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Oncology 50 Rapid-Review Facts: The Differences (MRCP Part 1)

TL;DR: 

Oncology in MRCP Part 1 is less about rare facts and more about recognising key differences—between similar cancers, syndromes, markers, and emergencies. This clinician-written rapid review distils the most tested contrasts, highlights exam traps, and finishes with a mini-MCQ and a practical study checklist for last-phase revision.


Why oncology differences matter in MRCP Part 1

MRCP Part 1 questions repeatedly test discrimination: two conditions that look similar clinically but differ in pathophysiology, investigations, or management. Marks are lost not because candidates “don’t know oncology,” but because they miss a defining difference under time pressure. This article supports the MRCP Part 1 overview by consolidating the contrasts that most often decide single-best-answer questions. Hub link: https://www.crackmedicine.com/mrcp-part-1/


Scope and exam emphasis

Expect oncology questions to focus on:

  • Core cancer biology (oncogenes vs tumour suppressors)

  • Common solid and haematological malignancies

  • Paraneoplastic syndromes

  • Oncological emergencies

  • Drug toxicities and screening principles


Ten high-yield differences you must know

Use these as rapid-fire recall pairs.

  1. Oncogenes vs tumour suppressor genes

    • Oncogenes: gain-of-function mutations (e.g. RAS)

    • Tumour suppressors: loss-of-function mutations (e.g. TP53, RB)

  2. Small-cell vs non-small-cell lung cancer

    • Small-cell: central, early metastasis, paraneoplastic syndromes (SIADH)

    • NSCLC: peripheral, surgical option if early stage

  3. Hodgkin lymphoma vs non-Hodgkin lymphoma

    • Hodgkin: Reed–Sternberg cells, contiguous nodal spread

    • NHL: non-contiguous spread, frequent extranodal disease

  4. Multiple myeloma vs MGUS

    • Myeloma: CRAB features, lytic bone lesions

    • MGUS: asymptomatic, <1% annual progression risk

  5. Tumour lysis syndrome vs DIC

    • TLS: ↑ urate, ↑ potassium, ↑ phosphate, ↓ calcium

    • DIC: ↑ PT/APTT, ↓ fibrinogen, ↑ D-dimer

  6. SIADH vs cerebral salt wasting

    • SIADH: euvolaemic hyponatraemia

    • CSW: hypovolaemic hyponatraemia

  7. Osteoblastic vs osteolytic metastases

    • Osteoblastic: prostate cancer

    • Osteolytic: breast, lung, myeloma

  8. Febrile neutropenia vs uncomplicated sepsis

    • Febrile neutropenia: immediate IV broad-spectrum antibiotics regardless of focus

  9. Curative vs palliative chemotherapy

    • Curative intent: testicular cancer, Hodgkin lymphoma

    • Palliative intent: most metastatic solid tumours

  10. Screening benefit vs lead-time bias

    • Earlier detection ≠ improved survival unless mortality is reduced


Five most tested oncology subtopics

  1. Paraneoplastic syndromes (SIADH, hypercalcaemia of malignancy)

  2. Tumour markers (AFP, PSA, CEA—uses and limitations)

  3. Chemotherapy toxicities (anthracyclines, bleomycin, cisplatin)

  4. Oncological emergencies (spinal cord compression, neutropenic sepsis)

  5. Screening principles (overdiagnosis, lead-time bias)


MRCP Part 1 oncology revision setup with textbooks, notes, and practice questions.

Rapid comparison table (exam favourite)

Feature

SIADH

Cerebral Salt Wasting

Volume status

Euvolaemic

Hypovolaemic

Urine sodium

High

High

Primary management

Fluid restriction

IV fluids ± fludrocortisone

Mini-MCQ (MRCP style)

Question: A 64-year-old man with known small-cell lung cancer presents with confusion. Serum sodium is 118 mmol/L. Serum osmolality is low, urine osmolality is high, and he appears clinically euvolaemic. What is the most appropriate initial management?

Answer: Fluid restriction. Explanation: This is classic SIADH, a paraneoplastic syndrome strongly associated with small-cell lung cancer. Hypertonic saline is reserved for severe or refractory neurological symptoms.


Five common exam traps

  • Treating tumour markers as diagnostic rather than supportive tests

  • Forgetting to assess volume status in hyponatraemia

  • Delaying antibiotics in febrile neutropenia

  • Confusing osteoblastic and osteolytic metastases

  • Assuming all lung cancers are managed surgically


Practical study-tip checklist

  • Learn oncology in contrasts, not isolation

  • Memorise signature drug toxicities, not full regimens

  • Practise oncological emergencies repeatedly in MCQs

  • Use timed question sets to build pattern recognition

  • Re-read this list in the final 48–72 hours

For active recall, combine this article with Free MRCP MCQshttps://www.crackmedicine.com/qbank/and at least one full-length mock testhttps://www.crackmedicine.com/mock-tests/


FAQs

Is oncology heavily tested in MRCP Part 1?

Yes. Oncology appears consistently, often through emergencies, paraneoplastic syndromes, and high-yield differences.

Do I need detailed chemotherapy protocols?

No. Focus on hallmark toxicities and classic associations.

Are tumour markers used for screening?

Rarely. Most are used for diagnosis support and disease monitoring, not population screening.

What oncology topic should I never miss?

Febrile neutropenia—immediate IV antibiotics save marks and lives.


Ready to start?

Use this article as a hub-support rapid review, then consolidate with questions from the /qbank/ and timed sessions from /mock-tests/. Link back to the MRCP Part 1 overview to keep your revision structured.


Sources

 
 
 

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