A5. General symptoms of tumors

Malignancies can present with many different signs and symptoms, most of which are unspecific.

Cancer's "seven warning signs"

According to a surgery lecture, these are “cancer’s seven warning signals”:

• Change in bowel or bladder habits
• A sore that does not heal
• Unusual bleeding or discharge
• Thickening or lump in breast or elsewhere
• Indigestion or difficulty in swallowing
• Obvious change in wart or mole
• Nagging cough or hoarseness

The following are other non-specific symptoms of cancer:

• Anaemia
• Weight loss
• Loss of appetite
• Weakness

Paraneoplastic syndrome refers to any sign or symptom which occurs due to hormone or cytokine production by tumour cells, or by the immune response to the malignancy. Generally, it's defined as any syndrome due to non-metastatic effects of the malignancy. Paraneoplastic syndromes are rare, occuring in somewhere from 2-20% of malignancies. They often develop before the cancer diagnosis.

It’s important to recognise these diseases because they can give earlier diagnosis of the tumour and because their prognosis is better the earlier the treatment is initiated.

"B symptoms" - fever, night sweats, and weight loss

Three constitutional symptoms for malignancy are especially well known. These are the so-called "B symptoms":

• Fever (38°C at least)
• Drenching night sweats (the clothes and bed sheets are soaked through by sweat)
• Unintentional weight loss >10% of weight in the last 6 months

These symptoms are called B symptoms because in the Ann-Arbor staging for Hodgkin lymphoma, the presence of these symptoms confer a worse prognosis and the tumour stage is denoted "B" if present (and "A" if absent). Despite originally being used in lymphomas, B symptoms may be present in any malignancy. The presence of B symptoms is a sign of systemic inflammation and a poor prognostic sign.

Cachexia, a severe catabolic state which leads to extreme weight loss and muscle wastage, may occur due to malignancy. It occurs due to production of TNF alpha and other cytokines by the tumour. Loss of appetite may also occur and contribue to the weight loss.