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Red Flags

Assessment of these areas should raise concern whether the problem has a systemic or viscerogenic origin.

Past Medical Hx

  • Personal/family Hx of cancer

  • Recent infection when followed by neurological Sx, joint or back pain

  • Recent Hx of trauma

  • Hx of immunosuppression

  • Hx of drug use: injection

Risk Factors of Possible Systemic Disease

  • Substance abuse including alcohol, drug, or tobacco

  • Age

  • Gender

  • BMI

  • Exposure to radiation

  • Race/ethnicity

  • Sedentary lifestyle

  • Domestic violence

  • Hysterectomy

  • Occupation

Clinical Presentation

  • Insidious onset/unknown etiology

  • Sx not improved or relieved by physical therapy

  • Significant weight loss or gain without attempting to lose or gain

  • Gradual, progressive, or cyclical presentation of Sx

  • Sx that are unrelieved by rest or change of position

  • Sx persisting beyond expected time of condition

  • Sx do not fit typical neuromuscular or musculoskeletal pattern

  • A growing mass or a hematoma that is not decreasing in size

  • Postmenopausal bleeding

  • Bilateral Sx such as edema, numbness, tingling, clubbing, nail bed changes, skin rash, or pigment changes

  • Change in muscle tone or ROM in those with neurological conditions

Pain Pattern

  • Pain w/full painless ROM

  • Pain not consistent with psychological overlay

  • Throbbing or deep, aching pain

  • Poorly localized pain

  • Pain that comes and goes like spasms

  • Pain associated with S&S relating to certain viscera or system, e.g., GI, GU, cardiac, pulmonary

  • Change of pain with food intake

Associated S&S

  • Unusual menstrual cycle or Sx

  • Presence of unusual/abnormal vital signs, including HR, temp, etc

  • Proximal muscle weakness and/or DTRs

  • Change in mental status including confusion

  • Joint pain with skin rashes

Cancer Assessment

Early Warning Cancer Signs (American Cancer Society)

  • Changes in bowel/bladder habits

  • Sore that does not heal in 6 wk

  • Unusual bleeding or discharge

  • Thickening or lump in breast or elsewhere

  • Indigestion or difficulty in swallowing

  • Obvious change in wart/mole

  • Nagging cough or hoarseness

  • Proximal muscle weakness

  • Change in deep tendon reflexes

Other Screening Clues

  • Previous personal Hx of any cancer

  • Recent wt loss of 10 lb or more within 1 mo

  • Constant pain, unrelieved by rest or change in position

  • Night pain

  • Development of new neurological deficits

  • Changes in size, shape, tenderness, & consistency of lymph nodes, painless & present in >1 location

  • Women: chest, breast, axillary, or shoulder pain of unknown cause

  • Bloody sputum

Adapted from Goodman C. and Snyder T. Differential Diagnosis for Physical Therapists, ed. 4. Philadelphia: Elsevier, 2006. p. 7.

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Types of Cancer
Type Etiology/Location
Adenocarcinoma Glandular tissue
Carcinoma Epithelial tissue
Glioma Brain, supportive tissue, spinal cord
Leukemia Blood-forming cells
Lymphoma Lymphatic cells
Melanoma Pigment cells
Myeloma Plasma cells
Sarcoma Mesenchymal cells

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