ELDER TIP Older patients may ignore bowel symptoms, believing that they result from constipation, poor diet, or hemorrhoids. Evaluate your older patient's responses to your questions carefully.
On the right side of the colon (which absorbs water and electrolytes), early tumor growth causes no signs of obstruction because the tumor tends to grow along the bowel rather than surround the lumen, and the fecal content in this area is normally liquid. It may, however, cause black, tarry stools; anemia; and abdominal aching, pressure, or dull cramps. As the disease progresses, the patient develops weakness, fatigue, exertional dyspnea, vertigo and, eventually, diarrhea, obstipation, anorexia, weight loss, vomiting, and other signs or symptoms of intestinal obstruction. In addition, a tumor on the right side may be palpable.
On the left side, a tumor causes signs of an obstruction even in early stages because in this area stools are of a formed consistency. It commonly causes rectal bleeding (in many cases ascribed to hemorrhoids), intermittent abdominal fullness or cramping, and rectal pressure. As the disease progresses, the patient develops obstipation, diarrhea, or “ribbon” or pencil-shaped stools. Typically, he notices that passage of stools or flatus relieves the pain. At this stage, bleeding from the colon becomes obvious, with dark or bright red blood in the feces and mucus in or on the stools.
With a rectal tumor, the first symptom is a change in bowel habits, in many cases beginning with an urgent need to defecate on arising (morning diarrhea) or obstipation alternating with diarrhea. Other signs are blood or mucus in stools and a sense of incomplete evacuation. Late in the disease, pain begins as a feeling of rectal fullness that later becomes a dull, and sometimes constant, ache confined to the rectum or sacral region.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Esophageal cancer:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Dysphagia and weight loss are the most common presenting symptoms. Dysphagia is mild and intermittent at first, but it soon becomes constant. Pain, hoarseness, coughing, and esophageal obstruction follow. Cachexia usually develops.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Fallopian tube cancer:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Generally, early stage fallopian tube cancer produces no symptoms. Late-stage disease is characterized by an enlarged abdomen with a palpable mass, amber-colored vaginal discharge, excessive bleeding during menstruation or, at other times, abdominal cramps, frequent urination, bladder pressure, persistent constipation, weight loss, and unilateral colicky pain produced by hydrops tubae profluens. (This last symptom occurs when the abdominal end of the fallopian tube closes, causing the tube to become greatly distended until its accumulated secretions suddenly overflow into the uterus.) Metastasis develops by local extension or by lymphatic spread to the abdominal organs or to the pelvic, aortic, and inguinal lymph nodes. Extra-abdominal metastasis is rare.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Gallbladder and bile duct cancer:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Clinically, gallbladder cancer is almost indistinguishable from cholecystitis — pain in the epigastrium or right upper quadrant, weight loss, anorexia, nausea, vomiting, and jaundice. However, chronic, progressively severe pain in an afebrile patient suggests malignancy. In patients with simple gallstones, pain is sporadic. Another telling clue to malignancy is palpable gallbladder (right upper quadrant), with obstructive jaundice. Some patients may also have hepatosplenomegaly.
Progressive profound jaundice is commonly the first sign of obstruction due to extrahepatic bile duct cancer. The jaundice is usually accompanied by chronic pain in the epigastrium or the right upper quadrant, radiating to the back. Other common signs or symptoms, if associated with active cholecystitis, include pruritus, skin excoriations, anorexia, weight loss, chills, and fever.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Gastric cancer:
Signs and symptoms
(Professional Guide to Diseases (Eighth Edition))
Early clues to gastric cancer are chronic dyspepsia and epigastric discomfort, followed in later stages by weight loss, anorexia, feeling of fullness after eating, anemia, and fatigue. If the cancer is in the cardia, the first sign or symptom may be dysphagia and, later, vomiting (commonly coffee-ground vomitus). Affected patients may also have blood in their stools.
The course of gastric cancer may be insidious or fulminating. Unfortunately, the patient typically treats himself with antacids or histamine blockers until the symptoms of advanced stages appear.
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Source: Professional Guide to Diseases (Eighth Edition), 2005
Testicular cancer:
Signs and symptoms
(Handbook of Diseases)
The first sign is usually a firm, painless, smooth testicular mass, varying in size and sometimes producing a sense of testicular heaviness. When such a tumor causes chorionic gonadotropin or estrogen production, gynecomastia and nipple tenderness may result.
In advanced stages, signs and symptoms include ureteral obstruction, abdominal mass, cough, hemoptysis, shortness of breath, weight loss, fatigue, pallor, and lethargy.
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Source: Handbook of Diseases, 2003
Bone tumors, primary malignant:
Signs and symptoms
(Handbook of Diseases)
age alert Limb pain and refusal to walk with limited range of motion are common findings in children with bone tumors.
Bone pain is the most common indication of a primary malignant bone tumor. It’s usually more intense at night and isn’t usually associated with mobility. The pain is dull and usually localized, although it may be referred from the hip or spine, which result in weakness or a limp. Another common sign is the presence of a mass or tumor.
The tumor site may be tender and swell; the tumor itself is often palpable. Pathologic fractures are common. In late stages, the patient may be cachectic, with fever and impaired mobility.
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Source: Handbook of Diseases, 2003
Brain tumors, malignant:
Signs and symptoms
(Handbook of Diseases)
Brain tumors cause central nervous system changes by invading and destroying tissues and by secondary effect — mainly compression of the brain, cranial nerves, and cerebral vessels; cerebral edema; and increased intracranial pressure (ICP). Generally, signs and symptoms result from increased ICP; these vary with the type of tumor, its location, and the degree of invasion. The onset of signs and symptoms is usually insidious, and brain tumors are commonly misdiagnosed. (See Clinical features of malignant brain tumors, pages 116 to 118.)
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Source: Handbook of Diseases, 2003
Bladder cancer:
Signs and symptoms
(Handbook of Diseases)
In early stages, about 25% of patients with bladder tumors have no symptoms. Commonly, the first sign is gross, painless, intermittent hematuria (often with clots in the urine). Patients with invasive lesions often have suprapubic pain after voiding. Other symptoms include bladder irritability, urinary frequency, nocturia, and dribbling.
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Source: Handbook of Diseases, 2003
Breast cancer:
Signs and symptoms
(Handbook of Diseases)
Warning signals of breast cancer include:
❑ a lump or mass in the breast (a hard, stony mass is usually malignant)
❑ a change in symmetry or size of the breast
❑ a change in breast skin (thickening, scaly skin around the nipple, dimpling, edema [peau d’orange], or ulceration)
❑ a change in skin temperature (a warm, hot, or pink area; suspect cancer in a non-breast-feeding woman past childbearing age until proven otherwise)
❑ unusual drainage or discharge (a spontaneous discharge of any kind in a non-breast-feeding woman warrants thorough investigation; so does any discharge produced by breast manipulation [greenish black, white, creamy, serous, or bloody]). If a breast-feeding infant rejects one breast, this may suggest possible breast cancer.
❑ a change in the nipple, such as itching, burning, erosion, or retraction
❑ pain (not usually a symptom of breast cancer unless the tumor is advanced, but it should be investigated)
❑ bone metastasis, pathologic bone fractures, and hypercalcemia
❑ edema of the arm.
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Source: Handbook of Diseases, 2003
Cervical cancer:
Signs and symptoms
(Handbook of Diseases)
Cervical dysplasia produces no symptoms or other apparent changes. Early invasive cervical cancer can cause abnormal vaginal bleeding, persistent vaginal discharge, and postcoital pain and bleeding. In advanced stages, cervical cancer causes pelvic pain, vaginal leakage of urine and stool from a fistula, anorexia, weight loss, and anemia.
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Source: Handbook of Diseases, 2003
Colorectal cancer:
Signs and symptoms
(Handbook of Diseases)
Signs and symptoms of colorectal cancer result from local obstruction and, in later stages, from direct extension to adjacent organs (bladder, prostate, ureters, vagina, sacrum) and distant metastasis (usually to the liver).
In the early stages, signs and symptoms are typically vague and depend on the anatomical location and function of the bowel segment containing the tumor. Later, they generally include pallor, cachexia, ascites, hepatomegaly, and lymphangiectasis.
Cancer on the right side
On the right side of the colon (which absorbs water and electrolytes), early tumor growth causes no signs of obstruction because the tumor tends to grow along the bowel rather than surround the lumen, and the fecal content in this area is normally liquid. It may, however, cause black, tarry stool; anemia; and abdominal aching, pressure, or dull cramps.
As the disease progresses, the patient develops weakness, fatigue, exertional dyspnea, vertigo and, eventually, diarrhea, obstipation, anorexia, weight loss, vomiting, and other signs and symptoms of intestinal obstruction. In addition, a tumor on the right side may be palpable.
Cancer on the left side
On the left side, a tumor causes signs and symptoms of an obstruction even in early stages because in this area, stool is of a formed consistency. It commonly causes rectal bleeding (typically ascribed to hemorrhoids), intermittent abdominal fullness or cramping, and rectal pressure.
As the disease progresses, the patient develops obstipation, diarrhea, or “ribbon” or pencil-shaped stool. Typically, he notices that passage of stool or flatus relieves the pain. At this stage, bleeding from the colon becomes obvious, with dark or bright red blood in the stool and mucus in or on the stool.
Rectal tumor signs
With a rectal tumor, the first indication is a change in bowel habits, often beginning with an urgent need to defecate on arising (“morning diarrhea”) or obstipation alternating with diarrhea. Other indications include blood or mucus in stool and a sense of incomplete evacuation.
Late in the disease, pain begins as a feeling of rectal fullness that later becomes a dull and sometimes constant ache confined to the rectum or sacral region.
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Source: Handbook of Diseases, 2003
Esophageal cancer:
Signs and symptoms
(Handbook of Diseases)
Patients are usually asymptomatic until they’re far advanced in the disease. Dysphagia and weight loss are the most common presenting symptoms. Dysphagia is mild and intermittent at first, but it soon becomes constant. Pain, hoarseness, coughing, and esophageal obstruction follow. Cachexia usually develops.
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Source: Handbook of Diseases, 2003
Gallbladder and bile duct cancers:
Signs and symptoms
(Handbook of Diseases)
Clinically, gallbladder cancer is almost indistinguishable from cholecystitis. The signs and symptoms of both disorders include pain in the epigastrium or right upper quadrant, weight loss, anorexia, nausea, vomiting, and jaundice. Chronic, progressively severe pain in an afebrile patient suggests cancer. With simple gallstones, the pain is sporadic.
Another telling clue to cancer is a palpable gallbladder (in the right upper quadrant) with obstructive jaundice. Some patients may also have hepatosplenomegaly.
Signs of bile duct cancer
Progressive, profound jaundice is commonly the first sign of obstruction caused by extrahepatic bile duct cancer. The jaundice is usually accompanied by chronic pain in the epigastrium or right upper quadrant, radiating to the back. Other common symptoms, if associated with active cholecystitis, include pruritus, skin excoriations, anorexia, weight loss, chills, and fever.
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Source: Handbook of Diseases, 2003
Gastric cancer:
Signs and symptoms
(Handbook of Diseases)
Early clues to gastric cancer are chronic dyspepsia and epigastric discomfort, followed in later stages by weight loss, anorexia, a feeling of fullness after eating, anemia, and fatigue. If the cancer is in the cardia, the first symptom may be dysphagia and, later, vomiting (typically coffee-ground vomitus). Affected patients may also have blood in their stools.
The course of gastric cancer may be insidious or fulminating. The patient typically treats himself with antacids until the symptoms of advanced stages appear.
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Source: Handbook of Diseases, 2003
Kidney cancer:
Signs and symptoms
(Handbook of Diseases)
Kidney cancer produces a classic triad of signs and symptoms — hematuria, pain, and a palpable mass — but any one may be the first indication of cancer. Microscopic or gross hematuria (which may be intermittent) suggests that the cancer has spread to the renal pelvis.
Constant abdominal or flank pain may be dull or, if the cancer causes bleeding or blood clots, acute and colicky. The mass is generally smooth, firm, and nontender. All three signs of kidney cancer coexist in only about 10% of patients.
Other signs and symptoms include fever (perhaps from hemorrhage or necrosis), hypertension (from compression of the renal artery with renal parenchymal ischemia), rapidly progressing hypercalcemia (possibly from ectopic parathyroid hormone production by the tumor), and urine retention. Weight loss, edema in the legs, nausea, and vomiting are signs and symptoms of advanced kidney cancer.
CLINICAL TIP: Bone pain or fracture from a metastatic lesion may also be a chief complaint.
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Source: Handbook of Diseases, 2003
Laryngeal cancer:
Signs and symptoms
(Handbook of Diseases)
With intrinsic laryngeal cancer, the dominant and earliest indication is hoarseness that persists longer than 3 weeks; with extrinsic cancer, it’s a lump in the throat or pain or burning in the throat when drinking citrus juice or hot liquid. Later signs and symptoms of metastasis include dysphagia, dyspnea, cough, enlarged cervical lymph nodes, and pain radiating to the ear.
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Source: Handbook of Diseases, 2003
Liver cancer:
Signs and symptoms
(Handbook of Diseases)
Signs and symptoms of liver cancer include:
❑ a mass in the right upper quadrant
❑ a tender, nodular liver on palpation
❑ severe pain in the epigastrium or the right upper quadrant
❑ a bruit, hum, or rubbing sound if the tumor involves a large part of the liver
❑ weight loss, weakness, anorexia, fever
❑ occasional jaundice or ascites
❑ occasional evidence of metastasis through the venous system to the lungs, from lymphatics to the regional lymph nodes, or by direct invasion of the portal veins
❑ dependent edema.
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Source: Handbook of Diseases, 2003
Lung cancer:
Signs and symptoms
(Handbook of Diseases)
Because early-stage lung cancer usually produces no symptoms, this disease is typically in an advanced state at diagnosis. The following late-stage signs and symptoms commonly lead to a diagnosis:
❑ with epidermoid and small cell carcinomas: smoker’s cough, hoarseness, wheezing, dyspnea, hemoptysis, and chest pain
❑ with adenocarcinoma and large cell carcinoma: fever, weakness, weight loss, anorexia, and shoulder pain.
Besides their obvious interference with respiratory function, lung tumors may also alter the production of hormones that regulate body function or homeostasis. Clinical conditions that result from such changes are known as hormonal paraneoplastic syndromes:
❑ Gynecomastia may result from large cell carcinoma.
❑ Hypertrophic pulmonary osteoarthropathy (bone and joint pain from cartilage erosion due to abnormal production of growth hormone) may result from large cell carcinoma or adenocarcinoma.
❑ Cushing’s and carcinoid syndromes may result from small cell carcinoma.
❑ Hypercalcemia may result from epidermoid tumors.
Metastatic signs and symptoms vary greatly, depending on the effect of tumors on intrathoracic and distant structures:
❑ bronchial obstruction: hemoptysis, atelectasis, pneumonitis, and dyspnea
❑ recurrent nerve invasion: hoarseness and vocal cord paralysis
❑ chest wall invasion: piercing chest pain; increasing dyspnea; and severe shoulder pain, radiating down the arm
❑ local lymphatic spread: cough, hemoptysis, stridor, and pleural effusion
❑ phrenic nerve involvement: dyspnea; shoulder pain; and unilateral paralyzed diaphragm, with paradoxical motion
❑ esophageal compression: dysphagia
❑ vena caval obstruction: venous distention and edema of the face, neck, chest, or back
❑ pericardial involvement: pericardial effusion, tamponade, and arrhythmias
❑ cervical thoracic sympathetic nerve involvement: miosis, ptosis, exophthalmos, and reduced sweating.
Distant metastasis may involve any part of the body, most commonly the central nervous system, liver, and bone.
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Source: Handbook of Diseases, 2003
Ovarian cancer:
Signs and symptoms
(Handbook of Diseases)
Typically, symptoms vary with the size of the tumor. Occasionally, in the early stages, ovarian cancer causes vague abdominal discomfort, dyspepsia, and other mild GI disturbances. As it progresses, it causes urinary frequency, constipation, pelvic discomfort, abdominal distention, and weight loss.
Tumor rupture, torsion, or infection may cause pain, which, in young patients, may mimic appendicitis. Granulosa cell tumors have feminizing effects (such as bleeding between periods in premenopausal women); conversely, arrhenoblastomas have virilizing effects. Advanced ovarian cancer causes ascites, rarely postmenopausal bleeding and pain, and symptoms relating to metastatic sites (most commonly pleural effusions).
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Source: Handbook of Diseases, 2003
Testicular Cancer as a Cause of Symptoms or Medical Conditions
When considering symptoms of Testicular Cancer, it is also important to consider Testicular Cancer as a possible cause of other medical conditions.
The Disease Database lists the following medical conditions that Testicular Cancer may cause:
- (Source - Diseases Database)
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