Curriculum standards
Knowledge guides
LG11: Cancer and its treatment
Key presentations and conditions
Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Trainees will understand these presentations and conditions.
Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.
Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.
Important specific issues
Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Evaluation of bone mineral density
- Gastroenteropancreatic and lung neuroendocrine tumours
- Hyperparathyroidism
- Pheochromocytoma / Paraganglioma
- Thyroid carcinoma, differentiated and non-differentiated
- Thyrotoxicosis for evaluation
Conditions
- Adrenal hypersecretory syndromes
- Graves disease
- Hyperparathyroidism
- MEN and other genetic conditions associated with poly-endocrinopathies
- Metabolic bone disease
- Neuroendocrine tumour hypersecretory syndromes
- Nodular thyroid disease
- Osteoporosis / Osteopaenia
- Subacute thyroiditis
PCH
- Child and adolescent conditions:
- bone mineral density
- hyperthyroidism
- thyroid malignancy
- Neonatal conditions:
- congenitalhypothyroidism
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
No presentations / conditions listed
PCH
- Congenital hyperinsulinism
- Genetic disorders associated with endocrinopathies
- Hyperparathyroidism
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
Endocrine anatomy, embryological origin, and physiology
- Adrenal glands:
- discuss the approach to an adrenal mass on CT, the diagnostic work-up of an adrenal lesion, and hypercortisolism
- understand hormone production and secretion of the adrenal glands, with particular attention to phaeochromocytomas and paraganglionomas
- Bone mineral density:
- therapies to improve bone health.
- calculate whether a significant interval change has occurred
- different BMD reference ranges
- dual energy X-ray absorptiometry (DXA) in the evaluation of bone mineral density and practical applications
- report DXA in accordance with the ANZBMS standards including absolute fracture risk
- Trabecular bone score
- technical limitations, artefacts, and common anatomical variants that may alter scan interpretation
- Parathyroids:
- discuss the difference between primary, secondary, and tertiary hyperparathyroidism, and the role of imaging in each of these settings
- understand physiology of PTH and regulation of secretion
- understand that the embryological origin of parathyroid tissue can help with localisation
- Pathophysiology of:
- adrenal hypersecretory syndromes
- hypo- and hyper-functioning thyroid nodules:
- correlate findings with relevant imaging
- indications for fine needle aspiration biopsy of thyroid nodules
- natural history of thyroid nodules, and the relationship of thyroid nodules to thyroid cancer
- primary, secondary, and tertiary hyperparathyroidism
- Thyroid gland:
- embryology and gross anatomy
- physiology of the thyroid gland and the hypothalamic–pituitary axis
- the mechanism of uptake of iodine / pertechnetate in thyroid tissue and how this may be affected during thyroid disease
- thyroid physiology in normal and pathological states, with respect to scintigraphic appearance
PCH
- Embryology and how it impacts on organ development
- Paediatric bone development and the impact on bone mineral density:
- bone densitometry in childhood skeletal dysplasias
- effect of childhood disease on bone growth and development
- reporting criteria for bone densitometry in childhood and adolescence
Investigations
- Functional imaging for neuroendocrine tumours:
- MIBG, labelled with I-123 or I-131
- PET radiotracers, such as Ga68 DOTATATE, F18 F- DOPA
- tektrotide (Tc-99m HYNIC-TOC)
- Parathyroid scintigraphy:
- imaging protocols for combined thyroid and parathyroid scintigraphy, including:
- choice of collimator
- correlative thyroid scintigraphy
- delayed imaging
- image subtraction techniques
- imaging of the mediastinum
- oblique imaging
- role of contrast CT and US in parathyroid imaging
- typical patterns of parathyroid adenomas / hyperplasia in the neck and in ectopic locations
- use of FCH PET in parathyroid imaging
- use of SPECT and SPECT / CT
- Tc-99m sestamibi imaging of the parathyroids
- imaging protocols for combined thyroid and parathyroid scintigraphy, including:
- DXA scanning
- ANZBMS reporting guidelines
- Frameworks for report fracture risk
- Thyroid imaging:
- RAI and imaging for hyperthyroidism and malignancy
- scintigraphy using I-123, SPECT / CT, and technetium, along with the ability to explain when to use them
- the role of PET / CT imaging with FDG and other PET radiotracers
- the role of ultrasound imaging and imaging guided biopsy in evaluation and diagnosis of thyroid pathology
Procedures
- Patient preparation needed prior to:
- mark thyroid nodule(s) so the nodule(s) can be clearly identified and related to radiological findings
- MIBG imaging
- parathyroid scintigraphy
- thyroid scintigraphy
- treatment of benign thyroid disease
PCH
- DXA
- Thyroid imaging
- Parathyroid scintigraphy
- F-18 F-DOPA PET / CT for congenital hyperinsulinism
- Functional imaging for neuroendocrine tumours
- Patient demographics, including geographic location, socioeconomic status, ethnicity, and cultural background, and the considerations when managing and following up these patients, such as travel from rural to metropolitan areas
- Radiation protection, patient safety
- Radioisotope decay and patient proximity to therapy / examination
PCH
- Administration of radioisotopes to children, and the impact on the family and child