Oncology Symptoms: Signs

Oncology Symptoms: Signs

I. General and Constitutional Symptoms

A. Fatigue: Persistent and Unexplained Exhaustion

1. Description: Fatigue is a pervasive feeling of tiredness, weakness, and lack of energy. It is distinct from normal tiredness after physical exertion or lack of sleep. Cancer-related fatigue (CRF) is often unrelenting, not relieved by rest, and disproportionate to the activity level.

2. Underlying Mechanisms:
   a. Cancer Burden: The energy demands of tumor growth can deplete the body’s resources.
   b. Metabolic Changes: Cancer cells alter metabolic pathways, leading to inefficient energy production.
   c. Inflammation: The immune system’s response to cancer can release inflammatory cytokines, contributing to fatigue.
   d. Anemia: Reduced red blood cell count can impair oxygen delivery to tissues, causing fatigue.
   e. Treatment Side Effects: Chemotherapy, radiation, and surgery can all induce fatigue.
   f. Psychological Factors: Anxiety, depression, and stress associated with cancer can exacerbate fatigue.

3. Associated Cancers: CRF is common in various cancers, including leukemia, lymphoma, breast cancer, lung cancer, colon cancer, and prostate cancer. Its severity can vary depending on the cancer stage, treatment regimen, and individual factors.

4. Diagnostic Considerations: When evaluating fatigue, healthcare professionals should rule out other potential causes, such as anemia, thyroid disorders, infections, and mental health conditions. Blood tests, physical exams, and patient history are essential for accurate diagnosis.

B. Unexplained Weight Loss

1. Definition: Unintentional weight loss of 10 pounds or more within a short period (e.g., 6 months) without dieting or increased exercise is a significant warning sign. It indicates that the body is burning more calories than it is consuming.

2. Pathophysiology:
   a. Increased Metabolic Rate: Cancer cells have a high metabolic rate, consuming significant amounts of glucose and other nutrients.
   b. Cachexia: A complex metabolic syndrome characterized by muscle wasting, loss of appetite, and systemic inflammation.
   c. Reduced Nutrient Absorption: Cancers affecting the digestive system can impair nutrient absorption.
   d. Anorexia: Loss of appetite can result from cancer itself or its treatment.

3. Cancer Associations: Unexplained weight loss is particularly common in cancers of the gastrointestinal tract (e.g., esophageal, stomach, pancreatic, colon), lung cancer, and advanced-stage cancers.

4. Evaluation: A comprehensive evaluation is crucial to determine the cause of unexplained weight loss. This includes a thorough physical examination, blood tests, imaging studies (e.g., CT scans, PET scans), and potentially a biopsy.

C. Fever (Persistent or Recurrent)

1. Definition: A fever is an elevation in body temperature above the normal range (typically above 37.5°C or 99.5°F). Persistent or recurrent fevers, especially without a clear infection source, should raise suspicion for cancer.

2. Mechanisms:
   a. Tumor-Induced Inflammation: Some cancers can trigger the release of inflammatory cytokines, leading to fever.
   b. Immune System Activation: The immune system’s response to cancer can also cause fever.
   c. Infection: Cancer and its treatments can weaken the immune system, making patients more susceptible to infections, which can present as fever.
   d. Tumor Necrosis: The breakdown of tumor cells can release pyrogens, substances that induce fever.

3. Cancer Links: Fever is a common symptom in leukemias, lymphomas, and other hematologic malignancies. It can also occur in solid tumors, particularly those that are rapidly growing or necrotic.

4. Investigation: The workup for unexplained fever includes blood cultures, urine analysis, chest X-ray, and potentially more advanced imaging studies to identify the source of infection or underlying malignancy.

D. Night Sweats

1. Description: Night sweats are severe episodes of sweating during sleep, soaking the bedclothes and requiring a change of pajamas or bed sheets. They are distinct from occasional sweating due to a warm room or heavy blankets.

2. Underlying Factors:
   a. Hormonal Imbalances: Certain cancers can disrupt hormone production, leading to night sweats.
   b. Autonomic Nervous System Dysregulation: Cancer can affect the autonomic nervous system, which controls sweating.
   c. Cytokine Release: Inflammatory cytokines released by cancer cells or the immune system can trigger night sweats.

3. Cancer Types: Night sweats are a hallmark symptom of lymphomas, particularly Hodgkin lymphoma and non-Hodgkin lymphoma. They can also occur in leukemia and some solid tumors.

4. Diagnostic Approach: A thorough medical history, physical examination, and blood tests are essential to evaluate night sweats. Investigations may include testing for infections, hormone imbalances, and signs of malignancy.

E. Pain (Persistent or Unexplained)

1. Description: Pain is a complex sensation that can range from mild discomfort to severe agony. Persistent pain, especially if it is new, unexplained, and not relieved by over-the-counter medications, can be a sign of cancer.

2. Pain Mechanisms:
   a. Tumor Invasion: Cancer cells can invade and destroy tissues, causing pain.
   b. Nerve Compression: Tumors can compress or infiltrate nerves, leading to neuropathic pain.
   c. Bone Metastasis: Cancer that spreads to the bones can cause bone pain.
   d. Inflammation: The inflammatory response to cancer can contribute to pain.
   e. Obstruction: Tumors can obstruct organs or blood vessels, causing pain.

3. Pain in Specific Cancers:
   a. Bone Cancer: Bone pain, often described as deep and aching.
   b. Pancreatic Cancer: Abdominal pain that may radiate to the back.
   c. Lung Cancer: Chest pain, shoulder pain, or back pain.
   d. Brain Tumors: Headaches, which may be persistent or worsen over time.
   e. Colon Cancer: Abdominal pain, cramping, or bloating.

4. Pain Management: Effective pain management is crucial for cancer patients. Treatment options include pain medications (e.g., analgesics, opioids), nerve blocks, radiation therapy, and surgery.

II. Site-Specific Symptoms: Cancers of Particular Organs

A. Breast Cancer Symptoms

1. Lump or Thickening: A new lump or thickening in the breast or underarm area is the most common symptom. Lumps can be painless or painful.

2. Changes in Breast Size or Shape: Any change in the size, shape, or contour of the breast should be evaluated.

3. Nipple Discharge: Spontaneous nipple discharge, especially if it is bloody or clear, is a concerning symptom.

4. Nipple Retraction or Inversion: A nipple that turns inward or becomes inverted.

5. Skin Changes: Redness, swelling, dimpling, puckering, or scaling of the breast skin (peau d’orange).

6. Pain: Breast pain is not usually a sign of breast cancer, but persistent pain should be evaluated.

7. Axillary Lymph Node Swelling: Swollen lymph nodes in the armpit (axilla).

B. Lung Cancer Symptoms

1. Persistent Cough: A new cough that doesn’t go away or a change in a chronic cough.

2. Coughing Up Blood (Hemoptysis): Even a small amount of blood in the sputum is a concerning symptom.

3. Chest Pain: Pain in the chest, shoulder, or back that may worsen with deep breathing or coughing.

4. Shortness of Breath (Dyspnea): Difficulty breathing or feeling breathless.

5. Wheezing: A whistling sound during breathing.

6. Hoarseness: A change in voice that persists.

7. Recurrent Pneumonia or Bronchitis: Frequent lung infections.

8. Weight Loss and Fatigue: General symptoms often associated with lung cancer.

C. Colon Cancer Symptoms

1. Change in Bowel Habits: Diarrhea, constipation, or a change in the consistency of stool that lasts for more than a few days.

2. Rectal Bleeding: Blood in the stool or on the toilet paper.

3. Dark Stools: Black, tarry stools may indicate bleeding in the upper gastrointestinal tract.

4. Abdominal Pain or Cramping: Persistent abdominal discomfort, gas, pain, or cramps.

5. Feeling That the Bowel Doesn’t Empty Completely: Tenesmus, a feeling that you need to have a bowel movement even when your bowels are empty.

6. Unexplained Weight Loss and Fatigue: Common general symptoms.

7. Anemia: Iron deficiency anemia may be a sign of chronic blood loss from the colon.

D. Prostate Cancer Symptoms

1. Frequent Urination: Needing to urinate more often than usual, especially at night (nocturia).

2. Weak or Interrupted Urine Stream: Difficulty starting or stopping urination, or a weak urine stream.

3. Urgency: A sudden and strong urge to urinate.

4. Painful Urination (Dysuria): Burning or pain during urination.

5. Blood in the Urine (Hematuria) or Semen (Hematospermia): Blood in the urine or semen is a concerning symptom.

6. Difficulty Erection (Erectile Dysfunction): Trouble getting or maintaining an erection.

7. Pain in the Hips, Back, or Pelvis: Advanced prostate cancer can spread to the bones, causing pain.

E. Leukemia Symptoms

1. Fatigue and Weakness: Extreme tiredness and lack of energy.

2. Frequent Infections: Increased susceptibility to infections due to a weakened immune system.

3. Fever and Night Sweats: Common symptoms of leukemia.

4. Easy Bleeding and Bruising: Thrombocytopenia (low platelet count) can cause easy bleeding and bruising.

5. Bone Pain or Tenderness: Leukemia cells can accumulate in the bone marrow, causing pain.

6. Swollen Lymph Nodes: Enlarged lymph nodes in the neck, armpit, or groin.

7. Weight Loss: Unexplained weight loss.

8. Petechiae: Small, red or purple spots on the skin caused by bleeding under the skin.

F. Lymphoma Symptoms

1. Swollen Lymph Nodes: Enlarged lymph nodes in the neck, armpit, or groin that are usually painless.

2. Fatigue: Persistent and unexplained tiredness.

3. Fever: Unexplained fever.

4. Night Sweats: Severe sweating during sleep.

5. Weight Loss: Unexplained weight loss.

6. Itching: Persistent itching, especially at night.

7. Abdominal Pain or Swelling: Lymphoma can affect the spleen and liver, causing abdominal symptoms.

8. Coughing or Shortness of Breath: Lymphoma in the chest can compress the airways.

G. Skin Cancer Symptoms

1. Change in Mole: A change in the size, shape, or color of an existing mole.

2. New Mole: A new mole that looks different from other moles on the body.

3. Sore That Doesn’t Heal: A sore that doesn’t heal within a few weeks.

4. Scaly or Crusty Patch: A raised, scaly, or crusty patch of skin that may bleed.

5. Irregular Borders: Moles with irregular, notched, or blurred borders.

6. Uneven Color: Moles with uneven color distribution.

7. Diameter: Moles larger than 6 millimeters (about the size of a pencil eraser).

The ABCDEs of melanoma detection:

• Asymmetry: One half of the mole does not match the other half.
• Border irregularity: The edges of the mole are irregular, notched, or blurred.
• Color variation: The mole has uneven color distribution, with shades of brown, black, red, white, or blue.
• Diameter: The mole is larger than 6 millimeters (about the size of a pencil eraser).
• Evolving: The mole is changing in size, shape, or color.

H. Ovarian Cancer Symptoms

1. Abdominal Bloating: Persistent abdominal bloating or swelling.

2. Pelvic or Abdominal Pain: Pain or discomfort in the pelvis or abdomen.

3. Difficulty Eating or Feeling Full Quickly: Feeling full after eating only a small amount of food.

4. Frequent Urination: Needing to urinate more often than usual.

5. Changes in Bowel Habits: Constipation or diarrhea.

6. Fatigue: Unexplained tiredness.

7. Back Pain: Pain in the lower back.

8. Painful Intercourse: Discomfort or pain during sexual intercourse.

I. Pancreatic Cancer Symptoms

1. Abdominal Pain: Pain in the upper abdomen that may radiate to the back.

2. Jaundice: Yellowing of the skin and whites of the eyes.

3. Weight Loss: Unexplained weight loss.

4. Loss of Appetite: Decreased appetite.

5. Nausea and Vomiting: Feeling sick to your stomach and throwing up.

6. Dark Urine: Urine that is darker than usual.

7. Light-Colored Stools: Stools that are pale or clay-colored.

8. Diabetes: New onset of diabetes or worsening of existing diabetes.

J. Brain Tumor Symptoms

1. Headaches: Persistent headaches that may be worse in the morning.

2. Seizures: Uncontrolled electrical activity in the brain that can cause convulsions.

3. Weakness or Numbness: Weakness or numbness in the arms or legs.

4. Vision Problems: Blurred vision, double vision, or loss of vision.

5. Speech Difficulties: Difficulty speaking or understanding language.

6. Balance Problems: Difficulty walking or maintaining balance.

7. Changes in Personality or Behavior: Alterations in mood, personality, or behavior.

8. Nausea and Vomiting: Feeling sick to your stomach and throwing up.

III. Paraneoplastic Syndromes

A. Definition: Paraneoplastic syndromes are a group of rare disorders that are triggered by an abnormal immune system response to a cancerous tumor. They occur when cancer-fighting antibodies or T cells mistakenly attack normal cells in the nervous system, endocrine system, or other parts of the body.

B. Examples:

1. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): Excess production of ADH, leading to fluid retention and low sodium levels. Common in small cell lung cancer.

2. Hypercalcemia: Elevated calcium levels in the blood. Can be caused by various cancers, including lung cancer, breast cancer, and multiple myeloma.

3. Cushing’s Syndrome: Excess production of cortisol, leading to weight gain, high blood pressure, and other symptoms. Can be caused by small cell lung cancer.

4. Lambert-Eaton Myasthenic Syndrome (LEMS): Muscle weakness caused by antibodies that attack nerve endings. Often associated with small cell lung cancer.

5. Paraneoplastic Neurologic Syndromes: A variety of neurological symptoms, including cerebellar degeneration, encephalitis, and neuropathy. Can be associated with various cancers.

IV. Importance of Early Detection

A. Improved Treatment Outcomes: Early detection of cancer allows for earlier treatment, which is often more effective.

B. Increased Survival Rates: Patients diagnosed with cancer at an early stage have a higher chance of survival.

C. Less Invasive Treatment Options: Early-stage cancers may be treated with less invasive procedures, such as surgery alone, rather than requiring chemotherapy or radiation therapy.

D. Better Quality of Life: Early treatment can help to preserve quality of life and reduce the long-term effects of cancer and its treatment.

V. When to See a Doctor

A. Any new or unexplained symptoms that persist for more than a few weeks should be evaluated by a doctor.

B. Do not ignore potential warning signs of cancer, even if they seem minor.

C. Early detection is key to successful treatment.

VI. Diagnostic Tests

A. Physical Exam: A thorough physical exam is an important first step in evaluating potential cancer symptoms.

B. Blood Tests: Blood tests can help to detect abnormalities in blood cell counts, liver function, kidney function, and other indicators of cancer.

C. Imaging Tests: Imaging tests, such as X-rays, CT scans, MRI scans, and PET scans, can help to visualize tumors and assess their size and location.

D. Biopsy: A biopsy involves removing a sample of tissue for examination under a microscope. A biopsy is often necessary to confirm a diagnosis of cancer.

VII. Risk Factors for Cancer

A. Age: The risk of cancer increases with age.

B. Family History: A family history of cancer increases the risk of developing the disease.

C. Tobacco Use: Smoking is a major risk factor for many types of cancer, including lung cancer, bladder cancer, and pancreatic cancer.

D. Alcohol Consumption: Excessive alcohol consumption increases the risk of certain cancers, such as liver cancer, breast cancer, and colon cancer.

E. Obesity: Obesity increases the risk of several types of cancer, including breast cancer, colon cancer, and endometrial cancer.

F. Exposure to Carcinogens: Exposure to certain chemicals and substances can increase the risk of cancer.

G. Infections: Certain infections, such as human papillomavirus (HPV) and hepatitis B and C viruses, can increase the risk of cancer.

VIII. Prevention Strategies

A. Healthy Lifestyle: Maintaining a healthy lifestyle, including a balanced diet, regular exercise, and maintaining a healthy weight, can help to reduce the risk of cancer.

B. Avoid Tobacco Use: Quitting smoking is the best way to reduce the risk of cancer.

C. Limit Alcohol Consumption: Limiting alcohol consumption can reduce the risk of certain cancers.

D. Sun Protection: Protecting the skin from the sun’s harmful rays can reduce the risk of skin cancer.

E. Vaccinations: Vaccinations against HPV and hepatitis B can help to prevent these infections and reduce the risk of associated cancers.

F. Regular Screening: Regular screening tests, such as mammograms, colonoscopies, and Pap tests, can help to detect cancer early, when it is most treatable.