Cancer Detection: Clinical Presentation Flashcards
Define a sign
objective evidence of a disease that can be observed by others (for example a skin rash or lump)
Define a symptom
subjective, apparent only to the patient (for example back pain or fatigue)
Define differentials
checklist of what symptoms could and could not be
What are the general common signs and symptoms of cancer?
- lump
- fatigue
- anorexia (loss of appetite)
- weight loss
Common symptoms of oesophageal cancers?
- dysphagia (difficulty swallowing)
Common symptoms of stomach cancers (lower GI tract cancers)?
- haematemesis (vomiting of blood)
- melaena (bleeding in stool- altered blood)
Common symptoms of lung cancers?
- haemoptysis (coughing of blood)
- dyspnoea (difficulty breathing)
- unresolved cough
- pleural effusion
Common symptoms of colorectal cancers?
- Bleeding per rectum (fresh blood in stool)
Common symptoms of kidney/urinary cancers?
- haematuria (bleeding in urine)
Common symptoms of liver tumours?
- jaundice (ALSO pancreatic and biliary tumours)
- ascites (collection of fluid in the abdominal cavity)
Common symptoms of uterine cancers?
- menorrhagia (heavy periods)
Common symptoms of multiple myeloma?
- renal failure
Common symptoms of brain tumours?
- hemiplegia (paralysis of one half of the body)
Common symptoms of pituitary tumours?
- hemianopia (blindness in half the eye)
Common symptoms of laryngeal tumours?
- hoarseness in voice
What is a basic approach to tracking symptoms? (use lung cancer as an example)
- organ of origin- eg. dyspnoea and haemoptysis
- effects on surrounding structures- eg. pleural/pericardial effusion, superior venacaval obstruction, effects on nervous system (brachial plexus, phrenic nerve)
- spread of cancer- eg. spread to brain (sudden onset epilepsy), liver (jaundice), bone (fractures)
- reaction to the tumour- eg. paraneoplastic syndromes (endocrine, neurological symptoms)
- generic effects of cancer- eg. anaemia, cachexia
Describe cancer cachexia and its causes
- severe loss of weight, including loss of fat and muscle mass
- loss of appetite
- feeling sick (nausea)
- weakness and fatigue
Postulated to be due to pro-inflammatory cytokine activity during cancer progression
What approach should we take for the history of cancer patients?
SOCRATES acronym
Site
Onset
Character
Radiation
Association
Time course
Exacerbating/relieving factors
Severity
What is particularly relevant in cancer history taking?
- past medical history
- family history
- treatment/drug history
- occupational history
How is past medical history important in cancer diagnosis? using examples
- testicular cancer is linked to undescended testes
- breast/uterine cancers are related to early menarche and late menopause
- H. Pylori infections are related to stomach cancers
- Schistosomiasis infections are related to bladder cancers
What suggests a strong family history of cancer?
- > 2 close relatives on the same side of the family with the SAME type of cancer
- young age of development (<50 years of age)
- mutation has been tested positive in a family member
What are some examples of familial cancers?
- breast/ovarian cancers due to BRCA1/2 mutations
- colorectal cancers due to mutations in APC gene or mismatch repair genes
- retinoblastoma
What drug/treatment history is relevant in cancer?
- smoking = lung, mouth, larynx. oesophagus
- alcohol = liver, breast, bowel
- HRT = endometrial, breast
- radiation = secondary cancers like leukaemia
- di-ethyl stilbestrol = breast
What to look for in a breast cancer exam?
- lump
- skin changes
- redness/rash
- pulling in of the nipple
- dimpling
