Q: How do I know whether my iron deficiency anemia is a symptom of cancer?

A: Anemia is a common blood disorder affecting more than three million Americans. It develops when the body lacks healthy red blood cells and hemoglobin, the protein that helps distribute oxygen throughout the body.

Iron deficiency anemia (IDA) develops when your body also lacks sufficient iron in its bloodstream.

IDA is not a diagnosis, but rather a symptom of a larger cause or condition. When the body does not receive enough iron, your cells cannot produce hemoglobin.

In many cases, IDA can serve as a red flag for health-care providers to search for cancer. Colon, uterine and bladder cancers, for example, can cause or increase blood loss. Anemia may also be a sign of a blood-related cancer such as leukemia or lymphoma.

Causes of IDA
Because people with certain cancers are at risk of developing iron deficiency, it is important to rule out causes of IDA other than cancer:

  • Blood loss: Red blood cells contain iron. Therefore, when you lose blood, you lose iron. Women with heavy menstrual cycles, patients with ulcers, and patients with hemorrhoids all have an increased risk of developing IDA.
  • Lack of iron in your diet: Your body receives iron from the foods you eat. Consuming too little iron can cause iron deficiencies over time. Eating iron-rich foods, such as eggs, red meats, and leafy green vegetables, can help lower your risk of IDA.
  • Inability to absorb iron: Iron is absorbed by the bloodstream in the small intestine. Patients with disorders affecting their gastrointestinal (GI) tracts, such as celiac disease, may be unable to absorb iron and other nutrients from food, increasing their risk of IDA.
  • Pregnancy: During pregnancy, the volume of blood in a woman's body expands, and more iron is needed to support her baby's growth. Your physician may prescribe iron supplements during pregnancy to help prevent complications such as preterm deliveries, postpartum depression, child anemia, and child developmental delays.

While each instance is different, IDA has several recognizable symptoms. You may feel weak or fatigued, making everyday activities seem challenging. You may experience intermittent headaches or dizziness, and your hands or feet may often feel cold, even in moderate temperatures. You may also experience dyspnea—a sudden or unexplained shortness of breath.

In rare cases, IDA can cause pica, a disorder characterized by persistent cravings of non-food  substances, such as paper, ice, or paint. Though uncommon, pica is often a dangerous side effect of IDA and should be treated immediately.

Screenings
A physician who suspects IDA might recommend additional screenings to determine whether  your IDA is linked to undiagnosed cancer.

  • Complete blood count (CBC) is a commonly used test that measures the levels of hemoglobin and red and white blood cells, and essential proteins in your bloodstream. Abnormally high or low results in your CBC not only can help your physician identify whether you have anemia, but also better understand its cause.
  • Iron studies evaluate the amount of iron in your blood.
  • Colonoscopy or endoscopy is a nonsurgical procedure used to examine a person's GI tract with a light, camera and scope. Your physician may use this to check for possible bleeding in your GI tract, as IDA and chronic GI bleeding are often the first symptoms of colon cancer. Your physician may also request a stool sample.

By identifying the cause of your IDA early, you and your physician can work to address it and improve your quality of life. Talk to your physician to assess your risk factors for IDA.

Yu Yu Thar, M.D., is a hematologist and oncologist at Mercy Fitzgerald Hospital and Mercy Philadelphia Hospital.