Symptoms and signs in oncology

2. ONCOLOGY
• Branch of medicine dealing with tumors, including the origin,
development, diagnosis & treatment of malignant neoplasms.
• Oldest treatment - surgery
• Non surgical treatment - Radiotherapy & drug treatments
• 2nd most common cause of death after cardiovascular diseases

3. SYMPTOMSITE
Hemorrhage
Lump
Pain
Skin abnormality
Stomach, Colon, Bronchus, Endometrium,
Bladder, Kidney
Breast, Lymph node, Testicle
Bone
Melanoma, Rodent ulcer (BCC)
LOCAL FEATURES OF MALIGNANCY

4. Ulcer, Obstruction
Pain, Cough, Recurrent infection
Odynophagia, Dysphagia, Vomiting,
Early satiety
Altered bowel habit, Pain, Distension
Abdominal swelling (Ascites)
Fracture
Oesophagus, Stomach, Skin
Bronchus
Gastro-oesophageal
Colon, rectum
Ovary, Gastric cancer
Metastatic cancer (Breast, Prostate,
Kidney, Bronchus, Thyroid

5. Feature Common associations
NON- METASTATIC MANIFESTATIONS
Weight loss & anorexia
Hyperkalemia
Prothrombotic tendency
Acanthosis nigricans
Dermatomyositis
GI tumors
Myeloma, breast, renal tumors
Pancreas & other GI tumors
Gastero-oesophageal tumor
Gastric, lung tumor

6. Hormonal effects
Syndrome of inappropriate ADH
secretion (SIADH)
Ectopic ACTH
Neuropathies & myopathies
Eaton Lambert Myasthenia like
syndrome
Sub acute cerebellar degeneration
Small-cell lung cancer
Small-cell lung cancer

7. BREAST CANCER
SYMPTOMS
• Lump in breast.
• Bloody discharge from nipple.
• Changes in shape or texture of the nipple or breast, peau d’orange
• .
• Skin : Ulcers or redness
• Also common : Cancer related fatigue, swollen lymph nodes or weight
loss

9. SYMPTOMS
• COUGH (most common early symptom) - mostly dry but
sputum may be purulent if secondary infection occurs.
A change in the character of the ‘regular’ cough of smoker associated with
other new respiratory symptoms.
• HEMOPTYSIS especially tumor arising in central bronchi.
Central tumor invade large vessels, cause massive hemoptysis (fatal).
Repeated episodes of scanty hemoptysis or blood streaking sputum in
smokers.
LUNG CANCER

10. • BRONCHIAL OBSTRUCTION can lead to pneumonia. Reccurrant
pneumonia at same site or slow response to treatment in smoker.
Lung abscess may develop.
Signs of displacement of mediastinum or elevation of diaphragm if major
portion of lung collapsed.
• BREATHLESSNESS - occlusion of large bronchus resulting collapse of a
lobe or lung or a large pleural effusion.
• STRIDOR (harsh inspiratory noise) - lower trachea, carina or main
bronchi are narrowed by primary tumor or by compression from malignant
enlargement of the sub cranial & paratracheal lymph nodes

11. • PLEURAL PAIN - Malignant invasion of pleura or distal infection.
Intercostal nerve involvement - pain in chest along nerve root distribution.
• Bronchial Ca in apex of lung cause
1. Horner’s syndrome - ipsilateral partial ptosis, enophthalmos, a small pupil
& hypohidrosis of face.
2. Pancoast’s syndrome - pain in shoulder and inner aspect of arm.
• Mediastinal spread result in DYSPHAGIA.
• BLOOD BORNE METASTASES- focal neurological defects, epileptic
seizures, personality changes, jaundice bone pain, skin nodule, anorexia,
weight loss.

13. NON METASTATIC EXTRA PULMONARY MANIFESTATIONS
• Endocrine - inappropriate ADH secretion, ectopic ACTH secretion, hyper
calcemia due to PTH related peptides, gynecomastia.
• Neurological - polyneuropathy, myelopathy, cerebellar degeneration,
myasthenia
• Other - clubbing, hypertrophic pulmonary osteoarthropathy, nephrotic
syndrome, polymyositis, dermatomyositis, eosinophilia

14. PHYSICAL SIGNS
• Examination is normal unless significant broncheal obstruction or spread to pleura
mediastinum or supraclavicular lymph nodes.
• A monophonic /unilateral wheeze fail to clear with coughing - fixed bronchial
obstruction.
• Stridor- obstruction at or above main carina.
• Hoarse voice- ineffectualor bovine cough, due to left recurrent laryngeal nerve palsy.
• Dullness of percussion & absence of breath sound at lung base- phrenic nerve
paralysis.
• Involvement of pleura- pleural rub / signs of pleural effusion.
• Superior vena cava syndrome- bilateral engorgement of juglar vein & edema of
face, neck arm & conjuctiva.

15. CARCINOMA OF OESOPHAGUS
• h/o progressive painless dysphagia for solid food.
• Late stage - wt loss, chest pain or hoarsness (due to mediastinal invasion)
• Coughing after swallowing - fistula b/w esophagus and trachea.
• Pneumonia and pleural effusion.
• Physical Signs : Cachexia , cervical lymphadenopathy.

16. GASTRIC CARCINOMA
SYMPTOMS AND SIGNS
• Early- asymptomatic but detected during endoscopy or investigation of
dyspepsia.
• Weight loss (2/3 rd of patients with advanced cancer)
• Ulcer like pain.
• Anorexia & nausea.

17. • Early satiety, hematemesis, melaena & dyspepsia alone are less
common.
• Dyspepsia - occur in tumor of gastric cardia which obstruct gastro-
oesophageal junction.
• Anemia - Occult bleeding.

18. Examination
• Signs of weight loss, anemia or palpable epigastric mass.
• Jaundice, ascites - metastasis
• Tumor spread to supraclavicular lymph nodes (Troisier’s sign),
umbilicus (sister joseph’s nodule), ovaries(krukenberg tumor)
• Metastasis most - liver, lungs, peritoneum, bone marrow

19. LARGE BOWEL
COLORECTAL CARCINOMA (98%)
Clinical symptoms
▪ Occult bleeding (melaena).
▪ Changes in bowel habits, more often left sided growth.
▪ Weight loss - weight loss due to alteration in metabolism (cancer cachexia syndrome)
▪ Loss of appetite (anorexia)
▪ Anemia, weakness, malaise
▪ Anxiety and depression
▪ Delirium and terminal agitation

20. RADIOGRAHIC FEATURES
• Barium enema- typically lesions appear as exophytic or sessile masses or
maybe circumferential (apple core sign)
• CT- most colorectal ca are soft tissue density that narrow the lumen. Ulceration
in large masses is also seen
• MRI- staging of rectal cancer
COMPLICATIONS
• Fistula, obstruction, intussusception, perforation

21. TUMORS OF LIVER
HEPATOCELLULAR CARCINOMA
SYMPTOMS
• Patients with cirrhosis - ascites, jaundice, variceal hemorrhages
• Weight loss, anorexia, abdominal pain
• Signs: hepatomegaly, right hypochondrial mass
• Tumor vascularity- abdominal bruit
• Hepatic rupture with intra abdominal bleeding

22. TUMORS OF PANCREAS
• Pain, weight loss, obstructive jaundice.
• Pain due to invasion of celiac plexus incessant and boring.
• Radiate from upper abdomen through to the back and may be eased a little by
bending backwards.
• 60% head of pancreas
• Few - diarrhoea, vomiting from duodenal obstruction, DM, recurrent venous
thrombosis, acute pancreatitis or depression.

23. SIGNS
Evidence of weight loss, palpable gall bladder in jaundice due to distal biliary
obstruction (Courvoisier sign)

24. PROSTATE CANCER
SYMPTOMS AND SIGNS
• Lower urinary tract symptoms indistiguishable from BPH.
(Benign prostatic hypertrophy)
• URINARY- difficulty starting and maintaining steady stream urine, dribbling of
urine, excessive urination at night, frequent urination, urge to urinate and
leaking, urinary retention or weak stream urine.
METASTASIS
Back pain, weight loss, anemia and obstruction of ureters
On Rectal examination prostate often feel nodular or stony hard, medial sulcus
may be lost

25. BLADDER CARCINOMA
• Hematuria(80%)- visible and painless
It should be assumed that such bleeding is from
tumor until proved otherwise.
• Frequent urination
Obstructive symptoms
Tumor at the lower end of ureter or bladder tumor involving the ureteric orifice
Examination usually unhelpful
Rectal examination detect very advanced tumor

26. NASOPHARYNGEAL CARCINOMA
SYMPTOMS
• Lump in the neck - swollen lymph node
• Blood in saliva
• Bloody discharge from nose
• Nasal congestion
• Sore throat
• Head ache
• Frequent ear infections
• Hearing loss

27. LARYNGEAL AND HYPOPHARYNGEAL CARCINOMA
SYMPTOMS
• Hoarseness of voice - cancer in glottis or vocal cord
• Sore throat
• Constant coughing
• Pain during swallowing
• Ear pain
• Trouble breathing
• Weight loss
• Lump or mass in neck

28. SALIVARY GLAND TUMORS
SYMPTOMS
• Lump or swelling on or near jaw or neck or mouth
• Numbness in part of face
• Muscle weakness on oneside of face
• Persistent pain in the area of gland
• Difficulty swallowing
• Trouble opening mouth widely

29. MELANOMA
• Flat or slightly elevated naevus with variegated pigmentation,
irregular border later secondary changes- ulceration bleeding
and increase size
Features
• Asymmetry
• Border irregular
• Colour irregular
• Diameter 0.6mm
• Elevation irregular
• (+ loss of skin markings)

30. TUMORS OF KIDNEY
RENAL ADENOCARCINOMA
• Hematuria (60%)
• Loin pain (40%), mass (25%)
• Triad of hematuria, pain and mass is late feature
• Systemic effects- fever, raised ESR, polycythemia, disorders of coagulation,
altered LFT
• Pyrexia (unknown origin), neuropathy
• Effect disappear when tumor removed but reappear when metastases develop

31. OVARIAN CANCER
SIGNS AND SYMPTOMS
• Pain areas- in abdomen orpelvis
• Gastrointestinal- bloating, change in bowel habits, indigestion or nausea
• Abdominal- abdominal fullness, fluid in abdomen, or lump in abdomen
• Whole body- cancer related fatigue, loss of wt or appetite

32. NON HODGKIN’S LYMPHOMA
Comprise a large group of heterogenous of neoplasm of lymphoid tissue and
blood
SYMPTOMS
• Swollen lymph node, fever, stomach ache, night sweats, weight loss, chest
pain and loss of appetite, hepatomegaly, splenomegaly
• Pain areas- in abdomen or chest
• Anemia, fatigue
• CNS infiltration, infections (due to cytopenia)

33. LEUKEMIA
ACUTE MYELOID LEUKEMIA
1. Due to bonemarrow failure
• Anemia- pallor, lethargy
• Bleeding disorders due to thrombocytopenia_ petechiae, bleeding gums
• Infections- mouth, throat, skin
• Fever
2. Due to organ failure
• Pain and tendreness of bone
• Lymphadenopathy (tonsil)

34. • Splenomegaly, subcapsular hemorrhage, splenic rupture
• Leukemic infraction of kidney
• Gum hypertrophy due to leukemic infraction of kidney
• Meningial involvement- raised intracranial pressure, head ache nausea,
vomiting, blurring of vision, diplopia
• Testicular swelling , mediastinal compression

35. CML
• Features of anemia - pallor, weakeness, dyspnoea, tachycardia
• Symptoms of hyper metabolism- wt loss, anorexia, night sweats
• Splenomegaly
• Bleeding tendencies - bruising, epistaxix, menorrhagia
• Gout, visual disturbances, neurologic manifestations
• Juvenile CML- LN enlargement

36. CHRONIC LYMPHOCYTIC LEUKEMIA
• Features of anemia- weakeness ,fatigue, dyspnoea
• Enlargement of superficial LN (symmetrical enlargement)
• Hepatomegaly, splenomegaly
• Hemorrhagic manifestations
• Respiratory tract infections
• Mediastinal pressure, tonsillar enlargement, disturbed vision, bone and joint pain

37. INTRACRANIAL NEOPLASAM
SYMPTOMS AND SIGNS
• Head ache- due to raised intracranial pressure, site of tumor and head ache
are not seme. Posterior fossa tumor pain in occiput or neck.
• The focal deficits- slow onset and progressive. In brain stem structural
defect result in neurological symptom. In frontal lobe tumor large when
symptom occur.
• Seizures- due to infiltration of tumor cells. Generalised or partial in nature.

38. MULTIPLE MYELOMA
Malignant proliferation of plasma calls
Symptoms
• Hyperviscocity- retinal bleeds, bruising, heart failure, cerebral ischemia
• Spinal cord compression- bony collapse, extra dural mass
• Anemia (normocytic normochromicor macrocytic) , pancytopenia, raised ESR,
hypercalcemia
• Bone- pain /fracture, lytic lesions
• Renal- renal failurenephrotic syndrome, hypercalcemia, infection, dehydration
• Paraprotenemia IgG/A/D/E(k&lambda)
• Amyloid- panda eyes, NS, carpel tunnel syndrome

39. BONE TUMORS
OSTEOSARCOMA
• Pain, tenderness, swelling of affected extremity
• Serum alkaline phosphatase raised but calcium normal
• Metastases- lung other bone & brain