Signs & Symptoms

Screening & Diagnosis

In Precancerous & Cancerous

disease

Dr KundanSurgical Oncology

Rajiv Gandhi Cancer Institute & Research Center

Niti Bagh. New Delhi

COMMON CANCERS : GLOBAL

Males Females

Developed Developing Developed Developing

Prostate Lung Breast Breast

Lung Stomach * Colorectal Cervix *

Colorectal Liver * Lung Stomach *

•Related to Infection

All the three common cancers above ( both developed & Developing) are also

leading causes of cancer death.

15 % of all cancers – infection related ( 3 times more in developing countries)

CANCER IN DEVELOPING COUNTRIES

INCREASING

• Deaths from infectious diseases

• Childhood mortality

• Longevity

• Adoption of Western Life style– Cigarette Smoking

– Higher consumption of saturated fat

– Consumption of Calorie dense foods

– Physical activity

Survival rates poorer in developing countries (lack of availability of early detection and treatment services)

• Signs and symptoms of cancer are relatively non-specific and mimic a variety of more common problems

• For an oncologist the index of suspicion for cancer is high

• For a primary care physician the opposite is true• ‘The eyes don’t see what the mind doesn’t

know”( D H Lawrence )

HIGH INDEX OF SUSPICION MUST

Nothing replaces a thorough medical history, family history and physical exam Familial/genetic diseases associated with increased cancer risk

Major categories of diseases linked with an increased cancer risk include

Immune deficiencies

Metabolic disorders

COMMON THINGS ARE NOT ALWAYS COMMON…

• Symptoms and Signs of cancer mimicking normal illnesses:– Generalized malaise, fever, adenopathy– Cough –persistent – Painless swelling anywhere– Unintentional loss of weight > 10% in six months – Headache, earache– Non healing ulcers – Nausea, vomiting, diarrhea,– Hepatomegaly, splenomegaly– Hematuria , abnormal bleeding PV/PR– Jaundice – Pelvic pain

IT IS GOOD TO REMEMBER

Head & Neck Cancer

• Non healing ulcer in oral cavity • White /red patch • Hoarseness of voice• Difficulty in opening in mouth • Multiple enlarged painless cervical lymph nodes • Persistent nasal stuffiness and epistaxis• Sensation of foreign body in throat • Painless swelling in thyroid region • Any of above with history of loss of weight & loss

of appetite

Investigations

• Imaging (Neck and Oral Cavity)

– MRI

– CECT

• Biopsy

Gastro intestinal cancers• Odynophagia /dysphagia• Persistent vomiting • Loss of weight & loss of appetite • Abdominal distension • Jaundice • Constipation • Changes in bowel habits• Change in the form of stool • Blood mixed stool • Passage of mucous per rectum

Investigations

• Imaging CECT whole abdomen &

pelvis

• Endoscopy & Endoscopy guided biopsy

• Tumor markers

CEA , CA 19-9

Breast cancer

• Painless swelling in the breast

• Hard swelling

• Bloody discharge

• Recent history of nipple retraction

• Painless swelling in axilla

• Breast swelling with cough/jaundice / bone pain

• History including family history, menstrual, obstetric history

• Associated with pregnancy/ lactation

• Biopsy in all abscess must

Investigation

• Mammography

• Usg Breast

• FNAC / Trucut Biopsy

Urological cancers

• Painless hematuria

• Passage of mucous in urine

• Painless Swelling in flanks

• Change in frequency & colour of urine

• Persistent rawness /plaque/ nodular thickening in penile region

• Painless swelling of rapid onset in testis

• Loss of testicular sensation

• Heaviness in testis

Investigation

• Cystoscopy

• CECT whole abdomen & Pelvis

• Biopsy

• Serum PSA in case carcinoma prostate

Gynecological cancers

• Abnormal bleeding PV

• Persistent serous discharge

• Lower abdominal pain

• Abdominal distension

• Jaundice /ascitis

Investigation

• PAP Smear

• Colposcopy guided biopsy

• CECT / MRI Pelvis

• CA 125 , CEA

Thoracic malignancy

• Symptoms similar to tuberculosis , so often missed

• Chronic cough

• Hemoptysis

• Difficulty in breathing

Investigation

• Chest Xray• Bronchoscopy• HRCT • EBUS / CT guided Biopsy • Tumor Marker• Sputum for malignant cells

RULE OUT CA BEFORE EMPIRICAL ATT

SKIN CANCERS

• Non healing ulcer

• Painless swelling

• Change in character of prior mole , itching

Investigation

• Biopsy is the investigation

Hematological malignancy

Generalized malaise, fever

Generalized painless lymphadenopathy

Night sweats

Anemia

Weakness

Bone pain

Loss of weight & loss of appetite

Painless swellings

hepato-spleenomegaly

Investigation

• Complete Blood count

• Peripheral Smear

• Bone Marrow Aspiration & Biopsy

Bone cancer

• Painless swelling

• Rapidly enlarging bony swelling

• Fracture at abnormal sites

• Bony/soft tissue swelling with fever

• Bony swelling with loss of weight

Investigation

• MRI

• Biopsy

ANOTHER WAY TO THINK OF THINGS…..

• What is it?

• Where is it?

• Where can it go?

• The answer to any one of the above can help answer the other two

Encourage the patients for screening

• PAP 3 yearly

• Mammography

• PSA

• CA 125

• USG Whole abdomen

• Chest x-ray

• CBC

Summary

• Presenting signs and symptoms of cancer are common to many illnesses

• Early diagnosis of cancer may improve outcome

• If the possibility of cancer is not considered, delayed diagnosis is the result

• Although the incidence of cancer is low, the impact of cancer makes it imperative that all professionals have a high index of suspicion of cancer

IT IS GOOD TO REMEMBER