Oncology

Question 1

What is the most common type of childhood cancer?

Answer 1

Leukaemia

Question 2

What is the most common leukaemia in children?

Answer 2

ALL

Question 3

What is the peak age of ALL?

Answer 3

2-3yo

Question 4

What is the 2nd most common leukaemia?

Answer 4

AML

Question 5

What is the peal age of AML?

Answer 5

<2yo

Question 6

What is the presentation of leukaemia?

Answer 6

Fever
Weight loss
Night sweats
Bleeding and bruising
Lymphadenopathy
one/joint pain
HEepatosplenomegaly
Pancytopenia- anaemia, thrombocytopenia, leukopenia

Question 7

What is an indication for investigation of leukaemia?

Answer 7

Any unexplained bruising/bleeding

Question 8

What investigations are done for acute leukaemia?

Answer 8

FBC- pancytopenia, very high or low WCC
Blood film- blast cells
Bone marrow and lymph node biopsy

Question 9

What is the management of acute leukaemia?

Answer 9

Chemotherapy

Bone marrow transplant

Question 10

What is the prognosis for childhood leukaemia?

Answer 10

ALL= 80% cure
AML= worse

Question 11

What is the 2nd most common childhood cancer>

Answer 11

Brain tumours

Question 12

What is the most common primary brain tumour in children>

Answer 12

Pilocytic astrocytoma

Question 13

What is the presentation of pilocytic astrocytoma?

Answer 13

Dependent on size and location
Most common= increased ICP
Slow growing

Question 14

What investigation and management if for pilocytic astrocytoma?

Answer 14

CT/MRI

Surgery

Question 15

Who is osteosarcoma sen in?

Answer 15

10-20yo

Question 16

What are the common sites of osteosarcoma?

Answer 16

Femur= most common

Tibia, humerus

Question 17

What is the presentation of osteosarcoma?

Answer 17

Persistent bone pain, worse at night
Bone swelling
Palpable mass
Restricted joint movement

Question 18

What is done for unexplained bone pain/swelling?

Answer 18

Urgent XR within 48 hours

Question 19

What is seen on XR with osteosarcoma?

Answer 19

Destruction of norma bone and fluffy appearance

Sunburst appearance

Question 20

What investigations are done for osteosarcoma?

Answer 20

XR
Bloods- elevated ALP
Staging- CT/MRI
PET
Biopsy

Question 21

What is the management of osteosarcoma?

Answer 21

Surgical resection, often with amptation

Adjuvant chemo

Question 22

What is a complication of osteosarcoma?

Answer 22

Pathological fracture

Question 23

Who gets Ewing sarcoma?

Answer 23

M>F

10-20yo

Question 24

What is the presentation of Ewing sarcoma?

Answer 24

Persistent bone pain0 worse at night
Bone swelling
Restricted joint movement

Question 25

What investigations are one for Ewing sarcoma?

Answer 25

XR- onion skin periosteal reaction, wide transition zone | MRI/CT= moth eaten destructive radiolucencies

Question 26

What is the management of Ewing sarcoma?

Answer 26

Chemo and surgery/radio

Question 27

Who is retinoblastoma seen in?

Answer 27

Almost exclusively young children

Question 28

What is the presentation of retinoblastoma?

Answer 28

Leukocoria- white appearance of retina Detrioration of vision Red irritated eye Strabismus- squint

Question 29

What is the screening for retinoblastoma?

Answer 29

Red reflex Hirschberg test Eye exam

Question 30

What is the most common cancer in babies?

Answer 30

Neuroblastoma

Question 31

What s the median age of neuroblastoma?

Answer 31

20 months

Question 32

What is neuroblastoma?

Answer 32

Arises from neural crest tissue of adrenal medulla and sympathetic nervous system

Question 33

What is the presentation of neuroblastoma?

Answer 33

Abdo mass Pallor Weight loss Hepatomegaly

Question 34

What is the investigation for neuroblastoma?

Answer 34

AXR | Biopsy

Question 35

What is nephroblastoma and when does it present?

Answer 35

Rare renal tumour of childhood | Presents usually in first 4 years

Question 36

What is the presentation of nephroblastoma?

Answer 36

``` Loin pain Haematuria Lethrgy Pyrexia Early mets ```

Question 37

What investigations are done for nephroblstoma?

Answer 37

US CT/MRI Biopsy

Question 38

What is the management of nephroblastoma?

Answer 38

Nephrectomy | +/- adjuvant chemo or radio

Question 39

What are some oncological emergencies

Answer 39

``` Febrile neutropenia Raised ICP Spinal cord compression Superior vena cava syndrome Superior mediastinal syndrome Tumour lysis syndrome ```

Question 40

What is the management of raised ICP?

Answer 40

Emergency= dexamethasone and refer to neurosurgery

Question 41

What is the neurosurgical management of raised ICP?

Answer 41

Ventriculostomy EVD= temporary VP shunt

Question 42

What is the management of spinal cord compression?

Answer 42

Urgent MRI Start dexamethasone Refer for surgery/radiotherapy

Question 43

What causes superior vena cava syndrome?

Answer 43

Mediastinal tumur compression of SVC | Usually lymphoma

Question 44

What is the presentation of SVC syndrome?

Answer 44

``` Oedema Cyanosis Distended veins Ill, anxious Reduced GCS ```

Question 45

What is the management of SVC syndrome?

Answer 45

Keep upright and calm | Urgent referral

Question 46

What is superior mediastinal syndrome?

Answer 46

Mediastinal tumour compression of trachea | Usually lymphoma

Question 47

What is the presentation of superior mediastinal syndrome?

Answer 47

Dyspnoea Tachypnoea Wheeze, cough

Question 48

What is the management of superior mediastinal syndrome?

Answer 48

Keep upright and calm | Urgent referral

Question 49

What are the features of tumour lysis syndrome?

Answer 49

Hyperkalaemia, hyperuricaemia, hyperphosphataemia Hypocalcaemia AKI

Question 50

What is the management of tumour lysis syndrome?

Answer 50

NEVER give potassium Dialysis Manage K= IV calcium gluconate, insulin-dextrose, salbutamol

Question 51

What is the prevention of tumour lysis syndrome?

Answer 51

Allopurinol

Question 52

What cancers are particularly associated with tumour lysis syndrome?

Answer 52

High grade lymphoma | Acute leukaemia