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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
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 (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*
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DIAGNOSTIC TRIADS/TETRADS FOR SPECIFIC CANCERS
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(In addition to probable constitutional symptoms, e.g. malaise, tiredness)
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Bladder: haematuria + frequency + dysuria Diagnosis: urine cytology × 3, cytoscopy
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Breast: lump + nipple changes (discharge, distortion)
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Diagnosis: fna/biopsy, excision biopsy, imaging
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Cerebral: seizure + cognitive impairment ± headache
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Cervix: postcoital bleeding + intermenstrual bleeding + vaginal discharge
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Diagnosis: Pap test, biopsy
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Colorectal: blood in stool + change in bowel habit ± abdominal discomfort
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Diagnosis: colonoscopy, FOBT
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Kidney: haematuria (60%) + loin pain (40%) ± palpable kidney mass
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Diagnosis: urine cytology × 3, ultrasound or CT/MRI
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Lung: persistent cough + weight loss ± haemoptysis
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Diagnosis: CXR, CT scan, PET scan, bronchoscopy
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Oesophagus: dysphagia + chest discomfort + weight loss ± hiccoughs
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Diagnosis: barium swallow, endoscopy
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Ovary: abdominal discomfort, distension or bloating ± bowel changes ± menstrual dysfunction
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Diagnosis: pelvic ultrasound, serum CA-125
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Pancreas: abdominal discomfort (75%) + jaundice + epigastric/back pain (esp. body of P). If head of P may → painless jaundice + enlarged gall bladder.
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Diagnosis: CT or MRI (MRCP), CA 19-9
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Prostate: BOO (70%) + back pain (15%) + haematuria (5%)
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Diagnosis: DRE, core biopsy (transrectal US), PSA
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Stomach: anorexia + dyspepsia + weight ...