整形外科で初めて癌と診断された症例の臨床的検討―癌を見逃さないための注意点

The Clinical Study about Patients Diagnosed as Cancer in Orthopaedics for the First Visit

　既往歴のない癌患者が整形外科を受診して約0.05％（20/37,927例）の頻度で，癌と診断されていた．内訳は，骨髄腫が7例と内臓癌が13例であった．病期は，骨髄腫7例中4例が病期Ⅲの進行期であった．内臓癌13例では，全例が他臓器に転移を有するⅣ期であった．初診時症状は，癌性疼痛が17例，癌に関連しない症状が3例であった．診断時に17例中13例（76％）に癌性疼痛を想起させる強い疼痛，安静時痛，あるいは夜間痛が認められた．残る4例（24％）は，消炎鎮痛薬でコントロールされており，疼痛の性状から癌の存在は疑われなかった．

　The number of cases firstly diagnosed as cancer by orhtopaedists are 20 (0.05％) among 37,927 patients. The kinds of cancer are seven myeloma cases and thirteen visceral cancer cases. Four cases are the stage Ⅲ which are advanced among seven myeloma cases. All cases of visceral cancer are stage Ⅳ which have metastases in other organs. Symptoms of first examination are cancer pain in 17 cases, and no relation with cancer in 3 cases. Pain which associate symptoms of cancer such as nocturnal pain, rest pain, and severe pain is recognized in 13 of 17 cases (76％). Pain is well controlled by NSAIDs, cancer is not suspected in the rest four cases (24％).