Oncology

Question 1

[Diagnose]

acute onset < 4 weeks
Anorexia, irritability, lethargy

anemia, bleeding, purpura, petechiae, low grade fever

Bone pain, LAD, splenomegaly

Answer 1

ALL

SSX due to leukemic expansion and crowding out of the normal bone marrow

Question 2

What is the most common childhood malignany

Answer 2

ALL

Question 3

What are the most important predictive factors in ALL?

Answer 3

1. Age of the patient at the time of diagnosis
2. Initial leukocyte count
3. Speed of response to treatment

Question 4

Where are the site of relapse in ALL?

Answer 4

1. Bone marrow
2. CNS
3. testis

Question 5

Where does ALL preferentially spread

Answer 5

1. Liver
2. Spleen
3. lymph nodes

Question 6

What are the poor prognostic factors of ALL

Answer 6

1. <2 years or >10 years old
2. Male
3. WBC > 100,000 u/L on presentation
4. Presence of CNS leukemia
5. Presence of a mediastinal mass

Question 7

What is the 2nd most common malignant abdominal tumor

Answer 7

wilms tumor

Question 8

Wilms tumor is associated with what syndromes

Answer 8

1. Neurofibromatosis
2. Beckwith-Wiedemann syndrome
3. WAGR syndrome

Question 9

What are the components of Beckwith-Wiedemann syndrome?

Answer 9

1. Hemihypertrophy
2. Visceromegaly
3. Macroglossia
4. Wilms tumor

Question 10

What are the components of WAGR syndrome

Answer 10

1. Wilms tumor
2. Aniridia
3. Genitourinary
4. Mental retardation

Question 11

[Diagnosis]

flank mass that does not cross the midline
hematuria
hypertension

Answer 11

Qilms tumor

Question 12

Worst prognosis in wilms tumor has the following features

Answer 12

1. > 500 grams
2. Stage III and IV
3. Unfavorable histologuc type

Question 13

What is the cure rate of Stage I to III Wilms Tumor

Answer 13

> 90%

Question 14

What are the tumors that present with small, round blue cell?

Answer 14

1. Wilms
2. Acute leukemia
3. Rhabdomyosarcoma
4. Mesothelioma/ Medulloblatoma
5. Ewing
6. Retinoblastoma
7. Primitive neuroectodermal tumor
8. Neuroblastoma

Question 15

Neuroblastoma is associated with what conditions?

Answer 15

1. Tuberous sclerosis - N-myc oncogene
2. Neurofibromatosis - pheochromocytoma
3. Hirschsprung disease

Question 16

[Diagnosis]

non-tender abdominal mass which may cross the midline

Horner syndrome

cord compression

raccoon eyes, dancing eyes, dancing feet (opsoclonus/myoclonus)

Answer 16

Neuroblastima

Question 17

What is parameter in the urine can be used to diagnose neuroblastoma

Answer 17

1. 24 hour VMA and HVA

Question 18

What are the prognostic factors of neuroblastoma?

Answer 18

1. Age at diagnosis
2. Stage at diagnosis
3. Shimada histology

Question 19

[Neuroblastoma Staging]

confined to the organ or structure of origin

Answer 19

Stage 1

Question 20

[Neuroblastoma Staging]

tumor extend beyond the structure of origin but not across the midline

Answer 20

Stage 2

2A - without ipsilateral LN involvement

2B - with ipsilateral LN involvement

Question 21

[Neuroblastoma Staging]

extend beyond the midline with or without bilateral LN involvement

Answer 21

Stage 3

Question 22

[Neuroblastoma Staging]

Disseminated to distant site

Bone, BM, lover, distant LN

Answer 22

Stage 4

Question 23

[Neuroblastoma Staging]

< 1 year old disseminated to liver, skin, BM without bone involvement with primary tumor

Answer 23

Stage 4S

Question 24

What is the cure rate pf stage 2 neuroblastima?

Answer 24

> 90%

Question 25

[Neuroblastoma vs Wilms tumor] seen in the kidney does not cross the midline HPN, Hematuria Can metastasize to the lungs

Answer 25

Wilms tumor

Question 26

[Neuroblastoma vs Wilms tumor] Seen anywhere along the neuroaxis, cross the midline Many HPN, hematuria, opsoclonus, cord compression, racoon eye mets to bones

Answer 26

Neuroblastoma CT scan = calcifications

Question 27

[Diagnose] Painless, non-tender, firm rubbery cervical or supravercical lymphadenopathy Weight loss >10% over 3 months, unexplained high-fever, drenching nigh sweats Regional adenopathy No hepatosplenomegaly

Answer 27

Hodgkin lymphoma Contigous LN spread

Question 28

[Diagnose] Painless, non-tender, firm rubbery cervical or supravercical lymphadenopathy Weight loss >10% over 3 months, unexplained high-fever, drenching nigh sweats systemic adenopathy more extranodal involvement hepatosplenomegaly

Answer 28

Non-hodgkin lymphoma

Question 29

What is the chemo protocol for HL?

Answer 29

COPAD or COMP Cyclophosphamide Vincristine Prednisone Doxorubicin ``` Cyclophosphamide Vincristine Methotrexate Prednisone 6-mercaptopurine ```

Question 30

What are the risk factors for HL

Answer 30

EBV, CMV, HHV Age 20-30 years old

Question 31

Pathognomonic histologic finding of HL

Answer 31

Reed-Sternberg cells arising from the germinal center of B cells

Question 32

EBV is associated with what type of NHL?

Answer 32

Burkitt lymphoma

Question 33

[Diagnosis] Pancytopenia hypocellular bone marrow

Answer 33

Aplastic anemia

Question 34

[Pancytopenia] ``` Aplastic anemia microcephaly micropthalmia hearing loss absent radii and thumbs ```

Answer 34

Fanconi Anemia Tx: Steroids, BMT

Question 35

What are the treatment options for Aplastic Anemia?

Answer 35

1. RBC and platelet transfusion 2. Allogenic BM transplant 3. Granulocyte colony-stimulating factor 4. Granulocyte macrophage colony-stimulating factor 5. Withdrawal of any toxic causative agent

Question 36

Most common solid tumor

Answer 36

Brain tumors

Question 37

Most common solid tumor outside CNS

Answer 37

Neuroblastoma

Question 38

Most common soft tissue tumor

Answer 38

Rhabdomyosacoma

Question 39

Malignancy with highest mortality

Answer 39

Brain (PNET)