Key Clinical Questions
What are the next steps in evaluation and management priorities for patients admitted to the hospital with suspected cancer diagnosis, including carcinoma of unknown primary?
What are the common tests, including molecular tests, utilized for cancer diagnosis and their significance?
What are the key issues to consider before discharging a patient admitted with suspected/new cancer diagnosis?
As an inpatient provider, one must adapt to each individual patient presentation of suspected malignancy, and expedite a workup with the goal of obtaining enough clinical, laboratory, and radiographic data for diagnosis. Most patients that are ill enough to require hospitalization with suspected malignancy present with either complications of their disease, paraneoplastic syndromes, or advanced stage of cancer. While it is important to obtain a comprehensive history and physical exam, every patient should be asked about the following:
Details of symptom duration and chronology leading to admission.
Comorbidities, any previous cancers, premalignant or spontaneously regressing lesions, and/or prior history of chemotherapy or radiation.
Risk factors causing predisposition for certain malignancies such as alcohol, tobacco, drug use, occupations with notable exposures, use of hormone replacement therapy.
Family history of any malignancies.
The next steps in assessment and management can be tailored to the particular patient presentation.
Knowledge of the incidence of common cancer across various age groups may help with the pretest probability when a patient is admitted with a suspected cancer diagnosis. Five cases highlight common presentations of suspected malignancy. These cases provide a diagnostic framework, but cannot be comprehensive due to the variety or patient characteristics and disease presentations.
Important to assess for comorbidities, any previous cancers, premalignant or spontaneously regressing lesions, and/or prior history of chemotherapy or radiation.
It is estimated that there will be more than 1.5 million new cases of cancer diagnosed in the United States in 2015. Breast cancer accounts for 29% of all newly diagnosed cancers in females, and it is the most common noncutaneous malignancy among females in the United States. In 2015, it is estimated that 231,840 women will be diagnosed with breast cancer. Among males, prostate cancer is the most common malignancy and accounts for 26% of new cancer cases in males. In 2015, it is estimated that 220,840 men will be diagnosed with prostate cancer. Lung cancer is second most common cancer among males and females followed by colorectal cancer.
While heart disease is the leading cause of death among all ages, cancer is actually the leading cause of death among adults between ages 40 to 59 and 60 to 79, with lung cancer being the most common among both sexes. It is estimated that approximately 86,380 men and 71,660 women will die of lung cancer in 2015. It should be noted that while pancreatic cancer is not in the top five most common cause of ...