Malignant Diseases

Question 1

Acute Lymphoblastic Leukaemia poor prognosis factors (5)

Answer 1

<1 year or >10 years
Male
Non-Caucasian
T or B cell surface markers
WBC >20x10^9/L at diagnosis

Question 2

Acute lymphoblastic leukaemia supportive therapy

Answer 2

Fluid intake to guarantee output 100mL/hour

Allopurinol or rasburicase - prevent tumour lysis syndrome

Prophylactic antibiotic, antifungal and antiviral

Prophylactic filgrastim (colony stimulating factor) to prevent febrile neutropenia

Norethisterone for female patients to suppress periods

Before treatment anaemia must be corrected using blood transfusion

Question 3

Acute lymphoblastic leukaemia no CNS disease management

Answer 3

Induction chemotherapy (standard includes prednisolone, vincristine, doxorubicin - anthracyclines, L-asparaginase)

Dexrazone (prevent cardiotoxicity from doxorubicin)

Rituximab (if CD20+)

Tyrosine kinase inhibitor (imatinib) - Philadelphia chromosome positive patients

Question 4

Acute lymphoblastic leukaemia CNS involvement

Answer 4

Cytotoxic drugs penetrate poorly in CNS

Standard induction therapy with intensified intrathecal chemotherapy

Intrathecal methotrexate alone or with cytarabine and hydrocortisone
+
Systemic treatment with high dose cytarabine (HDAC) or high dose methotrexate (HDM) to ensure good blood brain penetration

Question 5

Acute lymphoblastic leukaemia second phase management

Answer 5

Consists of consolidation and maintenance therapy

Remission when leukaemia blasts are eradicated and normal marrow function restored

Question 6

Acute lymphoblastic leukaemia relapse

Answer 6

High dose chemotherapy followed by bone marrow transplant

Question 7

Brain tumours management

Answer 7

Surgery aimed at treating hydrocephalus, tissue diagnosis and maximum resection

Question 8

Hodgkin’s lymphoma management

Answer 8

ABVD

Adriamycin
Bleomycin
Vinblastine
Dacarbazine
+/- radiotherapy

Question 9

Unfavourable Hodgkin’s lymphoma management

Answer 9

Four cycles of ABVD followed by medium radiation

Or BEACOPP followed by two cycles of ABVD and radiotherapy

Question 10

Primary refractory or relapse disease Hodgkin’s lymphoma management

Answer 10

High dose chemo and autologous stem cell transplant (ASCT)

Brentuximab vedotin if ASCT fails

Question 11

Hodgkin’s lymphoma monitoring

Answer 11

PET scan

80% cure rate

Question 12

Low risk neuroblastoma management

Answer 12

Localised without metastatic disease

USS every 3-6 weeks +/- surgery
Chemo of progress post surgery

Question 13

Immediate risk neuroblastoma management

Answer 13

Carboplatin, etoposide, cyclophosphamide and doxorubicin for 4-8 cycles and surgery

Question 14

High risk neuroblastoma management

Answer 14

Radiotherapy (high dose carboplatin, etoposide, cyclophosphamide and doxorubicin) for 5-6 cycles

Surgery

Bone marrow transplant

Immunotherapy and dinutuximab
Isotretinoin

Question 15

Retinoblastoma - gross vitreous seeding present management

Answer 15

Tumour cells floating in vitreous cavity

Enucleation
If infiltration of iris, ciliary body or sclera - adjuvant chemo (carboplatin, etoposide and vincristine)

Question 16

Retinoblastoma - minimal or no vitreous seeding management

Answer 16

Systemic chemotherapy (carboplatin, etoposide, vincristine) and focal therapy (cryo or laser)

Question 17

Retinoblastoma- FH or detected at birth management

Answer 17

Laser

Followed by examination under anaesthesia every month for a year

Question 18

Retinoblastoma- vitreous seeding after therapy management

Answer 18

External beam radiotherapy

Question 19

Wilm’s tumour management

Answer 19

Nephroblastoma

Nephrectomy and chemotherapy

Radiotherapy in more advanced disease

5% have bilateral disease