oncology

Question 1

define neuroblastoma

Answer 1

Most common malignancy. Tumors arise during fetal or early postnatal life from sympathetic nerve cells.

Question 2

where are neuroblastomas found

Answer 2

o Adrenal medulla
oabdominal sympathetic ganglia
o Cervical, thoracic ganglia

Question 3

signs and symptoms of neuroblastoma

Answer 3

Abdominal:
Mass 
pain
Respiratory:
RDS
Dysphagia
spinal cord compression:
Altered defecation, urination 
Gait
Neck/thorax:
Horner's 
Excess catecholamine secretion:
Diarrhea, weight loss, hypertension
Metastatic:
Bone pain
Anemia
Raccoon eyes 
Opoclonus myoclonus ( dancing eyes dancing feet)

Question 4

laboratory diagnosis of neuroblastoma

Answer 4

High levels:
LDH
Ferritin
catecholamine metabolites ( urine)

Question 5

imaging in neuroblastoma

Answer 5

Xray
US
CT
MRI

Question 6

other investigations neuroblastoma

Answer 6

biopsy- bone marrow, skin,excisional) see small round blue cells
MYCN amplification

Question 7

Define stage 4s neuroblastoma

Answer 7

Localized primary tumor dissemination limited to skin, liver, and bone marrow
only for <1 year old. Undergoes spontaneous regression even without treatment

Question 8

Treatment of neuroblastoma

low risk

Answer 8

usually low risk diseased so adjuvant chemotherapy and radiotherapy not needed
Only need surgical resection

Question 9

Treatment of patient intermediate risk neuroblastoma

Answer 9

chemotherapy
radiotherapy ( if unresectable tumour)
resection

Question 10

Treatment of patient high risk neuroblastoma

Answer 10

chemotherapy
stem cell transplant
retinoic acid
immunotherapy

Question 11

define wilm’s tumour

Answer 11

The most common cancer of the kidneys in children

Question 12

What is wilm’s tumour associated with

Answer 12

o Hemihypertrophy
o WAGR complex: Wilms tumor,
Aniridia (absence of the iris), Genitourinary malformations, Range of developmental delays (WT1 deletion)

Question 13

Clinical presentation of wilms tumour

Answer 13

Palpable abdominal/flank mass ( usually painless)
hematuria
hypertension
fever
US,CT,MRI

Question 14

Treatment of wilms tumour

Answer 14

Resection
Chemotherapy
Radiotherapy

Question 15

Define teratoma

Answer 15

malignant, aggressive tumors that form from multiple tissues foreign to the organ they come from

Question 16

location of teratoma

Answer 16

saccrococcygeal
gonads
thoracoabdominal

Question 17

diagnosis of teratoma

Answer 17

Disorganized heterogeneous appearance on ultrasound with solid, cystic, or complex components.
AFP

Question 18

define sacrococcygeal teratoma

Answer 18

Tumour that grows on the base of the coccyx

Question 19

Classification of sacrococcygeal teratoma

Answer 19

oPredominantly solid & vascular
oPredominantly cystic with relatively little vascularity
o Mixed with equal amounts of solid & cystic structures.

Question 20

Signs and symptoms of sacrococcygeal teratoma

Answer 20

Sacrococcygeal teratomas can grow rapidly in the fetus and require very high blood flow resulting in fetal heart failure, a condition known as hydrops.
signs:
dilation of heart, pleural , pericardial effusion, polyhydramnios

Question 21

treatment of sacrococcygeal teratoma

Answer 21

complete excision ( risk of malignancy)

Question 22

define cervical teratoma

Answer 22

tumour in the neck partly solid partly liquid

Question 23

Clinical presentation of cervical teratoma

Answer 23

Tracheal & esophageal obstruction can lead to acute respiratory failure in the newborn, or prenatal polyhydramnios

Question 24

Diagnosis of cervical teratoma

Answer 24

Prenatal
US- polyhydramnios
Postnatal:
Xray, Ultrasound,CT,MRI
AFP,HCG,urinary catecholamines

Question 25

Define vascular tumour

Answer 25

True neoplasms due to cellular hyperplasia

Question 26

Define vascular malformation

Answer 26

Congenital legions due to errors during embryonic development, have normal endothelial cell division.

Question 27

define hemangioma

Answer 27

benign tumor of the vessels appears on the skin.

Question 28

Clinical features of hemangioma

Answer 28

``` skin lesions ( mostly in head and neck)- early sign superficial lesions- red, raised lesion, may cause ulceration with bleeding Subcutaneous lesion- raised and blue in colour ```

Question 29

Complication of hemangioma

Answer 29

``` Ulceration,bleeding,pain Airway obstruction Liver hemangioma- CHF Facial lesions in eyelid, lip etc ambylopia- brain fails process inputs from one eye, favours the other eye ```

Question 30

Diagnosis of hemangioma

Answer 30

US,MRI

Question 31

Treatment of hemangioma

Answer 31

``` observation for majority ( will regress) If has complications: Corticosteroids( stops angiogenesis) propranolol (vasoconstriction) sclerosing agent injection Resection ( if well localised) ```

Question 32

vascular malformations presentation

Answer 32

Present at birth as permanent flat, pink red cutaneous lesions that do not fade with time

Question 33

Treatment of vascular malformations

Answer 33

mainly for cosmetic purposes: Laser therapy Surgery sclerotherapy