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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


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 (adults)

  • 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*

*also applies to childhood cancer plus white eye, increased swelling or persistent pain in bone

Diagnostic triads/tetrads for specific cancers

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


haematuria + frequency + dysuria

Diagnosis: urine cytology × 3, cytoscopy


lump + nipple changes (discharge, distortion)

Diagnosis: fna/biopsy, excision biopsy, imaging


seizure + cognitive impairment ± headache

Diagnosis: CT scan/MRI


post-coital bleeding, intermenstrual bleeding, vaginal discharge

Diagnosis: Pap test, biopsy


blood in stool + change in bowel habit ± abdominal discomfort

Diagnosis: colonoscopy, FOBT


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

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


persistent cough + weight loss ± haemoptysis

Diagnosis: CXR, CT scan, PET scan, bronchoscopy


dysphagia + chest discomfort + weight loss ± hiccoughs


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