Clinical images: Malignant disease

Cancer and the side-effects of treatment are discussed by Dr Philip Marazzi

Squamous cell carcinoma of the scalp

This 94-year-old man had served in the Far East during World War II, where he clearly received a great deal of sun exposure. He had developed a number of basal cell carcinomas over the past decade or so, but his scalp then took a significant downturn, producing a series of more aggressive squamous cell carcinomas. He was treated with surgery and radiotherapy for the lesions.


 

Non-Hodgkin's lymphoma

This elderly man presented with huge lymph nodes in his neck. He was convinced that they had just appeared, although as is often the case in these situations, they must have been present and growing for a while. A biopsy confirmed that he had diffuse large B-cell lymphoma. He had initial radiotherapy to the neck, then to an orbital metastasis. He has also had chemotherapy and so far, remains well.


Lymphoedema

This 82-year-old woman had a previous mastectomy and axillary clearance for breast cancer. Here, she demonstrates one of the problems following this operation, lymphoedema. This is the result of the disturbance to normal lymphatic flow, resulting in oedema of the limb. It is uncomfortable for the patient and carries an increased risk of becoming infected. Antibiotics should be prescribed. Improved surgical techniques and postoperative management have reduced this problem of late.


 

Secondary anal tumour

A 70-year-old woman had originally presented with a sore mouth. She had a large ulcer, which subsequently turned out to be an aggressive squamous cell carcinoma. Treatment involved initial laser therapy then more extensive surgery, but she later developed distant metastases. This image shows an anal tumour that produced a lot of pain, as well as problems with bowel dysfunction shortly before her death.


 

Malignant melanoma

This 87-year-old woman presented with a mole on her forearm. She thought it was another seborrhoeic wart, like the numerous ones dotted across her back. It was clearly not, and the irregular shape and pattern of pigmentation strongly suggested melanoma. She had a wide local excision but refused axillary clearance because she had a relative with severe lymphoedema. Histology confirmed the melanoma was 1.4mm thick. She is currently well after three months.


 

Lung cancer

This 62-year-old woman, who was an ex-smoker, presented after a road accident with this swelling over the sternum. She was convinced it was bruising from the seatbelt, but it felt hard. Further investigation revealed that she had a large bony metastasis. She also developed a pleural effusion and was found to have a lung primary. Sadly, she died from the disease within a few weeks of her initial presentation.


Glioblastoma multiforme

We often have to reassure patients with headaches that they do not have a brain tumour. This 50-year-old man presented with frontal headaches of recent onset associated with nausea, confusion and sensory inattention. This was clearly not the pattern of benign disease. Following investigation, he was found to have a grade 4 glioblastoma multiforme. Following a right parietal craniotomy, he has had chemotherapy and radiotherapy and has done very well.


 

Enteral feeding

A 73-year-old woman presented with symptoms of mild reflux and a little weight loss over a period of a month. Investigations revealed a type of stomach cancer called linitis plastica, with extensive tumour. The disease was incurable but she was quite well in other respects, so a jejunostomy tube was inserted and enteral feeding commenced. This image shows the pump that was used to control her feeding, which kept her weight stable for more than a year before liver metastases led to her death.

  • Dr Marazzi is a GP in East Horsley, Surrey.

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