Introduction

Terry's nails is a condition characterised by abnormal nail appearance, where most of the nail appears white or pale, with a narrow band of pink or brown near the tip.¹ This condition can be observed in other systemic illnesses, such as heart failure, kidney disease, diabetes, malnutrition, and liver disease, especially cirrhosis. Terry's nails have also been found in cancer patients, which raises concerns about any possible link between the condition and cancer. 

Understanding Terry's nails, investigating its incidence in cancer patients, and evaluating its clinical significance are the primary objectives of this article. Such nail alterations are useful, but sometimes a disregarded clinical indicator that may aid in the early identification of underlying medical disorders.¹

Understanding Terry’s nails

Appearance and features

Terry's nails are identified by a white or light discolouration that covers most of the nail, and includes a tiny pink or brown band at the tip. Usually, all of the fingernails are affected by the condition and occasionally, the toenails too.¹ The loss of the lunula, the half-moon-shaped structure at the nail's base, which can become weak or vanish completely, is another crucial feature.² These changes are often associated with systemic health issues and arise from changes in the vascular supply of the nail bed.

Causes and risk factors

Chronic diseases such as liver cirrhosis, heart failure, and kidney disease are very commonly linked to Terry's nails. These disorders can impact blood flow and protein levels, which can in turn, change the look of the nails.³ Malnutrition and ageing can also contribute to this as they can impair nail structure over time. Additionally, because cancer and its treatments, such as radiation and chemotherapy affect circulation and general health, they may result in comparable nail alterations.³

Possible mechanisms

Although, the precise cause of Terry's nails isn't known, it is thought to be caused by limited or inadequate blood flow to the nail bed. Nail discolouration may result from a shortage of oxygen and nutrients brought on by reduced blood flow.³ Albumin helps to maintain appropriate nail structure, therefore, low protein levels (hypoalbuminemia) is also suggested to be a contributing factor to this condition. Terry's nails can also occur as a result of systemic inflammation and alterations in nail growth brought on by cancer or chronic illness.⁴

Terry’s nails and cancer

How common is it in cancer patients?

Terry's nails have been associated with multiple cancers, including liver, lung, blood, and stomach cancers. Patients who are in the advanced stage of cancer, when systemic symptoms such as malnourishment, poor circulation, and organ malfunction are more common, seem more likely to have this illness.⁵ Its existence suggests underlying health decline and calls for additional medical assessment, even though it is not a conclusive diagnostic indicator of cancer.

Why does cancer cause Terry’s nails?

Direct effects of cancer

Terry's nails are identifiable by their distinctive discolouration. This is because cancer can directly affect the circulation of blood, which lowers the oxygen and nutritional supply to the nail bed. As well as this, severe nutritional shortages brought on by cancer-related weight loss (cachexia) may impact nail development and structure.¹

Effects of cancer treatment

Rapidly dividing cells, including those in the nail matrix, can be harmed by chemotherapy and radiation therapy, which can alter the structure of the nail. Additionally, cancer treatments impair immunity, increasing susceptibility to infections and delaying the growth or repair of the nails.⁵

Inflammation in cancer

Cancer can cause systemic inflammation in the body, which leads to the release of cytokines. These cytokines are chemical messengers that control immune responses.⁶ Terry's nails may indicate the advancement of an underlying disease, since these inflammatory substances can disrupt normal nail growth and contribute to the alterations observed in Terry's nails.

Importance of Terry’s nails in cancer diagnosis

Can it help to detect cancer?

Terry's nails could be a precursor of cancer or some other underlying disease. Even though it is not a conclusive diagnostic indicator, its existence should be a cause to carry out additional medical assessment, especially if it is coupled with other symptoms, including organ dysfunction, exhaustion, or unexplained weight loss. Healthcare professionals can evaluate a patient’s general health and identify possible systemic disorders earlier by recognising this nail change in cancer patients.⁴

How to differentiate Terry’s nails from other nail changes

It's important to distinguish Terry's nails from other nail anomalies that may also indicate systemic health problems. Lindsay's nails, sometimes referred to as "half-and-half nails", are frequently linked to chronic kidney disease and have a noticeable half-pink and half-white look. Muehrcke's lines, which are associated with low protein levels (hypoalbuminemia), manifest as horizontal white bands across the nails. 

Deep ridges or grooves in the nails known as Beau's lines appear when a person has chemotherapy, a serious illness, or other stressors that momentarily stop nail development.⁷ Recognising these variations allows for precise diagnosis and comprehension of the underlying medical problem.

Are Terry’s nails a sign of poor prognosis?

Terry's nails may be a sign of a more severe or advanced stage of cancer disease in patients. It may indicate deteriorating nutritional condition, circulation problems, or organ failure because it is frequently linked to chronic illness and systemic health decline. Its function as a cancer prognostic marker, however, requires further investigation. Better patient assessment and care may result from an understanding of its importance in oncology.⁵

Summary

Terry's nails present a visible change in the nail appearance that can be a clinical indicator of underlying systemic disorders, including cancer. Its existence in cancer patients raises the possibility of a connection between abnormalities of the nails and physiological changes associated with cancer, even though it is not a clear indication of malignancy. Early disease detection and patient assessment may benefit from an understanding of this connection. 

To determine its diagnostic and prognostic value in oncology, further investigation is necessary. Healthcare professionals can assess a patient's general health more thoroughly by identifying such minor bodily indicators.