HISTORY TAKING IN ONCOLOGY

1. HISTORY TAKING IN
CONTEXT TO ONCOLOGY
PRESENTER- Dr ABHISHEK MEWARA
MODERATOR- Dr N.S. SHAH
JLN MEDICAL COLLEGE AND HOSPITAL
DATE- 28/11/2023
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2. OVERVIEW-
1. INTRODUCTION
2. STEPS IN HISTORY TAKING
3. EXAMINATION
4. SOME OTHER IMPORTANT POINTS TO BE INCORPORATED IN
ONCOLOGY HISTORY
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3. 1. INTRODUCTION-
 Taking history is probably the most important part in making the
diagnosis, and subsequently directing the investigations and
treatment in the correct direction.
 The history has to be so detailed so as to include all relevant
information that is required by the doctor for his/ her workup,
but at the same time not so detailed so as to waste unnecessary
time and efforts.
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4.  The general scheme includes-
(1) History taking
(2) Physical examination
(3) Investigations
(4) Clinical Diagnosis
(5) Treatment
(6) Progress during post treatment period
(7) Follow-Up
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5. 2. STEPS IN HISTORY TAKING
A. GENERAL INFORMATION
Includes-
i. Name
ii. Age
iii. Gender
iv. Marital status
v. Address
vi. Occupation
vii. Religion
viii. Father/ Mother/ Spouse name
ix. Registration number
x. Date of admission/ discharge
xi. Provisional diagnosis 5

6. B. CHIEF COMPLAINTS
- They are the reason because of which the patient was compelled to visit the
doctor.
- They are taken in chronological order, while also noting the time since first
onset of each complaint.
- Make sure patient was free from any complaint before appearance of first
symptom.
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7. C. HISTORY OF PRESENT ILLNESS
- Brief description of all the complaints, in chronological order.
- Mode of onset- sudden or gradual.
- Progression of the symptom- whether increased or decreased in severity.
- Whether or not any treatment received for the same. If yes, then what was it?
- Any associated symptoms.
- Any alleviating or aggravating factors associated with the symptoms.
- Remember not to ask any sort of leading questions.
- Do focus on negative answers given by the patient.
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8. D. PAST HISTORY
Includes-
- History of any other acute/ chronic, systemic/ infectious diseases, mostly- T 2
DM, HTN, TB, Asthma, etc., with any sort of medication received for the same,
and whether the treatment was completed , abandoned, or ongoing.
- History of any allergy, to drugs or external allergen.
- History of previous hospitalization for any diseases, or surgeries, or RTA.
- In context to oncology, past history becomes even more important, as under
this heading only we ask patient about any history of previous radiation therapy,
or chemotherapy, or surgical intervention, if received.
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9. E. PERSONAL HISTORY
Includes-
- Appetite, sleep, bowel, bladder habits.
- Vegetarian/ non vegetarian.
- History of smoking, drinking, tobacco consumption, etc. Here we also ask the
frequency and quantity of substance used/ abused.
- Menstrual/ obstetric history-
* This becomes important in cases of women, both reproductive and non
reproductive groups.
* We ask about onset and cessation of menses, their frequency and duration,
amount (whether more or less than normal).
* We ask about obstetric profile of the patient, i.e. their GPLA score. Also
whether the deliveries were normal or cesarian.
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10. F. FAMILY HISTORY
- Ask about any heritable/ congenital disease running in family lineage.
- Some heritable cancers becomes important in our context, eg. HBOC, particularly those
associated with BRCA genes. Women with an inherited BRCA gene are more predisposed
to acquire breast and ovarian cancers, and men with acquired BRCA genes are more
predisposed to acquire breast and prostate cancers.
- There are some heritable syndromes associated with malignancies, eg-
1. Cowden- PTEN gene. Breast, brain, endometrium, skin, thyroid tumors.
2. Li Fraumeni- TP53 gene. Soft tissue sarcoma, breast, brain, lung, adrenal cancers.
3. FAP/ Gardner syndrome- APC gene. Colon cancer, osteomas, desmoid tumors.
4. Lynch/ HNPCC- Mutations in DNA mismatch repair genes. Colorectal and uterine
tumors.
5. VHL- Hemangioblastomas.
6. MEN- MEN 1- 3P cancers, MEN2- Thyroid cancer.
7. Haematological malignancies- AML, MDS, Aplastic anemias.
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11. 3. EXAMINATION
Includes-
1. Vitals and other general features
2. General physical examination
3. Systemic examination
1. Vitals and other general features-
- Includes BP, Pulse (rate, rhythm, force, character), RR, Temperature.
- General mental state and intelligence, consciousness, orientation, GCS.
- Physical appearance, gait, built, nutrition, facies.
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12. 2. General physical examination-
- Includes an examination from head to toe.
- Pallor, Cyanosis, Icterus, LAD, Clubbing, Edema.
- WRT oncology, one needs to make sure to examine sites of radiation for
radiation dermatitis, IV access for chemotherapy, surgical scars of
surgeries.
- If there is/was an administration of chemotherapy, it is mandatory to
examine for any possible side effects, eg. Hand foot syndrome/
palmoplantar erythrodysesthesia in case of 5FU/ capecitabine, venular
reactions in case of anthracyclines, etc.
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13. REF- MD ANDERSON CANCER CENTRE
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14. REF- RESEARCH GATE
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15. 3. Systemic examination-
Inspect, Palpate, Percuss, Auscultate
a. GIT- Per abdominal examination for any hardness, tenderness, bowel
sounds.
b. Respiratory- Air entry on both sides, any crepitations if heard.
c. CVS- Hear S1, S2, notice for any murmurs.
d. Genitourinary-
- External and internal examination.
- Internal examination, particularly in case of females, for cervical
cancer, is done by PV/ PS technique.
e. Breast
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16. f. Lymph nodes-
- For oncology, lymph nodes becomes particularly important, so one
should never forget to examine them, for respective malignancies.
- In case of head and neck cancers, look for all 7 levels of neck nodes.
- In case of breast cancer, look for clavicular and axillary lymph nodes.
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17. Cusco’s Speculum
Steps of Per Vaginal/ Per Speculum Examination
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18. BREAST EXAMINATION
REF- NATIONAL BREAST CANCER FOUNDATION
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19. REF- S. DAS
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20. REF- S. DAS
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21. REF- S. DAS
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22. Neck Nodes
REF- RADIOLOGY
ASSISTANT
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23. REF- CANADIAN CANCER SOCIETY
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24. THE AXILLARY GROUP OF LYMPH NODES
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25. Lymphatics In Pelvis
REF- MEDSCAPE
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26. Special Investigations-
1. Microscopic-
- Includes Biopsy, FNAC, Cytology, IHC.
- Some important IHC markers-
 ALK gene: Non-small cell lung cancer
 Alpha-fetoprotein (AFP): Liver cancer and germ cell tumors
 Beta-human chorionic gonadotropin (Beta-HCG): Choriocarcinoma and
testicular cancer
 BCR-ABL fusion gene: Chronic myeloid leukemia
 BRAF mutation V600E: Cutaneous melanoma and colorectal cancer
 BRCA 1, 2, CA 15-3/ CA 27.29: Breast cancer
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27.  CA19-9: Pancreatic cancer, gallbladder cancer, bile duct cancer, and
gastric cancer
 CA-125: Ovarian cancer
 Calcitonin: Medullary thyroid cancer
 Carcinoembryonic antigen (CEA): Colorectal cancer and breast cancer
 Chromogranin A (CgA): Neuroendocrine tumors
 Cytokeratin fragments 21-1: Lung cancer
 EGFR mutation analysis: Non-small cell lung cancer
 Estrogen receptor (ER)/ progesterone receptor (PR): Breast cancer
 Fibrin/ fibrinogen: Bladder cancer
 HE 4: Ovarian cancer
 HER2/ neu: Breast cancer, gastric cancer, and esophageal cancer
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28.  Immunoglobulins: Multiple myeloma and Waldenström
macroglobulinemia
 KIT: Gastrointestinal stromal tumor and mucosal melanoma
 KRAS mutation analysis: Colorectal cancer and non-small cell lung
cancer
 Lactate dehydrogenase: Germ cell tumors
 Prostate-specific antigen (PSA): Prostate cancer
 Urokinase plasminogen activator (uPA) and plasminogen activator
inhibitor (PAI-1): Breast cancer
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29. 2. Imaging-
Includes X Ray, USG, CT scan, MRI, PET CT Scan, etc.
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30. 4. Some other important points to be
incorporated in oncology history-
Treatment history-
a. Radiation-
- Note the date of commencement, place of radiation therapy received.
- Note the total dose (grays) and fractions of radiation received.
- Note whether any concomitant/ concurrent chemo radiation were received
or not.
- Also note if full radiation course was completed by the patient or not.
b. Chemotherapy-
- Note whether any individual chemotherapy was received by the patient or not.
- If received along with surgery, note whether the chemotherapy received was
adjuvant or neoadjuvant.
c. Surgery history- Note the date, place, and type of surgery done.
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31. THANK YOU,
AND HAVE A NICE DAY!
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