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High-Yield Oncology Differences for MRCP Part 1

TL;DR: 

This clinician-written guide summarises the most exam-relevant oncology differences tested in MRCP Part 1—tumour markers, paraneoplastic syndromes, classic presentations, and management principles. It includes a worked MCQ-style case, common traps, and a practical revision checklist. Use it to sharpen pattern recognition rather than memorise low-yield detail.


Why oncology differences matter in MRCP Part 1

Oncology in MRCP Part 1 is not about comprehensive cancer management. The exam repeatedly tests your ability to distinguish similar conditions—for example, small cell vs non-small cell lung cancer, Hodgkin vs non-Hodgkin lymphoma, or osteolytic vs PTHrP-mediated hypercalcaemia. Candidates who revise oncology as isolated facts often miss marks; those who revise comparatively tend to score higher.

This article supports the main MRCP Part 1 hub on Crack Medicine and is designed to be used alongside timed MCQ practice.



Scope of oncology tested in MRCP Part 1

The oncology content is integrated across multiple systems and usually appears as short clinical vignettes. Expect emphasis on:

  • Tumour markers (uses and limitations)

  • Paraneoplastic syndromes

  • Red-flag cancer presentations

  • Complications of chemotherapy and radiotherapy

  • Cancer-associated thrombosis

Depth is limited, but breadth is wide. The exam expects recognition, not protocol-level detail.


Ten high-yield oncology differences you must know

Below is a numbered list of contrasts that recur frequently in MRCP Part 1 questions.

  1. Small cell vs non-small cell lung cancer

    • Small cell: Central, strong smoking association, early metastasis, paraneoplastic syndromes (SIADH, ectopic ACTH).

    • Non-small cell: Often peripheral, surgery considered if localised, fewer endocrine effects.

  2. Hodgkin vs non-Hodgkin lymphoma

    • Hodgkin: Contiguous nodal spread, Reed–Sternberg cells, B symptoms common.

    • Non-Hodgkin: Non-contiguous spread, extranodal disease common.

  3. Multiple myeloma vs MGUS

    • Myeloma: CRAB features—hypercalcaemia, renal failure, anaemia, bone lesions.

    • MGUS: Asymptomatic monoclonal protein without end-organ damage.

  4. Colon vs rectal cancer

    • Colon: Iron-deficiency anaemia, altered bowel habit.

    • Rectal: Tenesmus, bleeding, often neoadjuvant radiotherapy.

  5. Hepatocellular carcinoma vs liver metastases

    • HCC: Cirrhosis background, raised alpha-fetoprotein (AFP).

    • Metastases: Multiple lesions, AFP often normal.

  6. Ovarian vs endometrial cancer

    • Ovarian: Vague symptoms, late presentation, CA-125 for monitoring not screening.

    • Endometrial: Post-menopausal bleeding, earlier detection.

  7. Pancreatic head vs tail tumours

    • Head: Painless obstructive jaundice, Courvoisier sign.

    • Tail: Pain and weight loss, late presentation.

  8. Mechanisms of malignancy-related hypercalcaemia

    • PTHrP secretion: Squamous cell carcinoma of lung.

    • Osteolytic metastases: Breast cancer, multiple myeloma.

  9. Tumour lysis syndrome vs SIADH

    • Tumour lysis: Hyperkalaemia, hyperphosphataemia, hypocalcaemia after chemotherapy.

    • SIADH: Euvolaemic hyponatraemia, concentrated urine.

  10. Screening vs diagnostic use of tumour markers

    • PSA and CA-125 are useful for monitoring and risk stratification, not definitive screening tests.

MRCP Part 1 oncology study setup with notes, textbooks, and MCQ practice

Five most tested oncology subtopics

1. Tumour markers

Questions often test misuse of markers rather than their absolute values.

2. Paraneoplastic syndromes

Endocrine (SIADH, Cushing syndrome), neurological (Lambert–Eaton), and dermatological clues are high yield.

3. Red-flag presentations

Unexplained weight loss, iron-deficiency anaemia, persistent lymphadenopathy.

4. Complications of treatment

Neutropenic sepsis, cardiotoxicity from anthracyclines, pulmonary fibrosis from bleomycin.

5. Cancer-associated thrombosis

Pancreatic and gastric cancers are particularly pro-thrombotic.


Mini-case (MCQ style)

Case: A 65-year-old man with a 40-pack-year smoking history presents with confusion and seizures. Blood tests show sodium 118 mmol/L, low serum osmolality, and inappropriately concentrated urine. Chest X-ray shows a central lung mass.

Question: What is the most likely underlying diagnosis?

Answer: Small cell lung carcinoma causing SIADH.

Explanation: Severe euvolaemic hyponatraemia with a central lung mass in a smoker strongly suggests SIADH secondary to small cell lung cancer. In MRCP Part 1, recognising the paraneoplastic pattern is the key step.


Common oncology pitfalls in MRCP Part 1

  • Treating tumour markers as screening tools

  • Forgetting that paraneoplastic syndromes may precede cancer diagnosis

  • Confusing mechanisms of hypercalcaemia

  • Over-interpreting imaging without clinical context

  • Missing chemotherapy-related complications in acute scenarios


Practical oncology revision checklist

  • Revise cancers as comparisons, not isolated facts

  • Attach one hallmark feature to each malignancy

  • Practise mixed oncology blocks in the Crack Medicine QBank

  • Use full-length mock tests to build speed and accuracy

  • Review weak areas with concise notes or targeted lectures

Helpful resources on Crack Medicine:


Frequently asked questions

Is oncology heavily weighted in MRCP Part 1?

It is moderately weighted but integrated across systems, so most candidates will see several oncology-related questions per paper.

Do I need to memorise chemotherapy regimens?

No. Focus on indications, complications, and classic associations rather than detailed protocols.

Are tumour markers high yield for the exam?

Yes—especially their limitations and inappropriate use in screening scenarios.

What is the best way to revise oncology close to the exam?

Difference-based summaries plus timed MCQ practice are more effective than textbook reading.


Ready to start?

Consolidate these oncology differences by practising targeted questions and tracking errors. Start with the MRCP Part 1 hub and integrate oncology revision into your daily question routine.


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