Presenting features of cancer
In the early stages of cancer development, the number of malignant cells is small and the patient is usually asymptomatic. With tumour progression, localised signs or symptoms develop due to mass effects and/or invasion of local tissues (Table 10.1). With further progression, symptoms may occur at distant sites as a result of metastatic disease or from non-metastatic manifestations due to the production of biologically active hormones by the tumour, or as the result of an immune response to antigens present on the tumour cells. Common presenting features are discussed below, with a suggested approach to examination of a patient suspected of having cancer.
General features on examination
Unintentional weight loss is a characteristic feature of advanced cancer, but can be due to other causes such as thyrotoxicosis, chronic inflammatory disease and chronic infective disorders. Fever can occur in any cancer secondary to infection, but may be a primary feature in Hodgkin’s disease, lymphoma, leukaemia, renal cancer and liver cancer. The presence of unexplained weight loss or fever warrants investigation to exclude the presence of an occult malignancy. Weight gain is seen in patients with ascites or Cushing’s syndrome (see Chapter 11). Patients with significant blood loss may demonstrate pallor due to anaemia, possibly from a primary site in the gastrointestinal or female genital tract.
Finger clubbing is a feature of many cancers, especially non-small cell lung cancer, although benign causes are recognised. Finger clubbing can be a feature of hypertrophic osteoarthropathy (HOA) in which there is periosteal new bone formation at the wrist and ankle (particularly seen in squamous cell lung cancer; see Chapter 30).
Local effects
A palpable mass or lump
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