Complete guide to Cancer, Skin and Infection OSCE stations including: common conditions, histories, examinations, explanations, data interpretation, ethics and law, prescribing and emergencies
Cancer, Skin and Infection OSCE
Oncology
Conditions
Lung cancer
Red flags for lung cancer:
o Cough (dry/productive) – if productive then send sputum for microscopy, sensitivity
and cytology
o Haemoptysis – remember to clarify amount. Many lung cancers do not present with
this, but it is very worrying if present
o Dyspnoea – check if this has changed recently
o Hoarse voice – could be a symptom of recurrent laryngeal nerve involvement which
would imply mediastinal involvement with cancer
o Chest pain – character important
o Fatigue
o Appetite loss
o Weight loss – how much over how long. Intentional? Proportion of usual weight.
Implies more advanced disease
There are 2 broad categories of lung cancer:
o Small-cell lung cancer
SCLC accounts for about 20% of all lung cancers. It has a very aggressive
behaviour and is considered a systemic disease at diagnosis. It develops in 3-
5 years and has a doubling time of 30 days. Up to 15 % of patients with
limited stage SCLC will have long-term survival. The commonest location of
SCLC is around the hilum and central areas of the lungs. SCLC is most
frequently associated with several para-neoplastic syndromes.
Small cell carcinomas arise from neuroendocrine cells and secrete many
different polypeptides. Some of the polypeptides have an auto feedback
loop which induces further tumour growth. Often the initial presentation of
patients with SCLC is with a paraneoplastic syndrome, such as Cushing’s
syndrome or Addison’s disease.
SCLC is extremely aggressive and spreads very early. Surgery does not play a
part in most cases. Although SCLC responds extremely well and quickly to
chemotherapy and radiation therapy, even those patients who respond
usually relapse within 12 months.
o Non-small cell lung cancer
Non-small cell lung cancer has 3 broad categories of histology.
Adenocarcinoma: the most common non-small cell lung cancer and is the
dominant lung cancer amongst females. Non-smokers with lung cancer most
often have adenocarcinoma. Typically, slow growing and are more often
found peripherally and therefore often present late with distant metastases
present at time of diagnosis in most patients. Adenocarcinomas arise from
mucous cells in the bronchial epithelium.
Squamous cell: more aggressive than adenocarcinoma and often cause
bronchial obstruction leading to infections. Up to 10% of squamous cell
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