Oncology

Question 1

What is ALL?

Answer 1

Acute lymphoblastic leukaemia
Most common in children
Affects B or T lymphocytes

Question 2

What syndrome increases risk of ALL?

Answer 2

Downs - by 30 times!

Question 3

What are the symptoms of ALL?

Answer 3

Lymphadenopathy
Anaemia
Infection
Bleeding
Headaches
Hepatosplenomegaly
Night sweats, failure to thrive, weight loss, petechiae

Question 4

What is the diagnosis for ALL?

Answer 4

Blast cells on bone marrow aspirate
PAS = positive
Positive nuclear staining for TdT

Question 5

What is the treatment for ALL?

Answer 5

Methotrexate chemotherapy
Steroids

Question 6

What is AML?

Answer 6

Neoplastic proliferation of immature blast cells unable to differentiate to mature neutrophils resulting in bone marrow failure

Question 7

What does AML lead to?

Answer 7

Crowding out of other cells causing loss of RBC (anaemia), platelets (bleeding) and neutrophils (infection)

Question 8

What are the symptoms of AML?

Answer 8

Only leukaemia with gum infiltration
General anaemia
Infections
Splenomegaly
Night sweats, fever, failure to thrive, petechiae

Question 9

What are the investigations for AML?

Answer 9

Auer rods on bone marrow biopsy
Blast cells on bone marrow aspirate

Question 10

What is the treatment for AML?

Answer 10

Blood and platelet transfusions
Chemotherapy
Allopurinol to prevent tumour lysis

Question 11

What is CML?

Answer 11

• Uncontrolled proliferation of myeloid cells
• Most cases are due to a reciprocal translocation of 9;22 of the Philadelphia chromosome which increases tyrosine kinase

Question 12

What is the treatment for CML?

Answer 12

Oral imatinib - tyrosine kinase inhibitor
Chemotherapy
Stem cell/ bone marrow transplant

Question 13

What is a complication of CML?

Answer 13

Can progress to AML

Question 14

What is wilms tumour?

Answer 14

Nephroblastoma - specific tumour affecting the kidney in children typically under 5

Question 15

What are the symptoms of wilms tumour?

Answer 15

Abdominal pain and mass
Haematuria
Lethargy
Fever
Hypertension
Weight loss

Question 16

What are some investigations for wilms tumour?

Answer 16

USS abdomen
CT scan of abdomen - claw sign
Biopsy

Question 17

What is the management for wilms tumour?

Answer 17

Nephrectomy
Chemotherapy/ radiotherapy
Regular USS and CXR

Question 18

What is a neuroblastoma?

Answer 18

A malignant embryonal tumour derived from neural crest tissue.

Question 19

What is the most common site of a neuroblastoma?

Answer 19

Adrenal glands followed by the abdominal sympathetic chain

Question 20

What rash can a neuroblastoma cause?

Answer 20

Blueberry muffin

Question 21

What is a urine test for neuroblastoma?

Answer 21

Urine catecholamine to creatinine ratio

Question 22

What is the gold standard investigation for neuroblastoma?

Answer 22

MIBG scan

Question 23

What is retinoblastoma?

Answer 23

A rare eye cancer affecting the retina which can be heritable or non-heritable.
Nearly all are caused by a heritable abnormality in the retinoblastoma gene (RB1).

Question 24

What are some symptoms of retinoblastoma?

Answer 24

Absent or abnormal light reflex
Squint
Visual deterioration
White glow/ reflection in pupil
Uncontrolled eye movements and pain

Question 25

What are the investigations for retinoblastoma?

Answer 25

Red reflex test USS of eye Blood tests MRI Vision test

Question 26

What are the majority of bone tumours?

Answer 26

Osteosarcoma and Ewing's sarcoma

Question 27

The majority of bone cancers spread from where

Answer 27

PBKTL - prostate, breast, kidney, thyroid, lung

Question 28

What is the presentation of osteosarcoma and where does it affect?

Answer 28

Localise pain and swelling Pathological fracture Mostly long bones around knee and humerus Metaphysis is more common than mid-shaft

Question 29

What are the investigations and gold standard for osteosarcoma?

Answer 29

Biopsy is gold X-ray Lactate dehydrogenase and alkaline phosphatase MRI of primary site Chest CT Isotope bone scan

Question 30

What is a Ewing's Sarcoma?

Answer 30

Arises from primitive poorly differentiated neuroectodermal cells Diaphysis of long bones most common Axial skeleton more than OS Pelvis most common

Question 31

What are the investigations for Ewings sarcoma?

Answer 31

Plain x-ray shows lytic lesion with periosteal reactions and 'onion skin' appearance Biopsy is gold

Question 32

What is an osteoid osteoma?

Answer 32

Benign tumour arising from osteoblasts Small tumours around metaphysis of long bones

Question 33

What is the presentation of osteoid osteoma?

Answer 33

Localised progressive pain Worse at night Improves with NSAIDs Localised swelling, tenderness and limping

Question 34

what is a hepatoblastoma?

Answer 34

Very rare cancer starting in the liver which usually doesn't metastasise

Question 35

What are some symptoms of hepatoblastoma?

Answer 35

Lump in abdomen Pain and swelling Loss of appetiite Weight loss Fatigue N+V Fever Itchy skin Jaundice

Question 36

What are the most common sites of low grade gliomas?

Answer 36

cerebellum and optic pathway

Question 37

What are some symptoms of brain tumours?

Answer 37

Headaches - worse in mornings N+V Seizures Irritable Losing interest in activities Eye problems Fatigue

Question 38

What are some investigations for brain tumours?

Answer 38

FBC CT MRI Biopsy