Lifestyle & Cancer Risk Assessment

Symptom Assessment

Please toggle the switch if you are experiencing any of the following symptoms to provide more details.

Do you have a new or worsening cough?

Lung Symptoms Details

Duration (days)

Coughing up blood?

Shortness of breath?

Severity (0-3)

Chest pain?

Chest Pain Severity (0-3)

Unexplained weight loss (kg)

Recurrent respiratory infections?

Wheezing?

Do you have frequent or worsening headaches?

Neurological Symptoms Details

Pattern

Severity (0-3)

Seizures?

Nausea or vomiting?

Behavior or memory changes?

Weakness/numbness on one side?

Vision problems?

Speech difficulties?

Balance or dizziness issues?

Do you feel a breast lump or mass?

Breast Symptoms Details

Location

Size (approx mm)

Breast swelling?

Skin dimpling (Orange peel)?

Nipple retraction?

Nipple discharge?

Is discharge bloody?

Breast/Nipple pain?

Pain Severity (0-3)

Armpit swelling?

Do you have a non-healing mouth sore?

Oral Symptoms Details

Duration (days)

White or red patches in mouth?

Unexplained oral bleeding?

Numbness or pain in mouth/face?

Difficulty chewing/speaking?

Loose teeth without cause?

Chronic bad breath?

Earache without infection?

Do you have any new or changing skin growth?

Skin Symptoms Details

Location

Changing mole?

Description of change

Non-healing skin sore?

Itching or pain around lesion?

Irregular border/multiple colors?

Rapidly growing bump?

Lesions on palms/soles/mucosa?