Oncology Practice Questions

Q: Which is the most common malignancy in children?

Leukemia. **Explanation:** In pediatric oncology, the distribution of malignancies differs significantly from adults. **Leukemia** is the most common malignancy in children, accounting for approximately **30% of all childhood cancers**. Among leukemias, **Acute Lymphoblastic Leukemia (ALL)** is the most frequent subtype (75-80%), followed by Acute Myeloid Leukemia (AML). **Analysis of Options:** * **Leukemia (Correct):** It is the overall most common childhood cancer. The peak incidence occurs between 2 and 5 years of age. * **Retinoblastoma:** This is the most common **intraocular** tumor in children, but it is relatively rare compared to systemic malignancies. * **Wilms Tumor (Nephroblastoma):** This is the most common **renal** tumor in children, typically presenting as an asymptomatic abdominal mass. * **Neuroblastoma:** This is the most common **extracranial solid tumor** in childhood and the most common malignancy in **infants** (under 1 year of age). **High-Yield Clinical Pearls for NEET-PG:** * **Most common childhood cancer:** Leukemia (specifically ALL). * **Most common solid tumor:** CNS Tumors (Brain tumors). * **Most common extracranial solid tumor:** Neuroblastoma. * **Most common abdominal mass in children:** Hydronephrosis (Benign); Wilms Tumor (Malignant). * **Most common neonatal/infantile malignancy:** Neuroblastoma. * **Most common soft tissue sarcoma:** Rhabdomyosarcoma. * **Most common primary bone tumor:** Osteosarcoma (followed by Ewing sarcoma).

Q: Which of the following statements is false regarding Wilm's tumor?

Spreads mostly by lymphatics. **Explanation:** Wilms tumor (Nephroblastoma) is the most common primary renal malignancy in children. The correct answer is **Option C** because Wilms tumor primarily spreads via **direct local invasion** and **hematogenous routes** (most commonly to the lungs), rather than lymphatics. While regional lymph node involvement can occur (seen in ~15% of cases), it is not the primary mode of spread. **Analysis of Options:** * **Option A (True):** The peak incidence is between **2 to 3 years** of age. Approximately 90% of cases are diagnosed before age 5, making it a classic pediatric malignancy. * **Option B (True):** The most common clinical presentation (80-90%) is an **asymptomatic, firm, smooth abdominal mass** that typically does not cross the midline (unlike Neuroblastoma). * **Option D (True):** Wilms tumor is a success story in pediatric oncology. With a multimodal approach (surgery, chemotherapy, and sometimes radiation), the overall cure rate exceeds **90%**. **High-Yield Clinical Pearls for NEET-PG:** 1. **WAGR Syndrome:** Wilms tumor, Aniridia, Genitourinary anomalies, and intellectual disability (formerly Retardation). Associated with **WT1 gene** deletion on Chromosome 11p13. 2. **Beckwith-Wiedemann Syndrome:** Macroglossia, organomegaly, and hemihypertrophy. Associated with **WT2 gene** on Chromosome 11p15. 3. **Diagnosis:** Contrast-enhanced CT (CECT) is the gold standard for staging. 4. **Prognosis:** The most important prognostic factor is **histology** (favorable vs. unfavorable/anaplastic). 5. **Management Tip:** Avoid vigorous palpation of the abdomen to prevent rupture of the tumor capsule and subsequent peritoneal seeding.

Q: What is the most common abdominal mass in children?

Neuroblastoma. **Explanation:** The correct answer is **Neuroblastoma**. In pediatric oncology and surgery, it is essential to distinguish between the most common abdominal *mass* and the most common abdominal *malignancy*. **1. Why Neuroblastoma is correct:** Neuroblastoma is the **most common extracranial solid tumor** of childhood and the **most common abdominal mass** overall in the pediatric population. It originates from primordial neural crest cells of the sympathetic nervous system, most frequently occurring in the adrenal medulla (approx. 40%). Clinically, it often presents as a firm, irregular, and nodular mass that **crosses the midline**, distinguishing it from other renal masses. **2. Why other options are incorrect:** * **Hydronephrosis:** While it is the most common cause of a palpable abdominal mass in **neonates** (newborns), it is not the most common cause across the entire pediatric age group. * **Wilms’ Tumor (Nephroblastoma):** This is the most common **primary renal malignancy** in children. Unlike Neuroblastoma, a Wilms' tumor is typically smooth, rarely crosses the midline, and the peak incidence is slightly later (3–4 years). * **Rhabdomyosarcoma:** This is the most common soft tissue sarcoma in children, but it typically involves the head, neck, or genitourinary tract (bladder/prostate) rather than presenting as a primary abdominal mass. **Clinical Pearls for NEET-PG:** * **Crossing the Midline:** Neuroblastoma crosses the midline; Wilms’ tumor usually does not. * **Calcification:** On CT, Neuroblastoma frequently shows stippled calcifications (85%), whereas Wilms’ tumor rarely does. * **Markers:** Elevated urinary catecholamines (VMA and HVA) are diagnostic for Neuroblastoma. * **Opsoclonus-Myoclonus Syndrome:** A high-yield paraneoplastic syndrome associated specifically with Neuroblastoma ("dancing eyes, dancing feet").

Q: What is the most common site of metastasis in neuroblastoma?

Lymph nodes. **Explanation:** Neuroblastoma is the most common extracranial solid tumor of childhood, arising from primordial neural crest cells. Understanding its metastatic pattern is crucial for NEET-PG. **1. Why Lymph Nodes are Correct:** In neuroblastoma, the most common route of spread is via the lymphatic system. **Regional lymph nodes** are the most frequent site of metastasis, occurring in approximately 70% of patients with disseminated disease. This is followed closely by the bone marrow and cortical bone. **2. Why the other options are incorrect:** * **Lung (A):** Unlike Wilms tumor (where the lung is the most common site), pulmonary metastasis is **rare** in neuroblastoma, occurring in less than 3% of cases. * **Liver (B):** While the liver is a common site of metastasis, particularly in **Stage 4S** (Special) neuroblastoma in infants (Pepper Syndrome), it is not the most frequent site overall across all age groups. * **Vertebrae (D):** While neuroblastoma frequently metastasizes to the **cortical bone** (especially the skull and orbit, leading to "raccoon eyes"), lymph node involvement remains statistically more prevalent than isolated vertebral metastasis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of origin:** Adrenal medulla (followed by the retroperitoneal sympathetic chain). * **Opsoclonus-Myoclonus Syndrome:** A paraneoplastic syndrome associated with favorable prognosis neuroblastoma ("Dancing eyes, dancing feet"). * **Homer-Wright Rosettes:** The characteristic histopathological finding (pseudorosettes). * **Urinary Markers:** Elevated VMA (Vanillylmandelic acid) and HVA (Homovanillic acid). * **N-myc Amplification:** The most important poor prognostic genetic marker.

Q: A 5-year-old child presents with a history of fever off-and-on for the past 2 weeks, petechial spots all over the body, and increasing pallor for the past 1 month. Examination reveals splenomegaly 2 cm below the costal margin. What is the most likely diagnosis?

Acute leukemia. **Explanation:** The clinical presentation of **fever, pallor, and petechiae** represents the classic triad of **pancytopenia** (anemia, leukopenia/dysfunction, and thrombocytopenia). In a pediatric patient, this triad combined with **organomegaly** (splenomegaly) is highly suggestive of **Acute Leukemia**, most commonly Acute Lymphoblastic Leukemia (ALL). 1. **Why Acute Leukemia is correct:** The infiltration of the bone marrow by malignant blast cells leads to "marrow failure," causing anemia (pallor), thrombocytopenia (petechiae), and functional neutropenia (fever/infections). The presence of **splenomegaly** indicates extramedullary involvement, which is a hallmark of leukemia and helps differentiate it from simple marrow failure. 2. **Why other options are incorrect:** * **Idiopathic Thrombocytopenic Purpura (ITP):** Typically presents with isolated petechiae/bruising in a "well-appearing" child. It does **not** cause pallor or splenomegaly. * **Aplastic Anemia:** While it presents with pancytopenia (pallor, fever, petechiae), it is characterized by an "empty" marrow. Therefore, **splenomegaly and lymphadenopathy are characteristically absent.** * **Hypersplenism:** While it can cause cytopenias, it usually presents with a massive spleen and an underlying cause (like portal hypertension), rather than the acute febrile onset seen here. **Clinical Pearls for NEET-PG:** * **Most common childhood cancer:** Acute Lymphoblastic Leukemia (ALL). * **Peak age for ALL:** 2–5 years. * **Key differentiator:** Pancytopenia + Splenomegaly = Leukemia; Pancytopenia + No Splenomegaly = Aplastic Anemia. * **Diagnostic Gold Standard:** Bone marrow aspiration showing >20% blasts.

Q: A 8-year-old boy presents with headache, a supracellar mass, and bilateral hemianopia. The MRI scan of his head is shown. What is the diagnosis?

Craniopharyngioma. ### **Explanation** **Diagnosis: Craniopharyngioma** **1. Why the Correct Answer is Right:** Craniopharyngiomas are the most common suprasellar tumors in children. They arise from remnants of **Rathke’s pouch**. The classic presentation involves a triad of: * **Visual Disturbances:** Compression of the optic chiasm leads to **bitemporal hemianopia**. * **Endocrine Dysfunction:** Growth hormone deficiency (short stature) or diabetes insipidus due to hypothalamic-pituitary axis compression. * **Increased Intracranial Pressure:** Headaches and vomiting. On imaging (MRI/CT), these tumors are characteristically **"90% tumors"**: 90% are cystic, 90% show calcification (especially the Adamantinomatous type seen in children), and 90% enhance with contrast. **2. Why the Other Options are Wrong:** * **Pituitary Apoplexy:** This is an acute clinical emergency caused by hemorrhage or infarction of the pituitary gland. It presents with sudden "thunderclap" headache and ophthalmoplegia, rather than the chronic progression seen in this child. * **Nasopharyngeal Fibroma:** This is a benign but aggressive vascular tumor found in the nasopharynx of adolescent males. It presents with recurrent epistaxis and nasal obstruction, not suprasellar neurological signs. * **Hypothalamic Glioma:** While located in the same region, these are typically solid tumors and less likely to show the heavy calcification or cystic components characteristic of craniopharyngiomas. **3. NEET-PG High-Yield Pearls:** * **Bimodal Age Distribution:** Peaks at 5–14 years and 50–75 years. * **Histology:** Two types—**Adamantinomatous** (children; "machine oil" fluid, calcification, wet keratin) and **Papillary** (adults; solid, lacks calcification). * **Imaging Hallmark:** Suprasellar calcification on CT is the most specific diagnostic clue in a pediatric patient. * **Management:** Surgical resection is the primary treatment, often followed by radiotherapy.

Q: All of the following are good prognostic factors for childhood Acute Lymphoblastic Leukemia, except?

t (12 : 21) translocation. In childhood Acute Lymphoblastic Leukemia (ALL), prognosis is determined by age, initial white blood cell (WBC) count, cytogenetics, and immunophenotype. ### **Analysis of Options** * **t(12;21) translocation (Correct Answer):** This translocation results in the *TEL-AML1* (ETV6-RUNX1) fusion gene. It is actually the **most common** genetic abnormality in childhood B-ALL and is associated with an **excellent prognosis**. The question asks for the "except" factor; however, in standard pediatric oncology, t(12;21) is a **good** prognostic factor. * *Note for NEET-PG:* If this question appears as "Except," it is often a "controversial" or "recall error" question. However, strictly speaking, all options listed (A, B, C, and D) are generally considered **good** prognostic factors. If forced to choose the "least good" or if the question intended to list a poor factor (like t(9;22)), t(12;21) remains clinically favorable. * **Hyperdiploidy (Incorrect):** Defined as >50 chromosomes per cell. This is a classic **good** prognostic factor. * **Female Sex (Incorrect):** Historically, girls have a slightly better prognosis than boys, partly due to the absence of the risk of testicular relapse. * **Pre-B cell ALL (Incorrect):** Common (Early) B-lineage ALL has a significantly better prognosis compared to T-cell ALL or mature B-cell (Burkitt) leukemia. ### **High-Yield Clinical Pearls for NEET-PG** | **Good Prognosis** | **Poor Prognosis** | | :--- | :--- | | Age: 1–9 years | Age: 10 years | | WBC: 50,000/µL | | Cytogenetics: **Hyperdiploidy, t(12;21)** | Cytogenetics: **t(9;22) [Philadelphia+], t(4;11)** | | Response: Rapid clearance of blasts | Response: Slow response to induction | | Sex: Female | Sex: Male |

Q: Which of the following are true about nephroblastoma except:

Treatment is chemotherapy followed by surgery. ***Correct Answer: Treatment is chemotherapy followed by surgery*** This is the **INCORRECT** statement (which makes it the correct answer for this EXCEPT question): - In **COG (Children's Oncology Group) protocol** used in India and US: **Primary treatment is upfront nephrectomy** (surgery first) followed by chemotherapy - SIOP protocol uses preoperative chemotherapy, but this is NOT the standard approach in India/FMGE context - **Surgery-first approach** allows for accurate staging and immediate tumor removal *Incorrect: Most common intra abdominal malignancy in children* - This is **TRUE** - Nephroblastoma (Wilms tumor) is indeed the most common intra-abdominal malignancy in children (peak age 3-4 years) *Incorrect: Early lung mets* - This is **TRUE** - Wilms tumor has propensity for **early hematogenous spread to lungs** - Lungs are the most common site of metastasis - Chest X-ray/CT is mandatory for staging *Incorrect: Hematogenous spread* - This is **TRUE** - Wilms tumor spreads via **hematogenous route** to lungs (most common), liver, and other sites - Unlike neuroblastoma which can spread lymphatically

Question 1

Which is the most common malignancy in children?

Accepted Answer

Leukemia

Answer

Retinoblastoma

Answer

Wilms tumor

Answer

Neuroblastoma

Question 2

A 6-year-old boy with lymphoreticular malignancy is scheduled for a cycle of chemotherapy. Which of the following investigations should be performed within the next 4 hours to diagnose tumor lysis syndrome?

Accepted Answer

Urea, creatinine, phosphate, Ca2+, and K+

Answer

Urea, creatinine, chloride, Ca2+, and K+

Answer

Urea, creatinine, magnesium, Ca2+, and K+

Answer

Urea, creatinine, sodium, and phosphate

Question 3

Which of the following statements is false regarding Wilm's tumor?

Accepted Answer

Spreads mostly by lymphatics

Answer

Presents before the age of 5 years

Answer

Mostly presents as an abdominal mass

Answer

Responds well to treatment

Question 4

What is the most common abdominal mass in children?

Accepted Answer

Neuroblastoma

Answer

Hydronephrosis

Answer

Wilms' tumor

Answer

Rhabdomyosarcoma

Question 5

What is the most common site of metastasis in neuroblastoma?

Accepted Answer

Lymph nodes

Answer

Lung

Answer

Liver

Answer

Vertebrae

Question 6

A 5-year-old child presents with a history of fever off-and-on for the past 2 weeks, petechial spots all over the body, and increasing pallor for the past 1 month. Examination reveals splenomegaly 2 cm below the costal margin. What is the most likely diagnosis?

Accepted Answer

Acute leukemia

Answer

Idiopathic thrombocytopenic purpura

Answer

Hypersplenism

Answer

Aplastic anemia

Question 7

A 8-year-old boy presents with headache, a supracellar mass, and bilateral hemianopia. The MRI scan of his head is shown. What is the diagnosis?

Accepted Answer

Craniopharyngioma

Answer

Pituitary apoplexy

Answer

Nasopharyngeal fibroma

Answer

Hypothalamic glioma

Question 8

All of the following are good prognostic factors for childhood Acute Lymphoblastic Leukemia, except?

Accepted Answer

t (12 : 21) translocation

Answer

Hyperdiploidy

Answer

Female sex

Answer

Pre B cell ALL

Question 9

All of the following are good prognostic factors for childhood Acute Lymphoblastic Leukemia, except?

Accepted Answer

t (12 : 21) translocation

Answer

Hyperdiploidy

Answer

Female sex

Answer

Pre B cell ALL

Question 10

Which of the following are true about nephroblastoma except:

Accepted Answer

Treatment is chemotherapy followed by surgery

Answer

Most common intra abdominal malignancy in children

Answer

Early lung mets

Answer

Hematogenous spread

Oncology — MCQs

Oncology — MCQs

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