Oncology Practice Questions

Q: Which is the commonest childhood cancer –

ALL. ***ALL*** - **Acute Lymphoblastic Leukemia (ALL)** is the most common cancer in children, accounting for about 1 in 3 childhood cancers. - It primarily affects **lymphoid progenitor cells** and is characterized by rapid progression. *AML* - **Acute Myeloid Leukemia (AML)** is more common in adults and has a lower incidence in children compared to ALL. - It involves the **myeloid lineage** of white blood cells. *CML* - **Chronic Myeloid Leukemia (CML)** is rare in childhood, primarily affecting adults. - It is often associated with the **Philadelphia chromosome (BCR-ABL fusion gene)**. *CLL* - **Chronic Lymphocytic Leukemia (CLL)** is extremely rare in children and predominantly affects older adults. - It is characterized by the accumulation of **mature B lymphocytes**.

Q: Opsoclonus as a paraneoplastic manifestation is most commonly seen in

Neuroblastoma. ***Neuroblastoma*** - Opsoclonus-myoclonus syndrome (OMS), characterized by **opsoclonus** (chaotic, rapid eye movements) and **myoclonus**, is most commonly associated with **neuroblastoma** in children. - This paraneoplastic syndrome is thought to be mediated by **autoantibodies** attacking specific neuronal proteins [1]. *Colon cancer* - While various paraneoplastic neurological syndromes can be associated with colon cancer, **opsoclonus-myoclonus syndrome** is not typically among the more common manifestations. [2] - Common paraneoplastic syndromes with colon cancer include **Lambert-Eaton myasthenic syndrome** or **cerebellar degeneration**. *Hepatocellular cancer* - **Hepatocellular carcinoma** is generally not known for causing paraneoplastic **opsoclonus-myoclonus syndrome**. - Paraneoplastic syndromes linked to liver cancer are relatively rare and usually involve endocrinological issues like **erythrocytosis** or **hypercalcemia** [2]. *Renal cell carcinoma* - **Renal cell carcinoma** can be associated with various paraneoplastic syndromes, most often endocrine or hematologic [2]. - Neurological paraneoplastic syndromes are less common, and **opsoclonus** is not a characteristic manifestation.

Q: What is the most common site of rhabdomyosarcoma in children?

Head and neck region. ***Head and neck region*** - The **head and neck region** is the most common site for rhabdomyosarcoma in children, accounting for approximately **35-40% of cases**. - Within the head and neck, common sub-sites include the **orbit**, **parameningeal sites** (nasopharynx, paranasal sinuses, middle ear), and other **non-parameningeal sites**. *Extremities* - Rhabdomyosarcoma can occur in the **extremities**, but it is less common than in the head and neck, typically accounting for about **20% of cases**. - When present in the extremities, it often involves the **proximal portions** of the limbs. *Genitourinary area* - The **genitourinary (GU) tract** is a significant site for rhabdomyosarcoma, particularly the **bladder** and **prostate**, accounting for approximately **20% of cases**. - While common, it is not the *most* common overall site compared to the head and neck. *Trunk* - Rhabdomyosarcoma in the **trunk** (including the chest wall, abdomen, and retroperitoneum) is less frequent, accounting for about **10-15% of cases**. - These tumors can arise from various muscle groups within the trunk, but are collectively less common than head and neck involvement.

Q: TRUE statement regarding childhood malignancy is-

Neuroblastoma typically occurs before 5 years of age. ***Neuroblastoma typically occurs before 5 years of age*** - **Neuroblastoma** is predominantly a malignancy of **early childhood**, with approximately **90% of cases** diagnosed **before the age of 5 years**. - The **median age at diagnosis** is around **17-22 months**, with about **40% occurring in the first year of life**. - It originates from **neuroblasts** in the adrenal medulla or sympathetic ganglia, which are rapidly developing tissues in infants and young children. *AML is the most common malignancy* - **Acute Lymphoblastic Leukemia (ALL)**, not Acute Myeloid Leukemia (AML), is the **most common childhood malignancy**, accounting for about **25-30% of all childhood cancers** and **75-80% of childhood leukemias**. - While AML does occur in children, its incidence is **significantly lower than ALL**. *Wilm's tumour is the commonest* - **Wilms' tumor** (nephroblastoma) is the **most common primary malignant renal tumor** in children, but it is **not the most common childhood malignancy overall**. - **Leukemias** (specifically ALL) are considerably more common than Wilms' tumor. *None of the options* - This option is incorrect because the statement regarding **neuroblastoma** is accurate, making it a true statement. - Therefore, at least one of the options provided is correct.

Q: The most common intracranial tumor in children is –

Glioma. ***Glioma*** - **Gliomas** are the most common type of intracranial tumor in children, accounting for approximately **50-60%** of all pediatric brain tumors. This broad category includes tumors like astrocytomas (e.g., **pilocytic astrocytoma**), ependymomas, and brainstem gliomas. - The most common subtype of glioma in children is the **pilocytic astrocytoma**, which often arises in the cerebellum or optic pathway. - Other common gliomas include **ependymomas** (arising in the ventricular system) and **diffuse brainstem gliomas**. *Meningioma* - **Meningiomas** are tumors arising from the meninges, the membranes surrounding the brain and spinal cord, and are **rare** in children. - These tumors are typically seen in **middle-aged to older adults**, and their occurrence in pediatric populations is uncommon, accounting for less than **2%** of pediatric brain tumors. *Lymphangioma* - A **lymphangioma** is a benign malformation of the lymphatic system, most commonly found in the **head and neck region** (e.g., cystic hygroma), not within the brain parenchyma. - It is a tumor of lymphatic vessels and is **not an intracranial brain tumor** in the typical sense. *Medulloblastoma* - **Medulloblastoma** is the most common **malignant** brain tumor in children and the most common **posterior fossa tumor** in the pediatric population. - However, when considering **all intracranial tumors** (both benign and malignant), **gliomas as a category** are more common overall than medulloblastomas alone. - Medulloblastomas arise from the cerebellum and account for approximately **15-20%** of pediatric brain tumors.

Q: A baby presents with recurrent ear infections with discharge, seborrheic dermatitis, hepatosplenomegaly, and cystic skull lesions. What is the most likely diagnosis?

Langerhans cell histiocytosis. ***Langerhans cell histiocytosis*** - This classic presentation involves a constellation of symptoms including **seborrheic dermatitis-like rash**, recurrent ear infections with discharge (due to infiltration of the mastoid bone), hepatosplenomegaly, and **cystic skull lesions**, all highly suggestive of Langerhans cell histiocytosis (LCH). - LCH is a rare disorder characterized by the proliferation of abnormal Langerhans cells, which can affect various organs and systems. *Hemophagocytic lymphohistiocytosis* - While patients with Hemophagocytic Lymphohistiocytosis (HLH) can present with **hepatosplenomegaly** and recurrent infections, they typically have high fevers, cytopenias, and poor clinical condition. - HLH does not typically cause **seborrheic dermatitis-like rashes** or **cystic bone lesions**. *Multiple myeloma* - Multiple myeloma is a **plasma cell malignancy** that predominantly affects older adults and is characterized by bone pain, anemia, renal failure, and hypercalcemia. - It does not present with recurrent ear infections, seborrheic dermatitis, or hepatosplenomegaly in this manner, and is exceedingly rare in infants. *Acute lymphoblastic leukemia (ALL)* - ALL is the most common childhood cancer and can cause **hepatosplenomegaly**, recurrent infections (due to neutropenia), and sometimes bone pain. - However, **seborrheic dermatitis-like rash** and **cystic skull lesions** are not typical features of ALL.

Q: A renal mass seen on prenatal check-up is most probably:

Mesoblastic nephroma. ***Mesoblastic nephroma*** - This is the most common **congenital renal tumor** and is often detected antenatally or in the **neonatal period**. - It is typically a **benign tumor** that presents as a solid, well-circumscribed renal mass. *Neuroblastoma* - While it can present as an abdominal mass in infants, **neuroblastoma** usually arises from adrenal glands or sympathetic ganglia, not primarily the kidney itself. - It often shows features of calcification and can be associated with elevated **catecholamines**. *Wilms' tumor* - **Wilms' tumor** is the most common childhood renal malignancy, but it is typically diagnosed in older infants and young children (peak incidence at 2-3 years), less commonly detected definitively on prenatal check-ups. - Prenatal detection of **Wilms' tumor** is rare, and it usually grows rapidly postnatally. *Renal sarcoma* - **Renal sarcoma** is an extremely rare primary renal tumor in children, making it a much less likely diagnosis than mesoblastic nephroma for a prenatal renal mass. - These tumors tend to be aggressive but are statistically much less common in the prenatal period.

Q: Most common malignant tumour in childhood:

Leukaemia. ***Leukaemia*** - **Leukaemia** is the **most common paediatric malignancy**, accounting for approximately 30% of all childhood cancers. - It involves the uncontrolled proliferation of abnormal white blood cells, primarily in the **bone marrow** and blood. - **Acute lymphoblastic leukaemia (ALL)** is the most common subtype. *CNS tumours* - **CNS tumours** (brain and spinal cord tumours) are the **second most common** paediatric malignancy, accounting for 20-25% of childhood cancers. - Include medulloblastoma, gliomas, and ependymomas. - While common, they are less frequent than leukaemia. *Rhabdomyosarcoma* - **Rhabdomyosarcoma** is a malignant tumour of **mesenchymal origin**, typically affecting skeletal muscle. - While it is the most common soft tissue sarcoma in children, it is not the most common overall childhood malignancy. *Neuroblastoma* - **Neuroblastoma** is a malignant tumour derived from **neural crest cells**, often arising in the adrenal glands or sympathetic nervous system. - It is one of the most common solid extracranial tumours in children but is less common than leukaemia.

Q: What is the most common presentation of neuroblastoma?

Abdominal mass. ***Abdominal mass*** - **Neuroblastoma** most frequently originates in the **adrenal glands (40%)** or **abdominal sympathetic ganglia** (25%), leading to a palpable abdominal mass as the most common initial presentation **(60-70% of cases)**. - This mass is typically **firm, irregular, and crosses the midline**, distinguishing it from **Wilms' tumor** (which is intrarenal and doesn't cross midline). - **Peak age:** 2-3 years; 90% diagnosed before age 5. - Clinical features may include abdominal distension, pain, and constitutional symptoms (fever, weight loss). *Secondaries in brain* - While neuroblastoma can metastasize, **brain metastases are rare** (<5% of cases). - Most common metastatic sites are **bone marrow (71%)**, **bone (56%)**, liver, and lymph nodes—not brain. - Neurological symptoms at presentation suggest advanced stage disease, not typical initial presentation. *Renal invasion* - Neuroblastoma arises from **neural crest cells** in sympathetic tissue, not renal parenchyma. - It may **displace** or **encase** the kidney but does not typically **invade** it as a primary presentation. - Direct renal involvement suggests locally advanced disease rather than initial presentation. *Lung metastasis* - **Lung metastases** occur in only **3-5%** of neuroblastoma cases—much less common than bone/bone marrow spread. - Neuroblastoma has hematogenous spread pattern favoring bone marrow and bone over lungs. - When lung involvement occurs, it indicates stage M (metastatic) disease, not the typical initial presentation.

Q: True about neuroblastoma:

Tumor of autonomic nervous system. ***Tumor of autonomic nervous system*** - **Neuroblastoma** is a malignancy that arises from **neuroblasts**, which are immature nerve cells of the **sympathetic nervous system** (part of the autonomic nervous system). - It most commonly originates in the **adrenal medulla** (50% of cases) or other areas along the sympathetic chain in the abdomen, chest, or neck. - This statement is **correct** and represents the fundamental pathophysiology of neuroblastoma. *Metastasis rarely present* - This statement is **incorrect** because neuroblastoma is known for its **high rate of metastasis** at diagnosis. - Approximately **50-60%** of patients present with **metastatic disease** at the time of diagnosis. - Common sites of metastasis include **bone marrow** (most common), bone, liver, and lymph nodes. - Stage 4 disease is more common than localized disease in children over 18 months. *Earliest detected in late childhood* - This statement is **incorrect** as neuroblastoma typically presents in **early childhood**, with a median age of diagnosis around **17-22 months**. - It is one of the most common **solid tumors in infants** and young children, with **90% of cases diagnosed before age 5 years**. - Rarely seen in late childhood or adolescence, making this the opposite of the truth. *All of the options* - This option is **incorrect** because only **one statement** (tumor of autonomic nervous system) is true, rendering "All of the options" false.

Question 1

Which is the commonest childhood cancer –

Accepted Answer

ALL

Answer

AML

Answer

CML

Answer

CLL

Question 2

Opsoclonus as a paraneoplastic manifestation is most commonly seen in

Accepted Answer

Neuroblastoma

Answer

Colon cancer

Answer

Hepatocellular cancer

Answer

Renal cell carcinoma

Question 3

What is the most common site of rhabdomyosarcoma in children?

Accepted Answer

Head and neck region

Answer

Extremities

Answer

Genitourinary area

Answer

Trunk

Question 4

TRUE statement regarding childhood malignancy is-

Accepted Answer

Neuroblastoma typically occurs before 5 years of age

Answer

AML is the most common malignancy

Answer

Wilm's tumour is the commonest

Answer

None of the options

Question 5

The most common intracranial tumor in children is –

Accepted Answer

Glioma

Answer

Meningioma

Answer

Lymphangioma

Answer

Medulloblastoma

Question 6

A baby presents with recurrent ear infections with discharge, seborrheic dermatitis, hepatosplenomegaly, and cystic skull lesions. What is the most likely diagnosis?

Accepted Answer

Langerhans cell histiocytosis

Answer

Hemophagocytic lymphohistiocytosis

Answer

Multiple myeloma

Answer

Acute lymphoblastic leukemia (ALL)

Question 7

A renal mass seen on prenatal check-up is most probably:

Accepted Answer

Mesoblastic nephroma

Answer

Neuroblastoma

Answer

Wilms' tumor

Answer

Renal sarcoma

Question 8

Most common malignant tumour in childhood:

Accepted Answer

Leukaemia

Answer

CNS tumours

Answer

Rhabdomyosarcoma

Answer

Neuroblastoma

Question 9

What is the most common presentation of neuroblastoma?

Accepted Answer

Abdominal mass

Answer

Secondaries in brain

Answer

Renal invasion

Answer

Lung metastasis

Question 10

True about neuroblastoma:

Accepted Answer

Tumor of autonomic nervous system

Answer

Metastasis rarely present

Answer

Earliest detected in late childhood

Answer

All of the options

Oncology — MCQs

Oncology — MCQs

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