Malignancy

Question 1

Common cancers before 6yrs old

Answer 1

Neuroblastoma

Wilm’s tumour

Question 2

Common cancers in adolescence

Answer 2

Hodgkin lymphoma

Bone

Question 3

Most common childhood cancer

Answer 3

Leukaemia

Question 4

Side effects of chemotherapy

Answer 4

Bone marrow suppression = anaemia
Immunosuppression = infections
Nausea and vomiting
Anorexia = malnutrition
Alopecia
Headache
Muscle atrophy

Question 5

Most common childhood leukaemia

Answer 5

Acute lymphoblastic leukaemia

Question 6

2 types of Acute lymphoblastic leukaemia

Answer 6

B and T lymphoblastic leukaemia

Question 7

Clinical features of acute lymphoblastic leukaemia

Answer 7

Pancytopenia = pallor, anaemia, bleeding, bruising, nose bleeds, infections.
Fatigue, malaise, anorexia
Bone pain
Painless lumps in neck, axilla and groin
Hepatosplenomegaly
Headaches

Question 8

Investigations for acute lymphoblastic leukaemia

Answer 8

FBC = normocytic normochromic anaemia. Thrombocytopenia/Low platelets, can get low WWC.
High lactate dehydrogenase, high urate.
Bone marrow biopsy diagnostic, shows blast nucleated cells.
LP = CSF high protein, low glucose, pleocytosis (high lymphocytes)
CXR = mediastinal mass in T cell type.

Question 9

Onset of symptoms of ALL and age

Answer 9

Within 4 weeks, 2-6yrs.

Question 10

Complication of ALL

Answer 10

Febrile neutropenic sepsis
Metastasis to CNS
Poor growth

Question 11

Management of ALL

Answer 11

Chemotherapy in 3 stages:
Induction treatment - aim to achieve remission, vincristine, dexamethasone + asparaginase.
Consolidation treatment - exterminate residual disease.
Maintenance treatment - extend remission, methotrexate and mercaptopurine.

Question 12

2 main types of brain tumours in kids

Answer 12

Astrocytoma

Medulloblastoma

Question 13

CFx of lymphoma

Answer 13

Painless lymphadenopathy (mostly neck)
Longer history of symptoms than leukaemia.
Cough

Question 14

Febrile neutropenic sepsis

Answer 14

Septicaemia

Piptazobactam and gentamicin.

Question 15

Risk factors for ALL

Answer 15

Down syndrome
Philedelphia chromosome
Radiation exposure

Question 16

High risk ALL

Answer 16

Age less than 1yr or greater than 10yrs
WCC greater than 50,000
CNS or testicular involvement
Genetics such as philedelphia chromosome.

Question 17

Name 3 types of brain cancers

Answer 17

Astrocytoma from glial cells
Craniopharyngioma (cause bilateral homonymous hemianopia)
Medulloblastoma.

Question 18

Presentation of brain tumour

Answer 18

Headache - worse on lying down
Early morning vomiting.
Squint, nystagmus, papilloedema
Ataxia
Personality and behaviour changes.

Question 19

Investigations for brain tumour

Answer 19

MRI

Question 20

Management of a brain tumour

Answer 20

Surgical resection if appropriate location (not brainstem!)

Radio +/- chemotherapy depending on age.

Question 21

Name of a neuroendocrine tumour

Answer 21

Neuroblastoma

Question 22

Origins of a neuroblastoma

Answer 22

adrenal medulla or sympathetic nervous system Rea e.g. sympathetic chain.

Question 23

Age of neuroblastoma

Answer 23

before 5

Question 24

Clinical features of a neuroblastoma

Answer 24

Englarged abdomen
Abdominal mass
Weight loss
Hepatomegaly
Limp and bone pain
Symptoms of compression of local structure or spinal root.

Question 25

Investigations for neuroblastoma

Answer 25

CT and check for metastasis High urine catecholamine Biopsy

Question 26

Management of neuroblastoma

Answer 26

Surgery +/- chemotherapy | If severe stem cell transplant

Question 27

Name 2 types of bone tumours

Answer 27

Osteogenic sarcoma (most common, esp in older children). Ewing's sarcoma (more common in younger)

Question 28

Age and gender of bone tumour

Answer 28

POST or during puberty! male

Question 29

Presentation of bone tumour

Answer 29

limp and bain

Question 30

Investigations and features of bone tumour

Answer 30

x-ray = nidus with central high density area, sclerosis or periosteal reaction, moth-eaten appearance. MRI Bone scan

Question 31

Management of bone tumour

Answer 31

Chemotherapy before surgery (endo-prosthetic resection)

Question 32

Name a kidney tumour

Answer 32

Nephroblastima/Wilm's

Question 33

Clinical features of a kidney tumour

Answer 33

Painless, abdominal mass Haematuria Hypertension Anorexia

Question 34

Investigations for a nephroblastoma

Answer 34

US/CT/MRI | Show distorted renal structure

Question 35

Management of a nephroblastoma

Answer 35

Chemo before and after nephrectomy or resection. | Radiotherapy if advanced/high-grade.