COMMON CANCERS IN ADULTS

CLINICAL FEATURES INVESTIGATIONS

Cancer of the oesophagus

  • Progressive dysphagia
  • Regurgitation
  • Weight loss
  • Iron deficiency anaemia
  • FBC
  • Barium Swallow
  • Endoscopy;
    visualise and biopsy
    tumour
  • CXR

Gastric Cancer

  • Anorexia, weight loss, vomiting
  • Anaemia
  • Haematemesis
  • Pain, epigastric mass
  • Melaena stool
  • Haemogram
  • Occult blood in
    stool
  • Barium Meal
  • Endoscopy;
    visualise and biopsy

Colorectal & Anal Cancer

  • Change in bowel habits;
    constipation, diarrhoea
  • Blood in stool
  • Anaemia, weight loss
  • Tenesmus
  • Lower abdominal mass
  • Haemogram
  • Iron-deficiency
    anaemia
  • Occult blood in
    stool
  • Barium Enema
    (double contrast)
  • Sigmoidoscopy
  • Coloscopy;
    visualise and biopsy
    tumour

Breast Cancer

  • A painless lump
  • Nipple retraction
  • Skin changes such as darkening
    and dimpling appearing like
    orange skin
  • Nipple discharge that may be
    bloody
  • Ulceration
  • Uniform breast enlargement
  • Pain is usually a late symptom
  • Symptoms and signs of
    metastasis
  • Mammography
  • FNAC Biopsy
  • Excisional biopsy
Ovarian cancer

  • No specific signs and symptoms,
    usually over 70% present as late
    stage
  • Abdominal discomfort e.g.,
    pressure, poor appetite, nausea,
    vomiting, weight loss
  • Urinary frequency
  • Pelvic pressure
  • Mass/masses in abdomen; if
    mass >15 cm in 40-69 years,
    suspect ovarian cancer
  • Abdominal distension
  • Irregular vaginal bleeding
  • Low back pain, fatigue
  • Dyspareunia
  • Pelvic ultrasound
  • Liver ultrasound
  • Ascitic tap for
    cytology, chemistry
    and microscopy
    to rule out
    Tuberculosis
  • CXR

Melanoma

Suspect where naevus shows:

  • A: Asymmetry
  • B: Border irregularity
  • C: Colour variegation
  • D: Diameter >6 mm
  • Ulceration
  • Regional lymph nodes
  • Wide excision
    punch biopsy
  • CXR
  • Abdominal U/S

Cervical Cancer
Early stage:

  • Vaginal discharge, sometimes
    foul smelling
  • Irregular vaginal bleeding
  • Post-coital bleeding in women
    of any age
  • Post-menopausal bleeding
    (especially if not responding to
    appropriate treatment)

Late stage:

  • Urinary frequency and urgency
  • Backache, lower abdominal pain

Very late stage:

  • Severe back pain
  • Weight loss
  • Oliguria (due to ureteric
    obstruction or renal failure)
  • Urinary/ faecal incontinence
  • Oedema of lower limbs
  • Dyspnoea (due to anaemia,
    metastasis or pleural effusion)
  • Biopsy
  • Abdominal
    ultrasound/CT

Non-Hodgkin’s Lymphoma (NHL)

  • Progressive lymph node
    enlargement
  • Unexplained weight loss
  • Drenching night sweats
  • Persistent fever
  • Pallor (anaemia)
  • Lymphadenopathy
    (generalised)
  • Splenomegaly
  • Hepatomegaly
  • Lymph node
    excision biopsy
  • Fine needle
    aspirations (FNA)
  • Full blood count
  • Bone marrow
    aspirate
  • LFTs, RFTs
  • LDH
  • Viral serology for
    HIV

Squamous cell cancer of skin

  • Non−healing ulcers
  • Bleeding
  • Pain
  • Lymph nodes
  • Wide excision
    incisional biopsy
  • X−Rays of bones
  • CXR

Kaposi’s Sarcoma (KS)

  • Indolent KS: nodular skin
    lesions, fungating nodules, bone
    involvement
  • Lymphadenopathic KS: lymph
    nodes, visceral involvement,
    GIT symptoms
  • AIDS related KS: skin nodules,
    mucous membranes, mouth
    palate and ENT lesions,
    lymphadenopathy, paraplegias,
    any organ can be impacted
  • Biopsies
  • Full blood count
  • HIV screening
  • CXR: pleural
    effusions
  • Abdominal X−Ray

Head and Neck cancers

  • Painless mass
  • Local ulceration with or without
    pain
  • Referred pain to teeth or ear
  • Dysphagia, loosening of teeth
  • Alteration of speech: difficulty
    pronouncing words, change in
    character, persistent hoarseness
  • Unilateral tonsillar enlargement
    in an adult
  • Persistent unilateral “sinusitis”,
    nosebleed or obstruction
  • Unilateral hearing loss
  • Cranial nerve palsies
  • Chest X-Rays and
    other relevant
    X-Rays
  • CT scan
  • Biopsy

Prostate Cancer

  • Urge to urinate often, especially
    at night
  • Difficulty in starting or stopping
    urine flow, inability to urinate
  • Weak, decreased or interrupted
    urine stream, a sense of
    incomplete emptying of bladder
  • Burning or pain during
    urination
  • Blood in the urine or semen
  • Painful ejaculation
  • Digital Rectal Exam
    (DRE)
  • Serum PSA
  • Ultrasound guided
    biopsy

Chronic Leukaemia

  • Classified into two: CLL and
    CML
  • Recurrent infections
  • Bleeding or easy bruisability
  • Unexplained weight loss
  • Drenching night sweats
  • Persistent fever
  • Waxing and waning lymph node
    enlargement (CLL)
  • Swelling and discomfort in
    the left flank due to massive
    splenomegaly (CML)


The following clinical signs
require full physical examination:

  • Pallor (anaemia)
  • Splenomegaly
  • Hepatomegaly
  • Bruising (purpura)
  • Lymphadenopathy
  • FBC
  • Peripheral blood
    film
  • Bone Marrow
    Aspirate
  • Biopsy
  • CLL: blood film
    >500 monoclonal
    lymphocytes
  • CML: leukocytosis,
    basophilia
    with immature
    granulocytes
  • CXR
  • LDH
  • Viral serology for
    HIV, Hepatitis B&C
  • Abdominal US scan
  • CT scan
  • Echo/ECG