every tumour.

Most primary brain tumours are classified by type and WHO grade rather than the usual stage I--IV system used for many body cancers. Grade reflects biological behaviour, while molecular alterations provide additional prognostic information. MRI evaluates location, size, swelling and spread within the brain or spinal fluid. Metastatic tumours in the brain are staged according to the cancer where they originated and are not reclassified as primary brain cancer.

Most brain tumours are not hereditary, and routine brain MRI is not recommended for relatives of an affected patient. Genetic counselling may be appropriate when tumours occur very young, are multiple, accompany characteristic skin or nerve findings, or cluster with other cancers suggesting a syndrome such as neurofibromatosis, Li-Fraumeni or Lynch syndrome. If a familial pathogenic variant is found, relatives need syndrome-specific counselling rather than general brain scans.

A lump that is enlarging, deep, firm, painful or larger than expected should be assessed, as should persistent focal bone pain, a pathological fracture or unexplained swelling. Most lumps and musculoskeletal pains are not sarcoma, but repeated removal without diagnosis can complicate definitive surgery. An enlarging mass should be imaged before being assumed to be a lipoma. Sudden severe pain or loss of limb function requires urgent evaluation.

MRI is commonly used for a limb or soft-tissue mass, with CT for certain sites and chest imaging because the lungs are a common site of spread. Diagnosis usually requires a planned core-needle biopsy. The biopsy route should be chosen by, or discussed with, the sarcoma team so it can be removed during surgery. Pathology review by an experienced sarcoma pathologist is valuable because there are many rare subtypes and molecular tests can clarify classification.

Staging incorporates tumour size, depth or site, grade, regional nodes and distant spread. Bone and soft-tissue sarcomas use different systems, and certain sarcomas have unique risk models. Grade estimates aggressive behaviour but is not assigned in the same way for every subtype. MRI defines local anatomy, while chest CT and selected other scans evaluate spread. Treatment planning should occur in a specialist multidisciplinary service whenever possible.

A persistent thyroid or neck lump, enlarging neck nodes, voice change, swallowing difficulty or breathing difficulty should be assessed. Most thyroid nodules are benign, and ultrasound with selected needle biopsy helps determine risk.

No. Surgery is central for many differentiated thyroid cancers, while radioactive iodine is selected according to tumour type, stage and recurrence risk. Medullary and anaplastic thyroid cancers require different approaches.

Look for a changing mole, a new irregular pigmented lesion, a sore that does not heal, repeated bleeding or a growing pearly, scaly or ulcerated area. Early clinical examination and biopsy are more reliable than photographs alone.

A painless testicular lump, heaviness, enlargement or persistent discomfort requires prompt ultrasound assessment. Many testicular cancers are highly curable, including some that have spread, but biopsy through the scrotum is generally avoided; management usually begins with specialist surgical evaluation.

It is metastatic cancer in which the original site is not found after appropriate evaluation. Pathology, imaging and selected molecular tests help identify a likely tissue of origin or a treatable subgroup; endless testing is not always beneficial.

Neuroendocrine tumours arise from cells with nerve-like and hormone-producing features and can occur in several organs. They vary from slow-growing well-differentiated tumours to aggressive neuroendocrine carcinomas, so grade, stage and hormone symptoms strongly influence treatment.

GIST is a sarcoma arising in the digestive tract, most often the stomach or small intestine. Surgery and mutation-directed medicines such as tyrosine-kinase inhibitors are important; it is not treated exactly like ordinary stomach or bowel carcinoma.

These are rare tumours arising in the thymus behind the breastbone. They may be found incidentally or cause chest symptoms and can be associated with autoimmune conditions such as myasthenia gravis. Specialist review is important because surgery, radiotherapy and systemic treatment depend on resectability and subtype.

Mesothelioma most often arises from the lining around the lungs and is associated with previous asbestos exposure, although not every patient recalls exposure. Diagnosis usually requires imaging and tissue biopsy; treatment may combine surgery, systemic therapy, radiotherapy and symptom control in selected patients.

They are a diverse group of rare tumours with different behaviour and molecular features. A persistent salivary or facial lump, pain, numbness or facial weakness requires assessment. Surgery is common, with radiotherapy or systemic treatment in selected cases.

These are uncommon cancers that may present with a persistent ulcer, lump, bleeding, discharge, itching, skin change or groin node. Embarrassment should not delay examination; earlier diagnosis may allow less extensive treatment.

Rare tumours are harder to classify and may have uncommon surgical, molecular or clinical-trial options. Specialist pathology and multidisciplinary review can reduce diagnostic error and help select appropriate treatment without necessarily transferring every part of care.