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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

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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