User:Massmedicine/Cancer signs and symptoms

Signs and Symptoms

Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body,

In medicine, a sign is an objective piece of data that can be measured or observed, as in a high body temperature (fever), a rash, or a bruise. A symptom, by contrast, is the subjective experience that may signify a disease, illness or injury, such as pain, dizziness, or fatigue. Signs and symptoms are not mutually exclusive, for example a subjective feeling of fever can be noted as sign by using a thermometer that registers a high reading.

Cancer can be difficult to diagnose because its signs and symptoms are often nonspecific, meaning they may be general phenomena that do not point directly to a specific disease process.

Because many symptoms of cancer are gradual in onset and general in nature, cancer screening (also called cancer surveillance) is a key public health priority. This may include laboratory work, physical examinations, tissue samples, or diagnostic imaging tests that a community of experts recommends be conducted at set intervals for particular populations. Screenings can identify cancers before symptoms develop, or early in the disease course.

Additionally, patient education about worrisome symptoms that require further evaluation is paramount to reduce morbidity and mortality from cancer.

Cancer Signs and Symptoms

The following symptoms may be manifestations of an underlying cancer:

• A persistent cough or hoarseness: These may be a symptom of lung cancer
• A change in bowel habits, such as unusual diarrhea or constipation: This may be a symptom of gastrointestinal or genitourinary cancers, including colon, prostate, or bladder cancer
• Difficulty passing urine: This too may be a symptom of genitourinary cancers, as in bladder or kidney cancer, or gastrointestinal cancers
• Difficulty in swallowing or continuing indigestion: This may be a sign of esophageal (throat) or gastrointestinal cancers
• Any abnormal bleeding, including bleeding from the vagina, or blood in urine or faeces: These may point to cancers of the gastrointestinal or genitourinary systems. Menstrual irregularities or pelvic pain that deviate from their general pattern may be symptoms of an underlying uterine, ovarian, or vaginal cancer. Postmenopausal vaginal bleeding is always abnormal and should be evaluated for possible cancer.
• A persistent sore or ulcer: These may be signs of skin cancer, oral cancers, or other cancers of the tissues where they develop. They are increasingly concerning in people who use tobacco or alcohol.
• Unexplained weight loss: Weight loss that is unintended and not explained by diet, exercise or other illness may be a warning sign of many types of cancer
• Unexplained pain: Pain that persists, has no clear cause, and does not respond to treatment may be a warning sign of many types of cancers.
• Unexplained tiredness or fatigue: Unusual and persistent tiredness may point to underlying illness, including blood cell cancers like leukemia or lymphoma
• Abdominal pain, bloating, or nausea: Stomach pain or nausea that does not resolve may be a sign of cancers of the digestive system, including stomach, pancreatic, or liver cancer. Significant bloating or the feeling of fullness (satiety) may be symptoms of ovarian or uterine cancers.
• Chronic headaches or new-onset seizures: Headaches that last for more than two weeks, or a first presentation of seizure should warrant evaluation for possible brain tumor.
• Skin changes such as an unexplained rash or unusual texture
• Unexplained night sweats or fever: These may be signs of an immune system cancer.
• Changes in a mole on the skin, such as size, color or shape thickness: This may be a sign of skin cancers, including melanoma, basal cell carcinoma, or squamous cell carcinoma
• Excessive bruising: Bruises out of proportion to direct injury or appearing often in unusual places may be a sign of blood cell cancers.
• The presence of unusual lump in the body: Lymph nodes may be swollen in the setting of infection but those that do not resolve may be a sign of underlying blood cell cancers. Soft tissue cancers may also present as unusual and persistent lumps under the skin. New and unusual lumps in breast tissue (below) may be a sign of breast cancer.
  • Breast changes: New lumps, changes in skin texture, dimpling or inversion of nipples may be a sign of breast cancer, especially but not exclusively in women.

The above symptoms may point to non-cancerous disease processes, benign tumors, or even be within the physiological range of normal. They may appear at the primary site of cancer or be symptoms of cancer metastasis, or spread. Further workup by a trained healthcare professional is required to diagnose cancer.

Cancer Signs: Medical Workup

A health professional may pursue a formal diagnostic workup to evaluate symptoms of cancer. The tests ordered will depend upon the type of cancer suspected. These may include the following:

• Basic Metabolic Panel
• Barium enema
• Biopsy
• Bone scan
• Bone marrow aspiration and biopsy
• Breast MRI
• Colonoscopy, Sigmoidoscopy, and/or Endoscopy
• Complete Blood Count and/or Peripheral Blood Smear
• Computed Tomography (CT) Scan
• Digital Rectal Exam
• Electrocardiogram (EKG) and Echocardiogram
• Fecal Occult Blood Tests
• Magnetic Resonance Imaging (MRI)
• Mammogram
• MUGA Scan
• Pap Test
• Positron Emission Tomography (PET) Scan
• Tumor Marker Tests
• Ultrasound

Treatment-Related and Secondary Symptoms

Cancers treatments may include surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy (including immunotherapy such as monoclonal antibody therapy) and synthetic lethality, most commonly as a series of separate treatments (e.g. chemotherapy before surgery). Certain cancers can be prevented with vaccines against the viruses that cause them (e.g., HPV vaccines as prevention against cervical cancer).

Some of these cancer therapies may produce treatment-related, or secondary, symptoms, including:

• Pain
  • Cancer pain may be caused by the tumor itself compressing nearby structures, impinging on nerves, or causing an inflammatory response. It may also be caused by therapies such as radiation or chemotherapy. With competent management, cancer pain can be eliminated or well controlled in 80% to 90% of cases, but nearly 50% of cancer patients in the developed world receive less than optimal care. Worldwide, nearly 80% of people with cancer receive little or no pain medication. Cancer pain in children and in people with intellectual disabilities is also reported as being under-treated.

• Infection
• Deep Vein Thrombosis
• Pulmonary Embolism
• Tumor Lysis Syndrome
• Muscle Aches

Symptoms that require immediate treatment include

• Fever that is 100.4° F (38° C) or higher
• Shaking chills
• Chest pain or shortness of breath
• Confusion
• Severe headache with a stiff neck
• Bloody urine

Signs of oncologic emergencies may include:

Hypercalcemia[***]

Elevated calcium levels in the blood may be due to tumor cells overproducing PTHrP, a hormone that stimulate calcium release. Small Cell lung cancer, breast cancer, renal cancer, and endometrial cancer have been linked to excess PTHrP stimulation.

Cancers may also stimulate the release of cancer from bone. Metastases from multiple myeloma, lung, or breast cancer have been associated with hypercalcemia due to local osteomyelysis.

Some cancer, including lymphoma, may stimulate Vitamin D analogues that encourage calcium release from cells.

Finally, mass cell death due to an underlying cancer (called Tumor Lysis Syndrome) may cause cells to release their contents, producing elevated levels of calcium, as well as potassium and other electrolytes, that may be life-threatening.

Symptoms of hypercalcemia may include the production of calcium stones in the kidneys or urinary tract, bone pain and destruction, abdominal pain and/or vomiting, dehydration, excessive urination, constipation, and/or psychiatric symptoms such as altered mood, lethargy, confusion, or hallucinations.

Work Plan

• The Lead

-- Add and link to pages describing a medical sign v symptom

-- Add notes on the importance of cancer screening given asymptomatic and nonspecific symptoms

• Cancer Symptoms

-- Describe general symptoms which may be nonspecific signs of cancer - consider by organ system/anatomic region

-- Create subheadings for cancer types that links to those pages' sections on symptoms

-- Research to find reliable sources on the most predictive symptoms for each cancer type

• Cancer Signs

-- Add information on the key diagnostic workup of cancer, including but not limited to the role of Lab studies (eg, blood counts to look for anemia, lab studies to look for high calcium), Imaging, and possibly Histology and Genetics (if this seems appropriate to the scope of the article?)

• Treatment-Related and Secondary Symptoms

-- Consider adding a section to address cancer pain, chemo-induced nausea, hair loss, risk of infection, psychiatric symptoms, etc

-- Look at cancer wiki pages for headings and content across the site

-- Palliative Care section/link

• Consider Alternative Medicines section?
• Consider Oncologic Emergencies section?

• Edit the overall organization and links to appropriate related pages on cancer

Article Draft

References

https://journals.sagepub.com/doi/full/10.2217/WHE.12.42 Meta Analysis. On limited awareness as a major factor in late presentation.

https://journals.sagepub.com/doi/abs/10.2190/PM.40.2.c Psychological symptoms among survivors.

Treatment-Related Symptoms

https://www.taylorfrancis.com/books/edit/10.3109/9781420052909/cancer-supportive-care-gary-lyman-jeffrey-crawford Book on management of cancer-related symptoms. Find also via library at https://search.library.ucsf.edu/permalink/01UCS_SAF/88i771/alma9914819192306531

https://www.sciencedirect.com/book/9781437710151/supportive-oncology or https://search.library.ucsf.edu/permalink/01UCS_SAF/18g6u8o/cdi_askewsholts_vlebooks_9781437735949

Cancer-related fatigue: https://search.library.ucsf.edu/permalink/01UCS_SAF/18g6u8o/cdi_askewsholts_vlebooks_9781907673764

ACS Principles: https://search.library.ucsf.edu/permalink/01UCS_SAF/18g6u8o/cdi_askewsholts_vlebooks_9781119468882