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Cancer investigation

Physical examination and biopsy

Endoscopy

Biopsy

Fluids

Often, malignancy give off a fluid. In the various parts of the body, this is more common. Especially the lungs. These can be examined to tell

Blood tests

Serum electrophoresis Hypercalcaemia

Radiology

Lytic regions: prostate, renal cell carcinoma, lung cancer, and sclerotic: prostate, leukaemia, bladder, or a mix: breast.

Xray CT scan Bone scan - inject with radioactivity - looks at changes in bone turnover. Mets tend to have increase or decreased metabolism, which can often show up on the scan. DEXA scan - low dose scan that looks at bone density PET scan - MRI scan -

Example Case

Mr Smith is a 65 year old man who presents to his GP with a 6 week history of breathlessness and weight loss.

He has also recently developed increasing pain in his lower back which wakes him at night.

He is usually fit and well, with no previous significant medical history. He is a smoker with a 25 pack year smoking history.

His GP organises a Chest Xray with a report as follows:

  • Normal heart size.
  • Left lower lobe collapse with enlargement of the left hilum.
  • The appearances are highly suspicious of an underlying malignancy and therefore urgent referral to the lung multidisciplinary team is recommended for further investigation.

Pleural tap

Look for exudates. transudates bronchoscopy CXR CT Bone scan

  • paraneoplastic - hypercalcaemia
  • staging and prognosis