Physical examination and appearance
During a physical examination of the patient, the physician relies on classical physical methods: inspection, palpation, and auscultation. Assessment of the patient's appearance is of paramount importance, yet it changes radically depending on the stage of the pathological process.
In the early stages, specific clinical manifestations are usually completely absent. Patients may look completely healthy, retain a so-called «thriving appearance», and their body weight remains within normal limits or may even be elevated. For this reason, visual assessment at the initial stage often gives no obvious cause for concern.
The situation changes cardinally in advanced forms of the disease. In these cases, characteristic changes in appearance develop, primarily pronounced body wasting. It was precisely by such striking visual signs that physicians of the past made diagnoses when early instrumental diagnostic methods were unavailable.
«Plus-tissue» syndrome
This symptom complex is particularly characteristic of various precancerous conditions, as well as the initial stages of cancer affecting the epithelium of the skin and mucous membranes. It is based on proliferative changes—excessive cell proliferation.
Diagnosis of the syndrome is most often carried out visually during a routine examination or using special optical instruments. Typical clinical manifestations include:
- The appearance of leukoplakia (characteristic white patches on mucous membranes).
- Proliferation of the surface epithelium of the mucosa, which may not be palpable at all.
- Transformation of pre-existing benign lesions, such as papillomas, polyps, or moles. Any changes in their initial size, density (consistency), or color should raise suspicion.
- The presence of senile dyskeratoses.
Pathological discharge syndrome
A key and most formidable manifestation of this syndrome is bloody discharge or overt bleeding. The presence of blood admixture is a very common sign of a malignant tumor, especially relevant for advanced stages of the oncological process.
In clinical practice, there is a strict tactic: absolutely any bleeding or appearance of bloody discharge dictates the necessity of mandatory instrumental or laboratory investigation. The main goal of such a thorough check is the reliable exclusion of cancer.
Functional impairment syndrome
The occurrence of this syndrome is due to a combination of anatomical damage to structures and functional disruptions in the work of the affected organ. The severity and time of onset of symptoms directly depend on the localization of the neoplasm and the anatomical volume of the organ itself.
- Intraorgan growth in small structures. If a tumor grows in small organs or narrow ducts, the symptoms of obstruction appear very early. A classic example: involvement of the major duodenal papilla quickly leads to duct obstruction and the development of jaundice.
- Growth into the lumen of voluminous organs. When hollow organs of large diameter (e.g., the colon) are affected, mechanical obstruction forms much later, and clinical signs appear only in the far-advanced process.
Assessment of the functional state may reveal hypofunction of the affected organ (e.g., a persistent decrease in the secretory activity of the stomach). In addition, functional manifestations associated with the tumor itself are possible, when the hormonal activity of the altered tissue leads to the development of general intoxication of the body.
Features of pain syndrome
The general clinical rule states that pain is uncharacteristic of tumors, especially in their early stages of development. The absence of pain often lulls patients' vigilance. However, there are exceptions where pain appears early: these are blood vessel tumors and neoplasms of nervous tissue, where symptoms are caused by direct compression of structures.
As the disease progresses, the mechanism of pain generation is associated with the compression of adjacent healthy tissues and the infiltration of nerve trunks. The character of the pain may indicate the type of pathological condition:
- Colicky pain: most frequently occurs with the development of mechanical obstruction due to luminal obturation of the intestine by a growing tumor.
- Constant pain: serves as an alarming signal indicating the extension of the process to the serosal membrane of the organ or deep infiltration of surrounding tissues.
- Tenesmus: agonizing false urges in the anorectal region, which are a characteristic sign of rectal cancer.
Briefly: answers to topical questions
What symptoms are included in Savitsky's syndrome of small signs?
The syndrome of small signs includes a state of discomfort and signs of impaired internal organ function. General symptoms are also observed, such as fatigue, drowsiness, decreased interest in surroundings, apathy, and reduced working capacity. Specific sensations include the lack of a feeling of relief after physiological evacuation, a sensation of heaviness, and a feeling of a foreign body.
What pathological discharges, other than bloody discharge, can be observed in malignant tumors?
In cervical cancer, besides bloody discharge, purulent and foul-smelling discharge may be observed. Blood admixture is also a frequent sign of a malignant tumor, especially in advanced stages.
What clinical symptoms are characteristic of tumor intoxication syndrome?
Tumor intoxication syndrome is characterized by fever, rapid fatigue, and weight loss. In malignant diseases, progressive weight loss combined with loss of appetite and anorexia may also be noted. In nodal T-cell lymphomas, profuse sweating is possible, predominantly in the evening and nighttime.
What paraneoplastic syndromes develop in malignant neoplasms?
In malignant neoplasms, Trousseau's paraneoplastic syndrome may develop—phlebothrombosis associated with tumor-induced hypercoagulation.
To memorize the basic clinical manifestations, you can use the PVD rule: Plus-tissue, Discharge (pathological), Organ dysfunction.
Class and exam questions
Does an oncology patient always look emaciated?
No, wasting (emaciation) is not characteristic of early stages. Patients may maintain a healthy appearance and normal body weight; cachexia develops in advanced forms.
Is pain an early sign of cancer?
As a rule, no. The only exceptions are tumors of neural tissue or blood vessels, where pain syndrome appears early due to compression.
Why does obstruction occur late in large bowel tumors?
The large intestine is a voluminous organ with a wide lumen. It takes a considerable amount of time for a tumor to completely block this lumen and cause obturation.
What else to study on this topic
- Instrumental methods for ruling out cancer in bleeding
- Differential diagnosis of senile dyskeratoses and melanoma
- Mechanisms of tumor intoxication development
- Pathogenesis of tenesmus in rectal lesions
Master the entire topic in the "General Surgery" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Main Syndromes in Oncology" and another 3,335 pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 70 video lessons on the subject
Other topics in "CHAPTER 14. TUMORS"
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.