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Mass Syndrome

The presence of a tumour may alone constitute a revealing symptom, either directly or by the disturbances that it induces. As cancer invades the nearby healthy structures, the tumour mass is generallyirregular and hard upon palpation.

On peut citer comme exemples

Here are a few examples:

• a lump in the breast
  
• brain mass with cerebral oedema (inducing intra cranial hypertension with headache, vomiting and seizures),
  
• dysphagia provoked by an oesophageal tumour,
  
• ureteral and/or urethral compression in relation to a prostate cancer
  
• small bladder syndrome (urgency) in relation to a bulky bladder carcinoma,
  
• various digestive disorders provoked by colic or ovarian carcinoma,
  
• bulky indolent testicle typical of testis cancer.

Local invasion

The cancerous tumour locally invades the organ, modifying its aspect or perturbing its functions:

• classical 'peau d'orange' (orange peel aspect) when breast cancer invades the skin,
  
• dysphonia when a vocal chord is invaded by a laryngeal carcinoma,
  
• deglutition disorders in relation with oesophageal or head and neck tumours,
  
• dyspepsia in relation to gastric tumours,
  
• constipation in relation to colic tumours.

When the cancer tumour invades the nearby structures, other symptoms are observed:

• compression oedema (enlargement of the arm provoked by invading breast cancer, frequent phlebitis in relation to pelvic tumours, ascitis from ovarian or gastric or colon tumours, cava superior syndrome in relation to mediastinal tumours)
  
• dyspnoea and atelectasis during lung cancer or massive lung metastases,
  
• lung carcinomatous lymphangitis restricting inspiration,
  
• pain in relation to peripheral nerves (otalgia during advanced laryngeal cancer, sciatica in relation to bone metastases or pelvic invasion),
  
• navel invasion during ovarian tumours ('syster Mary syndrome').

Haemorrhage

Since larger tumours need to be nourished, a fragile vascularisation system is elaborated by the nearby mesenchymatous structures. Haemorrhaging is therefore frequent in invading tumours:

• hemoptysis of bronchial tumours,
  
• haematemesis and melaena during gastric tumours,
  
• haematuria during bladder, kidney, ureter or prostate tumours,
  
• haemospermia during prostate cancer,
  
• rectal bleeding during rectal cancers,
  
• metrorrhagia in relation to cervix carcinoma (typically provoked by sexual intercourse) which can involve genuine flooding,
  
• menorrhagia and metrorrhagia during corpus uteri carcinoma,
  
• hemorrhagic ascitis during ovarian or digestive tumours,
  
• hemorrhagic pleurisis in relation to pleural metastases.

Every incidence of haemorrhaging requires a thorough exploration even if the patient is under anticoagulant medication.

Necrosis

Necrosis is due to poor tumour vascularisation. It frequently induces:

• healing delays,
  
• tumour infection,
  
• very strong foul-smelling (very characteristic of head and neck tumours or gynaecological tumours),
  
• spontaneous fistula or fistula occurring after irradiation,
  
• foul-smelling skin node ulceration or skin satellite nodules.

Remote evolution

Cancer discovery via a revealing metastasis occurs in approximately 15% of cancers.

• node metastases with the supraclavicular 'Troisier's' node revealing a digestive or pelvic cancer, inguinal node revealing a pelvic or a leg tumour, cervical massive nodes revealing head and neck cancers,
  
• skin metastases (in breast cancer, renal carcinoma, umbilicus 'sister Mary syndrome' in ovarian cancer, satellite tumours in melanoma...),
  
• liver metastases (revealed by jaundice or liver pains),
  
• lung metastases (rarely revealed by dyspnoea, most often by systematical lung radiography),
  
• cerebral metastases (revealed for instance by seizure),
  
• other metastases (may concern any organ).

A few typical revealing syndromes are described below:

• Colon cancer
  
• Bladder cancer
  
• Lung cancer