I hope you’ve been practising your cancer-minimising behaviours as we recommend to our patients? Quick recap – testicular self-check, breast self-check, sunscreen, stopping smoking, reduction in over-consumption of red or processed meat, and checking stool for blood. Remember to prioritise your own health!
This week is about oncology/haematology.
One of the major haematological conditions that come through my door is iron deficiency anaemia. Iron deficiency is common among young females with menorrhagia. However, as patients age and in males particularly, iron deficiency is not normal and requires further investigation. Reduced dietary input occurs occasionally, but typically the issues lie with poor absorption or occult blood loss. FOBT screening is for over 50-year-olds who are asymptomatic and is not the first line investigation for someone with iron deficiency of unknown cause. These patients require a colonoscopy.
Haemochromatosis, I have found, is much more common than I initially expected. If a patient has elevated ferritin levels and transferrin saturations in two or more blood samples, then further genetic testing for haemochromatosis is required. Management involves notification of family members that they may be at increased risk of developing the condition and referral to a haematologist for venesections.
I think every doctor is scared of missing a diagnosis of cancer in a patient. It’s important to frequently go through regular screening for signs/symptoms of cancer when taking a patient’s history. These history elements to ask should include but are not limited to the following: night sweats, unexplained weight loss, fatigue, breast changes, testicular changes, new lumps, change in stool colour, history of smoking, family history of cancer. Also, include lymph node examination as part of your routine for an extra level of thoroughness.
Be kind to yourself and get into the habit of sneaking a peek at your poo!
Dr Andrew Harris
Director of Amadeus Education.
Did you know?
According to BEACH data, 1.4% of all encounters in General Practice were specifically related to the blood and blood forming organs. Consider this as you are preparing for your exams. (Source: General practice activity in Australia: 2015-16. https://bit.ly/2c4d8Em)
These are the common presenting complaints that should be covered for this topic:
- Abdominal swelling (generalised) (https://bit.ly/2DcixDY)
- Chronic constipation (https://bit.ly/2W3HsRQ)
- Haemoptysis in adults (https://bit.ly/2VXjTtD)
- Jaundice (https://bit.ly/2Hd3o9O)
- Lymphadenopathy (https://bit.ly/2Hcd8AY)
- Purpura (https://bit.ly/2SVPBWr)
- Tiredness/chronic fatigue (https://bit.ly/2Fruqby) (BEACH)
Weight loss (https://bit.ly/2DfidV9)
These are the common conditions that should be reviewed for this topic:
Clotting/bleeding disorders – including thromboembolism, platelet disorders, haemophilia
Cancer – General
These are some important mnemonics relevant to this topic:Wells’ criteria (DVT/PE) (https://bit.ly/2D1eAll)
Here are the list of recommended Checks that would be useful in your study for GP exams (accessed via subscription from http://gplearning.racgp.org.au):
- Biochemistry, November 2012
- Cancer, September 2015
- Blood, April 2016
- Cancer, July 2016
Focus on clinical skills:
Here is a brief focus on some OSCE preparation topics related to this topic:
- Assessment of fatigue
- Lymph node examination playlist by GP Synergy: https://bit.ly/2SZ5qf2
Focus on medicolegal:
Here is a brief focus on the medicolegal issues covered in Australian Family Physician:
- Failure to diagnose: brain tumour. AFP, May 2010. (https://bit.ly/2Mnu7zd)
Copyright © 2021 Andrew Harris