The three cancers that are hardest to diagnose, according to a doctor

Cancer is cruel, and one of the cruellest things about it is that different types can hide in our bodies much better than others.

And delays in getting a diagnosis can prove deadly.

That’s why we wanted to hear from a doctor – to learn what types of cancers are the hardest to spot, and what to keep an eye out for to improve your chances of noticing anything amiss.

Dr Deborah Lee, of Dr Fox Online Pharmacy, tells that the top cancers that are hard to diagnose are pancreatic, ovarian, and bowel cancer.

‘All three cancers are believed to be present for many years before diagnosis but cause little or no symptoms, or if symptoms do occur, they are mistaken for something else,’ she explains.

‘We need to raise awareness of these cancers and make sure people look out for the signs and symptoms and see their GP sooner rather than later. Apart from bowel cancer, there are sadly still no screening programmes for ovarian or pancreatic cancer.’

Pancreatic cancer

Dr Deborah says more than 8,000 people in the UK die each year from pancreatic cancer.

‘Of all the cancers,’ she adds, ‘pancreatic cancer is particularly hard to diagnose, and most often presents when the disease is advanced and not amenable to curative treatment. Only 1% of people diagnosed with pancreatic cancer live for 10 years. Pancreatic cancer has the lowest five-year survival rate of the most common 22 types of cancer.

‘It’s believed that pancreatic cancer often takes 10-20 years to grow in the pancreas before it is detected. 80% of patients are diagnosed when it is at an advanced stage. This is because the pancreas sits high up at the back of the abdomen (tummy) and the symptoms are mild or put down to other conditions such as acid reflux, gall bladder disease, or peptic ulcers.’

The signs and symptoms:


  • Painless, progressive jaundice – yellowing of the skin and the whites of the eyes, with pale stools and dark-coloured urine.
  • Unexplained weight loss.
  • Loss of appetite.
  • Nausea and vomiting.
  • Change in bowel habit – diarrhoea or constipation – but often loose, putty-coloured stools that are hard to flush away.
  • Lethargy and fatigue.
  • Abdominal pain.
  • Indigestion.

Risk factors:

  • Pancreatic cancer usually affects people aged over 65 and is rare in those under the age of 40, but it can occur at any age.
  • 22% of pancreatic cancers are caused by smoking.
  • Alcohol, obesity, and lack of physical exercise.
  • It is more common in those who have previous cancer treatment.
  • The risk is significantly increased if you have one or two close relatives with the disease. It’s more common in those with the BRACA 2 gene and in those with Lynch syndrome.
  • It’s more common in those with chronic pancreatitis, or who have hepatitis B infection.
  • New onset diabetes.

Dr Deborah anyone who has any of the above symptoms to see their GP.

‘Most will not have pancreatic cancer,’ she adds, ‘but if a cancer is picked up early, this will greatly improve the chance of survival. Don’t suffer in silence. Even in these difficult NHS times, doctors still want to see you if you are not well.

‘There is no screening programme for pancreatic cancer but if you are high risk you may be able to join the European Registry of Hereditary Pancreatitis and Pancreatic Cancer Trial (EUROPAC).’

Ovarian cancer

Dr Deborah says that roughly 4,000 people die from ovarian cancer every year.

‘That’s about 11 women a day,’ she says. ‘The problem is that only 20% of women are diagnosed with ovarian cancer in the early stages – stages 1 and 2.

‘Ovarian cancer is often diagnosed when it is advanced and has already spread because the symptoms are nebulous and non-specific and often put down to other things. Because the pelvis and abdominal cavity are roomy, the tumour has to grow quite big before it causes sufficient symptoms for a woman to know anything is wrong.

‘Women need to know the symptoms. Be alert and go for help as soon as they think things are not right.’

The signs and symptoms:


  • Bloating.
  • Feeling full after meals.
  • Peeing frequently (due to pressure on the bladder).
  • Pain in the tummy and/or pelvis.
  • Feeling pressure in the tummy.
  • Swelling of the tummy.
  • Unexplained weight loss.
  • Fatigue.
  • Back pain.
  • Constipation.
  • Vaginal bleeding – postmenopausal bleeding.
  • Unusual vaginal discharge.
  • Painful sex.

Risk factors:

  • The peak age for ovarian cancer is 63 – it’s rare under the age of 40.
  • Being overweight or obese.
  • Starting periods early and finishing them late.
  • Never having had children.
  • Endometriosis.

Dr Deborah says there’s also ‘a strong genetic link’ at play.

She adds: ‘Women are more at risk if they have a first-degree relative (mother or sister) who has had ovarian or breast cancer. Women should see their GP if this is the case as they may meet the criteria to be referred for genetic cancer screening, and be tested for gene mutations such as BRACA1 and BRACA 2.

‘If they test positive, they will be advised about lowering their ovarian and breast cancer risks, which means the option of surgery to remove their ovaries and breasts before any malignancy occurs – if they choose to do this.’

Again, if you have any of the symptoms above, Dr Deborah says it’s time to go see your GP. You can also go to a sexual health clinic.

‘Most will not have ovarian cancer,’ she goes on, ‘but it’s always best to be thorough and be investigated to give yourself the best chance of picking up any serious conditions such as ovarian cancer early.

‘Stage 1 ovarian cancer has an 89% five-year survival rate whereas for stage 4 this drops to 20%.’

Bowel cancer

If it remains undetected, bowel cancer can end up spreading and growing into blood vessels, the bowel wall, lymphatics and other local tissues.

Dr Deborah explains: ‘Bowel cancer usually starts with the growth of a poly in the bowel wall.

‘Only around 10% of bowel polyps become malignant. The process takes 10-20 years during which there is plenty of time for the polyp to be discovered and removed.’

She also cites a study by Cancer Epidemiology which found that nearly one-third of bowel cancer patients experience an avoidable delay getting a diagnosis.

‘In 13% of cases,’ she adds, ‘the delay happened before they saw their GP, and in 38% the delay occurred after the GP referred them to the hospital. In 49% of patients, the delay was having tests waiting for test results to come back to the GP surgery.

‘Since this data was collected in 2014, things have worsened in the NHS with the Covid pandemic and the current NHS crisis with staff shortage, strikes and underfunding. This is extremely worrying and something that needs urgent attention.’

Signs and symptoms:


Risk factors:

  • Having had colonic polyps.
  • Inflammatory bowel disease – Crohn’s Disease or Ulcerative Colitis
  • Having a close family history of bowel cancer.
  • Having an inherited condition such as Lynch syndrome, or familial adenomatous polyposis.
  • Rare conditions such as Peutz Jeghers syndrome or cystic fibrosis
  • Having type-2 diabetes.
  • Age – Bowel cancer can occur at any age but is more common in those over 50.
  • Race – it is more common in American Indians, Native Alaskans, and Ashkenazi Jewish diaspora.
  • Being overweight or obese.
  • Excess alcohol smoking and physical inactivity.
  • Eating a lot of red meat.
  • Low levels of vitamin D – so it may be more common in night shift workers.

Dr Deborah urges us not to be embarrassed or ashamed of talking about our bathroom habits with a GP.

‘Your doctor also sits on the toilet!’ she says. ‘They have seen it all before and are there to help you.

‘Don’t just put your symptoms down to piles and ignore it – it’s important to get this properly checked out.

‘Do participate in the NHS Bowel Screening programme. Every adult in the UK registered with a GP will be sent a poo testing kit in the post every two years, between the ages 60 and 74. Don’t ignore this – get on and do it. Bowel screening has saved 20,000 lives in the UK over the past 10 years.’

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