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IM13.1-19 | Common Malignancies and Oncology — Assignment

CLINICAL SCENARIO

This assignment requires you to produce a comprehensive oncological patient assessment and integrated management plan for a real or constructed case of a cancer patient at any stage of disease. You may use a patient you have observed during your clinical posting or construct a realistic case drawing on your SDL learning. The case should involve a haematological or solid malignancy, present in the Indian clinical context, and include all five domains below. The goal is to demonstrate competency in structured oncological history-taking, clinical examination, diagnostic reasoning, management planning, and palliative/pain care principles — as required for an MBBS final-year student entering internship.

Instructions

Write a structured patient assessment and management plan in the five sections provided. Base it on a real patient observed during your medicine posting, or construct a realistic case. Use your own clinical reasoning — do not reproduce SDL text verbatim. Use generic drug names only. Apply correct diagnostic criteria and management thresholds (e.g., CRAB criteria for myeloma, Ann Arbor staging for lymphoma, ECOG performance status scale). Word limit: 1,200–1,600 words.

Length: 1,200–1,600 words across all five sections

What to Submit

Section 1: Oncological History

Guidance: Briefly describe your patient (age, sex, presenting complaint). Then write the complete oncological history structured across four domains: (1) presenting syndrome — what brought the patient to attention; (2) risk factor analysis — tobacco (pack-years), alcohol, dietary factors, occupational exposures, infective history (HBV/HCV/HPV/H. pylori), reproductive history in women; (3) systemic review — unexplained weight loss, fever, night sweats, bone pain, dyspnoea, altered bowel habit; (4) functional and psychosocial concerns — ECOG functional baseline, social support, patient's awareness of diagnosis. Approximately 300 words.

Section 2: Physical Examination and Differential Diagnosis

Guidance: Record your oncological examination findings in a structured format: (1) General — ECOG performance status (assign a score and justify); (2) Primary site — size, surface characteristics, consistency, fixity, transillumination/pulsatility if relevant; (3) Lymph node mapping — cervical, axillary, inguinal (describe each group using standard anatomical language); (4) Systemic — hepatosplenomegaly, ascites, pleural effusion, any skin signs or paraneoplastic features. Generate a prioritised differential diagnosis (most likely first) with one or two sentences of supporting clinical reasoning for each. Approximately 300 words.

Section 3: Diagnostic Work-Up

Guidance: Present your investigation plan in sequential order: first-line (CBC, LFT, RFT, LDH, relevant tumour marker), second-line (imaging — CXR, ultrasound, CT), and definitive (tissue biopsy — state the preferred method and why). For the CBC: what cancer-related pattern would you look for? For the tumour marker you select: state its sensitivity and specificity limitations. State clearly which investigation provides the definitive tissue diagnosis and why no treatment should begin without it. Approximately 250 words.

Section 4: Management Plan

Guidance: Begin by explicitly stating the treatment intent (curative or palliative) and justify this based on clinical stage and ECOG performance status. For each major modality (surgery, radiotherapy, systemic therapy), state whether it is applicable in your case and its specific role. Identify ONE oncological emergency relevant to your patient's diagnosis or treatment plan — describe its recognition criteria (clinical and biochemical) and the immediate management steps you would take. Describe how you would involve the patient in this decision, including what information you would give and how you would explore their goals and preferences. Approximately 350 words.

Section 5: Pain Assessment and Palliative Care

Guidance: Use a validated pain assessment tool (Numeric Rating Scale 0–10, or Brief Pain Inventory categories) to document the patient's pain characteristics: site, severity, character, radiation, and what makes it better or worse. Apply the WHO analgesic ladder — state which step is appropriate, the specific drug (generic name), dose, route, and frequency you would prescribe. Name TWO common opioid side effects and the specific intervention to prevent or manage each (in particular, state which type of laxative must be co-prescribed and which must be avoided). Conclude with two or three sentences articulating a patient-centred palliative care principle applicable to your case. Approximately 200 words.

Grading Rubric — Oncology Patient Assessment and Management Plan Rubric

Criterion	Points	Full-marks descriptor
Oncological History and Risk Factor Analysis (Section 1): Elicits a complete oncological history structured to answer: What is the presenting syndrome? What is the likely tumour site and extent? What is the risk factor burden? What are the patient's functional and psychosocial concerns? Quantifies relevant exposures and correctly identifies modifiable risk factors.	20 pts	All four history domains addressed with precision; tobacco quantified in pack-years; relevant infectious exposures (HBV, HPV, H. pylori, HCV) and occupational/reproductive risk factors documented; functional and psychosocial concerns elicited; B symptoms explicitly enquired about.
Physical Examination Findings and Differential Diagnosis (Section 2): Documents a systematic oncological examination including general appearance (ECOG performance status assigned and justified), locoregional examination of the suspected primary site, lymph node mapping, and systemic signs of metastatic disease or paraneoplastic syndromes. Generates a differential diagnosis with the most likely diagnosis and its supporting evidence clearly stated.	20 pts	ECOG performance status assigned with explicit justification; primary site examination documented with all relevant features (size, consistency, fixity, margins, lymph node mapping with anatomical notation); at least one systemic sign of spread or paraneoplastic effect assessed; differential diagnosis prioritised with supporting clinical reasoning.
Diagnostic Work-Up Selection and Interpretation (Section 3): Selects and sequences investigations logically (haematology, tumour markers, imaging, and histopathology), correctly interprets CBC results with cancer-specific lens, and interprets at least one tumour marker with its sensitivity/specificity caveats, correctly identifying which investigation provides definitive tissue diagnosis.	20 pts	Investigations selected and sequenced from basic to definitive with explicit reasoning for each; CBC interpreted with cancer-specific lens (e.g., leucoerythroblastic film = marrow infiltration; thrombocytosis = reactive vs paraneoplastic); tumour marker interpreted with sensitivity/specificity limitation stated; tissue biopsy correctly identified as the mandatory step for definitive diagnosis.
Management Plan — Curative vs Palliative Intent (Section 4): Explicitly states treatment intent (curative vs palliative) with justification based on stage and ECOG; outlines modality indications (surgery, radiotherapy, systemic therapy) with correct reasoning; addresses at least one oncological emergency relevant to the case (TLS, febrile neutropenia, hypercalcaemia, SVC syndrome, MSCC); demonstrates integration of patient preferences in the management decision.	25 pts	Treatment intent explicitly stated and justified (stage + ECOG); all three modalities considered with specific indication/role; one oncological emergency correctly identified, its recognition criteria and immediate management described; patient-centred framing demonstrates awareness of shared decision-making.
Pain Assessment and Palliative Care Principles (Section 5): Applies a validated pain assessment tool (NRS, Brief Pain Inventory, or WHO categories); correctly applies the WHO analgesic ladder with appropriate drug, dose, and route for the patient's pain severity; identifies opioid side effects and their management (especially constipation prophylaxis); articulates end-of-life care principles applicable to the case.	15 pts	Validated pain assessment tool applied and documented; WHO analgesic ladder applied with correct step (drug, dose, route, frequency); opioid side effects addressed with specific prophylaxis (stimulant laxative named); at least one end-of-life care principle articulated (comfort, dignity, advance care planning, or family support).

PEER REVIEW

Review your peer's oncology management plan using the rubric provided. For each of the five sections, assign a score and write one specific, constructive comment. Focus especially on: (1) whether treatment intent is explicitly stated and justified by stage AND ECOG performance status; (2) whether tissue biopsy is identified as the mandatory step for definitive diagnosis; (3) whether the opioid analgesic choice follows the WHO analgesic ladder and whether constipation prophylaxis (correct type of laxative) is addressed. Do not simply copy rubric descriptors — personalise your comment to the specific content of the submission. Complete your review within 72 hours.