Symptoms Depend on Type and Location

Symptoms Depend on Type and Location

This module is to give a basic understanding of how symptoms of a cancer can point to the type or location of the cancer. Many cancers are discovered after they cause certain symptoms which prompt an investigation. The symptoms of a cancer can roughly divided between those that affect the entire body compared with those that affect a specific location. An example of each of these might be a tumor of the adrenal gland compared with a thyroid cancer. A tumor of the thyroid that turns out to be cancer will cause problems in the neck related to its growth and involvement in that area. The thyroid gland is a shield like gland that is found in the front of the neck just on top of the airway. If a tumor of the thyroid grows it will push on things in that area. This would be referred to as local or regional disease. If the tumor spread to lymph nodes in the neck and they were enlarged then these would cause pressure in that area as well.

The symptoms of a cancer in a certain region of the body can almost always be understood by considering what lives in that “neighborhood”. For example, a tumor growing on the thyroid gland would push on the airway (tracheal compression causing shortness of breath), might push on the swallowing tube (esophageal compression causing difficulty swallowing or dysphagia), and pressure on the nerves in the neck might cause various weakness of muscles of the head or neck as well as a sensation of numbness (or paresthesia).

An understanding of human anatomy and the function of each organ system will make the disturbing or confusing symptoms relate together and make sense. For example, a man who complains of weight loss, pain in the chest and difficulty swallowing who has been a heavy smoker and alcoholic for many years likely has a cancer of the esophagus. Sometimes the growth or symptoms are more obvious such as the above examples. A tumor of the adrenal gland might be a bit more subtle. Perhaps a cancer of the adrenal gland will only cause vague pain or discomfort in the abdomen without other specific symptoms.

Some cancers are known to have very few symptoms until they are far advanced whereas other tumors cause symptoms early on making them known. A good example of these differences that might occur in the same organ system would be a tumor of the pancreas. The pancreas is an organ that sits roughly in the middle of the abdomen and is shaped like a fish; it has a head, neck, body and tail. The drainage tube (or pancreatic duct and bile duct), exits the head of the pancreas. A tumor of the head of the pancreas will quickly block the excretion of the pancreas and liver causing pain and yellow hue to the skin (known as jaundice). A tumor in this area will be found more quickly because the symptoms will be readily apparent and raise a red flag that something is wrong. Conversely, a tumor in the tail of the pancreas may not cause symptoms right away or even be there for months to years before it is detected. This is why a cancer of the pancreas found in the tail is generally harder to treat and likely more advanced than one in the head of the pancreas. A consistent theme with cancers is that the function and location dictates the severity and course of the disease.

Examples of common effects from tumor involvement are given below:

Organ/structure involved

  • Intestinal tumor
  • Invasion of nerve
  • Brain
  • Breast
  • Esophagus
  • Bone
  • Spine
  • Bladder
  • Prostate

Common symptom

  • intestinal blockage
  • weakness or numbness in the area supplied
  • headache
  • lump felt
  • difficulty swallowing
  • fracture or pain in the bones
  • weakness or paralysis
  • Blood in urine
  • Difficulty passing urine

It is possible for different types of tumors to grow in a similar location and cause different types of problems or differing level s of severity. An example of this might be a tumor of the muscle that grows on the thigh such as a myosarcoma. The prefix “myo” refers to muscle and the suffix sarcoma refers to a tumor that comes from the mesoderm layer (such as muscle, bone or fat). If one person has a less aggressive (low grade) myosarcoma of the thigh muscle, they may feel a lump but not have much pain from it. A low grade myosarcoma may also be easily curable as it will be less likely to spread to other areas of the body. Conversely, if a second person has a more aggressive (high grade) myosarcoma of the same area of the thigh muscle this may be much more difficult to treat. A high grade sarcoma will likely cause more pain locally and will be more likely to spread. It may not be possible to cure a high grade sarcoma that has already spread to other areas of the body by the time it is diagnosed.

There are many examples similar to this of different types of behaviors of the same type of cancer. This is why it is very important to get a sample of the tumor because the characteristics of it (and thus the eventual outcome or prognosis) can be gauged by its appearance under the microscope. Another common example of differing behaviors would be of breast cancer. Often, if a woman is told she has breast cancer she may immediately think that she will die from the cancer because she knew someone who had a really aggressive tumor. There are many different types of breast tumors and vary widely in prognosis.

REFERENCES:

  1. Goldman, L ; Schafer A.I. (2011). Goldman: Goldman’s Cecil Medicine, 24th ed. Chapters 182-183.New York,NY: Elsevier Saunders.
  2. Abeloff, M.D. (2008). Abeloff: Abeloff’s Clinical Oncology, 4th ed. Part II – Section A.Philadelphia,PA: Churchill Livingstone – Elsevier
  3. www.cancer.gov/cancertopics/factsheet/Sites-Types
  4. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.