Oncology

Question 1

A.L.L Overview 
Aetiology 
Poor prognostic factors 
Presentation 
Investigations 
Management 
Complications

Answer 1

Acute lymphoblastic leukaemia

Aetiology

• Downs
• Philly (22)
• Ionising radiation

Poor prognostic factors

• Male
• Non caucasian
• <2 or >10
• WCC >20

Presentation 
1) Bone marrow infiltration 
RBC - anaemia - pallor, lethargy, SOB
WCC - recurrent infection 
Platelets - bleeding/ bruising/ nosebleeds etc

2) Hepatomeg/splenomeg

3) Organ infiltration
- Painless testicular enlargement - Neuro - seizures, CNS palsies

Investigations
Bloods - anaemia, ^WC, decreased neutrophils
Urine - raised U+Creatining
CXR/ MRI - for mets

Management 
- chemo 
vincristine 
doxorubicin 
dex 
methotrexate etc 

Complications 
Neutropenic sepsis - taz 
Hyperuricaemia - alloprinol 
Secondary cancers 
Stunted growth

Question 2

Neuroblastoma

Answer 2

Cancer of the neural crest cells

• adrenal medulla
• sympathetic chain

Presentation

• General - pallor, lethargy
• Limp/ bone pain
• ABDO MASS

Other

• racoon eyes
• cervical lymphadenopathy
• Horner’s syndrome

Investigations

• MIBG scan
• Bloods - ^ VMAs (catecholamines)
• CT

Management
- Surgery/chemo

Question 3

Wilm’s tumour

Answer 3

from embryonal renal tissue tumour
WT1 gene

Abdominal mass 
Flank pain 
Painless haematuria 
HTN 
Symptoms of anaemia - may be bleeding into the tumour 

Investigations
CT

Management
Chemo/ nephrectomy

Question 4

Retinoblastoma

Answer 4

RB1 gene - chromosome 13 - autosomal dominant

Absence of red reflex 
Nystagmus 
Squint 
Eye pain/redness 
Visual problems 

Rx - surgery/ radio

Question 5

Wilm’s tumour symptoms

Answer 5

Abdo mass 
Painless haematuria 
Flank pain 
HTN 
Lethargy/ anaemia symptoms if bled into mass

Question 6

Effects of cancer treatment

Answer 6

Subfertility 
Psycho-social - eg missing school
Secondary cancers 
Effects of treatment 
Growth retardation

Question 7

Lymphoma

Answer 7

Reed sternberg cells = HL

Painless lymphadenopathy
Worse with alcohol
B symptoms
Breathless - lung mets

Investigations
Lymph node biopsy
CXR/CT
PET scan

Management
- Chemo/radio

Question 8

CNS tumours

Answer 8

Presentation 
^ICP 
- Vomiting 
- Headaches 
- papilloedema 
FND 
Ataxia 
Squint 
Nystagmus 
Personality ∆

Paeds red flag = headache in <3 y/o