Patient case share. Thoughts?

[BeatsPerMinute, BSN, RN]

Hello, 

I am a RN with approx 7 years of experience with the majority in cardiac critical care, some pre/post (IR, EP, Cath) + some IR & Cath intra-op experience. 

In my new job (first outpatient gig) a fellow nurse says she suspects cancer with a patient when she hears certain things. I know NOTHING about cancer patients. Thoughts about this case? 

28year old male with NKDA, doesn't take medications other than Ibuprofen/Tylenol to help with his symptoms, and has no sig past medical history. Comes in with complaints of general weakness, muscle aches, fatigue, chills, sweating, mild to moderate dry cough, sore throat, nausea, and a fever (ranging from 100.2 - 103.5) that's been going on for the last week or so. Had two (rapid) COVID tests done which are neg (PCR recently done, results pending). Negative for flu and strep as well. CXR unremarkable.  Other than the fever, vitals are WDL. Cardiac sounds normal and lung sounds clear. Pt also c/o occasional, random pain in the abd - left flank area. For the last 4-6 weeks also c/o "weird muscle, tendon or bone pain, in the right foot. Described as a cracking and spasming feeling and happens regularly throughout the day, even just when walking around the house, and had put a pause on any sort of long walks and jogging since that started. Labs pending, with only CBC results avail at this time. Abnormal CBC values: WBC = 2.5, Platelets = 92, Lym# = 0.5. Also, patient BMI 19 (per patient, has always been underweight). Has had relatives pos for random cancers here and there. His younger sister was treated for leukemia a few years ago and is doing well now. 

This is not my area of expertise - not one bit - and apologize if this is a silly question: Is there too little information in this case for it to be fair suspect cancer, or is it mod possible? Thanks! 

[JBMmom, MSN, NP]

A CBC alone with the symptoms you list doesn't appear strongly indicative of cancer to me, but there are some potential indicators and the full workup will help. Fatigue, night sweats and weight loss would be concerning for a potential cancer diagnosis, not sure whether he has actually experienced weight loss or that the chills and sweating indicate night sweats. A very low or very high white count can both be potential signs. For this patient perhaps hypercalcemia would be detected in a BMP. You should follow up with that nurse to find out the things she suspects. I'm not especially knowledgeable in this area either. Good luck. 

[JKL33]

Need more info.

He likely made the appointment due to his acute sx.

Also, BMI 19 = normal and since he describes always being "underweight" it doesn't seem like he is reporting a change.

Several differentials including viral illness.

13 hours ago, BeatsPerMinute said:

a fellow nurse says she suspects cancer with a patient when she hears certain things

You should ask like what. It isn't a particularly nuanced take on the situation. Once in awhile she will be right if she hears some basics and always thinks of cancer. There are many presentations where it is prudent to not overlook the remote possibility of malignancy even though other things are more likely.

Will be interested to hear covid PCR and other labs.

[Wuzzie]

What’s the ANC and HgB? Was an LDH or ESR drawn? Any palpable lymph nodes? Weight loss, fatigue, chills, sweating, unexplained fevers and weakness fall into the category of “B symptoms” that could be indicative of lymphoma but they do not come on acutely, are most often present for more than a week and are not usually associated with URI symptoms.