Oncology Revision Guide ✅

🎗️ Oncology is diagnosis, staging, treatment intent, complications and communication. A good oncology approach asks: what cancer is it?, where has it spread?, is treatment curative, disease-controlling or palliative?, and is there an acute oncology emergency? For exams and ward work, always look for neutropenic sepsis, metastatic spinal cord compression, hypercalcaemia, superior vena cava obstruction, tumour lysis syndrome, treatment toxicity and venous thromboembolism.

✅ 1. Core Oncology Principles

🧬 1.1 What Cancer Is

• Cancer is uncontrolled clonal cell growth with capacity for invasion and sometimes metastasis.
• Malignant cells acquire features such as uncontrolled proliferation, resistance to cell death, angiogenesis, immune evasion and invasion.
• Cancer behaviour depends on tumour biology, grade, stage, molecular markers and host factors.
• Metastasis occurs via lymphatics, blood, direct invasion or transcoelomic spread.
• Not all cancers behave the same: some are indolent for years; others progress quickly and require urgent treatment.

🎯 1.2 Treatment Intent

🧠 Exam pearl: “Palliative” does not mean “no treatment”. It means treatment is focused on comfort, function, symptom control and quality of life rather than cure.

🧑‍⚕️ 1.3 The MDT

• Oncology care is MDT-based: surgeons, medical oncologists, clinical oncologists, radiologists, pathologists, CNS nurses, palliative care, dietitians and allied health professionals.
• The MDT integrates histology, stage, molecular markers, patient fitness and preferences.
• Clinical nurse specialists often provide key coordination and patient support.
• Good oncology care includes psychosocial support, benefits advice, fertility discussion, genetics and survivorship planning.

🚩 2. Suspected Cancer and Red Flags

NICE NG12 covers recognition and referral of suspected cancer in children, young people and adults. It aims to help clinicians identify symptoms that may be caused by cancer and choose appropriate urgent referral or investigation pathways.

🚨 2.1 General Cancer Red Flags

• Unexplained weight loss.
• Persistent fatigue with anaemia or systemic symptoms.
• Night sweats, unexplained fever or persistent lymphadenopathy.
• New unexplained lump, especially hard, fixed, enlarging or supraclavicular.
• Persistent unexplained pain, especially bone pain/night pain.
• Unexplained bleeding: haemoptysis, haematuria, rectal bleeding, postmenopausal bleeding, haematemesis.
• Change in bowel habit, dysphagia, persistent hoarseness or non-healing ulcer.
• New neurological deficit, seizures or personality change.

🧭 2.2 Site-Specific Red Flags

🧪 2.3 Initial Primary Care / General Assessment

• Clarify duration, progression, systemic symptoms and functional impact.
• Examine relevant system plus lymph nodes, abdomen and general condition.
• Check FBC, U&E, LFT, CRP/ESR, calcium and ferritin where clinically appropriate.
• Use FIT, PSA, CA125, CXR, ultrasound or endoscopy pathways according to symptoms and local guidance.
• Do not use a normal test to override persistent red-flag symptoms if clinical concern remains.

⚠️ Safety pearl: Iron deficiency anaemia in adult men or postmenopausal women is gastrointestinal blood loss or malignancy until adequately assessed.

🧫 3. Diagnosis, Histology and Staging

🔬 3.1 Tissue Diagnosis

• Most cancers require histological confirmation before definitive treatment.
• Biopsy route should be planned to avoid compromising future surgery, especially sarcoma and testicular cancer pathways.
• Histology identifies tumour type: carcinoma, sarcoma, lymphoma, melanoma, germ cell tumour, neuroendocrine tumour.
• Grade describes how abnormal/aggressive cells appear under microscopy.
• Immunohistochemistry and molecular testing can identify tissue origin and treatment targets.
• Liquid biopsy and circulating tumour DNA are increasingly used in selected cancers but do not replace histology in most initial diagnoses.

📍 3.2 Staging

• Staging describes extent of disease and guides prognosis/treatment.
• TNM: Tumour size/local invasion, Node involvement, Metastases.
• Imaging may include CT chest/abdomen/pelvis, MRI, PET-CT, bone scan or site-specific imaging.
• Some cancers use distinct staging systems, e.g. Ann Arbor for lymphoma, FIGO for gynaecological cancers.
• Stage is anatomical; performance status and biology also strongly influence treatment decisions.

🏃 3.3 Performance Status

🧠 Exam pearl: Stage tells you where the cancer is; performance status tells you whether the patient can tolerate treatment.

💊 4. Systemic Anti-Cancer Therapy

🧪 4.1 Chemotherapy

• Cytotoxic chemotherapy targets rapidly dividing cells.
• Common toxicities: myelosuppression, nausea/vomiting, mucositis, diarrhoea, alopecia, fatigue and infection risk.
• Specific toxicities vary: anthracyclines can cause cardiomyopathy; platinum drugs can cause neuropathy/nephrotoxicity/ototoxicity; taxanes can cause neuropathy and hypersensitivity.
• Cycles allow normal tissue recovery between treatments.
• Fever after chemotherapy is neutropenic sepsis until proven otherwise.

🎯 4.2 Targeted Therapy

• Targets specific molecular pathways in cancer cells.
• Examples: EGFR, ALK, BRAF, HER2, PARP, VEGF and tyrosine kinase inhibitors.
• Toxicities differ from chemotherapy and may include rash, diarrhoea, hypertension, thrombosis, pneumonitis, liver toxicity or cardiac effects.
• Requires molecular testing and specialist monitoring.

🛡️ 4.3 Immunotherapy

• Checkpoint inhibitors stimulate immune response against cancer.
• Examples target PD-1, PD-L1 and CTLA-4 pathways.
• Immune-related adverse events can affect any organ: colitis, pneumonitis, hepatitis, endocrinopathies, nephritis, myocarditis, rash and neurological toxicity.
• Toxicity can occur during treatment or months after stopping.
• Treatment may require steroids and specialist oncology input; do not simply give antibiotics for all diarrhoea or breathlessness in immunotherapy patients.

🧬 4.4 Hormonal Therapy

• Used in hormone-sensitive cancers such as breast and prostate cancer.
• Breast: tamoxifen, aromatase inhibitors, ovarian suppression, fulvestrant and combinations.
• Prostate: androgen deprivation therapy, antiandrogens and androgen pathway inhibitors.
• Toxicities: hot flushes, sexual dysfunction, bone loss, metabolic effects, mood change, thrombotic risk with some drugs.

☢️ 5. Radiotherapy

🎯 5.1 Radiotherapy Principles

• Radiotherapy uses ionising radiation to damage DNA and kill cancer cells.
• It can be curative, adjuvant, neoadjuvant or palliative.
• Fractionation spreads dose over sessions to allow normal tissue recovery.
• Planning balances tumour control against normal tissue toxicity.
• Clinical oncologists plan and prescribe radiotherapy in the UK.

🩹 5.2 Common Acute Side Effects

• Skin erythema/desquamation in treatment field.
• Fatigue.
• Mucositis if head/neck or upper GI field.
• Oesophagitis with thoracic radiotherapy.
• Diarrhoea/cystitis with pelvic radiotherapy.
• Hair loss only in irradiated area.

⏳ 5.3 Late Side Effects

• Fibrosis and tissue stiffness.
• Lymphoedema.
• Infertility or gonadal dysfunction depending on field.
• Radiation pneumonitis/fibrosis.
• Bowel/bladder dysfunction after pelvic radiotherapy.
• Secondary malignancy risk, usually years later.

🌿 5.4 Palliative Radiotherapy

• Useful for painful bone metastases, bleeding tumours, brain metastases and spinal metastases.
• Can give rapid symptom benefit in selected cases.
• Performance status, prognosis, logistics and patient priorities guide treatment.

📌 Clinical reasoning: Radiotherapy toxicity occurs in the treated field. Dysphagia after thoracic radiotherapy, diarrhoea after pelvic radiotherapy and mucositis after head/neck radiotherapy are anatomically predictable.

🔪 6. Surgical Oncology

• Surgery may be diagnostic, curative, cytoreductive, palliative or reconstructive.
• Curative surgery usually requires complete resection with adequate margins and nodal assessment where relevant.
• Margins matter: R0 means no microscopic residual tumour; R1 microscopic residual; R2 macroscopic residual.
• Neoadjuvant treatment may shrink tumours and improve resectability.
• Palliative surgery may relieve obstruction, bleeding, pain or perforation risk.
• Fitness, frailty, nutrition, anaemia and patient priorities strongly affect surgical decisions.

🚨 7. Acute Oncology Emergencies

UKONS acute oncology initial management guidance covers the initial assessment and immediate management of adults with a cancer diagnosis presenting as an emergency or unplanned admission due to disease or treatment complications.

🦠 7.1 Neutropenic Sepsis

NICE CG151 covers prevention, identification and management of neutropenic sepsis in people receiving cancer treatment.

• Neutropenic sepsis is fever or sepsis in a patient with low neutrophils, usually after chemotherapy or marrow disease.
• It is a medical emergency even if the patient looks well.
• Symptoms may be subtle because neutrophils are needed to generate pus and local inflammatory signs.
• Ask about chemotherapy date, regimen, central line, mucositis, diarrhoea, urinary symptoms, cough and skin/perianal pain.
• Management: ABCDE, blood cultures including line cultures if present, FBC/U&E/LFT/CRP/lactate, urgent broad-spectrum IV antibiotics according to local policy.
• Do not wait for neutrophil result if clinical suspicion is high.

🧠 7.2 Metastatic Spinal Cord Compression

NICE NG234 covers recognition, referral, investigation and management of spinal metastases and metastatic spinal cord compression, and aims to prevent neurological injury.

• MSCC is compression of spinal cord or cauda equina by metastatic disease.
• Red flags: new severe back pain, night pain, radicular pain, limb weakness, sensory change, gait disturbance, bladder/bowel dysfunction.
• Known cancers with high risk: breast, lung, prostate, renal, thyroid, myeloma and lymphoma.
• Do not wait for paralysis — early symptoms are often pain and subtle gait change.
• Management: urgent MRI whole spine, immobilisation if instability suspected, dexamethasone if MSCC suspected unless contraindicated/local policy, urgent oncology/spinal input.
• Treatment may include radiotherapy, surgery, steroids and systemic treatment depending on prognosis and stability.

🧪 7.3 Hypercalcaemia of Malignancy

• Common in myeloma, breast, lung, renal and squamous cancers.
• Symptoms: thirst, polyuria, dehydration, constipation, nausea, abdominal pain, confusion, drowsiness and arrhythmia.
• Mechanisms include bone metastases, PTHrP secretion and calcitriol production in some lymphomas.
• Initial management: IV fluids if not overloaded, stop contributing drugs, treat cause, consider IV bisphosphonate or denosumab depending on renal function and specialist advice.
• Check corrected calcium, renal function, phosphate, magnesium and ECG if severe.

🫁 7.4 Superior Vena Cava Obstruction

• Usually due to lung cancer, lymphoma or mediastinal masses.
• Features: facial/neck/arm swelling, distended neck/chest wall veins, dyspnoea, cough, headache, plethora, worse lying flat.
• Severe features: stridor, laryngeal oedema, cerebral oedema, reduced consciousness.
• Management: sit upright, oxygen if needed, urgent CT chest/venography, tissue diagnosis if not known, oncology/respiratory/interventional radiology input.
• Treatment may include steroids in lymphoma/thymoma suspicion, stenting, radiotherapy or chemotherapy depending on cause.

⚡ 7.5 Tumour Lysis Syndrome

• Rapid cancer cell breakdown releases potassium, phosphate and nucleic acids, causing hyperkalaemia, hyperphosphataemia, hypocalcaemia, hyperuricaemia and AKI.
• High-risk cancers: high-grade lymphoma, acute leukaemia, bulky chemosensitive disease, high tumour burden.
• Can occur after treatment or rarely spontaneously.
• Management: prevention with hydration and urate-lowering therapy in high-risk patients; emergency treatment of hyperkalaemia, fluids, rasburicase/allopurinol by risk and renal support if severe.
• Monitor U&E, calcium, phosphate, urate, creatinine and ECG.

🧠 7.6 Raised Intracranial Pressure / Brain Metastases

• Features: headache, vomiting, papilloedema, seizures, focal neurology, personality change, drowsiness.
• Common primary sites: lung, breast, melanoma, renal and colorectal cancer.
• Management: urgent imaging, dexamethasone for symptomatic oedema where appropriate, anticonvulsants if seizures, neurosurgery/radiotherapy/systemic therapy decisions.
• Do not give prophylactic anticonvulsants to all brain metastasis patients unless specialist-directed; treat if seizures occur.

🚨 Exam pearl: In a chemotherapy patient with fever, do not wait for the neutrophil count before treating suspected neutropenic sepsis.

🧯 8. Treatment Toxicities

💩 8.1 Diarrhoea and Colitis

• Chemotherapy can cause mucositis, enteritis and infective diarrhoea.
• Immunotherapy can cause immune-mediated colitis, which can be severe and life-threatening.
• Assess stool frequency, blood, abdominal pain, fever, dehydration, neutropenia and recent antibiotics.
• Send stool cultures/C. difficile testing when appropriate.
• Immunotherapy diarrhoea may require steroids and oncology input rather than simple antidiarrhoeals.

🫁 8.2 Pneumonitis

• Can be caused by immunotherapy, radiotherapy, targeted therapy or chemotherapy.
• Symptoms: dry cough, dyspnoea, hypoxia, fever may be absent.
• Differentials: pneumonia, PE, pulmonary oedema, progression, lymphangitis carcinomatosis.
• CT chest and specialist assessment are often required.
• Management may include holding treatment, steroids and oxygen depending on severity.

🧬 8.3 Endocrine Toxicity from Immunotherapy

• Checkpoint inhibitors can cause thyroiditis, hypothyroidism, hyperthyroidism, hypophysitis, adrenal insufficiency and type 1 diabetes.
• Symptoms may be non-specific: fatigue, headache, nausea, dizziness, hypotension, weight change, polyuria or confusion.
• Check thyroid function, cortisol, glucose/ketones and electrolytes when suspicious.
• Adrenal crisis and DKA are emergencies.

🫀 8.4 Cardiotoxicity

• Anthracyclines and HER2-targeted therapy can cause LV dysfunction/cardiomyopathy.
• Some TKIs and immunotherapy can cause myocarditis, arrhythmia, hypertension or ischaemia.
• Symptoms: breathlessness, oedema, chest pain, palpitations, syncope.
• Investigations may include ECG, troponin, BNP and echocardiography.

🧠 8.5 Neuropathy

• Platinum drugs, taxanes and vinca alkaloids commonly cause peripheral neuropathy.
• Symptoms: numbness, tingling, burning pain, balance problems, fine motor difficulty.
• Can limit treatment and persist after completion.
• Assess falls risk, function and dose modification needs.

🦷 8.6 Mucositis

• Painful inflammation/ulceration of oral/GI mucosa after chemotherapy or radiotherapy.
• Risks: poor oral intake, dehydration, infection, opioid requirement.
• Severe mucositis plus neutropenia is high risk for sepsis.
• Management: oral care, analgesia, hydration, nutritional support and infection assessment.

🩸 9. Cancer-Associated Thrombosis and Bleeding

🦵 9.1 VTE in Cancer

• Cancer increases thrombotic risk through tumour biology, immobility, surgery, central lines and systemic therapy.
• Common presentations: DVT, PE, catheter-associated thrombosis, incidental PE on staging scan.
• High-risk cancers: pancreas, stomach, brain, lung, ovarian and haematological malignancy.
• Treatment often uses LMWH or DOACs depending on bleeding risk, renal function, cancer type and drug interactions.
• GI/GU cancers may have higher bleeding risk with some DOACs; specialist guidance is needed.

🩸 9.2 Bleeding in Cancer

• Causes: tumour invasion, thrombocytopenia, coagulopathy, anticoagulation, liver disease, DIC, radiotherapy effects.
• Examples: haemoptysis, GI bleeding, haematuria, vaginal bleeding, fungating tumour bleeding.
• Management depends on severity: pressure, tranexamic acid in selected cases, transfusion, radiotherapy, embolisation, endoscopy or surgery.
• Major bleeding needs ABCDE, crossmatch, reversal of anticoagulation where appropriate and senior help.

🧪 9.3 Anaemia and Transfusion

• Cancer anaemia may be due to bleeding, marrow infiltration, chemotherapy, inflammation, renal disease, haemolysis or nutritional deficiency.
• Symptoms and treatment intent guide transfusion decisions.
• Iron deficiency should be investigated if appropriate and treated.
• Transfusion is symptom-relieving but temporary if underlying cause persists.

🍽️ 10. Nutrition, Cachexia and Functional Decline

⚖️ 10.1 Cancer Cachexia

• Cachexia is a metabolic syndrome with weight loss, muscle wasting and inflammation.
• It is not simply starvation and may not fully reverse with calories alone.
• Common in pancreatic, gastric, lung and advanced GI cancers.
• Assess weight loss, appetite, swallowing, nausea, pain, constipation, mood and social barriers.
• Dietitian input, symptom control and realistic goals are important.

🥤 10.2 Nutrition Problems by Site

🚶 10.3 Prehabilitation and Rehabilitation

• Prehabilitation aims to improve fitness before treatment using exercise, nutrition and psychological support.
• Rehabilitation supports function after surgery, chemo, radiotherapy or advanced disease complications.
• Fatigue management includes pacing, exercise, sleep, anaemia/endocrine assessment and mood support.

🌿 11. Palliative Oncology and Symptom Control

🧭 11.1 Palliative Care Principles

• Palliative care can run alongside active anti-cancer treatment.
• It addresses pain, nausea, breathlessness, fatigue, mood, spiritual distress, family support and advance care planning.
• Early palliative care can improve quality of life and reduce crisis admissions.
• Discuss what matters to the patient, not just what treatment is technically possible.

💊 11.2 Pain in Cancer

• Types: bone pain, visceral pain, neuropathic pain, soft tissue pain, incident pain.
• Bone metastases may respond to analgesia, radiotherapy, bisphosphonates/denosumab and systemic treatment.
• Neuropathic pain may need adjuvants such as duloxetine, gabapentinoids or amitriptyline depending on patient factors.
• Strong opioids require laxatives, antiemetic planning and monitoring for sedation/respiratory depression.
• Incident pain may need breakthrough analgesia timed before movement/care.

🤢 11.3 Nausea and Vomiting

• Causes: chemotherapy, opioids, constipation, bowel obstruction, raised ICP, hypercalcaemia, gastric stasis, liver capsule stretch.
• Treatment should match mechanism: dopamine antagonists, 5-HT3 antagonists, steroids, cyclizine/antihistamines, anticholinergics or prokinetics depending on cause.
• Bowel obstruction requires careful assessment before prokinetics.

🫁 11.4 Breathlessness

• Causes: pleural effusion, lung metastases, PE, infection, anaemia, lymphangitis, COPD/HF, anxiety.
• Management: treat reversible cause, fan, positioning, breathing techniques, opioids for refractory breathlessness, oxygen if hypoxic.
• Recurrent malignant pleural effusion may need aspiration, indwelling pleural catheter or pleurodesis.

📝 11.5 Advance Care Planning

• Discuss prognosis sensitively and check what the patient wants to know.
• Consider DNACPR/ReSPECT or local treatment escalation planning.
• Clarify preferred place of care/death where appropriate.
• Anticipatory medicines can prevent distress in the last days of life.

🌿 Communication pearl: In advanced cancer, “What are you hoping for?” and “What would you want to avoid?” often reveal more useful treatment goals than asking only about symptoms.

🧬 12. Genetics, Screening and Prevention

🧬 12.1 Familial Cancer Syndromes

• Red flags for inherited cancer risk: young age at diagnosis, multiple relatives, bilateral cancers, multiple primary cancers, rare tumour types.
• BRCA1/2: breast, ovarian, prostate and pancreatic cancer risk.
• Lynch syndrome: colorectal, endometrial, ovarian, gastric and other cancers.
• Familial adenomatous polyposis: numerous colorectal polyps and high colorectal cancer risk.
• MEN syndromes: endocrine tumours.
• Genetic testing should include counselling and implications for relatives.

🔎 12.2 Screening

• Screening aims to detect disease earlier in asymptomatic populations where benefits outweigh harms.
• UK screening programmes include breast, cervical and bowel screening.
• Harms include false positives, false negatives, anxiety, overdiagnosis and procedure risks.
• High-risk individuals may need enhanced surveillance outside routine population screening.

🛡️ 12.3 Prevention

• Smoking cessation is the highest-yield cancer prevention intervention.
• HPV vaccination reduces cervical and other HPV-related cancers.
• HBV vaccination reduces hepatocellular carcinoma risk.
• Alcohol reduction, healthy weight, physical activity and sun protection reduce risk across several cancers.
• Occupational/environmental exposures include asbestos, radon, UV and certain chemicals.

🎗️ 13. High-Yield Cancer Site Summaries

🫁 13.1 Lung Cancer

• Risk factors: smoking, asbestos, radon, air pollution, family history.
• Symptoms: cough, haemoptysis, weight loss, dyspnoea, chest pain, recurrent pneumonia.
• Types: non-small cell lung cancer and small cell lung cancer.
• Molecular testing guides targeted therapy in advanced NSCLC.
• Emergencies: SVCO, massive haemoptysis, brain metastases, hypercalcaemia.

🩸 13.2 Breast Cancer

• Presentation: lump, nipple change/discharge, skin tethering, peau d’orange, axillary node.
• Triple assessment: clinical exam, imaging, biopsy.
• Markers: ER, PR and HER2 guide systemic therapy.
• Treatment: surgery, radiotherapy, endocrine therapy, chemotherapy, HER2 therapy depending on subtype/stage.
• Metastatic sites: bone, liver, lung, brain.

🚽 13.3 Colorectal Cancer

• Symptoms: change in bowel habit, rectal bleeding, iron deficiency anaemia, weight loss, obstruction.
• Right-sided cancers often cause anaemia; left-sided cancers often cause bleeding/change in bowel habit.
• Staging: CT, colonoscopy/biopsy, MRI rectum for rectal cancer.
• Treatment: surgery, chemotherapy and radiotherapy depending on site/stage.
• Emergency: obstruction, perforation, bleeding.

🧔 13.4 Prostate Cancer

• May be asymptomatic or present with LUTS, abnormal DRE, high PSA or metastatic bone pain.
• PSA is not cancer-specific; shared decision-making is important.
• Staging uses MRI, biopsy and metastatic imaging where indicated.
• Treatment ranges from active surveillance to surgery, radiotherapy, androgen deprivation and systemic therapy.
• Metastatic prostate cancer commonly affects bone and can cause MSCC.

🍽️ 13.5 Upper GI and Pancreatic Cancer

• Oesophageal cancer: progressive dysphagia and weight loss.
• Gastric cancer: early satiety, weight loss, anaemia, vomiting.
• Pancreatic cancer: painless jaundice, weight loss, epigastric/back pain, new diabetes, pale stools/dark urine.
• Pancreatic cancer has high VTE risk and often presents late.

🌸 13.6 Gynaecological Cancers

• Endometrial cancer: postmenopausal bleeding is key red flag.
• Ovarian cancer: persistent bloating, early satiety, pelvic pain, urinary frequency.
• Cervical cancer: postcoital bleeding, intermenstrual bleeding, abnormal discharge; HPV-related.
• Vulval cancer: persistent itch, lump, ulcer or bleeding.

🩸 13.7 Haematological Malignancy

• Leukaemia: fatigue, infections, bruising/bleeding, bone pain, blasts/cytopenias.
• Lymphoma: painless lymphadenopathy, B symptoms, mediastinal mass, extranodal disease.
• Myeloma: CRAB — hypercalcaemia, renal impairment, anaemia, bone lesions.
• Emergencies: neutropenic sepsis, hyperviscosity, tumour lysis, MSCC, hypercalcaemia.

🗣️ 14. Communication in Oncology

💬 14.1 Breaking Bad News

• Prepare: private space, time, results, support person if wanted.
• Check what the patient understands and how much they want to know.
• Warn before bad news: “I’m afraid the results are more serious than we hoped.”
• Use clear language and avoid euphemisms.
• Pause and respond to emotion before giving too much detail.
• Summarise next steps and ensure support.

🧭 14.2 Shared Decision-Making

• Discuss benefits, burdens, alternatives and no-treatment option.
• Explore patient values: time, independence, side effects, family, work, travel, symptom control.
• Use absolute numbers where possible rather than vague percentages.
• Confirm understanding and avoid coercion.
• Document decisions and revisit them as disease/treatment response changes.

🌧️ 14.3 Psychological Impact

• Cancer commonly causes anxiety, depression, adjustment disorder, PTSD symptoms and fear of recurrence.
• Assess sleep, appetite, mood, panic, trauma symptoms, family stress and finances.
• Screen for suicidal thoughts, especially in advanced disease, uncontrolled pain or social isolation.
• Offer CNS support, psychology, psychiatry, social prescribing, benefits advice and palliative care where appropriate.

🚨 15. Acute Oncology Presentation Table

📚 16. OSCE / Exam Pearls

• Cancer patient plus fever after chemotherapy is neutropenic sepsis until proven otherwise.
• Back pain in cancer needs neurological screening and MSCC red-flag questions.
• Hypercalcaemia causes “stones, bones, groans and psychiatric overtones” but in oncology often presents as dehydration and confusion.
• SVCO causes facial/arm swelling, venous distension and dyspnoea, often worse lying flat.
• Immunotherapy toxicity can affect any organ and can occur after treatment has stopped.
• Performance status often determines whether treatment is realistic.
• Stage is anatomical; grade and biomarkers describe tumour biology.
• Palliative care can be alongside active treatment.
• Do not promise prognosis with false precision; discuss uncertainty honestly.
• Always ask what the patient understands before giving major results.

📌 17. Quick Differentials Table

📚 References

• NICE. Suspected cancer: recognition and referral. NG12.
• NICE. Neutropenic sepsis: prevention and management in people with cancer. CG151.
• NICE. Spinal metastases and metastatic spinal cord compression. NG234.
• UKONS. Acute Oncology Initial Management Guidelines.
• NICE. Metastatic malignant disease of unknown primary origin in adults: diagnosis and management. CG104.
• NICE cancer-site guidance should be checked for tumour-specific diagnosis and management pathways.
• Local acute oncology, SACT toxicity, radiotherapy, palliative care, major haemorrhage, sepsis and MSCC pathways should always be followed.

⚠️ Disclaimer

This article is for medical education and exam revision. Clinical decisions should follow current local oncology, acute oncology, haematology, palliative care, radiotherapy, antimicrobial, sepsis, thrombosis and emergency pathways, formularies, senior advice, NICE guidance and specialist MDT recommendations. Oncology emergencies such as neutropenic sepsis, metastatic spinal cord compression, hypercalcaemia, superior vena cava obstruction, tumour lysis syndrome, massive haemoptysis, raised intracranial pressure and severe treatment toxicity require urgent senior input.