Oncology and Haematology for MRCP Part 1

I’m currently waiting to start another set of medical registrar night shifts unfortunately so I’m going to spend a couple of hours hammering out this guide to be somewhat productive and hopefully help out some of you guys.

Similar to respiratory, haematology and oncology occupy 15 marks out of the total 200 in Part 1 so you should dedicate roughly 7.5% of your total study time to this section.

Oncology

For the following three conditions you’ll need to have a basic understanding of how to establish a diagnosis and also have knowledge of any relevant investigations:

  • Hypercalcaemia
  • Spinal cord compression
  • Common cancers (presentation, diagnosis, staging and treatment principles): lung, bowel, breast, prostate, stomach, oesophagus, bladder, skin, haematological, testicular and ovarian

Whilst for the next three you’re only expected to establish a diagnosis:

  • SVC obstruction
  • Premalignant conditions e.g. familial polyposis coli
  • Paranoplastic conditions e.g. ectopic ACTH

It might seem a bit overwhelming for a subject we don’t routinely get rotations in during FY2 and CMT but hypercalcaemia, MSCC and SVCO are all general medical emergencies. Perhaps it’s my ignorance but from experience, cancer treatment essentially revolves around surgery, chemotherapy and radiotherapy. Like the above parenthesis suggests, you’ll be expected to know treatment principles but I would strongly advocate against rote learning the staging systems for all the different malignancies!

I used this book when I studied for oncology because the format was very readable after a long hospital shift but also outlined basic treatment principles in addition to background on common cancers, and less common ones if you’re interested. In hindsight it saved me a lot of time as I’m someone who spends way too long when writing my own notes.

If you’re someone who prefers hardcore guidelines then you’ll be happy to hear that there are NICE guidelines on hypercalcaemia and metastatic spinal cord compression.

Right, onto haematology before I fall asleep…

Haematology

For the following 12 conditions, MRCP Part 1 will be satisfied if you can establish a diagnosis:

  • Bone marrow failure: causes and complications
  • Thrombocytopaenia
  • Transfusion reactions
  • Thrombophilia: classification; indications and implications of screening
  • Myelodysplastic syndromes
  • Leukaemia
  • Lymphoma
  • Myeloma
  • Myeloproliferative disease
  • Inherited diseases of haemoglobin (sickle cell disease, thalassaemias)
  • Amyloid
  • Principles of haematopoietic stem cell transplantation

And for these two conditions, you’ll be expected to establish a diagnosis AND have knowledge of relevant investigations:

  • Bleeding disorders: DIC, haemophilia
  • Anticoagulation treatment: indications, monitoring, management of over-treatment

There’s actually only one condition in which you need to be able to establish a diagnosis, have knowledge of relevant investigations, have knowledge of prognosis and likely response to therapy:

  • Anaemia: iron deficient, megaloblastic, haemolysis, sickle cell.

Haematology was and still is a huge and confusing subject for me. Breaking it all down makes you realise that even MRCP appreciate this fact. Remember that you’re sitting this exam to demonstrate your ability to work as a medical registrar, not a haematology one. The reason you don’t need to have extensive knowledge of haematology as a general physician is because conditions such as lymphoma and bone marrow failure are now exclusively
managed by haematologists.

Realising that the list of 12 conditions exist (I hope you do if you’ve made it this far!), reading around them in reasonable detail and learning a few key high yield facts on each condition e.g. the significance of the Philadelphia chromosome will help you progress a lot further than the candidate who overcomplicates haematology and neglects other important subjects.

For you perfectionists (I’m one, sometimes) there’s a reason why your consultant requests a haematology review on the ward – it’s safer for the patient for the expert to come! Just know anaemia inside out, have a good knowledge of bleeding disorders and principles of anticoagulation treatment and the rest should be studied but not at the expense of other core subjects,

Hopefully this reference guide has pointed you in the right direction for where to start your haematology and oncology revision for MRCP Part 1. Try not to be too disheartened and just get on with it would be my top tips.

Keep in mind that if you’re comprehensive with your studying, you’ll be covering a lot of endocrinology when you’re studying ACTH or hypercalcaemia. Good luck!

If you enjoyed this article make sure you get your own copy of my MRCP Part 1 & 2 Written Guide. In this guide, I explore the above and other concepts such as time allocation and the most preferable resources for the written exams in much more detail.