1. szöveg
Clinical signs and symptoms of cancer
Generally speaking cancer presents to the physician in three different ways.
First, the patient or physician may find an abnormal skin lesion or a lump in a superficial organ such as the breast, the testes, the thyroid, the lymph nodes of the neck, groin or armpit. In other cases an x-ray may unexpectedly discover a lung or bone tumor producing no symptoms.
Asymptomatic tumors may be discovered within the framework of a screening program for breast, colon or cervical carcinoma.
The second way in which cancer comes to the attention of the physician is when the tumor compresses, or invades into surrounding tissue. As a rule, this will produce symptoms. Depending on where the tumor is situated the symptom may be a cough if the tumor is in the bronchi, difficulty in swallowing if it is in the esophagus, jaundice if a tumor constricts the common bile duct, dysuria if it is in the bladder or prostate.
A tumor situated within the central nervous system may produce any number of symptoms. These commonly include seizures, headaches, vomiting, visual disturbances, sensory disturbances - and the list goes on.
Local invasion of surrounding tissue may involve nerve fibers and cause pain or may erode blood vessels in mucous membranes causing bleeding, such as hemoptysis, hematuria, vaginal bleeding or gastrointestinal bleeding.
The American Cancer Society has attempted to raise the level of awareness of the general population to the most common presenting signs of cancer by publicizing very widely what are called cancer’s seven warning signs.
1. A change in bowel or bladder habits.
2. A woundthat does not heal.
3. Any unusual bleeding or discharge.
4. A thickening or lump in the breast or elsewhere.
5. Indigestion or difficulty in swallowing.
6. An obvious change in a mole or wart.
7. A persistent cough or hoarseness.
The third and final way tumors come to attention is through the appearance of systemic symptoms related to metabolic, hematologic or immunologic disturbances. By and large, these can be grouped under the heading of 'paraneoplastic syndrome'.
A very common problem in patients with cancer is the progressive decline and wasting known as cachexia. The patient or his family may note a loss of appetite, progressive weight loss and increasing lethargy and fatigue.
A substance called tumor necrosis factor or TNF secreted by the macrophages can mimic the cachectic syndrome.
Fever is another sign associated with malignancy and may be due to an underlying infection.
In advanced malignancy, anemia is commonly observed.
So, on the whole, cancer presents in these three different ways: discovery of an abnormal symptomatic mass, signs of compression or invasion into adjacent structures and systemic symptoms. I'll keep this brief and hope you'll listen again. Thank you.
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2. szöveg
You are going to hear a dialogue between a doctor and a patient.
Doctor: I understand you're having stomach pain. Does it start at night?
Patient: Yes, but not too often.
Doctor: When it starts do you get up?
Patient: Yes, I get up and walk around and it relieves the pain.
Doctor: Does anything but the painkiller help it?
Patient: I’ve been on a strict diet for six months. I never touch milk.
Doctor: Does any position help you?
Patient: No. It starts after tea, at about five. I have my main meal midday.
Doctor: Have you vomited?
Patient: Only at the beginning. I vomited a lot then.
Doctor: Are you nauseous?
Patient: Yes, I’m nauseous but I can’t vomit.
Doctor: Does the pain travel to the back?
Patient: No, but it goes under my armpits.
Doctor: What’s your weight right now?
Patient: I’ve lost 9.5 kg but I’ve been on a fat-free diet for six months.
Doctor: What’s your appetite like?
Patient: Poor as ever.
Doctor: What about your bowels?
Patient: I go to the toilet twice a day, in the morning.
Doctor: Is this a life-long habit?
Patient: Yes.
Doctor: What do the stools look like? Well-formed? Firm?
Patient: Yes.
Doctor: What about the colour? Has it changed?
Patient: No.
Doctor: Are they dark?
Patient: Yes.
Doctor: Any sign of blood?
Patient: No.
Doctor: Do they smell bad?
Patient: No.
Doctor: Have you noticed any difference in your water?
Patient: No.
Doctor: Do you have to get up at night?
Patient: Once.
Doctor: Your water hasn’t been darker?
Patient: No.
Doctor: Do you smoke?
Patient: 10 cigarettes a day.
Doctor: Do you drink?
Patient: Not much.
Doctor: Do you have any other trouble?
Patient: No, my angina has improved.
Doctor: When did you first start with your tummy trouble?
Patient: About 14 years ago.
Doctor: Is it the same but more bothersome now?
Patient: Yes, it’s worse.
Doctor: Have you ever been jaundiced?
Patient: No.
Doctor: Well, I’d like to examine you. Will you get undressed and lie on the couch please?
Doctor: Do you suffer from heartburn?
Patient: No.
Doctor: Have you had any children?
Patient: No.
Doctor: Are your hands always cold and red?
Patient: Yes.
Doctor: Just hold your breath for a moment. Breathe through your mouth. Show me where you get this pain. How old are you?
Patient: 62.
Doctor: When did your periods finish?
Patient: When I was about 52 or 53.
Doctor: Any tenderness here?
Patient: A bit sore, but not a lot.
Doctor: Do you have any pains in your legs?
Patient: I get cramps when I am in bed.
Doctor: Is it worse in one leg than in the other leg?
Patient: I get it in my right leg affected by varicose veins.
Doctor: Apart from this you’ve had no other serious illness in the past 14 years?
Patient: No.
Doctor: I’m going to make a blood test and a stomach X-ray. You’ll have to swallow a contrast medium called barium meal.
Source: Joy Parkinson: A Manual of English for the Overseas Doctor Churchill Livingstone