Cancer (By Presentation)

Question 1

Abdominal Distension

Answer 1

• Mechanical Bowel obstruction by primary tumour or metastases
• Ileus – paralysis causing non-mechanical obstruction as tumour or metastases invades nerves causing peristalsis
• Peritonitis as tumour irritates peritoneum
• Hepato-splenomegaly due to metastases or haematological malignancy
• Internal bleeding from cancer

Question 2

Abdominal Mass

Answer 2

• Masses from colon, renal or gastric cancers

* Hepato-splenomegaly due to metastases or haematological malignancy

Question 3

Ascites

Answer 3

• Cancer irritates the peritoneum and produces fluid
• Lymph nodes are blocked by the cancer so fluid cannot drain
• Cancer has spread to the liver and there is increased pressure
• Ascites most commonly occurs in cancers of the ovary, breast, colon, stomach and pancreas

Question 4

Bleeding from upper and lower GI tract?

Answer 4

• Due to primary gastrointestinal malignancy or there are metastases to the GI tract
• Bleeding occurs because blood vessels in the tumour are fragile (because it is growing too fast) or because the cancer has actually grown into the blood vessel

Question 5

Bone Pain

Answer 5

• Due to bone metastases or hypercalcaemia of malignancy
• Bone lesions or metastases are common in prostate, thyroid, breast, myeloma, lung, lymphoma
• Can get bone pain in leukaemias
• Hypercalcaemia may occur in lung cancer is squamous carcinoma produces PTHrp or in myeloma where the myeloma cells cause bone breakdown

Question 6

Breast Lump

Answer 6

• Breast metastases are rare so if a breast lump this is likely a primary breast cancer

Question 7

Breathlessness and/or cough and/or haemoptysis?

Answer 7

• This is likely due to lung cancer or lung metastases

Question 8

Change in bowel habit?

Answer 8

• Most likely a symptom of colorectal cancer

Question 9

Decreased appetite

Answer 9

• As a systemic symptom or due to obstruction as above

Question 10

Electrolyte abnormalities

Answer 10

• As a result of drugs to treat the cancer
• Hypercalcaemia – bone lesions, myeloma, PTHrp secretion by cancer (e.g. squamous lung cancer)
• Tumour lysis syndrome – occurs due to tumour cell breakdown, most common in haematological malignancies, may occur at start of chemo or spontaneously if there is a big tumour burden, there is a massive release of intracellular ions such as potassium and phosphate, big risk of AKI
• Hyponatraemia – cancer secretes ADH (e.g. small cell lung cancer)
• Overall cancers can cause electrolyte abnormalities if the cancer cells are using more or less ions etc.

Question 11

Fatigue

Answer 11

• Systemic symptom in many cancers

* Also consider if treatment is causing fatigue

Question 12

Haematuria

Answer 12

Renal cancers / urological cancers

Question 13

Headaches?

Answer 13

• Primary brain tumour
• Metastatic brain tumour
• Primary headaches as a systemic symptom

Question 14

Jaundice

Answer 14

• Due to blockage of bile duct
• Cancers that could cause this are cholangiocarcinoma, carcinoma of the gallbladder, pancreatic cancer, primary liver cancer or metastatic cancer in the liver

Question 15

Limb weakness

Answer 15

• Eaton lambert syndrome in lung cancer
• Primary brain tumours or metastatic brain tumours affecting motor cortex
• Tumours affecting peripheral motor nerves
• Metastatic bone lesions resulting in abnormal bones and weakness

Question 16

Lump in groin

Answer 16

• Usually due to lymphadenopathy

Question 17

Lymphadenopathy

Answer 17

• In lymphomas lymphadenopathy should be smooth, rubbery, non-tender and non-tethered
• In metastatic lymphadenopathy lymph nodes will be irregular, hard and tethered

Question 18

Lump in neck

Answer 18

• Thyroid cancer
• Lymphadenopathy
• Pharyngeal and laryngeal cancers

Question 19

Pain on inspiration?

Answer 19

• Lung cancer has invaded the chest wall
• Other metastatic invasion of the chest wall
• Pulmonary embolism (cancer makes you hypercoagulable)

Question 20

Painful swollen leg

Answer 20

• Unprovoked DVT as cancer makes you hypercoagulable

Question 21

Pelvic mass

Answer 21

• Potentially a sign of ovarian cancer

Question 22

Pleural effusion

Answer 22

• Exudative pleural effusions are malignant
• Malignant pleural effusions are most common in lung, breast, lymphoma and mesothelioma
• They occur because the cancer has spread into the pleura or the lymph nodes near by
• Exudative pleural effusions are more likely to be unilateral, they have high protein content as they actively form, e for energy (whereas transudative are passive as it’s a problem with pressure)

Question 23

Scrotal/ testicular pain lump/ swelling

Answer 23

• Testicular cancer - painless, insensitive testicular swelling – a hard stony mass
• Leukaemias can affect the testicles

Question 24

Swallowing problems?

Answer 24

• Oesophageal cancers
• Pharyngeal Cancers
• Brain Metastases or Primary Cancer affecting the nerves
• As a side effect of treatment e.g. radiotherapy

Question 25

Weight loss?

Answer 25

• Systemic effect of many cancers
• Cancer cells need more energy so you lose weight
• Might have reduced appetite which results in weight loss
• Might have absorption problems if cancer in GI tract
• Might have difficulties swallowing in oesophageal or pharyngeal cancer
• Might be as a result of treatment