Curriculum standards
Knowledge guides
LG21: Endocrine oncology
Key presentations and conditions
Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.
Less common or more complex presentations and conditions
Advanced Trainees will understand these presentations and conditions.
Advanced Trainees will understand the resources that should be used to help manage patients with these presentations and conditions.
Epidemiology, pathophysiology, and clinical sciences
Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.
Investigations, procedures, and clinical assessment tools
Advanced 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.
Advanced 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
Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management and integrate these into care.
Presentations
- Abdominal pain
- Diarrhoea
- Dizziness
- Dysphagia
- Dyspnoea
- Early / Precocious puberty
- Excessive sweating
- Fatigue
- Frequent urination
- Growth failure
- Gynaecomastia
- Headache
- Heart palpitations
- High blood pressure
- Increased thirst
- Localised pain / swelling
- Nausea
- Short stature
- Skin rash
- Stomach ulcers
- Visual disturbance
- Vomiting
- Weight changes
Conditions
- Craniopharyngiomas
- Endocrine effects of cancer treatment (see ‘Important specific issues’)
- Endocrinopathies associated with primary oncological presentations:
- germinoma
- Langerhans cell histiocytosis
- optic gliomas and other suprasellar neoplasms
- sex cord stromal tumours
- testicular germ cell tumours
- Inherited tumour syndromes, including but not limited to:
- Beckwith–Wiedemann syndrome
- Carney complex
- DICER1 mutations
- Li Fraumeni syndrome
- Lynch syndrome
- multiple endocrine neoplasia:
- type 1
- type 2
- PTEN hamartoma syndrome
- SDH mutations
- Von Hippel-Lindau syndrome
- Other solid tumours:
- adrenocortical tumours
- phaeochromocytomas
- thyroid cancers
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
Conditions
- Neuroendocrine tumours:
- carcinoid
- gastrinomas
- insulinomas
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
- Effects of treatment of cancer on the neuroendocrine system
- Growth hormone-IGF-1 axis and the brain
- End-organ, hypothalamic, and pituitary physiology and feedback systems for adrenal, gonads, growth hormone, and thyroid
- Neuroendocrine control of appetite and satiety
- Neuroendocrinology and the reproductive axis
- Regulation of appetite and weight
- Thyroid axis and the brain
Pharmacological therapy
- Classes of chemotherapy drugs and their endocrine effects (basic understanding of)
- Gonadotropin-releasing hormone (GnRH) analogues
- Hormone replacement therapy, such as:
- desmopressin
- glucocorticoid replacement
- growth hormone replacement
- pubertal induction and maintenance therapy:
- oestrogen therapy – oral, transdermal
- testosterone therapy – gel, intramuscular
- use of gonadotrophin therapy
- thyroxine replacement
- Perioperative blockade for phaeochromocytomas:
- pharmacological therapy perioperatively:
- alpha and beta blockade
- calcium channel blockers
- pharmacological therapy perioperatively:
- Precision therapies and their endocrine effects (basic understanding of), including:
- dopamine receptor agonists
- prolactinomas
- somatostatin analogues
Investigations
- Hormone stimulation tests (order and interpret), including basal and dynamic testing of pituitary function
- Pituitary MRI
Procedures
- Options for fertility preservation, including procedures such as:
- oocyte harvest
- ovarian tissue cryopreservation
- semen analysis
- testicular aspiration
- testicular biopsy
Endocrine effects of cancer treatment
- Awareness of possible endocrinopathy associated with precision therapies, which remains in evolution:
- CAR-T – autoimmune thyroid disease
- monoclonal antibodies:
- adrenalitis
- autoimmune thyroid disease
- hypophysitis
- polyendocrinopathies
- type 1 diabetes
- small molecule kinase inhibitors – hypothyroidism
- Awareness of the interaction between other chemotherapy agents and endocrinopathies, such as:
- PEG-asparaginase-hyperglycaemia
- steroids:
- AVN
- fractures
- hyperglycaemia
- osteoporosis
- Complex late effects of cancer treatment
- Complications of alkylating chemotherapy, including:
- primary gonadal failure and effects, as per radiotherapy below
- Effects and complications of radiotherapy by region of exposure:
- cranial:
- central adrenal insufficiency
- central hypothyroidism
- central precocious puberty
- GH deficiency
- hypothalamic / pituitary axis dysfunction
- metabolic-like syndrome
- gonads:
- primary ovarian insufficiency, including:
- infertility / subfertility
- premature menopause
- pubertal delay / arrest
- testicular failure, including:
- infertility / subfertility
- post-pubertal testosterone deficiency
- pubertal delay / arrest
- primary ovarian insufficiency, including:
- thyroid:
- primary hypothyroidism
- thyroid nodules and carcinoma
- cranial:
- Endocrine complications of bone marrow transplant (note that complications of alkylating chemotherapy and total body irradiation also apply):
- autoimmune thyroid disease
- infertility / hypogonadism
- metabolic syndrome
- Endocrine complications of neurosurgery:
- pituitary (or nearby):
- central diabetes insipidus
- multiple pituitary hormone deficiencies (see LG16)
- pituitary (or nearby):
- Potential for multiple areas of endocrine end-organ damage, and how the interaction between comorbid endocrinopathies can impact management, such as:
- central precocious puberty with comorbid growth hormone deficiency
- mixed central and primary gonadal failure
- pubertal assessment in males after gonadotoxic therapies, and implications for clinical assessment and treatment
Inherited cancer syndromes
- Implications of genetic testing and the principles of clinical genomics
- Screening guidelines for inherited cancer syndromes, and interpret investigations