Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • bone pain
  • FHx of cancer

Other diagnostic factors

  • jaundice
  • ascites
  • personal hx of previous cancer
  • hx of smoking
  • pain
  • palpable mass
  • symptoms of post-obstructive pneumonia
  • neurological pain or weakness
  • headaches
  • seizures
  • cervical chain adenopathy
  • constitutional symptoms
  • depression
  • delirium
  • hx of heavy alcohol consumption
  • hepatomegaly
  • haemoptysis

Risk factors

  • age >60 years
  • black ancestry

Diagnostic investigations

1st investigations to order

  • CXR
  • CT (chest, abdomen, pelvis)
  • mammography
  • MRI of breast
  • transvaginal ultrasound
  • diagnostic paracentesis
  • upper aerodigestive panendoscopy (for patients with isolated cervical adenopathy)
Full details

Investigations to consider

  • colonoscopy (for patients with resectable liver metastases)
  • light microscopy, with haematoxylin and eosin (H&E) staining
  • immunohistochemical (IHC) markers
  • oestrogen and progesterone receptor status
  • serum tumour markers
Full details

Emerging tests

  • positron emission tomography (PET)
  • gene expression profiling
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Director

Division of Medical Oncology

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

RCD declares that he has no competing interests.

Dr Ross C. Donehower would like to gratefully acknowledge Dr David Cosgrove and Dr Hatim Hussain, previous contributors to this monograph. DC and HH declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Department of Medicine

Roswell Park Cancer Institute

Buffalo

NY

Disclosures

NK declares that he has no competing interests.

Associate Professor

Radiation Oncology

Children's Hospital of Philadelphia

Philadelphia

PA

Disclosures

ZT declares that he has no competing interests.

Consultant Medical Oncologist/Senior Lecturer

Department of Medical Oncology

Imperial College/Imperial Healthcare NHS Trust

Charing Cross Hospital

London

UK

Disclosures

JS declares that he has no competing interests.

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