Signs and Symptoms of Cancer Metastasis in Hospice

Introduction

Actual symptom occurrence and extent is dependent upon tumor size and exact location. Not all patients will experience these symptoms nor will they experience them to the same extent. Many etiologies can be responsible for the development of various symptoms; careful assessment must be utilized to differentiate metastatic disease from various other etiologies.

Symptoms

Bone: Somatic Pain (with tenderness and/or warmth over lesion), Fractures, Spinal Cord Compression, Functional Limitation, Neurological Dysfunction, Hypercalcemia (most tumors capable of bone metastasis can also produce hypercalcemia).

Skin: Melanoma: Asymmetrical lesion with border irregularity and color variation with diameter typically greater than 0.6 cm. Malignant wounds/fungating lesions – typically characterized by excessive purulent drainage and odor. Poor vascular perfusion and altered collagen synthesis result in tissue ischemia and necrosis.

Lung: Hemoptysis, Visceral Pain, Dyspnea, Pleural Effusion, Cough, Wheezing

Liver: Weight loss, Fullness in epigastrium (especially) after meals, Visceral Pain (may radiate to right scapula), Profound progressive weakness and fatigue, Swelling, Cirrhosis, Elevated liver enzyme levels and liver function tests

Bowel/rectum: Palpable mass on rectal and/or colon/abdominal examination, Evidence of blood in feces, Pain

Nodes: Palpable, usually nontender, hard lymph nodes

Kidney: Pain, Bleeding, Endocrinopathy

Brain: Increased Intracranial Pressure – headache, papilledema/visual disturbance, cognitive impairment, vomiting, cranial nerve dysfunction, neurologic deficits, seizures, coma.

Meninges: Headache (with or without neck stiffness), Pain in lower back and buttocks, Cauda Equina Damage, Malignant Cells in CSF

References

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