The Basic Blood Panel: A GP's First Line of Defence Against Missed Cancers

Across the eight cases in Dr. Niti Raizada's masterclass, one piece of advice repeated more than any other: before reaching for imaging, run a basic blood panel. It is inexpensive, fast, and in her experience catches problems that a symptom-based conversation alone would miss.

CBC, LFT, RFT: the three tests Dr. Raizada asks every GP to remember

When a patient presents with persistent, unexplained symptoms, Dr. Raizada's standing advice to GPs is to order a complete blood count, hemoglobin, white blood cell count and platelets, along with liver function tests and kidney function tests. Together, these three panels, CBC, LFT and RFT, generate enough clues to tell a clinician whether something significant is happening, well before any scan is ordered. If any of the three come back abnormal, that alone is reason to become more alert and investigate further: low hemoglobin, high bilirubin, deranged kidney function, or abnormal sodium or potassium should all prompt attention rather than reassurance. Her instruction was explicit: instead of jumping into a scan, start with the basic blood panel and take it from there. If there is any suspicion of a bleeding disorder specifically, PT, PTT and INR should be added to that initial workup.

A case that illustrates the cost of skipping this step

During the session's discussion, one clinician described a patient who presented with no history of alcohol use or hepatitis, where preliminary triple-phase CT staging had not been possible before a decision was made to proceed toward hepatectomy. The patient developed a crisis from bile build-up and died during the consultation process. Dr. Raizada's response focused on what a basic panel could have flagged earlier: liver cancer carries a real risk of coagulopathy and bleeding, so any patient with chronic liver disease needs regular PT, PTT and INR monitoring, along with treatment for any bleeding diathesis, including vitamin K and blood products where needed. Chronic liver disease patients also commonly have low white cell counts and low platelets, which is exactly the kind of finding a routine CBC would surface before a crisis develops.

Recap: how Dr. Raizada distinguishes acute from chronic leukaemia

Asked to recap leukaemia management during the Q&A, Dr. Raizada laid out the basic framework GPs need to hold in mind. Leukaemias are broadly acute or chronic. Acute leukaemias have a short history, present with fever and bleeding manifestations, and typically show low hemoglobin, white cell count and platelets, as in the AML M3 case earlier in this series. Chronic leukaemias generally occur in older age groups and include chronic myeloid leukaemia, CML, and chronic lymphocytic leukaemia, CLL; these are often managed with tablets alone.

Within acute leukaemia, the two main categories are AML, acute myeloid leukaemia, and ALL, acute lymphoblastic leukaemia, the most common leukaemia in children and young adults, where treatment starts with steroids and proceeds based on whether the leukaemia is T-cell or B-cell in origin. Genetic and molecular testing subcategorises each type further: CML is confirmed by Philadelphia chromosome positivity, t(9;22), or BCR-ABL positivity; CLL is worked up with a FISH panel to check p53 status and classify it as standard-risk or high-risk; and AML overall is categorised as good-risk, intermediate-risk or high-risk, which determines the treatment path. Within AML specifically, the M3 subtype, acute promyelocytic leukaemia, is rare but highly curable with ATRA or arsenic trioxide tablets, while non-M3 AML requires standard chemotherapy.

The bigger picture: what cancer looks like globally, and in Africa specifically

Dr. Raizada closed the masterclass by placing these eight cases in a wider context. Across both genders combined, lung cancer is the most common cancer worldwide, followed by breast cancer, then colon, prostate and stomach cancer, the five leading cancers globally. By cancer-related mortality, the leading causes of death are lung, colon and liver cancer; breast cancer, despite its prevalence, drops to fourth in mortality because it is highly curable when caught early, the exact argument for the screening schedules described throughout this series.

In Africa specifically, Dr. Raizada was candid that recorded cancer numbers likely understate the true burden substantially: what gets reported is only the fraction of patients who are identified, brought to medical attention, and complete treatment. The top three causes of cancer death in Africa, combining both genders, are breast cancer, cervical cancer and liver cancer, meaning cancers affecting women dominate the region's cancer mortality. In men, prostate cancer carries the highest mortality, followed by liver and then lung cancer. Her closing message to the doctors on the call was direct: finding these patients earlier, and treating them correctly once found, is the challenge the group is positioned to change, and time remains the variable that most determines who survives.