Oncology Practice Questions

Q: A 5-year-old child presents with fatigue, pallor, bruising, bone pain, and recurrent infections. Examination reveals hepatosplenomegaly and petechiae. Laboratory findings show pancytopenia and blasts. Bone marrow biopsy indicates acute lymphoblastic leukemia (ALL). What is the next step?

Chemotherapy. ***Chemotherapy (Correct Answer)*** - Given the diagnosis of **acute lymphoblastic leukemia (ALL)**, the primary treatment involves **multi-agent chemotherapy** to eradicate the leukemic blasts and achieve remission. - The combination of **fatigue, pallor, bruising, bone pain, recurrent infections, hepatosplenomegaly, petechiae, pancytopenia, and blasts** are classic signs and symptoms of ALL, necessitating immediate aggressive treatment. - Standard ALL protocols include **induction, consolidation, and maintenance phases** with multiple chemotherapy agents. *Supportive care with steroids (Incorrect)* - While **steroids** (prednisone or dexamethasone) are a component of ALL treatment protocols, they are typically used in conjunction with other chemotherapy agents, not as standalone "supportive care." - Monotherapy with steroids would not be sufficient to achieve remission or cure ALL and would only provide temporary relief of some symptoms. *Surgical intervention (Incorrect)* - **Surgical intervention** is generally not a primary treatment for leukemia, which is a systemic disease affecting the bone marrow and blood. - Surgery might be considered in very rare instances for complications such as a localized mass causing life-threatening compression, but it does not address the underlying systemic malignancy. *Supportive care for anemia (Incorrect)* - **Supportive care for anemia** (e.g., blood transfusions) is often necessary in patients with ALL due to reduced red blood cell production from bone marrow infiltration. - However, treating only the anemia addresses a symptom, not the underlying leukemia, and would not lead to cure or remission.

Q: What is the most common cause of cranial irradiation in children?

Acute Lymphoblastic Leukemia (ALL). ***Acute Lymphoblastic Leukemia (ALL)*** - **ALL** is the **most common childhood cancer** and remains the most common indication for cranial irradiation in children when it is needed - While modern protocols have **reduced** the use of cranial irradiation due to long-term neurocognitive side effects, it is still indicated in: - **High-risk ALL** (typically 12-18 Gy for CNS prophylaxis) - **CNS relapse** or CNS involvement at diagnosis - **T-cell ALL** with high-risk features - The shift toward **intrathecal chemotherapy** has reduced but not eliminated the need for cranial irradiation in ALL *Craniopharyngioma (a brain tumor)* - Craniopharyngioma is a **relatively rare** pediatric brain tumor (1-2% of all pediatric brain tumors) - Treatment is primarily **surgical resection** with radiation as **adjuvant therapy** in selected cases - Due to its rarity compared to ALL, it is not the most common cause of cranial irradiation in children *Small Cell Lung Cancer (SCLC)* - **SCLC** is primarily a disease of **adult heavy smokers** and is **exceedingly rare** in children - This is essentially not a pediatric disease and would not be a common indication for cranial irradiation in the pediatric population *Acute Myeloid Leukemia (AML)* - **AML** is less common than ALL in children - **CNS prophylaxis** is less frequently required in AML compared to ALL - Treatment primarily involves **intensive chemotherapy** with intrathecal therapy for CNS prophylaxis when needed

Q: What is the most common malignancy in children?

Acute Lymphoblastic Leukemia. ***Acute Lymphoblastic Leukemia*** - **Acute Lymphoblastic Leukemia (ALL)** is the **most common childhood malignancy**, accounting for approximately 25% of all pediatric cancers. - It arises from the uncontrolled proliferation of immature lymphoid cells (lymphoblasts) in the bone marrow and often presents with symptoms like **fatigue**, **fever**, **bleeding**, and **bone pain**. *Acute Myeloid Leukemia* - While **Acute Myeloid Leukemia (AML)** is also a common leukemia in children, it is **less frequent than ALL**, accounting for about 20% of pediatric leukemias. - AML involves the abnormal proliferation of immature myeloid cells and typically presents similar symptoms to ALL, but it tends to affect a **slightly older age group** within childhood. *Neuroblastoma* - **Neuroblastoma** is a common **solid tumor** of childhood, originating from immature nerve cells in the sympathetic nervous system. - It is the **most common extracranial solid tumor** in children but occurs less frequently than ALL overall. *Wilms tumor* - **Wilms tumor**, also known as nephroblastoma, is the **most common primary malignant renal tumor** in children. - Although it is a significant childhood cancer, its incidence is lower than that of ALL.

Q: What is the most common gastrointestinal malignancy in children?

Lymphoma. ***Lymphoma*** - **Non-Hodgkin lymphoma (NHL)** is the most common gastrointestinal malignancy in children, with **Burkitt lymphoma** being the predominant subtype. - Typically presents as abdominal masses, intussusception (especially ileocolic), or bowel obstruction. - GI involvement in childhood cancers is most frequently seen with **lymphoproliferative disorders**. *Adenocarcinoma* - **Adenocarcinoma of the gastrointestinal tract** is extremely rare in children and is typically a disease of older adults. - Originates from **glandular cells** and usually requires prolonged exposure to risk factors not present in childhood. *Sarcoma* - While sarcomas can occur in children, they are more common in soft tissues and bone rather than as primary **gastrointestinal malignancies**. - **Gastrointestinal stromal tumors (GISTs)** are a type of sarcoma that can rarely affect the GI tract in children, but are much less common than lymphoma. *Carcinoid* - **Carcinoid tumors** (neuroendocrine tumors) are very rare in children as a primary GI malignancy. - These are typically **slow-growing tumors** more common in adults, often found incidentally.

Q: A 6-year-old child presents with an abdominal mass, fever, bone pain, and inferior vena cava (IVC) thrombosis. What is the most likely diagnosis?

Neuroblastoma. ***Neuroblastoma*** - **Neuroblastoma** is the most likely diagnosis given the combination of **abdominal mass** (typically from adrenal/retroperitoneal origin), **bone pain from metastases** (bone is the most common site of metastasis in neuroblastoma), and systemic symptoms. - **Bone pain and bone metastases** are highly characteristic of neuroblastoma and occur in approximately 50-60% of cases at presentation. - **Inferior vena cava thrombosis** can occur due to tumor compression or direct extension, and **fever** is a common paraneoplastic symptom. - Peak age: 2-5 years, but can occur at 6 years. *Wilm's tumour* - **Wilm's tumor** typically presents as a unilateral, smooth, firm abdominal mass and can extend into the IVC via the renal vein (in 4-10% of cases). - **KEY DIFFERENTIATOR:** Bone metastases are **extremely rare** in Wilm's tumor (<2% of cases), making **bone pain** a critical feature that strongly favors neuroblastoma over Wilm's tumor. - Wilm's tumor more commonly metastasizes to lungs and liver, not bone. *Langerhans cell Histiocytosis* - **Langerhans cell Histiocytosis** can cause **bone lesions** (lytic skull lesions are classic) and **fever**, but an **abdominal mass** and **IVC thrombosis** are not characteristic presentations. - This condition typically presents with skin rash, lymphadenopathy, diabetes insipidus, or isolated bone lesions—not a primary abdominal mass. *Gastric lymphoma* - **Gastric lymphoma** is rare in young children and primarily affects the stomach with abdominal pain, weight loss, and sometimes a palpable mass. - Does not typically cause widespread **bone pain** or **IVC thrombosis** as primary presenting features. - More common in adolescents and adults rather than young children.

Q: Among the following, which pulmonary tumor is most likely to occur in children?

Carcinoid. ***Carcinoid*** - **Bronchial carcinoid tumors** are the most common primary lung tumors found in children and adolescents, accounting for a significant percentage of pediatric pulmonary neoplasms. - These tumors arise from **neuroendocrine cells** and generally have a low-grade malignant potential. *Small cell carcinoma* - **Small cell lung carcinoma (SCLC)** is strongly associated with smoking and is highly aggressive, almost exclusively occurring in adults. - It is exceedingly rare in children, making it an unlikely diagnosis in this age group. *Adenocarcinoma* - **Adenocarcinoma** is the most common histological type of lung cancer in adults who do not smoke but is still extremely rare in children. - Although it can occur in non-smokers and younger adults, it is not the most likely primary pulmonary tumor in the pediatric population. *Squamous cell carcinoma* - **Squamous cell carcinoma** is primarily linked to extensive smoking history and is predominantly seen in older adult patients. - It is virtually unheard of in children, making it a highly improbable diagnosis.

Q: On USG, a mass was found in the abdomen which was displacing the kidney laterally in a 1-year-old child. What is the most likely diagnosis?

Neuroblastoma. ***Neuroblastoma*** - A retroperitoneal mass displacing the kidney laterally in an infant is highly characteristic of **neuroblastoma**, which originates from neural crest cells in the adrenal gland or sympathetic ganglia. - The key finding is **extrarenal origin** - the mass pushes the kidney aside rather than arising from within it. - Most common extrarenal abdominal mass in children under 2 years. *Wilms' tumor* - This is an **intrarenal mass** that originates within the kidney parenchyma. - Wilms' tumor **expands and distorts the kidney** rather than displacing it laterally from outside. - Most common renal tumor in children (peak age 3-4 years), presenting with abdominal mass, hematuria, and hypertension. *Renal cell carcinoma* - Exceedingly **rare in a 1-year-old child** - primarily an adult malignancy (typically >40 years). - Would be an intrarenal mass, not an extrarenal mass displacing the kidney laterally. *All of the options* - Incorrect because the specific imaging finding of **lateral kidney displacement** indicates an extrarenal origin, which is pathognomonic for neuroblastoma, not the intrarenal tumors listed.

Q: Which of the following cancers has the highest cure rate?

Retinoblastoma. ***Retinoblastoma*** - This **childhood eye cancer** has an excellent prognosis, with a reported cure rate of **over 95%** when diagnosed early and treated promptly. - Treatment options like **chemotherapy**, **radiation**, **laser therapy**, and **enucleation** contribute to its high survival rate. *Wilm's Tumor* - While **Wilm's tumor** (nephroblastoma) also has a high cure rate in children, typically **around 90%**, it is slightly lower than that of retinoblastoma. - It is a **kidney cancer** primarily affecting children and is highly responsive to treatment. *Rhabdomyosarcoma* - The cure rate for **rhabdomyosarcoma**, a rare and aggressive cancer of the soft tissues, varies significantly based on factors like **tumor location**, **stage**, and **histology**. - Overall survival rates are generally lower than for retinoblastoma and Wilm's tumor, often ranging from **60-70%**. *All of the options* - This option is incorrect because while all three cancers listed have good prognoses, **retinoblastoma** specifically stands out with the highest cure rate among them. - The cure rates for Wilm's tumor and rhabdomyosarcoma, while good, are not as high as that for retinoblastoma.

Q: Most common site of extramedullary relapse of ALL in a 6-year-old boy is

CNS (Central Nervous System). ***CNS (Central Nervous System)*** - The **central nervous system** is the **most common site of extramedullary relapse** in pediatric acute lymphoblastic leukemia (ALL), accounting for the majority of extramedullary relapses. - CNS is an immunologically privileged sanctuary site where chemotherapy penetration is limited due to the blood-brain barrier. - CNS relapse presents with symptoms like headache, vomiting, cranial nerve palsies, or signs of increased intracranial pressure and requires intrathecal chemotherapy and cranial irradiation. - Prophylactic CNS therapy is a standard component of ALL treatment protocols to prevent CNS relapse. *Testes* - **Testes** are the **second most common** site of extramedullary relapse and the most common **solid organ** site in boys with ALL. - Like the CNS, testes are immunologically privileged sites with limited chemotherapy penetration. - Testicular relapse presents as painless testicular enlargement (unilateral or bilateral) and requires testicular radiation plus systemic therapy intensification. *Liver* - While **hepatic infiltration** can occur in ALL, the liver is not a common site for **isolated extramedullary relapse**. - Hepatic involvement typically indicates widespread systemic disease rather than a primary relapse site. *Lung* - **Pulmonary involvement** in ALL is rare as an isolated extramedullary relapse site. - Lung findings in ALL patients are more commonly due to infection, leukostasis in hyperleukocytosis, or disseminated disease.

Question 1

A 5-year-old child presents with fatigue, pallor, bruising, bone pain, and recurrent infections. Examination reveals hepatosplenomegaly and petechiae. Laboratory findings show pancytopenia and blasts. Bone marrow biopsy indicates acute lymphoblastic leukemia (ALL). What is the next step?

Accepted Answer

Chemotherapy

Answer

Surgical intervention

Answer

Supportive care for anemia

Answer

Supportive care with steroids

Question 2

What is the most common cause of cranial irradiation in children?

Accepted Answer

Acute Lymphoblastic Leukemia (ALL)

Answer

Craniopharyngioma (a brain tumor)

Answer

Small Cell Lung Cancer (SCLC)

Answer

Acute Myeloid Leukemia (AML)

Question 3

What is the most common malignancy in children?

Accepted Answer

Acute Lymphoblastic Leukemia

Answer

Acute Myeloid Leukemia

Answer

Neuroblastoma

Answer

Wilms tumor

Question 4

What is the most common gastrointestinal malignancy in children?

Accepted Answer

Lymphoma

Answer

Adenocarcinoma

Answer

Sarcoma

Answer

Carcinoid

Question 5

A 7 – year old boy presented with abdominal pain, vomiting, oliguria, and periorbital puffiness    following chemotherapy. Investigations reveal hyperuricemia, raised creatinine levels, and    hyperkalemia. What is the next best step in the management of this condition ?

Accepted Answer

Hydration

Answer

Probenecid

Answer

Allopurinol

Answer

Rasburicase

Question 6

A 6-year-old child presents with an abdominal mass, fever, bone pain, and inferior vena cava (IVC) thrombosis. What is the most likely diagnosis?

Accepted Answer

Neuroblastoma

Answer

Wilm's tumour

Answer

Langerhans cell Histiocytosis

Answer

Gastric lymphoma

Question 7

Among the following, which pulmonary tumor is most likely to occur in children?

Accepted Answer

Carcinoid

Answer

Small cell carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma

Question 8

On USG, a mass was found in the abdomen which was displacing the kidney laterally in a 1-year-old child. What is the most likely diagnosis?

Accepted Answer

Neuroblastoma

Answer

Wilms' tumor

Answer

Renal cell carcinoma

Answer

All of the options

Question 9

Which of the following cancers has the highest cure rate?

Accepted Answer

Retinoblastoma

Answer

Wilm's Tumor

Answer

Rhabdomyosarcoma

Answer

All of the options

Question 10

Most common site of extramedullary relapse of ALL in a 6-year-old boy is

Accepted Answer

CNS (Central Nervous System)

Answer

Testes

Answer

Liver

Answer

Lung

Oncology — MCQs

Oncology — MCQs

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