Radiotherapy & Oncology Revision

#RONCrg Revision Group – Case-study 6

Brenda And Her Breast Lump

Breast Cancer (number 1) – 28th Oct 2014

Run by Smizz & Emma Russell

Introduction:

Brenda is a normally fit & healthy 37 year old female, with no children who is the managing director of her own online travel company. She leads a very busy, at times stressful, life.

Brenda hasnt visited her GP in years. However, whilst on a rushed lunch break, she slipped in Debenhams.  This led her to find a hard, unusual lump on her left breast. She ignored it, thinking didn’t have the time to go to the doctor, and believed it probably go away. However she felt that it “didn’t seem normal”, and she noticed that it had gotten bigger. So she made an appointment to visit her GP.

  Signs & Symptoms:

She complains of being tired but puts this down to her busy lifestyle. She doesn’t smoke, and drinks only on occasion & specific business deals. She claims she has left-side shoulder pain, but believes this is due to the fall.

Vitals show she has no temp but is hypertensive. There are 3 palpable, moveable rubbery lymph nodes under left axilla on examination, & a hard lump in the upper left quadrant of left breast.

#RONC Revision Group – Case-study 5

Jez’s Overwhelming Tiredness

Leukaemia (AML) (number 1) – 22nd April 2014

Run by Smizz & Emma Russell

  Jez is a 32 year old of Indian heritage male who is a small Internet business owner who has been feeling extremely unusually tired. He thinks that maybe it’s just burnout but visits his GP anyways as he thinks that maybe he is just coming down with an infection as he has noticed a non-itchy rash (Petechiae – not a rash) around his ankles. He explains to the doctor how even walking upstairs seems like a chore.

  The GP notices how pale Jez is, and asks if he has noticed anything else unusual. Jez says he has noticed when he brushes his teeth that his gums bleed and they feel a bit tender.

  The GP immediately orders urgent bloods and takes Jez’s temperature, which is 38.6C, and checks for any Hepatomegaly and splenomegaly which isn’t present.

#RONCrg Revision Group – Case-study 4

Shirley And Her Chest Pain

Non-Small-Cell-Lung-Cancer (NSCLC) (number 1) – 28th Feb 2014

Run by Smizz & Emma Russell

READ THE #RONCrg Live-Tweet session as it happened HERE: 

Shirley is a 61 year old female, who ‘fell’ and sustained a hip fracture requiring hospitalisation. She is not sure whether she collapsed or fell. However, during the hospitalisation she had an episode of chest pain and a CT scan was performed. The CT revealed a right infrahilar mass 3.1 cm & subcranial lymph node measuring 1.2 cm with the right lower lobe collapsed. The Bronchoscope revealed a narrowing obstruction of right lower lobe. Extrinsic compression of posterior wall of bronchus intermedius

Fine needle aspiration of the mass revealed that Squamous Cell - non-small cell carcinoma, poorly  differentiated. Lab results show high molecular weight keratin

  Shirley has limited stage disease: T2N2 – Stage 3A

  Shirley denies weight loss, haemoptysis, but has been complaining of hoarseness for the past 3 weeks. She has been complaining of chronic back pain and she denies headache, changes in mental states/coordination.

  She has a pack of smokes per week smoking history.

She seems relatively well – Performance status is allocated 3 due to hip-fracture & age.

  Past Medical History:

-       Chronic back pain

-       Hypothyroidism

-       Polycystic Ovaries

  What other things do we need to do, and what treatment options are best for Shirley. JOIN US 28TH FEB AT 8PM ON #RONCrg 

#RONC Revision Group – Case-study 3

Ollies Crazy Shoulder Pain

Lymphoma (Hodgkin’s) (number 1) – 28th Jan 2014

Run by Smizz & Emma Russell

HERE'S  THE STORIFY TALK AS IT HAPPENED!

http://storify.com/RONCrg/ollie-s-strange-shoulder-pain-lymphoma-1-case-stud

Patient History:

Ollie is a fit and healthy 21 year old Male. He’s been enjoying life at university studying Sports Science but has gone to his GP with complaints of a pain in his left shoulder, which is exacerbated by drinking alcohol.  He can’t remember injuring himself but thinks that maybe it could be a sports related injury, since that’s what he does.

In the consultation, in answer to his GP’s questions he casually mentions that he has felt a lot more unusually tired recently, and is experiencing heavy sweating at night (drenching night sweats) – which he puts down to university housing heating.

The GP needs to send Ollie for a series of basic diagnostic tests.  What diagnostic tools should he use?

  JOIN US 8PM GMT USING #RONCrg on the 28th Jan 2014.

Think about diagnostic tools, bloodmarkers, biopsies,  staging/grading/prognosis, treatment plans specific for Ollie and his age, side-effects, aftercare. 

HERE'S THE GOOGLE REVISION DOCUMENT FOR THE TALK THAT YOU CAN DOWNLOAD HERE:

#RONC Revision Group – Case-study 2

ROD & HIS SUDDEN URGE TO PEE

Prostate Cancer (number 1) – 20th December 2013

Run by Smizz & Emma Russell

Patient History:

Rod is a 46 year old male who is married and has 2 kids. After a few weeks of sleepless nights due to having to pee more often and with sudden urgency, his wife tells him to go to visit his GP. Rod claims that he has had no pain, but has felt "quite tired recently, probably from interrupted sleep & stress at work". The GP physically checks Rod out by doing a digital rectal examination and orders a set of tests, including a urine sample to check for infection and a prostate-specific antigen (PSA) blood-test.

When the PSA test comes back high Rod’s GP is concerned & refers Rod to see a urologist. Who then decides on a set of diagnostic tests to help diagnosis what the problem is. YOU CAN FIND THE STORIFY TWITTER DISCUSSION AS IT HAPPENED: http://storify.com/RONCrg/rod-and-his-sudden-urge-to-pee

And you can download the Google Revision Doc here:  https://drive.google.com/file/d/0B4iSTwyeVho_RlkwdmRVd3hhTWs/edit?usp=sharing

#RONC Revision Group – Case-study 1

JOAN & HER SKIN LESION

Melanoma – 19th November 2013

Run by Smizz & Emma Russell

  SEE the STORIFY tweets & replies here: http://storify.com/RONCrg/joan-and-her-skin-lesion-what-do-we-do

Patient History:

Joan is a 40 year old woman who is mom of 2. She has a skin lesion on her  left shoulder that keeps bleeding and is itchy, she says it “just doesn’t heal.” She claims to have had the skin lesion for a while, thinking it would “just go away”. 

She doesn’t know if it’s a mole that has evolved or a new lesion. It is 8mm in diameter with a bit of pigmentation. She has had some bad headaches too, mostly when she wakes up. But she assumes it's because she's busy at work and busy being a mom of 2. 

She says that she frequently stays out in the sun, classes herself as a “beach babe” and has on many occasions across her life, especially when she was younger, had bad sun burn because she wanted a tan and didn’t use the correct sun cream factor.

She has recently been to Australia and visits frequently for beach holidays and to visit family.

Think about - Skin Cancer scales. Preferred Biopsies. Diagnostic tools for staging & grading. First-day treatment. Treatment dosage. Side-effects. Socio-psycho elements, aftercare.  We will be looking at some CT Scans too. 

HERE'S THE ANSWERS & REVISION DOCUMENT 

Can you name all 12 structures in this CT scan of a normal, healthy abdomen?

Image from Pocket Tutor: Surface Anatomy, 2012.  By Richard Tunstall & Nehal Shah, published by JP Medical Ltd., pg 82.

9781907816178

WE HAVE RELEASED THE ANSWERS:

DOWNLOAD/VIEW THE PDF DOCUMENT HERE:

Just some general information to make sure we can have the best time online! 

These things do go without saying, but just incase you forget!

- Never mention which department you work at.

- Never talk about your patients, especially specifically  and by name. Sometimes you might refer to a case-study, that's OK - i.e. I once saw a case where Melanoma had metastasised to virtually every organ. Just don't be super specific to it.

- Never talk about the people you work with in your department, unless it's all glowing stuff! (Like their research).

- All the images we use will be stuff from books, or gained from things online, credited & referenced appropriately.

There's a few other things, but that's basically the REALLY important stuff. Here's some extra reading if you're at a commercial break whilst watching the X Factor.

https://students.shu.ac.uk/lits/it/documents/pdf/How%20to%20use%20social%20media%20responsibly.pdf

https://students.shu.ac.uk/lits/it/documents/pdf/Digital_Footprint.pdf

The idea for this group is that a topic/area of study for revision will be decided (and can be requested by you!)

A revision document will then be posted on the blog, using google Drive to store & access & edit the documents. When it reaches discussion time, at 8PM on TUESDAYS, we'll log on to twitter and get the discussion going with all tweets marked with the #RONCrg hashtag. No need to @roncgr ! Just #

Everyone is welcome to join in, and there's no such thing as a stupid question!

 We'll discuss the topic and some cases, as well as the reasoning behind our decisions related to those cases, and also try and answer queries as we go along.

You'll be able to catch the full thing on our storify account where each discussion will be archived! http://storify.com/RONCrg.

We hope to make some fun youtube videos too! But for now, keep it twitter!

Fingers crossed this will be a valuable revision tool for all involved!