oncology

Question 1

Wilms’ nephroblastoma / Wilm’s tumour is one of the most common childhood malignancies. At what age does it typically present?

Answer 1

under 5 years of age, with a median age of 3 years old.

Question 2

What are features of Wilms’ tumour?

Answer 2

• abdominal mass (most common presenting feature)
• painless haematuria
• flank pain
• other features: anorexia, fever
• unilateral in 95% of cases
• metastases are found in 20% of patients (most commonly lung)

Question 3

unexplained enlarged abdominal mass in children – next step in management?

Answer 3

possible Wilm’s tumour - arrange paediatric review with 48 hours

Question 4

How is Wilm’s tumour managed?

Answer 4

• nephrectomy
• chemotherapy
• radiotherapy if advanced disease
• prognosis: good, 80% cure rate

Question 5

what is the most common malignancy in children?

Answer 5

Acute lymphoblastic leukaemia (ALL)

80% of childhood leukaemias

Question 6

what are features of bone marrow failure in ALL?

Answer 6

• anaemia: lethargy and pallor
• neutropaenia: frequent or severe infections
• thrombocytopenia: easy bruising, petechiae

Question 7

what other features can be seen in ALL?

Answer 7

• bone pain (secondary to bone marrow infiltration)
• splenomegaly
• hepatomegaly
• fever is present in up to 50% of new cases (representing infection or constitutional symptom)
• testicular swelling

Question 8

what are the types of ALL?

Answer 8

• common ALL (75%), CD10 present, pre-B phenotype
• T-cell ALL (20%)
• B-cell ALL (5%)

Question 9

what are poor prognostic factors in ALL?

Answer 9

• age < 2 years or > 10 years
• WBC > 20 * 10^9/l at diagnosis
• T or B cell surface markers
• non-Caucasian
• male sex

Question 10

what is the peak incidence of ALL?

Answer 10

2-5 years