26 Malignant Tumors – Clinical Manifestations (Signs and Symptoms)

Signs and Symptoms of Malignant Tumors

Cancerous cells can cause problems at both the local and systemic levels as discussed in previous section which include:

• compression of local tissues
• inducing inflammation, hypoxia, and necrosis of surrounding cells and tissues,
• destroying and remodelling extracellular matrix (ECM)
• paraneoplastic syndrome with the adverse effects related to changes in levels of hormone, autoantibodies, cytokines, growth factors

All of the above can give rise to signs and symptoms that may be observed.  These clinical manifestations can be warning signs of cancer.

Local Warning Signs:

• Compression:  can cause obstruction of ducts or passageways, leading to symptoms like difficulty swallowing (dysphagia), urinary retention or dysuria, constipation, diarrhea, or difficulty breathing, as well as nerve compression causing paresthesias, muscle weakness, cognitive, sensory or autonomic dysfunction, seizures, headaches, or hallucinations.
• Pain: nociceptor sensory neurons can be triggered by several components associated with tumors:  compression, inflammatory cytokines, ischemia, bleeding, or stretching of a visceral capsule (kidney or liver).
• Unexplained Edema which can occur when tumor obstructs lymphatic flow or when fluid from inflammation accumulates in body cavities.
• Unexplained Cough or Hoarseness in voice
• Lump: that is solid that may or may not be painful
• Change in Wart or Mole: change in size, colour, border shape
• Bleeding or Discharge: that is unusual,
  • can be a sign that the tumor has eroded blood vessels
  • can be due to bone marrow depression & hypoproteinemia which may contribute to poor clotting
  • and chronic bleeding is common when tumors affect the digestive tract – where damaged gastric mucosa can have difficulty regenerating quickly

Systemic Warning Signs:

• Signs of Hormonal Imbalances
  • Cushing Syndrome depicted by high ACTH and cortisol levels, hypokalemia, facial hair, peripheral edema, weight gain, muscle weakness, hypertension, high blood glucose (can give rise to Type II Diabetes), thin skin, slow healing.
  • Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) depicted by hyponatremia, increased urine osmolality, nausea, lethargy, anorexia, possibly confusion, seizures and coma.
  • Excess Parathyroid hormone can produce hypercalcemia causing muscle weakness or twitches, nausea, confusion, fatigue, or bone pain.

• Systemic Effects (can occur in many diseases and should be investigated) – these include:
  • Unexplained Fatigue
    • due to anemia caused by loss at tumor site, or nutritional deficits due to loss of appetite, or bone marrow depression (i.e., reduced haematopoiesis, if tumor affects RBC production)
    • due to stress, or inflammatory response, or anorexia (loss of appetite)
  • Unexplained Weight loss, Anorexia (loss of appetite), Cachexia (severe tissue wasting)
    • due to fatigue, pain, stress, and increased demands on the body from tumor cells which are hypermetabolic
  • Frequent Infections
    • due to tumor promoting immunosuppressive factors and causing damage which may be slow to heal
  • Unexplained Fever
    • due to tumor promoting the production of pro-inflammatory cytokines and triggering inflammatory response
  • Slow healing rates or unhealed sores