CLINICAL CANCER DIAGNOSIS

 
 CLINICAL CANCER DIAGNOSIS
 
Cancer diagnosis as mentioned before cancer diagnosis can be done by laboratory and clinical features or pictures of the cancers now
 
what are the clinical features of malignancy
It can be divided into three groups as

 Local features of the tumours
 Distant clinical features
 Systemic or general clinical features

Local features of the neoplasm or tumours

Including either mass, pain ,changes in organ function obstruction in a hollow viscus ,bleeding or infarction
 
Mass

• May be palpable

• May be a primary tumour or secondary lymphadenopathy

• May be painful or more commonly, painless (eg breast lump, testicular lump

• May cause a mass effect

 Compression of surrounding structures o Raised ICP in intracranial lesions

Pain

This may be a feature of

• Local compression

• Capsular stretch (eg hepatic, renal

• Infiltration of regional nerves by the tumour

• Obstruction of a hollow lumen

• Metastasis eg bone pain

Changes in organ function

• eg liver metastasis presenting with jaundice

Obstruction in a hollow viscus

• Arising intraluminally (eg embolism of tumour invading large vessel

• Arising from the vessel wall (eg annular circumferential rectal tumour

• Arising extraluminally (eg peritoneal deposits obstructing ureters

Bleeding

May be effect of local tumour ulceration eg rectal carcinoma
May be result of erosion into large vessel eg gastric cancer
Acute bleed into tumour mass may provoke pain eg hepatoma
Infarction torsion and infarction of ovarian masses

GENERAL CLINICAL FEATURES OF NEOPLASMS

General features of neoplasms include

Anaemia

Metabolic effects

Exudates

Paraneoplastic syndromes

Cancer cachexia

Ectopic hormone secretion

Distant clinical features of the tumours

Anaemia

• Occult or overt bleeding

Poor nutritional state

• Low erythropoietin production

Metabolic effects

Weight loss
Anorexia
Pyrexia
Altered sensation eg taste

Specific effects of metastasis

.Exudates eg ascites pleural effusion

Bone metastasis and pathological fractures

Discussions of paraneoplastic syndrome

Paraneoplastic syndromes refer to non-metastatic systemic symptom complexes accompany malignant disease. Symptoms may affect any system of the body and occur

remotely from the site of the primary tumour of secondary deposits. They may be due to

the release of cytokines or autoimmunity generated by cross-reactivity against antibodies
produced against the tumour

Types of paraneoplastic syndrome

Approximately 10% of patients with advanced malignancies have paraneoplastic syndromes. These syndromes are divided into the following categories: miscellaneous(non-specific), rheumatological, renal, gastrointestinal, haematological, cutaneous endocrine, and neuromuscular.

Paraneoplastic syndromes

Rheumatological

Arthropathies, Scleroderma

SLE

. Amyloidosis

Renal

Tumours that can produce ACTH, antidiuretic hormone (ADH), and gut hormones. may cause hypokalaemia, hyponatraemia or hypernatraemia, hyperphosphoramia and alkalosis/acidosis

Nephrotic syndrome

Gastrointestinal

Malabsorption (especially with tumours that produce prostaglandins eg medullary thyroid
Diarrhoea

Haematological Anaemia Thrombocytosis

Disseminated intravascular coagulation (DIC) Migrating vascular thrombosis (Trousseau syndrom
Cutaneous
Itching  Herpes zoster Alopecia Hypertrichosis   Acanthosis migricans (blackish pigmentation of the skin occurring in patients with
metastatic melanomas or pancreatic tumours
Endocrine Cushing syndrome (excessive ACTH or ACTH-like peptides

- Hypercalcaemia (osteolysis or calcaemic humoral substances

Neuromuscular

.Neuromyopathic syndromes such as myasthenia gravis

;management of paraneoplastic syndromes
 respond to resection of the primary tumour. In some cases, where there are clearly identifiable autoantibodies, immunosuppression is considered

Cancer cachexia

 Cachexia is a wasting syndrome with progressive loss of body fat and severe weakness. is unclear but it may be related to the secretion of cytokines by the tumour or response to the tumour. It does not occur in proportion to tumour size (eg can occur dramatically in small oesophageal tumours
Ectopic hormone secretion and neoplasia

 Many tumors that arise from endocrine tissue continue to secrete functional hormones. some tumors that have no basis in endocrine tissue also secrete peptide molecules that are very similar in structure to active hormones or hormone fragments and these molecules acts as analogues
 mostly commonly these peptides mimic the CRF-ACTH axis and result in Cushing syndrome
sometimes ADH may be released and the syndrome of inappropriate ADH is produced

tags:cancer,diagnosis,clinical