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Cancers of the tongue and mouth begin with a small hard lump, and sometimes with a little sore; both of which are attended with pricking pains, and they spread in the same manner with cancerous sores in other parts. It is so great an evil, that the slightest suspicion of it occasions very great uneasiness.
WILLIAM HEBERDEN (1710–1801)
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The terms malignancy, cancer and neoplasia are usually used interchangeably. The differences between a malignant tumour and a benign tumour are summarised in TABLE 26.1.
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Malignant disease accounts for 1 in 8 deaths of people under 35 years in Australia and 3 in every 10 (29%) of deaths in those over 45 years.1 Cancer is the only major cause of death in Australia that is increasing in both sexes. At current rates about 1 in 3 males and 1 in 4 females will develop a cancer, excluding non-melanoma skin cancers, by the age of 75.1
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The six most common causes of death from cancer in Australia and the US are cancer of the lung, bowel, breast, prostate, lymphoma and pancreas.
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Neoplasia, especially malignancy of the silent areas, can present as undifferentiated illness and be a real masquerade. The so-called ‘silent’ malignancies that pose a special problem include cancer of the ovary, pancreas, kidney, caecum and ascending colon, liver (hepatoma), melanoma and haematological tissue.
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This chapter focuses on the general features of several of these malignancies in order to promote early diagnosis and urgent referral at the primary care level. Specific common cancers are discussed in other chapters.
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Acute emergency problems that can develop with various malignancies include spinal cord compression, malignant effusions, disseminated intravascular coagulation and hypercalcaemia.
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Although uncommon in children under 15 years, cancer is the second most common cause of death in this age group. The most common cancers (in order) are leukaemias, especially acute lymphocytic leukaemia (34%); brain tumours, especially astrocytoma (20%); lymphomas, especially non-Hodgkin (13%); neuroblastoma; Wilms tumour; soft tissue tumours, especially rhabdomyosarcoma; and bone tumours.
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Survival has improved dramatically in recent decades, indicating the value of early diagnosis and referral for expert treatment.
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Studies have highlighted the importance of GPs responding to concerns of parents even if they could find no abnormality after examination. Parents of children eventually diagnosed with cancer and who were in dispute with their GP were alerted by signs and symptoms which were often vague, non-specific and common, or unusual or ‘scary’. They felt that ...