Primary cancer symptoms
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Primary Cancer Symptoms: An Overview
Brain and Central Nervous System (CNS) Cancer Symptoms
New-Onset Seizures and Diagnostic Challenges
In primary care, the risk of brain/CNS cancer is notably low for most symptoms, with new-onset seizures being the exception. This symptom has a positive predictive value (PPV) of over 1% in adults, increasing to 2.3% in those aged 60-69 years 1. However, the overall low PPVs for other symptoms pose a diagnostic challenge, often leading to delayed diagnosis and poor prognosis 1.
Core Symptoms in Brain Tumor Patients
Patients with primary brain tumors frequently report a core set of symptoms, including fatigue, drowsiness, memory difficulties, disturbed sleep, and distress. These symptoms significantly interfere with daily activities and quality of life 2. The prevalence of these symptoms underscores the need for comprehensive symptom management in clinical care 2.
Symptom Clusters in Cancer Patients
Common Symptom Clusters
Cancer patients often experience multiple symptoms that appear in clusters. Commonly identified clusters include fatigue-pain, fatigue-insomnia, and anxiety-depression. These clusters are influenced by the primary cancer site, disease stage, and treatment type 3. For instance, nausea and vomiting often cluster together, as do anxiety and depression 3.
Advanced Cancer Symptom Clusters
In advanced cancer patients, distinct symptom clusters such as fatigue, drowsiness, nausea, decreased appetite, and dyspnea are prevalent. These clusters account for a significant portion of the symptom burden and are influenced by the primary cancer site 8. Addressing these clusters rather than individual symptoms may offer better therapeutic outcomes 8.
Symptoms in Pediatric Cancer
General and Unspecified Symptoms
Children with cancer typically present with few symptoms, most of which are general and unspecified, such as pain, swelling, or fatigue. Only a small percentage present with alarm symptoms, which can delay diagnosis 4. This highlights the importance of careful symptom evaluation in pediatric patients to ensure timely diagnosis and treatment 4.
Symptoms in Advanced Cancer
Prevalent Symptoms
Patients with advanced cancer commonly experience symptoms like pain, fatigue, and anorexia. These symptoms are consistently among the most prevalent and severe across various cancer types 5. The high prevalence of these symptoms necessitates focused symptom management to improve patient quality of life 5.
Long-Term Symptoms in Cancer Survivors
Persistent Symptom Burden
Cancer survivors often continue to experience symptoms long after completing primary treatment. Common long-term symptoms include physical and cognitive limitations, depression, anxiety, sleep problems, fatigue, pain, and sexual dysfunction 6. These symptoms can persist for over a decade, indicating the need for ongoing symptom management in survivorship care 6.
Oesophagogastric Cancer Symptoms
Diagnostic Value of Symptoms
In primary care, symptoms like dysphagia, weight loss, and anemia are strongly associated with oesophagogastric cancers, although they have relatively low sensitivity and high specificity. These findings support the need for thorough investigation of these symptoms to improve early diagnosis 7.
Conclusion
Understanding the primary symptoms of various cancers is crucial for early diagnosis and effective management. While some symptoms like new-onset seizures in brain cancer or dysphagia in oesophagogastric cancer have higher predictive values, many cancer symptoms are non-specific and pose diagnostic challenges. Symptom clusters and long-term symptom burdens further complicate patient care, underscoring the need for comprehensive and ongoing symptom management strategies.
Sources and full results
Most relevant research papers on this topic
Symptomatic diagnosis of cancer of the brain and central nervous system in primary care: a systematic review.
All symptoms of brain tumors are low risk, except for new-onset epilepsy, posing a diagnostic challenge and requiring liberalized investigation for better outcomes.
Systematic Review
Rigorous JournalThe symptom burden of primary brain tumors: evidence for a core set of tumor- and treatment-related symptoms.
A core set of symptoms common in other solid tumor patients is present in primary brain tumor patients, impacting clinical care and treatment assessment.
Observational StudyRigorous Journal
Highly CitedCancer symptom clusters: clinical and research methodology.
Nausea-vomiting, anxiety-depression, and dyspnea-cough clusters are common cancer symptoms, with potential clinical importance.
Systematic ReviewHighly CitedPresenting symptoms of children with cancer: a primary-care population-based study.
Children with cancer present with few symptoms in general practice, most of which are 'general and unspecified'; only 20% present alarm symptoms, and 27% present vague and non-specific symptoms, which may influence the time from symptom presentation to final diagnosis.
Observational StudyRigorous JournalThe symptoms of advanced cancer.
Advanced cancer patients experience polysymptomatic symptoms, with pain, anorexia, and easy fatigue being the most prevalent and clinically important at most primary sites.
Literature ReviewHighly CitedIt's Not over When it's Over: Long-Term Symptoms in Cancer Survivors—A Systematic Review
Cancer survivors experience long-term symptoms, including depressive symptoms, pain, and fatigue, for more than 10 years after treatment completion.
Systematic ReviewHighly CitedDiagnostic value of symptoms of oesophagogastric cancers in primary care: a systematic review and meta-analysis.
Dysphagia, weight loss, and anaemia are the strongest diagnostic features of oesophagogastric cancers in primary care, but other symptoms may be less reliable.
Meta-AnalysisSymptom clusters in patients with advanced cancers
In advanced cancer patients, distinct symptom clusters can be identified, influenced by primary cancer site, suggesting targeted treatments may provide greater therapeutic benefit.
Observational StudyHighly CitedRisk of ovarian cancer in women with symptoms in primary care: population based case-control study
Women with ovarian cancer often report symptoms to primary care, often months before diagnosis, which can help select patients for investigation and guideline development.
Observational StudyRigorous JournalHighly CitedCancer diagnosis in primary care.
Primary care diagnosis of common UK cancers like breast, lung, colon, and prostate requires GPs to assess symptoms and determine whether cancer is a possible explanation, despite the presence of benign diseases.
Literature ReviewHighly Cited