Diagnosis

Question 1

What indicates an urgent referral for possible lung cancer?

Answer 1

Admission - symptomatic SVC obstruction, stridor

> 40 with unexplained haemoptysis/suggestive CXR

> 40 with

• persistent/recurrent chest infection
• finger clubbing
• supraclavicular/cervical lymphadenopathy
• thrombocytosis
• 2x cough, fatigue, SOB, chest pain, weight loss, anorexia, smoker, asbestos hx

Question 2

What indicates an urgent referral for possible upper GI cancer?

Answer 2

Endoscopy

• dysphagia
• > 55 with weight loss and upper abdo pain/reflex/dyspepsia

> 40 with jaundice/upper abdo mass

CT of pancreas

• > 60 with weight loss and…
• diarrhoea/back pain/abdo pain/nausea/constipation/ new diabetes

Non-urgent endoscopy

• > 55 years with…
• tx resistant dyspepsia/upper abdo pain with low Hb or platelets/N&V with upper GI symptoms or weightloss
• OR haematemesis

Question 3

What indicates an urgent referral for possible lower GI cancer?

Answer 3

Definitely:

• Positive faecal occult blood
• > 40 with abdo pain and weightloss
• > 50 with PR bleeding
• > 60 with iron deficiency anaemia/change in bowel habit

Maybe:

• Rectal/abdo mass
• anal ulceration
• <50 with PR bleed plus GI sx/weight loss/iron deficiency anaemia

Question 4

When should faecal occult blood testing be done?

Answer 4

> 50 with abdo pain/weight loss
<60 with change in bowel habit/iron deficiency anaemia
60 with anaemia

Question 5

What indicates an urgent referral for possible gynae cancer?

Answer 5

Ascites
Pelvic mass (not fibroid)
>55 with post menopausal bleeding

Question 6

What indicates an urgent referral for possible breast cancer?

Answer 6

> 30 with breast lump
50 with Sx/nipple change

Maybe:

• skin changes
• > 30 with axillary lump

Question 7

What indicates an urgent referral for possible urology cancer?

Answer 7

Irregular prostate on PR
Abnormal age-specific PSA

> 40 with unexplained visible haematuria
60 with unexplained non-visible haematuria with high WCC/dysuria

Non-painful enlargement/change to testicle

Question 8

What indicates an urgent referral for possible CNS cancer?

Answer 8

Progressive subacut loss of central neurological function

Question 9

What are the main non-specific signs of cancer?

Answer 9

Weight loss
Anorexia
DVT
Night sweats
Malaise
Fatigue

Question 10

What are the histopathological signs of meningioma?

Answer 10

Spindle cells in concentric whorls

Calcified psammoma bodies

Question 11

What are the symptoms of renal cell carcinoma?

Answer 11

Haematuria
Flank apin 
Abdo mass
Weigth loss
Fevers 
HTN
Night sweats 
Malaise

Question 12

What are the signs of teratomas?

Answer 12

High bHCG and AFP
Non-seminomas
Testes lump - dragging sensation

Question 13

What are the signs of pancreatic cancer?

Answer 13

Painles sjaundice
Stool chanes
Dark urine

Conjugated hyperbilirubinaemia