Oncology and Palliative Care
Oncological emergencies, systemic anti-cancer therapy and end of life care.
- Principles of Cancer Diagnosis and Staging The three questions behind every cancer diagnosis - tissue type, anatomical stage and patient fitness - with TNM, the grade-versus-stage distinction, staging imaging and ECOG performance status.
- Metastatic Cancer of Unknown Primary The MUO to CUP pathway, the immunohistochemistry panel that changes management, the favourable treatable subsets, and when further investigation stops helping.
- Systemic Anti-Cancer Therapy and its Toxicity Drug classes from alkylating agents to checkpoint inhibitors, the signature toxicity each one causes, the neutrophil nadir, and the never events around vincristine and methotrexate.
- Radiotherapy and its Side Effects Why the dose is fractionated, the techniques from IMRT to brachytherapy, the single 8 Gy fraction for bone pain, and acute versus late toxicity by site.
- Neutropenic Sepsis Why antibiotics go in within the hour and before the blood count, the NICE definition and its clinical alternative to fever, the MASCC score, and G-CSF prophylaxis.
- Malignant Spinal Cord Compression The back pain that comes weeks before the weakness, why the whole spine is scanned within 24 hours, dexamethasone before imaging, and choosing surgery over radiotherapy.
- Malignant Hypercalcaemia Correcting calcium for albumin, the PTHrP mechanism and suppressed PTH, why saline precedes zoledronic acid, and why furosemide is not routine treatment.
- Tumour Lysis Syndrome Cairo-Bishop criteria and risk stratification, fluids with allopurinol or rasburicase before the first dose, the G6PD contraindication, and why urine is no longer alkalinised.
- Malignant Bowel Obstruction Why multi-level peritoneal obstruction is usually managed medically, the syringe-driver combinations that control it, and why metoclopramide is contraindicated with colic.
- Malignant Pleural Effusion Light's criteria and the limits of cytology, CT before drainage, trapped lung, and the pleurodesis-versus-indwelling-catheter decision from TIME2 and AMPLE.
- Cancer Pain and the Analgesic Ladder Total pain and the three pain mechanisms, titrating morphine with a one-sixth breakthrough dose, the conversion table, matching adjuvants to mechanism, and opioid toxicity.
- Nausea and Vomiting in Palliative Care The four pathways to the vomiting centre and the receptor each uses, choosing haloperidol over cyclizine over metoclopramide, and why cyclizine cancels a prokinetic.
- Breathlessness in Palliative Care The panic cycle and why the handheld fan is first-line, the evidence that oxygen helps only the hypoxaemic, low-dose morphine, and the reversible causes worth chasing.
- Care in the Last Days of Life Recognising dying and the reversible causes that mimic it, the five priorities of care, anticipatory subcutaneous prescribing, and what to say to families.
- Advance Care Planning The two-stage capacity test and best-interests checklist, which planning tools are legally binding and which are not, why next of kin cannot consent, and the Tracey duty to discuss DNACPR.
- Breaking Bad News The SPIKES framework step by step, why you ask before you tell, the words to use and avoid, and handling collusion, anger and the how-long question.
- Suspected Cancer Referral Pathways The NG12 3% threshold and the urgency categories, the site-by-site triggers worth memorising, FIT in colorectal referral, safety netting, and the 28 and 62 day standards.