Patient Questionnaire with Cancer Warning Signs

• rapid weight loss without apparent cause?

• a scab, sore or ulcer on the skin or in the mouth that does not heal within 3 weeks?

• a blemish or mole that grows, bleeds or itches?

• indigestion or difficulty swallowing?

• a nagging cough or hoarseness?

• coughing up bloody phlegm?

• thickening or lump in the breast?

• a lump in any other part of the body?

• blood in the urine without pain during urination?

• a change in bowel habits?

• a change in bladder habits?