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 CancerEarly 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
|