oncology

A 72-year-old woman, status post mastectomy, presents with a lesion. What is the MOST appropriate initial diagnostic test?

A 68-year-old male with a long history of alcohol-related cirrhosis and previous treatment for hepatitis C presents with increasing abdominal distension, fatigue, and a dull ache in the right upper quadrant. He denies acute pain or fever. On examination, he has mild jaundice, shifting dullness, and spider naevi. His vital signs are stable. Recent blood tests show albumin 28 g/L, INR 1.4, total bilirubin 45 µmol/L, ALT 65 U/L, AST 88 U/L, creatinine 90 µmol/L. Alpha-fetoprotein (AFP) is 850 µg/L (normal <10). An abdominal CT scan with contrast is performed, axial views of which are shown. Considering the patient's clinical presentation, laboratory results, and the findings on the provided imaging, what is the MOST appropriate immediate next step in the management of this patient?

A 62-year-old man presents with a 4-month history of increasing fatigue, unintentional weight loss of 7 kg, and intermittent upper abdominal discomfort. He reports no change in bowel habits, dysphagia, or vomiting. His past medical history includes hypertension and osteoarthritis. He is a non-smoker and drinks alcohol occasionally. On examination, he is pale. His vital signs are stable. Abdominal examination reveals mild epigastric tenderness but no masses or organomegaly. There is no peripheral lymphadenopathy. Initial blood tests show haemoglobin 92 g/L (reference range 130-170), MCV 74 fL (80-95), ferritin 12 mcg/L (30-300), and CRP 18 mg/L (<5). Liver function tests and renal function tests are within normal limits. Which of the following is the most appropriate initial investigation?

A 3-year-old child is investigated for a 2-month history of increasing abdominal distension and intermittent pain. On examination, a firm, non-tender mass is palpable in the upper abdomen. Initial blood tests reveal mild anaemia. Vital signs are stable. The provided image was obtained as part of the diagnostic evaluation. Considering the clinical presentation and the findings demonstrated, which of the following investigations is most crucial for determining the extent of disease spread, a key factor in guiding subsequent management decisions for this paediatric patient?

A 3-year-old presents with a 2-month history of increasing abdominal distension and intermittent pain. Physical examination reveals a firm, non-tender mass in the upper abdomen. Blood tests show mild anaemia. Vitals are stable. This CT scan was performed as part of the initial workup. Considering the clinical presentation and the findings demonstrated in the provided image, which of the following investigations is the most critical next step for accurate staging and risk stratification to guide appropriate management in this paediatric patient?

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 72-year-old woman presents with a 6-month history of a non-healing rash on her chest wall at the site of a previous mastectomy performed 10 years prior for invasive ductal carcinoma. She completed adjuvant chemotherapy and radiation. Examination reveals the findings shown. What is the MOST appropriate next step in management?

A 58-year-old male with known alcoholic cirrhosis undergoes surveillance. AFP is 600 ng/mL. The provided image was obtained. What is the next step?

A 65-year-old woman presents with a chronic, non-healing lesion at the site of her mastectomy scar, performed 7 years ago. She denies pain but reports occasional itching. What is the MOST appropriate next investigation?

A 58-year-old male with cirrhosis secondary to alcohol abuse presents with new-onset ascites and RUQ pain. His AFP is markedly elevated. A CT abdomen with IV contrast is performed, as shown. What is the MOST appropriate next step in confirming the suspected diagnosis?

A 68-year-old woman presents to her GP with a 3-month history of a persistent, mildly pruritic skin lesion on her left chest wall. She had a left simple mastectomy for invasive ductal carcinoma 10 years ago, followed by adjuvant therapy. She denies fever, weight loss, or other systemic symptoms. Physical examination reveals the appearance shown. What is the most appropriate initial diagnostic investigation?

A 45-year-old woman has a mother diagnosed with colorectal cancer at age 55 and a maternal aunt with endometrial cancer at age 60. What is the most appropriate initial step regarding genetic testing for hereditary cancer syndrome?

Which genetic variant classification most strongly mandates clinical action?

A 65-year-old male presents with a 3-month history of unintentional weight loss and early satiety. Gastroscopy and biopsy confirmed a gastric mixed adenoneuroendocrine carcinoma. Staging CT imaging is shown. Considering the clinical presentation and the findings on the provided imaging, what is the most appropriate initial management strategy?

A 58-year-old woman presents for her scheduled screening mammogram. She denies any breast lumps, pain, or nipple discharge. She has no family history of breast cancer. Her physical examination is unremarkable. The image provided is a detail from her left craniocaudal view. Considering this finding, what is the most appropriate immediate next step in her clinical management?

A 62-year-old woman presents with fatigue, constipation, and bone pain. Serum calcium is elevated. The images are obtained. What is the MOST appropriate next step in management?

A 58-year-old male presents with fatigue and microcytic anemia. He denies overt bleeding but reports occasional dark stools. Colonoscopy reveals the image shown. Biopsies confirm adenocarcinoma. What is the MOST appropriate next investigation to stage the cancer?

A 2-year-old with a palpable abdominal mass and periorbital ecchymoses has the shown CT. What is the MOST likely diagnosis?

A 68-year-old male presents with dysphagia and weight loss. Gastroscopy and biopsy confirm gastric adenocarcinoma. Staging CT imaging is shown. His ECOG performance status is 1. Considering the clinical presentation and the findings demonstrated in the provided images, what is the most appropriate initial management strategy for this patient?

A patient has a pathogenic variant in MLH1 identified via genetic testing. What cancer screening is most strongly indicated?

A 62-year-old woman presents with fatigue, constipation, and bone pain. Serum calcium is elevated. The provided imaging was obtained. What is the MOST likely underlying cause of her presentation?

A 58-year-old male with cirrhosis presents for routine surveillance. His AFP is elevated. A CT scan with contrast is performed (image attached). What is the MOST appropriate next step to determine definitive management?

A 4-year-old presents with abdominal distension, pain, and weight loss over several weeks. On examination, a firm, irregular abdominal mass is palpable. Blood tests show mild anaemia. The provided image is an axial CT slice of the abdomen. Considering the clinical presentation and the findings demonstrated in the image, which of the following investigations is the MOST appropriate initial step to establish a definitive diagnosis?

A 65-year-old male with recently diagnosed gastric mixed adenoneuroendocrine carcinoma presents with unintentional weight loss. Endoscopy confirmed the diagnosis. Staging imaging is provided. His ECOG performance status is 1. Based on the clinical context and the findings demonstrated, what is the primary goal of initial management for this patient?

A 55-year-old woman undergoes routine screening mammography. She is asymptomatic with no personal or family history of breast cancer. Physical examination is unremarkable. The provided image is a magnified view from the craniocaudal projection of the right breast. Based on the findings demonstrated, what is the most appropriate immediate next step in the management of this patient?

A 65-year-old male with known alcoholic cirrhosis undergoes surveillance. The provided contrast-enhanced ultrasound was obtained. What is the MOST appropriate next step?

A 62-year-old male presents to the emergency department with right upper quadrant abdominal pain, weight loss, and jaundice. He has a known history of chronic hepatitis C infection. His vital signs are stable. Physical examination reveals hepatomegaly and mild ascites. The patient denies any alcohol consumption. Laboratory investigations reveal elevated alpha-fetoprotein (AFP) levels. A CT scan of the abdomen with and without contrast is performed, as shown. Based on the imaging and clinical findings, what is the MOST appropriate next step in management?

A 70-year-old presents with iron deficiency anaemia and intermittent rectal bleeding. Colonoscopy was performed, and a representative image is shown. Biopsies are pending but malignancy is strongly suspected based on the endoscopic appearance. What is the MOST appropriate next investigation to guide definitive management?

A 4-year-old presents with abdominal distension and back pain for 2 months. Exam reveals a firm, fixed abdominal mass. Vitals are normal. An abdominal CT is performed (axial view shown). Which lab finding would MOST strongly support the suspected diagnosis?

A 55-year-old man with prostate cancer and bony metastases is experiencing severe pain and is not responding to strong analgesia. He is reluctant to use NSAIDs. What is the next step?

A 67-year-old woman presents to her GP with fatigue, weight loss, and night sweats over the past two months. She has a history of smoking and hypertension. On examination, she has palpable lymphadenopathy in the cervical and axillary regions. Blood tests reveal a hemoglobin level of 10 g/dL, elevated lactate dehydrogenase (LDH), and a peripheral blood smear showing atypical lymphocytes. What is the most likely diagnosis?

A 72-year-old male presents with a 4-month history of increasing fatigue, anorexia, and a 10 kg weight loss. He reports occasional nausea but no vomiting or abdominal pain. His vital signs are stable. Physical examination reveals mild jaundice and palpable hepatomegaly. Blood tests show Hb 105 g/L, elevated AST/ALT, and a mildly raised bilirubin. An upper endoscopy showed a large gastric mass, with histology pending. A CT scan of the abdomen and pelvis was performed. Considering the clinical context and the findings on the provided imaging, what is the most likely implication for this patient's overall management strategy?

A 55-year-old man with a history of renal transplant on long-term immunosuppressive therapy presents with a 3-month history of intermittent right upper quadrant pain and unintentional weight loss. He denies fever or chills. Physical examination is unremarkable. Liver function tests show mild elevation of alkaline phosphatase and gamma-GT. Inflammatory markers (CRP, ESR) are slightly elevated. Imaging is performed. Considering the clinical context and the findings on imaging, which of the following represents the most appropriate next diagnostic step to guide management?

A 3-year-old boy presents to the emergency department with a one-week history of abdominal pain, decreased appetite, and irritability. His parents also report that he has been increasingly tired and pale. On examination, the child is noted to have a palpable abdominal mass. A CT scan of the abdomen is performed, the axial view is shown. Based on the image and clinical presentation, which of the following is the MOST appropriate next step in management?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history includes a recent diagnosis of gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A 58-year-old male presents with a 3-month history of dyspepsia, early satiety, and unintentional weight loss. Upper endoscopy revealed a large, ulcerated mass in the gastric antrum. Biopsy confirmed adenocarcinoma. Staging investigations were performed, including the provided imaging. His ECOG performance status is 1. Blood tests show mild anaemia and normal liver function tests. Given the clinical presentation and the findings on the provided imaging, which of the following is the most appropriate primary goal of management for this patient?

A 62-year-old woman undergoes routine screening mammography. She is asymptomatic with no relevant family history of breast cancer. Physical examination is unremarkable. The provided image is a detail from her mammogram. Based on the findings demonstrated in the image, what is the most appropriate immediate next step in the management of this patient?

A 65-year-old male presents with fatigue and occult blood in stool. Colonoscopy findings are shown. What is the MOST appropriate next step in management?

A 65-year-old male with recently diagnosed gastric mixed adenoneuroendocrine carcinoma presents with unintentional weight loss. Endoscopy confirmed the diagnosis. Staging imaging is provided. His ECOG performance status is 1. Considering the extent of disease demonstrated, which of the following represents the most appropriate initial therapeutic approach?

A 72-year-old woman presents with a persistent, slowly expanding skin lesion on her right chest wall, present for several months. She underwent a right mastectomy for invasive ductal carcinoma 12 years ago. She denies pain, discharge, or systemic symptoms. Physical examination reveals the appearance shown. Considering the patient's history and the clinical finding, which of the following investigations is most appropriate to assess for potential underlying malignancy or systemic involvement?

A 62-year-old male with a history of hepatitis C presents with new onset ascites and right upper quadrant pain. His AFP is markedly elevated. A contrast-enhanced ultrasound is performed, as shown. What is the MOST appropriate next step in management?

A 65-year-old male presents with a 3-month history of unintentional weight loss and epigastric discomfort. Endoscopy revealed a gastric mass, and biopsy confirmed a mixed adenoneuroendocrine carcinoma. Staging imaging is shown. His ECOG performance status is 1. Considering the clinical presentation and the findings demonstrated in the provided images, what is the most appropriate initial management strategy for this patient?

A 68-year-old woman presents with a persistent rash following a mastectomy 5 years prior. What is the MOST appropriate next step in management?

A 62-year-old woman presents with fatigue and bone pain. Serum calcium is elevated. The provided imaging was obtained. What is the MOST likely underlying cause of her hypercalcemia?

A 68-year-old male presents with fatigue, weight loss, and vague abdominal discomfort. His past medical history is significant for a recently diagnosed gastric mixed adenoneuroendocrine carcinoma (MANEC). A CT scan of the abdomen is performed. Based on the imaging, what is the MOST appropriate next step in management?

A 65-year-old male presents with a 2-month history of fatigue, poor appetite, and 5kg weight loss. He reports mild upper abdominal discomfort. Physical examination is unremarkable. Initial blood tests show mild anaemia. An upper endoscopy revealed a suspicious gastric lesion, with biopsy results pending. A CT scan of the abdomen and pelvis was performed. Given the clinical presentation and the findings on the provided imaging, which of the following statements regarding this patient's likely prognosis and management is most accurate?

A 3-year-old presents with abdominal distension, irritability, and periorbital ecchymosis. Examination reveals a firm, irregular abdominal mass. The provided image is an axial CT slice. Considering the clinical presentation and the findings demonstrated in the image, which of the following biochemical markers is MOST likely to be significantly elevated?

A 68-year-old man presents with a 4-month history of increasing constipation alternating with loose stools, occasional rectal bleeding, and fatigue. He denies significant weight loss. Physical examination is unremarkable. Full blood count shows a haemoglobin of 115 g/L with low ferritin. A colonoscopy was performed, and the image provided is a representative view. Biopsies were taken from the observed lesion. Considering the clinical presentation and the endoscopic finding, what is the most appropriate next investigation to determine the extent of disease and inform definitive management planning?

A 62-year-old woman presents for a routine follow-up appointment several years after undergoing a simple mastectomy for pT1N0M0 invasive ductal carcinoma of the left breast. She completed adjuvant endocrine therapy and has been well since. During the consultation, she mentions that she has noticed a persistent area of skin change on her left chest wall, near the mastectomy scar, over the past few months. She describes it as occasionally itchy and slightly raised, but denies pain, discharge, or systemic symptoms such as weight loss or fever. Her vital signs are stable, and physical examination reveals no palpable axillary or supraclavicular lymphadenopathy. The appearance of the affected area is shown in the image. Considering the patient's history and the clinical presentation, what is the most appropriate initial diagnostic step?

A 70-year-old male with cirrhosis secondary to NAFLD presents for routine surveillance. A new 3 cm lesion was found in segment VIII on ultrasound, with AFP 45. Contrast-enhanced ultrasound was performed, with representative images shown. Considering the clinical context and the findings demonstrated, what is the most appropriate immediate next step in this patient's management?