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Calf pain

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

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

++ Not to be missed
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Deep venous thrombosis, thrombophlebitis

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

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Cancer

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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:

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  • 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

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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

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Diagnostic triads/tetrads for specific cancers

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

++ Bladder
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haematuria + frequency + dysuria

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Diagnosis: urine cytology × 3, cytoscopy

++ Breast
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lump + nipple changes (discharge, distortion)

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Diagnosis: fna/biopsy, excision biopsy, imaging

++ Cerebral
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seizure + cognitive impairment ± headache

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Diagnosis: CT scan/MRI

++ Cervix
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post-coital bleeding, intermenstrual bleeding, vaginal discharge

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Diagnosis: Pap test, biopsy

++ Colorectal
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blood in stool + change in bowel habit ± abdominal discomfort

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Diagnosis: colonoscopy, FOBT

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

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

++ Lung
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persistent cough + weight loss ± haemoptysis

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Diagnosis: CXR, CT scan, PET scan, bronchoscopy

++ Oesophagus
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dysphagia + chest discomfort + weight loss ± hiccoughs

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Diagnosis: barium swallow, endoscopy

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

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Diagnosis: pelvic ultrasound, serum CA-125

++ Pancreas
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abdominal ...

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