Solid Tumour Principles and Oncological Emergencies — WACS Viva & Clinical Scenarios (Haematology and Medical Oncology)

Exam-style solid tumour principles and oncological emergencies viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: A 58-year-old male with metastatic prostate adenocarcinoma presents with a 3-day history of progressively worsening lower back pain radiating around his flank, progressive weakness in both lower limbs, and urinary retention with overflow incontinence. Physical examination demonstrates motor power grade 3/5 in bilateral lower extremities, hyperreflexia at the patellar and Achilles tendons, a sensory level at the T10 dermatome, and loss of anal sphincter tone. Outline your immediate emergency evaluation, pharmacological stabilization, neuroimaging requirements, and definitive management pathway
• SCENARIO 2: A 46-year-old female receiving adjuvant fluorouracil, epirubicin, and cyclophosphamide for breast carcinoma presents to the emergency department on day 10 of her cycle with a single oral temperature of 38.6°C, shivers, lightheadedness, and profound fatigue. Her blood pressure is 90/60 mmHg, heart rate is 115 beats per minute, and absolute neutrophil count is 0.28 × 10⁹/L. Detail the clinical diagnostic criteria for febrile neutropenia, the Multinational Association for Supportive Care in Cancer risk stratification tool, immediate empiric diagnostic workup, and the specific antimicrobial and su
• SCENARIO 3: A 22-year-old male with newly diagnosed bulky Burkitt lymphoma develops oliguria 24 hours after commencing combination chemotherapy. Laboratory results reveal serum potassium 6.4 mmol/L, serum phosphate 2.4 mmol/L, serum calcium 1.75 mmol/L (corrected), serum uric acid 720 µmol/L, and serum creatinine 280 µmol/L. State the diagnostic criteria defining laboratory and clinical tumour lysis syndrome according to the Cairo-Bishop classification, detail the underlying pathophysiological mechanisms, and explain the acute pharmacological and dialytic management strategies.
• SCENARIO 4: A 64-year-old female heavy smoker with newly suspected central right lung malignancy presents with severe facial swelling, periorbital oedema, distended non-pulsatile neck and upper chest wall veins, and dyspnoea exacerbated by bending forward (Pemberton sign positive). Formulate the systematic diagnostic approach to superior vena cava obstruction, differential etiologies, risk stratification, and tiered multimodal management ranging from acute supportive measures to interventional stenting and oncological therapies.
• SCENARIO 5: Explain the pharmacological principles and classification of antineoplastic agents. For cytotoxic agents, molecularly targeted therapies, and immune checkpoint inhibitors, describe the hallmark systemic toxicities, preventative protocols, and acute intervention guidelines, with specific reference to anthracycline cardiotoxicity, platinum nephrotoxicity, and immune-related adverse events.