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