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Calf pain is usually not serious except if swelling or severe pain 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. ‘Monkey muscle’ injury or ‘tennis leg’ is a rupture or severe strain of the medial head of gastrocnemius muscle. Treat initially with RICE every 2 waking hrs for 48 hrs. Follow up with heel raise and stretching exercises.


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*/unusual bleeding or bruising

  • 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 . In children, commonest cancers are leukaemias esp. ALL, brain, neuroblastoma, nephroblastoma (Wilms).

Diagnostic triads/tetrads for specific cancers

(In addition to probable 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: postcoital 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 ...

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