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IMF-040-02-0001-en	Why can a repeat biopsy or circulating tumour analysis change treatment?	A biopsy samples one region at one time, and because selection keeps reshaping the tumour, the dominant clone in a metastasis or relapse may differ from the primary.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0002-en	Why is a mutation labelled pathogenic not automatically the active driver in a given tumour?	Its significance depends on allele fraction, copy number, expression, clonality and biological context, not on the label alone.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0003-en	How does aerobic glycolysis benefit cancer cells even when their mitochondria still function?	It allows carbon intermediates to be diverted into biomass, supplying building blocks for proliferation.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0004-en	How do abnormal tumour vessels contribute to drug resistance?	They leak, shunt and collapse under pressure, delivering drugs unevenly and leaving sanctuaries where resistant cells survive.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0005-en	Why is adjuvant systemic treatment given after surgery has removed all visible disease?	Surgery cannot prove that microscopic disseminated cells are absent, and dormant cells can reactivate years later, so treatment is given when recurrence risk justifies toxicity.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0006-en	How does checkpoint blockade kill cancer, and why are durable responses limited to some tumours?	It does not poison malignant cells directly but restores activity of many existing tumour-reactive T cells, so it works only where antigenicity, presentation, trafficking and effector function remain sufficient.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0007-en	Why may hormone replacement continue after an immune-related endocrinopathy has settled?	Immune attack on endocrine glands can leave hormone deficiency that is permanent even after the inflammation resolves.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0008-en	Why should a patient with suspected immune toxicity and physiological instability be treated before infection is excluded?	Myocarditis, severe pneumonitis, neuromuscular-junction disorders and adrenal crisis are uncommon but rapidly fatal, and mild symptoms do not establish that an organ is safe.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0009-en	Why is imaging used to target a viable advancing margin rather than the most accessible site for biopsy?	The most accessible site is not necessarily the most representative, and a necrotic centre may not yield viable tumour for diagnosis.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0010-en	Why does an association between a marker and outcome not justify targeting that marker?	Association does not prove that targeting the marker improves outcome, so validated companion tests and clinical evidence are needed.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0011-en	Why can a lesion enlarge on imaging during effective treatment?	Treatment can cause necrosis, inflammation, fibrosis, oedema or immune-cell infiltration that temporarily enlarges a lesion without viable progression.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0012-en	When only a few sites progress on an otherwise effective drug, why might that drug be continued?	Escape confined to isolated sites can be controlled by adding local treatment, preserving the systemic drug that still controls the remaining disease.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0013-en	Why does a negative liquid biopsy not rule out a resistance mutation?	When tumour shedding into the circulation is low, circulating tumour DNA may not reveal a mutation that is present in the tumour.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending
IMF-040-02-0014-en	In a stable patient with superior vena-cava obstruction, why should radiation not be rushed before tissue diagnosis?	Radiation before biopsy can destroy the pathology needed for diagnosis; only airway compromise, cerebral oedema or circulatory crisis justify treating before diagnosis.	Integrated Medical Foundations; chapter 40, TTS module 2; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: 9dd97be25818d857591f1fd8fdbd46cc015f5a6402825a80730a882909845058; editorial review pending	imf lang::en chapter::040 module::040-02 review::pending