Cancer may lead to pain, weight loss, neuropathy, nausea, fatigue, seizures, or obstruction of visceral organs. Death typically occurs as a result of failure of one or more organ systems.
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 Pain: Treatment of Pain).
Cardiac tamponade can result from malignant pericardial effusion and often occurs precipitously. The most common causes are breast cancer, lung cancer, and lymphoma. The preceding effusion may cause ill-defined chest pain or pressure that is worse when patients are supine and better when they are sitting up (see Pericarditis: Cardiac tamponade). Patients with tamponade may experience signs and symptoms of decreased cardiac output (eg, dizziness or syncope). On physical examination, heart signs may be muffled and a friction rub and pulsus paradoxus may be present. X-ray may show a globular cardiac silhouette. Pericardiocentesis should be done for diagnostic and therapeutic purposes, and a pleuropericardial window or pericardiectomy should be considered.
Pleural effusions should be drained if symptomatic and monitored for reaccumulation. If the effusion reaccumulates rapidly, thoracostomy tube drainage (see Diagnostic Pulmonary Procedures: Tube Thoracostomy) and sclerosing agents or repeated catheter drainage should be considered. Palliative surgical pleurectomy can be used for refractory effusions in advanced malignant disease.
Spinal cord compression (see Spinal Cord Disorders: 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 often cause complications in cancer patients. Tumors produce procoagulants, such as tissue factors, leading to excess clot formation, particularly in after surgery. Anticoagulants 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 complications.
Last full review/revision August 2008 by Bruce A. Chabner, MD; Elizabeth Chabner Thompson, MD, MPH