Oncology

Question 1

Two commonest cancers in childhood

Answer 1

Leukaemia

Brain tumour

Question 2

What type of cancer is Down’s associated with?

Answer 2

Leukaemia

Question 3

What type of cancer is NF associated with?

Answer 3

Glioma

Question 4

Side effects if doxorubicin

Answer 4

Cardiotoxicity

Question 5

Side effects of cisplatin

Answer 5

Renal failure and deafness

Question 6

Side effects of cyclophosphamide

Answer 6

Haemorrhagic cystitis

Question 7

Side effects of vincristine

Answer 7

Neuropathy

Question 8

Do children or adolescents have poorer cancer outcomes?

Answer 8

Adolescents and young adults

Question 9

5 years survival for childhood cancers

Answer 9

75%

Question 10

Categories of presenting complaints of childhood cancer

Answer 10

Localised mass
Pressure effect/obstruction
Disseminated disease

Question 11

Age of presentation ALL

Answer 11

2-5 years

Question 12

Presentation of ALL

Answer 12

Insidious (weeks) onset:

• Malaise
• Pallor, lethargy (anaemia)
• Purpura/bruising (thrombocytopenia)
• Recurrent infection (neutropenia)
• Lymphadenopathy
• Hepatosplenomegaly

(Testicular enlargement in boys)

Question 13

Ix for suspected ALL

Answer 13

Bloods (low Hb, plts, neutros, raised WCC)
Blood film (blasts in periphery)
Bone marrow (flow cytometry - CD34,3,19)
Immunological phenotyping

Question 14

Poor prognostic factors for ALL

Answer 14

Age <1, >10 years
High tumour load (high WCC)
MLL rearrangement 
Poor chemo response 
Large residual disease

Question 15

Mx newly diagnosed ALL (with no CNS involvement)

Answer 15

Induction chemotherapy:

• prednisolone
• vincristine
• anthracycline (doxorubicin)

CD20+ Rituximab
bcr-abl Imatinib

Question 16

Mx ALL bcr-abl +ve

Answer 16

Imatinib

Question 17

Mx ALL CD20+

Answer 17

Rituximab

Question 18

Supportive treatments for ALL

Answer 18

Blood transfusion (anaemia)
Fluids + allopurinol
Prophylactic abx, antifungals and antivirals
Norethisterone to reduce periods if low platelets

Question 19

What can be used to reduce periods in patients with ALL and low platelet count

Answer 19

Norethisterone

Question 20

Remission rates after induction chemotherapy

Answer 20

95%

Question 21

Definition of ALL remission

Answer 21

Leukaemic blast cells eradicated

Normal marrow fx restored

Question 22

Mx ALL if CNS involvement

Answer 22

Standard induction therapy intrathecally

- Cytotoxic drugs penetrate poorly into CNS

Question 23

How long is ALL continued for after initial induction therapy?

Answer 23

3 years boys

2 years girls

Question 24

Are most childhood brain tumours primary or secondary?

Answer 24

Primary

Question 25

Are most childhood brain tumours supra or infratentorial?

Answer 25

Infra

Question 26

Leading cause of childhood cancer death

Answer 26

Brain tumour

Question 27

Commonest solid tumour in children

Answer 27

Brain tumour

Question 28

Commonest brain tumour in children

Answer 28

Astrocytoma

Question 29

Particularly malignant astrocytoma

Answer 29

Glioblastoma multiforme

Question 30

Presentation of glioblastoma mulitforme

Answer 30

Seizure, hemiplegia

Focal neuro deficits

Question 31

Location of medulloblastoma

Answer 31

Midline posterior fossa

Question 32

Presentation medulloblastoma and ependydoma (posterior fossa tumours)

Answer 32

Visual field loss, truncal ataxia, coordination problems, convergent squint

Question 33

Two examples posterior fossa tumours

Answer 33

Medulloblastoma and ependydoma

Question 34

Mx brainstem glioma

Answer 34

Palliative

Question 35

Features of craniopharyngioma

Answer 35

If in midline - bitemporal hemianopia

If obstructing pituitary - FTT, diabetes insipidus, weight gain

Question 36

Management brain tumour

Answer 36

Often surgery - reduce hydrocephalus, biopsy and resection