The diagnostic process

From Oncology for Medical Students
Ideal oncology curriculum > The diagnostic process

Objective 4.2

At graduation, the student should be able to:

a) demonstrate an understanding of the wide range of potential presentations of cancer, and be open to unusual presentations
b) take history and conduct a physical examination, tailoring the latter to natural history and patterns of spread of common cancers
c) assess performance status
d) discuss the differential diagnosis of common cancers based on specific oncological findings
e) describe how to establish a diagnosis of cancer: outcome overview; diagnostic tools (biopsy, surgery, cytology, imaging, endoscopy); genetic/biochemical/molecular markers
f) demonstrate an understanding of the histopathological classification and staging of cancers, including the concept of TNM and the implications of staging for prognosis and treatment
g) recognise common complications of malignant disease, e.g. superior vena cava obstruction, spinal cord compression, bone involvement
h) evaluate critically the cost effectiveness of investigations.

Prerequisite knowledge

  • Sufficient basic scientific knowledge of tumours, benign and malignant processes, the principles of ‘cure’ of cancer (including epidemiological concepts such as five-year survival)

Representative questions that suggest the required depth of knowledge

1. Explain performance status.

Essential in answer:

  • Knowledge of ECOG and Karnofsky Performance Scales and how performance status affects outcomes

2. Describe the diagnostic process for a woman presenting with a breast lump. If malignant, what further investigations should you perform?

Essential in answer:

  • Physical examination, mammography, ultrasound, fine needle aspiration
  • If malignant assess pathology report and metastatic spread

3. What is the purpose of staging tumours?

Essential in answer:

  • Prognosis
  • Treatment decisions
  • Comparison with other data sets

4. A 60-year-old female smoker presents with a one-month history of worsening back pain and a history of work-related back pain over 12 years. What are the potential causes and how would you establish a diagnosis?

Essential in answer:

  • Metastatic lung cancer
  • Non-malignant causes
  • Establish diagnosis – plain X-Ray films, bone scan, CT, biopsy