2. ONCOLOGY
โข Branch of medicine dealing with tumors, including the origin,
development, diagnosis & treatment of malignant neoplasms.
โข Oldest treatment - surgery
โข Non surgical treatment - Radiotherapy & drug treatments
โข 2nd most common cause of death after cardiovascular diseases
5. Feature Common associations
NON- METASTATIC MANIFESTATIONS
Weight loss & anorexia
Hyperkalemia
Prothrombotic tendency
Acanthosis nigricans
Dermatomyositis
GI tumors
Myeloma, breast, renal tumors
Pancreas & other GI tumors
Gastero-oesophageal tumor
Gastric, lung tumor
6. Hormonal effects
Syndrome of inappropriate ADH
secretion (SIADH)
Ectopic ACTH
Neuropathies & myopathies
Eaton Lambert Myasthenia like
syndrome
Sub acute cerebellar degeneration
Small-cell lung cancer
Small-cell lung cancer
7. BREAST CANCER
SYMPTOMS
โข Lump in breast.
โข Bloody discharge from nipple.
โข Changes in shape or texture of the nipple or breast, peau dโorange
โข .
โข Skin : Ulcers or redness
โข Also common : Cancer related fatigue, swollen lymph nodes or weight
loss
8.
9. SYMPTOMS
โข COUGH (most common early symptom) - mostly dry but
sputum may be purulent if secondary infection occurs.
A change in the character of the โregularโ cough of smoker associated with
other new respiratory symptoms.
โข HEMOPTYSIS especially tumor arising in central bronchi.
Central tumor invade large vessels, cause massive hemoptysis (fatal).
Repeated episodes of scanty hemoptysis or blood streaking sputum in
smokers.
LUNG CANCER
10. โข BRONCHIAL OBSTRUCTION can lead to pneumonia. Reccurrant
pneumonia at same site or slow response to treatment in smoker.
Lung abscess may develop.
Signs of displacement of mediastinum or elevation of diaphragm if major
portion of lung collapsed.
โข BREATHLESSNESS - occlusion of large bronchus resulting collapse of a
lobe or lung or a large pleural effusion.
โข STRIDOR (harsh inspiratory noise) - lower trachea, carina or main
bronchi are narrowed by primary tumor or by compression from malignant
enlargement of the sub cranial & paratracheal lymph nodes
11. โข PLEURAL PAIN - Malignant invasion of pleura or distal infection.
Intercostal nerve involvement - pain in chest along nerve root distribution.
โข Bronchial Ca in apex of lung cause
1. Hornerโs syndrome - ipsilateral partial ptosis, enophthalmos, a small pupil
& hypohidrosis of face.
2. Pancoastโs syndrome - pain in shoulder and inner aspect of arm.
โข Mediastinal spread result in DYSPHAGIA.
โข BLOOD BORNE METASTASES- focal neurological defects, epileptic
seizures, personality changes, jaundice bone pain, skin nodule, anorexia,
weight loss.
12.
13. NON METASTATIC EXTRA PULMONARY MANIFESTATIONS
โข Endocrine - inappropriate ADH secretion, ectopic ACTH secretion, hyper
calcemia due to PTH related peptides, gynecomastia.
โข Neurological - polyneuropathy, myelopathy, cerebellar degeneration,
myasthenia
โข Other - clubbing, hypertrophic pulmonary osteoarthropathy, nephrotic
syndrome, polymyositis, dermatomyositis, eosinophilia
14. PHYSICAL SIGNS
โข Examination is normal unless significant broncheal obstruction or spread to pleura
mediastinum or supraclavicular lymph nodes.
โข A monophonic /unilateral wheeze fail to clear with coughing - fixed bronchial
obstruction.
โข Stridor- obstruction at or above main carina.
โข Hoarse voice- ineffectualor bovine cough, due to left recurrent laryngeal nerve palsy.
โข Dullness of percussion & absence of breath sound at lung base- phrenic nerve
paralysis.
โข Involvement of pleura- pleural rub / signs of pleural effusion.
โข Superior vena cava syndrome- bilateral engorgement of juglar vein & edema of
face, neck arm & conjuctiva.
15. CARCINOMA OF OESOPHAGUS
โข h/o progressive painless dysphagia for solid food.
โข Late stage - wt loss, chest pain or hoarsness (due to mediastinal invasion)
โข Coughing after swallowing - fistula b/w esophagus and trachea.
โข Pneumonia and pleural effusion.
โข Physical Signs : Cachexia , cervical lymphadenopathy.
16. GASTRIC CARCINOMA
SYMPTOMS AND SIGNS
โข Early- asymptomatic but detected during endoscopy or investigation of
dyspepsia.
โข Weight loss (2/3 rd of patients with advanced cancer)
โข Ulcer like pain.
โข Anorexia & nausea.
17. โข Early satiety, hematemesis, melaena & dyspepsia alone are less
common.
โข Dyspepsia - occur in tumor of gastric cardia which obstruct gastro-
oesophageal junction.
โข Anemia - Occult bleeding.
18. Examination
โข Signs of weight loss, anemia or palpable epigastric mass.
โข Jaundice, ascites - metastasis
โข Tumor spread to supraclavicular lymph nodes (Troisierโs sign),
umbilicus (sister josephโs nodule), ovaries(krukenberg tumor)
โข Metastasis most - liver, lungs, peritoneum, bone marrow
19. LARGE BOWEL
COLORECTAL CARCINOMA (98%)
Clinical symptoms
โช Occult bleeding (melaena).
โช Changes in bowel habits, more often left sided growth.
โช Weight loss - weight loss due to alteration in metabolism (cancer cachexia syndrome)
โช Loss of appetite (anorexia)
โช Anemia, weakness, malaise
โช Anxiety and depression
โช Delirium and terminal agitation
20. RADIOGRAHIC FEATURES
โข Barium enema- typically lesions appear as exophytic or sessile masses or
maybe circumferential (apple core sign)
โข CT- most colorectal ca are soft tissue density that narrow the lumen. Ulceration
in large masses is also seen
โข MRI- staging of rectal cancer
COMPLICATIONS
โข Fistula, obstruction, intussusception, perforation
21. TUMORS OF LIVER
HEPATOCELLULAR CARCINOMA
SYMPTOMS
โข Patients with cirrhosis - ascites, jaundice, variceal hemorrhages
โข Weight loss, anorexia, abdominal pain
โข Signs: hepatomegaly, right hypochondrial mass
โข Tumor vascularity- abdominal bruit
โข Hepatic rupture with intra abdominal bleeding
22. TUMORS OF PANCREAS
โข Pain, weight loss, obstructive jaundice.
โข Pain due to invasion of celiac plexus incessant and boring.
โข Radiate from upper abdomen through to the back and may be eased a little by
bending backwards.
โข 60% head of pancreas
โข Few - diarrhoea, vomiting from duodenal obstruction, DM, recurrent venous
thrombosis, acute pancreatitis or depression.
23. SIGNS
Evidence of weight loss, palpable gall bladder in jaundice due to distal biliary
obstruction (Courvoisier sign)
24. PROSTATE CANCER
SYMPTOMS AND SIGNS
โข Lower urinary tract symptoms indistiguishable from BPH.
(Benign prostatic hypertrophy)
โข URINARY- difficulty starting and maintaining steady stream urine, dribbling of
urine, excessive urination at night, frequent urination, urge to urinate and
leaking, urinary retention or weak stream urine.
METASTASIS
Back pain, weight loss, anemia and obstruction of ureters
On Rectal examination prostate often feel nodular or stony hard, medial sulcus
may be lost
25. BLADDER CARCINOMA
โข Hematuria(80%)- visible and painless
It should be assumed that such bleeding is from
tumor until proved otherwise.
โข Frequent urination
Obstructive symptoms
Tumor at the lower end of ureter or bladder tumor involving the ureteric orifice
Examination usually unhelpful
Rectal examination detect very advanced tumor
26. NASOPHARYNGEAL CARCINOMA
SYMPTOMS
โข Lump in the neck - swollen lymph node
โข Blood in saliva
โข Bloody discharge from nose
โข Nasal congestion
โข Sore throat
โข Head ache
โข Frequent ear infections
โข Hearing loss
27. LARYNGEAL AND HYPOPHARYNGEAL CARCINOMA
SYMPTOMS
โข Hoarseness of voice - cancer in glottis or vocal cord
โข Sore throat
โข Constant coughing
โข Pain during swallowing
โข Ear pain
โข Trouble breathing
โข Weight loss
โข Lump or mass in neck
28. SALIVARY GLAND TUMORS
SYMPTOMS
โข Lump or swelling on or near jaw or neck or mouth
โข Numbness in part of face
โข Muscle weakness on oneside of face
โข Persistent pain in the area of gland
โข Difficulty swallowing
โข Trouble opening mouth widely
29. MELANOMA
โข Flat or slightly elevated naevus with variegated pigmentation,
irregular border later secondary changes- ulceration bleeding
and increase size
Features
โข Asymmetry
โข Border irregular
โข Colour irregular
โข Diameter 0.6mm
โข Elevation irregular
โข (+ loss of skin markings)
30. TUMORS OF KIDNEY
RENAL ADENOCARCINOMA
โข Hematuria (60%)
โข Loin pain (40%), mass (25%)
โข Triad of hematuria, pain and mass is late feature
โข Systemic effects- fever, raised ESR, polycythemia, disorders of coagulation,
altered LFT
โข Pyrexia (unknown origin), neuropathy
โข Effect disappear when tumor removed but reappear when metastases develop
31. OVARIAN CANCER
SIGNS AND SYMPTOMS
โข Pain areas- in abdomen orpelvis
โข Gastrointestinal- bloating, change in bowel habits, indigestion or nausea
โข Abdominal- abdominal fullness, fluid in abdomen, or lump in abdomen
โข Whole body- cancer related fatigue, loss of wt or appetite
32. NON HODGKINโS LYMPHOMA
Comprise a large group of heterogenous of neoplasm of lymphoid tissue and
blood
SYMPTOMS
โข Swollen lymph node, fever, stomach ache, night sweats, weight loss, chest
pain and loss of appetite, hepatomegaly, splenomegaly
โข Pain areas- in abdomen or chest
โข Anemia, fatigue
โข CNS infiltration, infections (due to cytopenia)
33. LEUKEMIA
ACUTE MYELOID LEUKEMIA
1. Due to bonemarrow failure
โข Anemia- pallor, lethargy
โข Bleeding disorders due to thrombocytopenia_ petechiae, bleeding gums
โข Infections- mouth, throat, skin
โข Fever
2. Due to organ failure
โข Pain and tendreness of bone
โข Lymphadenopathy (tonsil)
34. โข Splenomegaly, subcapsular hemorrhage, splenic rupture
โข Leukemic infraction of kidney
โข Gum hypertrophy due to leukemic infraction of kidney
โข Meningial involvement- raised intracranial pressure, head ache nausea,
vomiting, blurring of vision, diplopia
โข Testicular swelling , mediastinal compression
36. CHRONIC LYMPHOCYTIC LEUKEMIA
โข Features of anemia- weakeness ,fatigue, dyspnoea
โข Enlargement of superficial LN (symmetrical enlargement)
โข Hepatomegaly, splenomegaly
โข Hemorrhagic manifestations
โข Respiratory tract infections
โข Mediastinal pressure, tonsillar enlargement, disturbed vision, bone and joint pain
37. INTRACRANIAL NEOPLASAM
SYMPTOMS AND SIGNS
โข Head ache- due to raised intracranial pressure, site of tumor and head ache
are not seme. Posterior fossa tumor pain in occiput or neck.
โข The focal deficits- slow onset and progressive. In brain stem structural
defect result in neurological symptom. In frontal lobe tumor large when
symptom occur.
โข Seizures- due to infiltration of tumor cells. Generalised or partial in nature.
39. BONE TUMORS
OSTEOSARCOMA
โข Pain, tenderness, swelling of affected extremity
โข Serum alkaline phosphatase raised but calcium normal
โข Metastases- lung other bone & brain