Cancer clinical presentation

Burgers JK, Badalament RA, Drago JR (1992) Penile cancer. Clinical presentation, diagnosis, and staging. Urol Clin North Am 19 247-256... 

Early diagnosis of skin cancer is the key to improved prognosis. Diagnostic accuracy and clinical skills are two essential factors in the appropriate management of skin cancer. On presentation to a clinician s office, patients may offer a history of a new growth or an area of irritation. Conversely, the skin cancer may have been present for years undetected by the patient. The definitive diagnosis of any suspected cutaneous malignancy should be confirmed by a biopsy prior to treatment. 

LP is a 58-year-old man with newly diagnosed stage IIIA non-small cell lung cancer who presents to the clinic complaining of loss of appetite, excess thirst, nausea and vomiting, and confusion x 2 days. The medication history lists NKDA, hydrochlorothiazide 50 mg by mouth daily for hypertension, and naproxen 500 mg by mouth twice daily for arthritis. 

Rebbeck TR, Jaffe JM, Walker AH, Wein AJ, Malkowicz SB. Modification of clinical presentation of prostate tumours by a novel genetic variant in CYP3A4. J Natl Cancer Inst 1998 90 1225-1229. 

The differential diagnosis of depression is organized along both symptomatic and causative lines. Symptomatically, major depression is differentiated from other disorders by its clinical presentation or its long-term history. This is, of course, the primary means of distinguishing psychiatric disorders in DSM-1V. The symptomatic differential of major depression includes other mood disorders such as dysthymic disorder and bipolar disorder, other disorders that frequently manifest depressed mood including schizoaffective disorder, schizophrenia, dementia, adjustment disorder, and post-traumatic stress disorder, and, finally, other nonpsychiatric conditions that resemble depression such as bereavement and medical illnesses like cancer or AIDS. 

PEM is one of the most frequent cancer-associated syndromes. This complex disorder usually affects several areas of the CNS. Cerebellar and brain stem disorders, as well as limbic encephalitis, are the most common clinical presentations of PEM [31, 32], Focal involvement of the sensorimotor cortex has been described in a few cases [33], and PEM may manifest as epileptic seizures or epilepsia partialis continua [33, 34], or as extrapyramidal symptoms [35], Two-thirds of the patients are affected in both the CNS and the peripheral nervous system. The predominant feature in more than half of these is SN [32, 36], hence the commonly used term is PEM/SN. Autonomic dysfunction is common in PEM/SN patients [36], often presenting as gastrointestinal dysmotility [37]. 

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