Oncology

Question 1

Most common malignant neoplasm in chilhood

Answer 1

Leukemia

Question 2

Most common malignant childhood malignancy

2-6y/o; M>F

Clinical manifestation:
Acute onset <4 weeks

Answer 2

Acute lymphobastic leukemia

Question 3

Diagnosis of ALL

Answer 3

BMA: >25% of the BM cells as a homogenous population of lymphoblasts

Question 4

Poor prognostic factors

Answer 4

<2y/o or >10y/o
Male
WBC >100,000u/L on presentation
Presence of CNS leukemia
Presence of Mediastinal Mass

Question 5

Single most important prognostic factor in ALL

Answer 5

Treatment

Question 6

Treatment of ALL

Answer 6

Remission induction: to eradicate leukemic cells
Condolidation phase: 14-28wks to prevent CNS relapse
Maintenance phase: 2-3years

Question 7

Drugs used in Remission induction

Answer 7

Vincristine, Prednisone, L-asparaginase for 4 weeks PLUS CNS prophylactic irradiation or chemotherapy

Question 8

Drugs used in Maintenance Phase

Answer 8

Mercaptopurine daily AND Methotrexate weekly

Question 9

Complication pf treatment of ALL

Answer 9

Tumor lysis syndrome

Question 10

Remission in ALL

Answer 10

<5% blasts in the BM and a return of neutrophil and platelet count to near-normal levels after 4-5weeks of treatment

Question 11

Sites of Relapse in ALL

Answer 11

Bone marrow
CNS
testes

Question 12

Where does ALL spread?

Answer 12

Liver
Spleen
Lymph nodes

Question 13

Bimodal age distribution: 20-30 years and >50y/o

REGIONAL Painless nontender, firm, rubbery cervical or supraclavicular adenopathy

Hepatosplenomegaly is Rare; contiguous lymph mode spread

Weight loss >10% over 3mos, unexplained high grade fever, drenching night sweats

Reed-Sternberg Cell

Answer 13

Hodgkin’s lymphoma

Question 14

60% of all lymphomas in children and adolescents

Systemic adenopathy; Hepatosplenomegaly; more extranodal involvement; non-contiguous lymph node spread

Weight loss >10% over 3mos, unexplained high grade fever, drenching night sweats

Answer 14

Non-Hodgkin’s Lymphoma

Question 15

Most common posterior fossa tumor of childhood; has the best prognosis

Clinical Manifestations: personality changes, signs of increased ICP, motor weakness, ataxia, seizures

Dx: MRI
Tx: resection, radiotherapy, steroids, supportive

Answer 15

Cerebellar Astrocytoma

Question 16

2nd most common posterior fossa tumor of childhood; from the roof of the 4th ventricle

Very aggressive, can metastasize to extracranial sites

Clinical manifestations: prominent signs of increases ICP

Answer 16

Medulloblastoma/PNET

Question 17

3rd most common posterior fossa tumor of childhood; infiltrates the pons and spreads throughout the brainstem

Clinical Manifestations: changes in personality, cranial nerve and long-tract signs

Tx: surgery not possible, limited radiotherapy, steroids

Answer 17

Brainstem gliomas

Question 18

2nd most common malignant abdominal tumor in childhood

Painless abdominal mass that does not cross the midline

Tx: transabdominal nephrectomy and post surgical chemotherapy

Answer 18

Wilms Tumor

Question 19

3rd most common pediatric cancer; embryonal tumor neural crest cell origin

Non-tender abdominal mass which may cross the midline

Answer 19

Neuroblastoma

Question 20

Most common sites of metastasis Of neuroblastoma

Answer 20

Long bones and skull, BM, liver, lymph nodes, skin