Sign and Symptoms of metastases (the common sites)

Manifestation would be depending on the site of metastases. It is true that cancerous cell can metastases like almost everywhere it wants, hijacking anywhere they are settled in. But there are favored organs or site which are commonly found, probably due to receptor-molecular-blah-blah thingy. If you know it, it is a bonus then.  Sometimes, the sign and symptoms of metastases might be found much earlier. 

1. Lymph node

• Lymphadenopathy which is not mobile as it commonly is fixated, irregular margins and any characteristics which are suggestive of malignant lumps. But, if the location is intraabdominal, I t can only be visualized by imaging unless if it get soooooo big.

• Sentinel lymph node is the first site of LN which are first to be infiltrated. How do they know it is the sentinel LN is by injecting radioactive liquid into tumor  which nodes got colored via scan.

• Nontender

2. Liver

• Jaundice as it deposited in liver

• Hepatomegaly- abdominal discomfort

• Obstructive jaundice can also be caused by extensive liver deposits or LN in porta hepatis compressing the bile duct

3. Lung

• Cough 

• Hemoptysis

• SOB due to pleural effusion --->Collection of fluid in the pleural space

o Trachea and apex beat displaced away from a massive effusion

o Expansion reduced on affected site

o Stony dullness over the fluid

o Breath sounds reduced or absent

o Vocal resonance reduced

4. Bone

• Pathological fracture

• Bone pain

• Sometimes may cause stenosis of it affect vertebrae and compressing the spinal cord. Patients may come with weakness of lower limbs bilaterally if it compressing the lumbar parts. Look for any bowel incontinence or urination habit is altered as that may signify compression of cauda equina. Do more reading on that!

5. Brain 

• Headache

• Blurred vision

• Seizure

• Limb weakness

• Paresis, ataxia

• Behavioral or personality changes

• SSx of space occupying lesion 

6. Other common sites are peritoneum or adrenal glands.

References :

1. Talley O connor Physical Examination textbook
2. Burkitt, H.G, et. al, Essential Surgey: Problems, Diagnosis & Management(2007), Fourth Edition.