Instant Wisdom for GPs by Hopcroft Keith;

Author:Hopcroft, Keith;
Language: eng
Format: epub
Publisher: CRC Press LLC
Published: 2017-09-22T00:00:00+00:00

Obscure or overlooked diagnoses

1.Haematological malignancies

These are fortunately rare but impossible to diagnose without getting a full blood count. The prognosis is very variable and can only be accurate after suitable laboratory investigation. Avoid getting drawn into outcome conversations until after this is completed.

2.Childhood cancers

These are extremely rare and mostly curable. Possible symptoms of something being seriously amiss include lethargy, failure to concentrate, weight loss, difficulty in interacting with others and general withdrawal. It is best to believe the mother if she says something’s wrong and it persists. The family will need considerable support during and after what is often protracted chemotherapy and sometimes radiotherapy. However inconvenient, it’s worth travelling to a specialised unit for best care.

3.Cancer of unknown primary (CUP)

This is a very distressing diagnosis for patients as they can’t explain to others the type of cancer they actually have. Usually presenting with lymph node, liver or lung metastases, a biopsy may be completely unhelpful in determining the tissue of origin, especially if poorly differentiated. Most cancer centres use a straightforward protocol to try to sort out the best therapy, but the prognosis is generally poor except for lymphomas and germ cell tumours.

4.Unexplained weight loss

A rare presentation of a wide range of different cancers, sometimes with no localising symptoms whatsoever. Get a chest X-ray, abdominal ultrasound and the usual blood work. If no clues become apparent refer to a local general physician – if you do not have one, then a gastroenterologist is your best bet.

5.Solitary lymph node enlargement

The critical diagnostic is a biopsy or excision. The differential is wide – metastasis, lymphoma, inflammatory, infection and sarcoid. Avoid jumping to conclusions until the histology is back. With an unexplained cervical node, an ENT referral is probably best in older patients and a general surgeon for those under 60.

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