Oncology Clinical Signs and Symptoms
Differential Diagnosis
Paraneoplastic Syndromes
- fever
- skin rash
- clubbing of the fingers
- pigmentation
- arthralgias
- paresthesias
- thrombophlebitis
- proximal muscle weakness
- anorexia, malaise, weight loss
Metastases
-Skeletal
- neurogenic bone pain
- pain on weight bearing
- hypercalcemia
CNS (drowsiness, lethargy,
headaches, depression of apathy,
irritability, confusion)
Musculoskeletal (weakness, muscle
flaccidity, bone pain, pathologic fractures)
Cardiovascular (cardiac arrest,
hypertension)
GI (anorexia, nausea, vomiting, abdominal
pain, constipation, dehydration,
polydipsia)
-Neurologic
- nerve and cord compression
- brain tumors (headache, altered mentation,
sensory and motor disturbances)
- paraneoplastic syndrome
-Pulmonary
- pleural pain
- dyspnea
-Hepatic
- bilateral carpal/tarsal tunnel syndrome
- abdominal pain and tenderness
- general malaise and fatigue
Early Melanoma
- (A) Asymmetry: uneven edges, lopsided in
shape, one half unlike the other half
- (B) Border: irregularity, irregular edges,
scalloped or poorly defined edges
- (C) Color: black, shades of brown, red,
white, occasionally blue
- (D) Diameter: larger than a pencil eraser
Metastasized Breast Cancer
- palpable mass in supraclavicular, chest, or
axillary regions
- unilateral upper extremity numbness and
tingling
- back or shoulder pain
- pain or weight bearing
- leg weakness or paresis
- bowel/bladder symptoms
Breast Cancer
- nontender, firm or hard lump
- skin or nipple retraction
- discharge from nipple
- erosion, retraction, enlargement, itching of
nipple
- redness or skin rash
- generalized hardness, enlargement, or
shrinking of breast
- axillary mass
- swelling of arm
- bone or back pain
- weight loss
- jaundice
Endometrial (uterine) Cancer
- vaginal bleeding or vaginal discharge after
menopause (extremely significant sign)
- persistent, irregular premenopausal
bleeding, especially in obese women
- abdominal or pelvic pain
- weight loss, fatigue
Ovarian or Primary Peritoneal Cancer
- persistent vague GI complaints
- abdominal discomfort, bloating
- indigestion, belching
- early satiety
- mild anorexia in a woman age 40 or older
- urinary frequency
- pelvic discomfort or pressure
- ascites, pain, and pelvic mass (advanced
disease
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Acute and Chronic Leukemias
- abnormal bleeding
- easy bruising of the skin
- petechiae
- epistaxis (nosebleeds) and / or bleeding
gums
- hematuria (blood in the urine)
- rectal bleeding
- infections, fever
- weakness
- easy fatigability
- enlarged lymph nodes
- bone and joint pain
- weight loss
- loss of appetite
- pain or enlargement in the left upper
abdomen (enlarged spleen)
Multiple Myeloma
- recurrent bacterial infections (especially
pneumococcal pneumonias)
- anemia with weakness and fatigue
- bleeding tendencies
- Bone destruction
- skeletal/bone pain (especially pelvis,
spine and ribs)
- spontaneous fracture
- osteoporosis
-hypercalcemia (confusion, increased
urination, loss of appetite, abdominal
pain, vomiting, and constipation
- Renal Involvement
- kidney stones
- renal insufficiency
- Neurologic abnormalities
- carpal tunnel syndrome
- back pain with radicular symptoms
spinal cord compression (motor or
sensory loss, bowel/bladder
dysfunction, paraplegia)
Hodgkin’s Disease
- painless, progressive enlargement of
unilateral lymph nodes, often in the neck
- pruritus (itching) over entire body
- unexplained fevers, night sweats
- anorexia and weight loss
- anemia, fatigue, malaise
- jaundice
- edema
- nonproductive cough, dyspnea, chest pain,
cyanosis
- nerve root pain
- paraplegia
Non-Hodgkin’s Lymphoma
- enlarged lymph nodes
- fever
- night sweats
- weight loss
- bleeding infection
- red skin and generalized itching of
unknown origin
AIDS- NHL
- painless, enlarged mass
- subcutaneous nodules
- constitutional symptoms (fever, night
sweats, weight loss)
- musculoskeletal lesions (lytic bone, pain,
swelling)
Soft Tissue Sarcoma
- persistent swelling or lump in a muscle
(most common finding)
- pain
- pathologic fracture
- local swelling
- warmth of overlying skin
Osteosarcoma
- pain and swelling of the involved body part
- loss of motion and functional movement of
adjacent joints
- tender lump
- pathologic fracture
- occasional weight loss
- malaise
- fatigue
Ewing’s Sarcoma
- increasing and persistent pain
- increasing and persistent swelling over a
bone (localized over the area of tumor)
- decrease in movement if a limb bone is
involved
- fever
- fatigue
- weight loss
Chondrosarcoma
- back or thigh pain
- sciatica
- bladder symptoms
- unilateral edema
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Brain Tumors
- Increased intracranial pressure
headache, especially retro orbital
nausea and vomiting
visual changes (blurring, blind spots,
diplopia)
- Changes in mentation
difficulty concentrating (e.g., reading)
memory loss
personality change, irritability
increased sleeping
- Seizures (without previous history)
- Sensory changes
- Muscle weakness or hemiparesis
- Bladder dysfunction
- Increased lower extremity reflexes
compared with upper extremity reflexes
- Decreased coordination, ataxia
- Positive Babinski reflex
- Clonus (ankle or wrist)
Spinal Cord Tumors
- pain
- decreased sensation
- spastic muscle weakness
- progressive muscle weakness
- muscle atrophy
- paraplegia or quadriplegia
- thoracolumbar pain
- unilateral groin or leg pain
- pain at rest and/or night pain
- bowel/bladder dysfunction (late finding)
FROM: DIFFERENTIAL DIAGNOSIS IN
PHYSICAL THERAPY, GOODMAN AND
SNYDER, 3rd edition.
Clues to Screening for Cancer
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Age older than 50 years
Previous personal history of any cancer,
especially in the presence of carpal tunnel
symptoms, back pain, shoulder pain, or
joint pain of unknown or rheumatic cause at
presentation
Any woman with chest, breast, axillary, or
shoulder pain of unknown cause
Anyone with back, pelvic, groin, or hip
pain accompanied by vague abdominal
complaints, palpable mass
For women: Prolonged or excessive
menstrual bleeding (or in the case of the
postmenopausal woman who is not taking
hormone replacement, breakthrough
bleeding)
For men: Additional presence of sciatica
and past history of prostate cancer
When a back “injury” is not improving as
expected or if symptoms are increasing
Early warning signs, including proximal
muscle weakness and changes in deep
tendon reflexes
Recent weight loss of 10 pounds or more
within 1 month (weight gain is more typical
with true musculoskeletal dysfunction
because pain has limited physical activities)
Constant pain (unrelieved by rest or change
in position)
Pain present at night
Signs of nerve root compression must be
screened for cancer as a possible cause
Development of new neurologic deficits
(e.g., weakness, sensory loss, reflex change,
bowel or bladder dysfunction)
Changes in size, shape, tenderness, and
consistency of lymph nodes, especially
painless, hard, rubbery lymph nodes present
in more than one location and occurring for
more than 4 weeks
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