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Calf pain


Calf pain is usually not serious except if swelling is present.

++ Common causes

Cramp, muscle stiffness, muscle injury, e.g. gastrocnemius tear, claudication (PVD)

++ Not to be missed

Deep venous thrombosis, thrombophlebitis

++ Others

Ruptured Baker cyst, referred pain (back, knee), Achilles tendon rupture




Cancer (malignancy) accounts for 1 in 8 deaths of people <35 yrs and 1 in every 4 of those >45 yrs. The six most common causes of death from cancer in Australia and the USA are cancer of the lung, bowel, breast, prostate, lymphoma and pancreas. Neoplasia, esp. malignancy of the silent areas (ovary, kidney, caecum and ascending colon, liver and haematological tissue) can present as undifferentiated illness and be a real ‘masquerade’. The clinical manifestations of malignancy are due to:


  • pressure effect of the growth (e.g. abdominal pain)

  • infiltration or metastases in various organs

  • systemic symptoms

    • tiredness, malaise, weakness

    • anorexia and nausea

    • weight loss

  • paraneoplastic effects, e.g.

    • hypercalcaemia (causes thirst)

    • hyponatraemia (causes drowsiness)

    • fever and sweats

    • ectopic hormone production

    • haematological disorders (e.g. coagulopathy)

    • neuropathies


Red flag pointers for cancer

  • constitutional (systemic) symptoms: tiredness, malaise, weakness, anorexia, nausea

  • fever, night sweats

  • unexplained weight loss

  • age >50

  • past history of malignancy

  • unresolved pain

  • unusual lumps or swellings

  • family history, e.g. breast, ovary, stomach

  • unresponsive to treatment


Diagnostic triads/tetrads for specific cancers


(In addition to constitutional symptoms, e.g. malaise, tiredness)

++ Bladder

haematuria + frequency + dysuria


Diagnosis: urine cytology × 3, cytoscopy

++ Breast

lump + nipple changes (discharge, distortion)


Diagnosis: fna/biopsy, excision biopsy, imaging

++ Cerebral

seizure + cognitive impairment ± headache


Diagnosis: CT scan/MRI

++ Cervix

post-coital bleeding, intermenstrual bleeding, vaginal discharge


Diagnosis: Pap test, biopsy

++ Colorectal

blood in stool + change in bowel habit ± abdominal discomfort


Diagnosis: colonoscopy, FOBT

++ Kidney

haematuria (60%) + loin pain (40%) ± palpable kidney mass


Diagnosis: urine cytology × 3, ultrasound or CT/MRI

++ Lung

persistent cough + weight loss ± haemoptysis


Diagnosis: CXR, CT scan, PET scan, bronchoscopy

++ Oesophagus

dysphagia + chest discomfort + weight loss ± hiccoughs


Diagnosis: barium swallow, endoscopy

++ Ovary

abdominal discomfort, distension or bloating ± bowel changes ± menstrual dysfunction


Diagnosis: pelvic ultrasound, serum CA-125

++ Pancreas

abdominal ...

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