Image of the week.

Welcome to Image of the Week. Click on the image or red text to find the answers, and on the highlighted red text to read more! Each week answers will be updated. Leave your own ideas and we can generate discussion.

Week 31: Breaking Bad News

Every day bad news has to be discussed in an Oncology ward or clinic.

1. What are some of the key ways this can be done sensitively?

2. Have you heard of SPIKES? What is it?

3. How would you go about this difficult task?

Answers can be seen here – a must read.

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Week 30: Pancreatic Cancer

The boss of Apple, Steve Jobs, resigned this month. He has been the drive behind Apple’s success in recent years. He has also been suffering from a form of pancreatic cancer. What do you know of this tumour?

1. What are the common pathologies of pancreatic cancer?

2. What are the commonest symptoms?

3. What are the treatment options?

Answers available here..

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Week 29: Cancer in pregnancy

Fortunately cancer in pregnancy is rare. Sometimes however, it does happen.

1. Which cancers are most frequently seen?

2. Can a woman who is pregnant undergo surgery for a cancer?

3. Can a woman who is pregnant receive radiotherapy or chemotherapy?

Answers here!

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Week 28: Acrometastases

1. What are acrometastases? what do you see here?

2. If it is an acrometastasis, what are the likely primary cancers?

3. How will you treat this rare presentation?

Answers available here..

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Week 27 : The Liver

1. Describe what you see here?

2. Why is the liver a common site of metastatic disease?

3. What symptoms may occur as a result and how may you treat them?

Answers here…

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Week 26: A CXR

1. Describe this CXR.
2. What tumours could cause this appearance?
3. How would you manage it?

Answers here...

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Week 25: Another skin lesion

1. Can you describe what you see?

2. If I tell you it is a cancer, which malignancy do you think it is?

3. What are the main causes of this cancer?

Answers here…

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Week 24: Skin lesion

1. What is the differential Dx here?

2. If it is malignant, what treatment would you offer? Surgery? Radiotherapy?

Answers here….

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Week 23: Radiation and Cancer

1. The terrible Japanese earthquake this week has led to a possible radiation leak from a nuclear reactor. Radiation is used to treat cancer, but it is also a risk factor for causing it. How can the very thing that causes cancer also be a cure?

Answer here

More details on radiation effects here from the BBC

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Week 22: Pain control

1. What is the Analgaesic Ladder?

2. If someone is still in pain from a malignant process, despite taking cocodamol and ibuprofen, how would you recommend they amend their analgaesia?

3. If someone recently commenced on MST plus oramorph PRN, is admitted with confusion, what investigations and initial management would you begin?

For answers click here..

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Week 21: European Opportunities

1. How as a medical student can you increase your exposure to European Medicine?

2. How can you improve your language skills?

3. What European organisations can you work in as Dr / Oncologist?

Answers click here

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Week 20: New Year Resolutions

1. As a Dr, how can you help someone quit smoking?

2. Why does more exercise reduce your risk of cancer?

3. Is alcohol ever good for you? Is the red wine story fact or fiction?

Postcard answers here.

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Week 19: Cancer and the Weather

As snow brings much of Scotland to a halt, and Ninewells runs a reduced service, a frosty theme for the week. This image was taken in January this year, from Dundee Satellite station overlooking the River Tay. Fantastic!

1. If you are an Arctic Eskimo, which Cancer are you most likely to get? Why?

2. Does cryotherapy have a role in treating Cancers?

Answers here!

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Week 18: Oral Cancer:

1. Describe what you see here.
2. What symptoms may the patient have?
3. What may have caused this?
4. What are the treatment options?

Answers here!!

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Week 17: Cutaneous manifestations of Cancer

1. What is this skin condition?
2. With what malignancy is it associated?
3. With which benign conditions is it associated?

Click here for the answers.

Interested in skin conditions? Click on to Dundee Skin to learn more.

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Week 16: Cancer as a Global problem.

Click here for the picture

1. Which countries have the highest incidence of cancer? Why do you think this is?
2. Why does Africa have the lowest incidence?
3. How do you think the patterns will change in the next 50 years?

Click here for answers / ideas

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Week 15: Abnormal CXR

Describe the obvious abnormality on this CXR

1. Describe this CXR.
2. What history may the patient describe?
3. What next 2 investigations would you perform?
4. What is your differential Dx?

Click here for answers

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Week 14:

What is the abnormality?

1. Describe what you see?
2. Which cancers can cause this appearance?<
3. How might you treat this?

Click here for answers
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Week 13:

An American stamp - The Pap Test

1. What is the Pap test?
2. Which cancer does it screen for?
3. What is the cause of most of these cancers?
4. What developments have there been recently to reduce the incidence of this particular cancer?

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Week 12:

1. What is this medicine?
2. For which tumours is it used in the UK?
3. How does it work?

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Week 11:

1. How many carcinogens do cigarettes contain?
2. How do you define a patient’s smoking history in terms of “pack years”?
3. How can you support a patient to stop smoking?
4. When a patient is diagnosed with a smoking related cancer, is there any benefit in them giving up the habit at that point?

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Week 10:

1. What is this?
2. What is it’s purpose?
3. Do all patients have to where one of these?
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Week 9:

1. What is this drug?
2. For which malignancies is it used?
3. What are its main side effects?
4. What colour does it turn the urine?

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Week 8:

1. Who is this?
2. What did he discover?
3. Can you name some other important figures in the history on Oncology?

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Week 7:

1. What type of imaging is this?
2. Describe what you see.
3. What types of cancer most commonly lead to this picture?

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Week 6:

1. Describe this hand.
2. What may this clinical sign be associated with, and particularly which malignancies?
3. What other para-neoplastic manifestations of cancer do you know?

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Week 5:

Mammogram

1. What type of imaging is this?
2. Describe what you see and what is the likely diagnosis?
3. What other investigations would you perform?
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Week 4:

Round nodule

1. Describe what you see here?
2. What is the differential diagnosis?
3. If it is malignant, how would you treat it?

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Week 3:

1.What is this type of investigation? What does it show?
2. What symtoms might the patient have been suffering from?
3. What other investigations would you arrange?
4. What do you think is the likely diagnosis? What risk factors do you know for this type of cancer?
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Week 2:

1. Describe what you see.
2. What could be the diagnosis?
3. What typical morphology do cancer cells arising from this organ have?
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Week 1:

1. What do you see here?
2. How might this present?
3. What may have caused it?
4. What treatement options are available?

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Responses

  1. Week 2:
    1. That looks like a hepatomegaly to me, with haemorrhage at the back.
    2. Liver sarcoma.
    3. No idea…
    4. Surgical resection and chemotherapy?

    Complete guesses, I should probably know more by now…

    • That necrotic thing at the back of the liver is a kidney! If you look at the anterior part of it, you can see contrast in the renal cortex.

      If it’s a clear cell tumour, it can be resected.

      If there’s metastases, Sunitinib (?sp) has been shown to be very expensive, but effective.


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