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Paeds BPT Written Exam > Oncology > Flashcards

Oncology Flashcards

1
Q

Risk factors for ALL?

A
  • Prenatal radiation exposure
  • Postnatal exposure to high doses of radiation
  • Down syndrome
  • Ataxia- telangiectasia
  • Fanconi anaemia
  • Neurofibromatosis
  • Bloom syndrome
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2
Q

Top 4 most common childhood malignancies?

A

Leukaemias (25%)

CNS tumours (17%)

Neuroblastomas (7%)

NHL (6%) and Wilms (6%)

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3
Q

Key pathology finding in Hodgkins Lymphoma

A

Reed-Sternberg cells, large multinucleated cells that divide rapidly and live longer than normal cells

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4
Q

Histologic subtypes of Non-Hodgkin Lymphoma

A
  • Burkitt lymphoma
  • Lymphoblastic lymphoma
  • Diffuse large B cell
  • Anaplastic large cell
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5
Q

Common brain tumour associated with NF1?

A

OPTIC GLIOMAS
Meningiomas
Ependymomas

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6
Q

Common brain tumour associated with NF2?

A

BILATERAL VESTIBULAR SCHWANNOMA
regional glioma
meningioma
glioma
schwannomas (cranial and peripheral nerve)

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7
Q

Common brain tumour associated with tuberous sclerosis?

A

Subependymal giant cell tumours

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8
Q

What is rasburicase

A

Used in patients with TLS with high rate levels or those at high risk of TLS

It is an enzyme that degrades uric acid

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9
Q

AFP is a tumour marker for which cancers?

A

Hepatoblastoma and HCC
Yolk sac tumours
Immature teratomas
embryonal carcinomas

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10
Q

Beta hCG is a tumour marker for which tumours

A

Choriocarcinomas
Seminomas
Some dysgerminomas

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11
Q

Tumour markers for neuroblastoma

A

Urine catecholamines (VMA and HMA)
Neuron specific enolase (NSE)

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12
Q

Cancers associated with Beckwith-Wiedemann Syndrome?

A

Hepatoblastoma
Wilms Tumour

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13
Q

Cancers associated with Gorlin Syndrome

A
  • BCC
  • Medulloblastoma

PTCH gene mutation

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14
Q

Staging of Wilms Tumour

A
  • Stage 1: limited to 1 kidney
  • Stage 2: extends beyond the kidney but can be completely excised
  • Stage 3: confined to abdomen and local lymph nodes
  • Stage 4: haemogenous spread - commonly to lungs
    Stage 5: bilateral kidney involvement (5-10%)
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15
Q

Which cancers are associated with Li Fraumeni syndrome?

A

Sarcomas
Breast cancer
Adrenocortical cancer
Brain cancer
ALL
Lymphoma (esp HL)

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16
Q

PTEN hamartoma syndrome is associated with what clinical features and cancer predisposition?

A
  • Acral keratosis (papules on hands/feet)
  • Facial papules
  • Hamartomas tumours of the outer hair sheath follicle
    increased risk of THYROID, breast, endometrial, kidney, and colorectal cancers.
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17
Q

Cancers associated with ataxia-telangiectasia?

A
  • Leukaemia and lymphoma
  • Breast cancer
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18
Q

Cancers associated with HNPCC (Lynch Syndrome)

A
  • Colorectal
  • Endometrial and ovarian
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19
Q

Cancers associated with familial adenomatous polyposis? (APC gene mutation)

A
  • Colorectal
  • Hepatoblastoma
  • Thyroid
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20
Q

Cancer associated with Noonan Syndrome?

A

Myeloproliferative disorder/ Juvenile Myelomonocytic Leukaemia (JMML) - A rare, agressive leukaemia

21
Q

Management of Philadelphia chromosome positive ALL?

A

Need addition of tyrosine kinase inhibitor (eg imatinib)

22
Q

Poor prognostic indicators in ALL?

A
  • Age <1 or >10 at diagnosis
  • Philadelphia chromosome t(9;22)
  • T cell leukaemia
  • Extramedullary disease (ie CNS or testicular disease)
  • Measurable residual disease at end of induction (>0.01% blasts)
  • Mature B cell leukaemia
  • WCC>50 at presentation

(Hyperdiploidy, rapid response to treatment, trisomies of chromosome 4 and 10 and T(12;21) translocation are GOOD prognostic factors)

23
Q

Chloromas (green-hued skin lesions), subcutaneous nodules (“blueberry muffin”) and infiltration of gingiva are distinguishing features of which cancer?

A

AML

24
Q

Pathognomonic blood film finding in AML?

A

Auer rods (inside peripheral blood cell blasts)

25
Q

Common condition seen in early infancy in T21?

A

Transient abnormal myelopoeisis (circulating blasts, often associated with hepatomegaly)- resolves spontaneously in most cases

26
Q

Side effects of cyclophosphamide?

A
  • Haemorrhagic cystitis (give Mesna)
  • Anaphylaxis
  • secondary malignancies
  • Myelosuppression
  • Infertility
27
Q

Side effects of doxorubicin /anthracyclines?

A

Cardiomyopathy + arrhythmia
Red urine
Tissue necrosis with extravasation
Myelosuppression

28
Q

Which chemotherapy agent commonly causes ototoxicity?

A

Platinums (eg cisplatin, carboplatin)

29
Q

Which chemo agent commonly causes constipation?

A

Vincristine

30
Q

Which chemo agent commonly causes peripheral neuropathy?

A

Vincristine

31
Q

Which chemo agent commonly causes diarrhoea?

A

Irinotecan

32
Q

Which chemo agents cause pulmonary fibrosis?

A

Bleomycin
Busulfan

33
Q

Main side effects of methotrexate?

A

Myelosuppression
Mucositis
Hepatitis
Stomatitis
High dose - renal toxicity, neurocognitive effects

Long term: osteopenia

34
Q

Which chemo agents need genetic testing performed to ensure toxic dosing not given?

A

Mercaptopurine and azathioprine

Thiopurine S- methyltransferase (TMPT) gene encodes one of the metabolising enzymes of thiopurines (azathioprine, mercaptopurine). Low levels of this enzyme -> accumulation -> severe myelosuppression

35
Q

5 Features of veno-occlusive disease?

A
  • Weight gain >5% above baseline
  • Tender hepatomegaly
  • Ascites
  • Rising bilirubin from baseline on 3 consecutive days
  • refractory thrombocytopenia

Highest risk in first month post bone marrow transplant

36
Q

Management of veno-occlusive disease?

A

Defibrotide (a single stranded polydeoxyribomucleotide which has local anti-thrombotic, anti-ischaemic, anti-inflammatory activity)

Supportive care: diuretics, analgesia, electrolyte replacement

37
Q

Mixed linear leukaemia is commonly seen in which type of leukaemia?

A

Infant ALL. Rare disorder with much poorer outcome

38
Q

Acute promyelomyelocytic leukaemia

A
  • May present with DIC
  • If survive induction, often very good prognosis
  • Manage with retinoid acid +/- arsenic
39
Q

What are CAR-T cells?

A

Engineered autologous T cells
- T cells taken out, reprogrammed using a viral vector to recognise cancer cells/ other cells expressing a particular antigen - infused after lymphodepleting chemotherapy

Used in B cell malignancy (eg B cell lymphoma, CD19+ ALL)

40
Q

Which type of HSCT has the highest rates of GVHD?

A

Peripheral blood stem cells > bone marrow > cord blood

41
Q

Order of preference for Allogenic HSCT?

A
  1. Matched sibling donor (Marrow >PBSCs)
  2. Matched unrelated donor - BM
  3. Matched unrelated donor - cord
  4. Mismatched familial haploidentical donor- BM
  5. Matched unrelated donor - PBSC
  6. Miamatched unrelated donor - cord > marrow > PBSC
42
Q

Acute GVHD affects which organs?

A

Skin
Liver
Intestines (diarrhoea)

43
Q

Risk factors for Acute GVHD

A

HLA mismatch
Unrelated donor
Sex mismatch
Total body irradiation
High T cell numbers in donor
Low concentration of recipient immunosuppressive meds

44
Q

Management of acute GVHD

A
  • Optimise immunosuppression
  • Increase ciclosporin
  • Steroids
  • Wet wraps
45
Q

Poor prognostic factors in hyperleukocytosis (WCC >100)?

A
  • WCC >200
  • Age <1 or >10yrs
  • AML (due to size of blasts)

Associated with neuromuscular and Resp complications, DIC and tumour lysis syndrome

46
Q

Features of posterior reversible encephalopathy syndrome (PRES)?

A

Headache
HTN (75%)
Confusion
Convulsions
Vision loss

MRI; bilateral hyperintense densities in parieto-occipital region on T2

47
Q

Which chemotherapies are associated with increased risk of secondary AML/ myelodysplastic syndrome?

A

Etoposide
Alkylating agents (eg cyclophosphamide)

48
Q
A

Paeds BPT Written Exam (18 decks)

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