CANCER - sign & Symptoms and investigation

My Guest Lecture at BAKSON Homeopathy Medical College , Greater Noida India

1. Signs & Symptoms Screening & Diagnosis In Precancerous & Cancerous disease Dr Kundan Surgical Oncology Rajiv Gandhi Cancer Institute & Research Center Niti Bagh . New Delhi

2. 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)

3. 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)

4. 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

5. 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

6. 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

7. IT IS GOOD TO REMEMBER

8. 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

9. Investigations Imaging (Neck and Oral Cavity) MRI CECT Biopsy

10. 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

11. Investigations Imaging CECT whole abdomen & pelvis Endoscopy & Endoscopy guided biopsy Tumor markers CEA , CA 19-9

12. 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

13. History including family history, menstrual, obstetric history Associated with pregnancy/ lactation Biopsy in all abscess must

14. Investigation Mammography Usg Breast FNAC / Trucut Biopsy

15. 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

16. Investigation Cystoscopy CECT whole abdomen & Pelvis Biopsy Serum PSA in case carcinoma prostate

17. Gynecological cancers Abnormal bleeding PV Persistent serous discharge Lower abdominal pain Abdominal distension Jaundice / ascitis

18. Investigation PAP Smear Colposcopy guided biopsy CECT / MRI Pelvis CA 125 , CEA

19. Thoracic malignancy Symptoms similar to tuberculosis , so often missed Chronic cough Hemoptysis Difficulty in breathing

20. Investigation Chest Xray Bronchoscopy HRCT EBUS / CT guided Biopsy Tumor Marker Sputum for malignant cells RULE OUT CA BEFORE EMPIRICAL ATT

21. SKIN CANCERS Non healing ulcer Painless swelling Change in character of prior mole , itching

22. Investigation Biopsy is the investigation

23. Hematological malignancy Generalized malaise, fever Generalized painless lymphadenopathy Night sweats Anemia Weakness Bone pain Loss of weight & loss of appetite Painless swellings hepato-spleenomegaly

24. Investigation Complete Blood count Peripheral Smear Bone Marrow Aspiration & Biopsy

25. Bone cancer Painless swelling Rapidly enlarging bony swelling Fracture at abnormal sites Bony/soft tissue swelling with fever Bony swelling with loss of weight

26. Investigation MRI Biopsy

27. 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

28. Encourage the patients for screening PAP 3 yearly Mammography PSA CA 125 USG Whole abdomen Chest x-ray CBC

29. 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

30. IT IS GOOD TO REMEMBER