Cancer Symptomatology

CANCER SYMPTOMATOLOGY

Being the oncologists, we all know that in this field of medicine the size matters and if the tumor has been diagnosed at an early stage, then we’ve done a favor to the patient. My purpose is to concentrate on the main and the most common cancers prevailing in our society; that if a patient comes with particular symptoms we need to think about this particular cancer.

Starting with Gender Specific Cancers-

Most common cancer among female population in India is Cervix Cancer. Any woman more than 21 years of age having a complaint of post coital bleeding with or without vaginal discharge should be suspected for CA Cervix and should be sent for PAP smear as an investigation (age limit for PAP smear is 21-65 years but can vary sometimes according to doctors recommendation).

Another commonly prevailing cancer is Uterine Cancer among which Endometrial Cancer is most common. Always remember that if a post menopausal woman (12 months after menopause) comes to the physician with a complaint of bleeding; we being physicians must suspect for Endometrial cancer. If a morbidly obese patient comes then you must ask her if she has bleeding (since these females do not exhibit the general symptoms but a leading question helps the clinician because such females are more prone to Endometrial cancer than others).

Ovarian Cancer though is least common of gynaecological malignancies is most difficult to treat because its mostly diagnosed when the tumor has reached inoperable or incurable stage. Nearly 90% among these are Epithelial cancers which arise at the surface and spreads very fast. We physicians would be really very lucky if we can get torsion due to ovarian mass which can occur before the peritoneal spread. Another is Germ- cell malignancy under this category which can be picked up easily because torsion is more common in them. Whenever you are in any doubt get a CT-scan done. Though ovarian cancer can occur in younger women but mostly common in females more than 50 years & thus, it increases with the age.

Now discussing about Breast Cancer, lump formation is the most common symptom and then axillary mass; another important point to consider is Nipple discharge. I’m not discussing about nipple retraction or inverted nipple because it’s a sign rather than a symptom.

Early Prostate Cancer is difficult to detect based on symptoms as the symptoms are uncommon because prostate tissue involved in malignancy is peripheral tissue and not the central tissue. Thus, doesn’t cause any obstructive symptom. For prostate cancer, symptoms will be present in the form of metastasis to the bones; therefore, Backache is the classical presentation of it. Hence, screening of prostate cancer is important via digital rectal examination.

Testicular Malignancy is one of the most common solid tumors in young males and can be presented with enlarged scrotal lump (sometimes its confused with hydrocele). It is treatable by local medications.

Now lets move on to Cancers Of Gastro-Intestinal Tract-

Esophageal Cancer being the most common cancer among the Indian population; which is most commonly localized in the middle 3^rd part. If the patient comes with complaint of dysphagia (difficulty in swallowing) and localizes the obstruction in the middle of the chest then the cancer can be anywhere but if he or she localizes it specifically near the xiphi-sternum then the cancer is almost at the junction of esophagus and the cardiac part of the stomach.

Remember the “2 week rule” – according to it, if the patient has recent onset but 2-week long dyspepsia or epigastric pain after consumption of food, then you should recommend the patient to undergo endoscopy, suspecting it for Stomach Cancer.

Colo-Rectal Cancer being more prevalent in western culture due to low fibre diet. Bleeding pr (rectal bleeding) is a common symptom. There will be different presentation in the part above the sigmoid colon and the part below it; if the blood coming out of stool is mixed and altered in proximal colon whereas its frank red in distal colon. If there’s change in the frequency of bowel movement alongwith the symptoms mentioned above then it is a red flag for the physicians.

In stomach and esophageal cancer common presentation is with symptoms of anemia, by which the disease progress. So if the patient comes to us with bleeding in the form of melena & Hb=5-6g/dL, suspect it to be a cancer though it would be little late.

Abdominal Cancers -

Generally in case of Pancreatic Cancer, if the size of the tumor is (>3cm) its incurable but if its (<3cm) its curable. Cancer of body of pancreas can be suspected if the patient comes with epigastric pain radiating to the back. For Peri-ampullary cancer, painless jaundice can be seen.

Main risk factors for Hepato-Cellular Carcinoma (HCC) are – alcoholic cirrhosis, Hepatitis B &C cirrhosis. In case of alcoholic cirrhosis the patients can be asked to leave alcohol & nowadays Hepatitis B & C can be treated, so these patients live longer and hence, the cancer can progress within their body. Thus, frequent screening is required in HCC patients.

Oropharyngeal Cancer-

It’s the most common cancer among male population in India due to tobacco use. Sub-mucous fibrosis and painless trismus (lock jaw without pain) are peculiar signs of this cancer. Also painless ulcer >2 weeks of duration may indicate cancer. Since, lingual nerve passes over there, Otalgia (ear pain >2 weeks duration) is a peculiar symptom of patient having Post 1/3^rd Tongue Cancer due to tobacco chewing.

Lung Cancer-

A chronic smoker usually knows what is meant by “smoker’s cough” (cough which occurs after 1^st cigratte and disappears in few minutes); if the patient comes and say that his smoker’s cough is different than usual, then you must suspect the cancer. In India, cough with hemoptysis can occur due to sinusitis and tuberculosis.  There is 2% chance of malignancy if the smoker has hemoptysis but still should not be ignored.

Brain Tumors-

A constant 24x7 headache for >2 weeks, which is associated with vomiting, high function and focal neurological deficit (the person forgets very easily) should be suspected for cancer of the brain.

Lymphomas-

If the patient comes to you with unexplained pruritus, look for lymph nodes (to check for lymphadenopathy); it may be associated with constitutional symptoms like fever & weight loss. Basic feature of Hogkin’s Lymphoma is pain in lymph nodes after consuming alcohol.

Renal-Cell Carcinoma-

It’s the most common adult malignancy which can be noticed by – macroscopic hematuria, flank mass and flank pain; it’s treatable.

Hence, only treating the patient with malignancy is not enough, rather diagnosing the malignancy at an early stage provides a gift to the concerned patient.