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When cancer begins it invariably produces no symptoms with signs
and symptoms only appearing as the mass continues to grow or
ulcerates. The findings that result depend on the type and location of
the cancer. Few symptoms are specific, with many of them also
frequently occurring in individuals who have other conditions. Cancer
is the new "great imitator". Thus it is not uncommon for people
diagnosed with cancer to have been treated for other diseases to which
it was assumed their symptoms were due.
Local symptoms may occur due to the mass of the tumor or its
ulceration. For example, mass effects from lung cancer can cause
blockage of the bronchus resulting in cough or pneumonia; esophageal
cancer can cause narrowing of the esophagus, making it difficult or
painful to swallow; and colorectal cancer may lead to narrowing or
blockages in the bowel, resulting in changes in bowel habits. Masses
in breasts or testicles may be easily felt. Ulceration can cause
bleeding which, if it occurs in the lung, will lead to coughing up
blood, in the bowels to anemia or rectal bleeding, in the bladder to
blood in the urine, and in the uterus to vaginal bleeding. Although
localized pain may occur in advanced cancer, the initial swelling is
usually painless. Some cancers can cause build up of fluid within the
chest or abdomen.
General symptoms occur due to distant effects of the cancer that are
not related to direct or metastatic spread. These may include:
unintentional weight loss, fever, being excessively tired, and changes
to the skin. Hodgkin disease, leukemias, and cancers of the liver
or kidney can cause a persistent fever of unknown origin.
Specific constellations of systemicsymptoms, termed
paraneoplastic phenomena, may occur with some cancers. Examples
include the appearance of myasthenia gravis in thymoma and clubbing in
Symptoms of metastasis are due to the spread of cancer to other
locations in the body. They can include enlarged lymph nodes (which
can be felt or sometimes seen under the skin and are typically hard),
hepatomegaly (enlarged liver) or splenomegaly (enlarged spleen) which
can be felt in the abdomen, pain or fracture of affected bones, and
neurological symptoms. Most cancer deaths are due to cancer that
has spread from its primary site to other organs (metastasized).