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Clinical Sequelae of Cancer

By Bruce A. Chabner, MD, Professor of Medicine;Clinical Director, Harvard Medical School;Massachusetts General Hospital Cancer Center ; Elizabeth Chabner Thompson, MD, MPH, Private Practice, New York Group for Plastic Surgery

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Cancer may lead to pain, weight loss fatigue or obstruction of visceral organs. Death typically occurs as a result of inanition and organ failure.

Pain in patients with metastatic cancer frequently results from bone metastases, nerve or plexus involvement, or pressure exerted by a tumor mass or effusion. Aggressive pain management is essential in the treatment of cancer and for maintenance of quality of life (see Treatment of Pain).

Pleural effusions should be drained if symptomatic and monitored for reaccumulation. If the effusion reaccumulates rapidly, thoracostomy tube drainage (see How to Do Tube Thoracostomy) and sclerosing agents or repeated catheter drainage should be considered.

Spinal cord compression (see Spinal Cord Compression) can result from cancer spread to the vertebrae and requires immediate surgery or radiation therapy. Symptoms may include back pain, lower extremity paresthesias, and bowel and bladder dysfunction. Diagnosis is confirmed by CT or MRI.

Clots in the veins of the lower extremities, leading to pulmonary emboli, are frequent in patients with pancreatic, lung, and other solid tumors and in patients with brain tumors. Tumors produce procoagulants, such as tissue factors, leading to excess clot formation, particularly in after surgery. Anticoagulation may be necessary to prevent pulmonary emboli.

Metabolic and immune consequences of cancer can include hypercalcemia, hyperuricemia, increased ACTH production, antibodies that produce neurologic dysfunction, hemolytic anemia, and many other paraneoplastic complications (see Paraneoplastic Syndromes).

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