Oncology Practice Questions

Q: Which of the following are common childhood tumors?

Acute lymphoblastic leukemia and Brain tumor. **Explanation:** The distribution of pediatric malignancies differs significantly from adult oncology. In children, the most common types of cancer are hematological malignancies followed by solid tumors of the central nervous system. 1. **Why Option A is Correct:** * **Acute Lymphoblastic Leukemia (ALL):** This is the most common malignancy in children, accounting for approximately 25–30% of all pediatric cancer cases. Its peak incidence occurs between 2 and 5 years of age. * **Brain Tumors:** These are the most common **solid tumors** in children and the second most common malignancy overall (approx. 20%). Common types include medulloblastoma and astrocytoma. Together, ALL and Brain tumors represent nearly half of all childhood cancer diagnoses. 2. **Analysis of Incorrect Options:** * **Options B & C (Chronic Lymphoblastic Leukemia - CLL):** CLL is almost exclusively a disease of the elderly (median age >70 years). It is virtually non-existent in the pediatric population. * **Option D (Wilms’ Tumor):** While Wilms’ tumor (nephroblastoma) is the most common primary renal tumor in children, its overall incidence is significantly lower (approx. 5–6%) compared to brain tumors. **NEET-PG High-Yield Pearls:** * **Most common childhood cancer:** Acute Lymphoblastic Leukemia (ALL). * **Most common solid tumor:** Brain tumors (Infratentorial tumors are more common in children than adults). * **Most common extracranial solid tumor:** Neuroblastoma (often presents with an abdominal mass that crosses the midline). * **Most common renal tumor:** Wilms’ tumor (typically does *not* cross the midline). * **Most common intraocular tumor:** Retinoblastoma (associated with the RB1 gene).

Q: What is the most common intra-abdominal tumor in children under two years of age?

Neuroblastoma. **Explanation:** **Neuroblastoma** is the most common extracranial solid tumor of childhood and the **most common intra-abdominal tumor in children under two years of age**. It originates from primordial neural crest cells of the sympathetic nervous system, most frequently occurring in the adrenal medulla (approx. 40%). Its peak incidence is in infancy (median age 19 months), which distinguishes it from other pediatric malignancies. **Analysis of Options:** * **Wilms’ Tumor (Nephroblastoma):** While it is the most common primary renal tumor in children, its peak incidence is between **3 to 4 years of age**. It rarely presents in children under one year. * **Hepatoblastoma:** This is the most common primary liver tumor in children, but it is significantly less frequent overall than neuroblastoma. * **Lymphoma:** While common in older children and adolescents (specifically Burkitt’s lymphoma in the abdomen), it is rare in the infant age group. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Neuroblastoma often presents as a firm, irregular, nodular abdominal mass that **crosses the midline** (unlike Wilms’ tumor, which is usually smooth and rarely crosses the midline). * **Diagnostic Markers:** Elevated urinary catecholamines (**VMA and HVA**) are found in 90% of cases. * **Opsoclonus-Myoclonus Syndrome:** A classic paraneoplastic syndrome ("dancing eyes, dancing feet") associated with neuroblastoma. * **Prognosis:** The **N-myc (MYCN) oncogene** amplification is the most important indicator of poor prognosis. * **Staging:** The presence of "blueberry muffin" skin nodules and massive hepatomegaly characterizes Stage 4S, which often has a favorable prognosis due to spontaneous regression.

Q: In a child, which of the following conditions does NOT typically involve CSF examination for diagnosis?

Hodgkin's lymphoma. **Explanation:** The correct answer is **Hodgkin’s Lymphoma (HL)**. The decision to perform a cerebrospinal fluid (CSF) examination in pediatric oncology is based on the propensity of the malignancy to involve the Central Nervous System (CNS). **1. Why Hodgkin’s Lymphoma is the correct answer:** Hodgkin’s Lymphoma is primarily a disease of the lymph nodes and rarely involves the CNS at the time of diagnosis or during relapse. Because CNS involvement is extremely uncommon, routine lumbar puncture for CSF cytology is not part of the standard staging or diagnostic workup for HL. **2. Why the other options are incorrect:** * **ALL (Acute Lymphoblastic Leukemia):** CNS involvement is common in ALL. CSF examination is mandatory at diagnosis for staging (CNS-1, 2, or 3) and for the administration of intrathecal chemotherapy, which is a cornerstone of treatment. * **AML (Acute Myeloid Leukemia):** While less frequent than in ALL, CNS involvement occurs in approximately 5-10% of pediatric AML cases (especially the monocytic subtypes M4 and M5). Routine CSF analysis is required at diagnosis. * **Non-Hodgkin’s Lymphoma (NHL):** Pediatric NHL (such as Burkitt lymphoma or Lymphoblastic lymphoma) is highly aggressive and has a high predilection for CNS spread. Staging always includes a CSF examination. **Clinical Pearls for NEET-PG:** * **CNS Sanctuary Sites:** The CNS and testes are considered "sanctuary sites" in leukemias because systemic chemotherapy often fails to reach therapeutic concentrations there due to the blood-brain barrier. * **L-Asparaginase:** While used in ALL, it does not cross the BBB; hence, direct intrathecal therapy (Methotrexate, Cytarabine, Hydrocortisone) is vital. * **Staging:** Remember that while HL uses the **Ann Arbor Staging**, pediatric NHL often uses the **St. Jude (Murphy) Staging System**, where any CNS involvement automatically classifies the disease as Stage IV.

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

Wilms tumor. **Explanation:** **Wilms Tumor (Nephroblastoma)** is the most common primary renal tumor and the **most common abdominal tumor** in children. It typically presents as a large, smooth, firm, and asymptomatic abdominal mass that rarely crosses the midline. It usually occurs in children between 2 and 5 years of age. **Analysis of Options:** * **Neuroblastoma (Option A):** This is the most common **extracranial solid tumor** in children and the most common abdominal tumor in **infants** (<1 year). Unlike Wilms tumor, neuroblastoma is often irregular, calcified, and frequently **crosses the midline** because it arises from the adrenal medulla or sympathetic chain. * **Renal Cell Carcinoma (Option C):** RCC is extremely rare in children and is primarily a tumor of adults (typically seen in the 6th–7th decades). * **Teratoma (Option D):** While sacrococcygeal teratomas are the most common germ cell tumors in neonates, they are not the most common abdominal tumors across the pediatric age group. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Presentation:** A healthy-looking child with an incidental abdominal mass found by a parent during bathing. * **Associated Syndromes:** WAGR syndrome (Wilms, Aniridia, Genitourinary anomalies, Retardation), Beckwith-Wiedemann Syndrome (macroglossia, hemihypertrophy, omphalocele), and Denys-Drash Syndrome. * **Genetics:** Associated with the **WT1 gene** on Chromosome 11p13. * **Metastasis:** The most common site of distant spread is the **Lungs** (presents as "cannonball" appearance on X-ray). * **Management Tip:** Avoid vigorous palpation of the mass to prevent rupture and peritoneal seeding.

Q: A malignant tumor of childhood that frequently metastasizes to bone marrow most often is:

Neuroblastoma. **Explanation:** **Neuroblastoma** is the most common extracranial solid tumor of childhood, arising from primordial neural crest cells. It is notorious for its aggressive nature and early hematogenous spread. Approximately 70% of patients present with metastatic disease at the time of diagnosis. The most frequent sites of metastasis are the **bone marrow (70%)**, cortical bone, liver, and non-regional lymph nodes. In fact, bone marrow aspiration and biopsy are mandatory components of the staging workup for Neuroblastoma. **Analysis of Incorrect Options:** * **Wilms’ Tumor (Nephroblastoma):** This is the most common renal tumor in children. Unlike Neuroblastoma, it primarily spreads via direct extension or the bloodstream to the **lungs** (most common site of metastasis). Bone marrow involvement is extremely rare. * **Adrenal Gland Tumors:** While Neuroblastoma often originates in the adrenal medulla, other adrenal tumors (like Adrenal Cortical Carcinoma) are rare in children and do not typically show the same predilection for bone marrow metastasis. * **Granulosa Cell Tumor:** This is a sex cord-stromal tumor of the ovary. While it can occur in juveniles, it usually presents with precocious puberty and remains localized to the pelvis/abdomen; bone marrow spread is not a characteristic feature. **High-Yield Clinical Pearls for NEET-PG:** * **Homer-Wright Rosettes:** Characteristic histological finding in Neuroblastoma. * **Opsoclonus-Myoclonus Syndrome:** A classic paraneoplastic syndrome associated with Neuroblastoma ("dancing eyes, dancing feet"). * **Urinary Markers:** Elevated VMA (Vanillylmandelic acid) and HVA (Homovanillic acid) are diagnostic. * **N-myc Amplification:** The most important prognostic factor; its presence indicates a poor prognosis. * **Pepper Syndrome:** Massive hepatomegaly due to metastasis (usually in infants).

Q: Neuroblastoma differs from Wilms tumor by all, EXCEPT:

Age group. This question tests the ability to differentiate between the two most common abdominal malignancies in children: **Neuroblastoma** and **Wilms Tumor (Nephroblastoma)**. ### **Why "Age Group" is the Correct Answer** The question asks for the feature that is **NOT** a point of difference (i.e., a similarity). Both Neuroblastoma and Wilms tumor primarily affect the same pediatric age group, typically occurring between **1 to 5 years of age**. While the median age for Neuroblastoma is slightly younger (~2 years) compared to Wilms (~3 years), they are clinically considered to overlap significantly in their age of presentation, making "Age Group" the least reliable factor to distinguish between them. ### **Why the Other Options are Points of Difference** * **A. Calcification:** Highly characteristic of Neuroblastoma (seen in >80% on X-ray/CT). It is rare in Wilms tumor (<10-15%). * **B. Relation to Vessels:** Neuroblastoma is notorious for **encasing and displacing** major vessels like the Aorta and IVC. In contrast, Wilms tumor typically **pushes** vessels aside without encasing them (though it may invade the renal vein/IVC). * **D. Bone Metastasis:** Neuroblastoma frequently metastasizes to the bone and bone marrow (e.g., "Hutchinson’s syndrome"). Wilms tumor rarely spreads to the bone; its most common site of distant metastasis is the **lung**. ### **High-Yield Clinical Pearls for NEET-PG** | Feature | Neuroblastoma | Wilms Tumor | | :--- | :--- | :--- | | **Origin** | Neural Crest (Adrenal medulla/Sympathetic chain) | Metanephric blastema (Kidney) | | **Mass** | Irregular, nodular, **crosses the midline** | Smooth, spherical, **rarely crosses midline** | | **Urinary Markers** | Elevated VMA and HVA | Absent | | **Systemic Features** | Child appears sick, fever, weight loss | Child often appears healthy/asymptomatic | | **Key Association** | N-myc amplification (poor prognosis) | WAGR syndrome, Beckwith-Wiedemann |

Q: The following physical appearance is seen in which of the following conditions?

Neuroblastoma. ***Neuroblastoma*** - **Periorbital ecchymosis** (raccoon eyes) is a classic pathognomonic sign of neuroblastoma with **orbital bone metastases**. - This physical appearance results from **hemorrhage** and **tumor infiltration** into the orbital tissues, commonly seen in advanced neuroblastoma. *Nephroblastoma* - Also known as **Wilms tumor**, it primarily affects the **kidneys** and presents with abdominal mass. - Does not typically cause **orbital involvement** or periorbital ecchymosis as seen in the image. *Retinoblastoma* - An **intraocular malignancy** that presents with **leukocoria** (white pupillary reflex) rather than periorbital bruising. - May cause **proptosis** but does not typically result in the **raccoon eyes** appearance. *Osteoblastoma* - A **benign bone tumor** that commonly affects the **spine** and **long bones**. - Does not have a predilection for **orbital bones** and would not cause this characteristic periorbital appearance.

Q: The most common site of neuroblastoma is

Adrenal medulla. **Explanation:** Neuroblastoma is the most common extracranial solid tumor of childhood, arising from primordial neural crest cells that normally form the adrenal medulla and the sympathetic nervous system. **Why Adrenal Medulla is correct:** The most frequent primary site for neuroblastoma is the **adrenal medulla (approximately 40-50% of cases)**. This is because the adrenal medulla contains the highest concentration of chromaffin cells derived from the neural crest. When considering the entire abdomen (adrenal plus non-adrenal sites), it accounts for nearly 65-75% of all primary tumors. **Analysis of Incorrect Options:** * **A. Posterior mediastinum:** This is the second most common site (approx. 15-20%). While it is the most common site for neuroblastoma in infants, it is not the most common site overall across all pediatric age groups. * **C. Paravertebral sympathetic chain:** While the tumor can arise from any sympathetic ganglion (including the abdominal, thoracic, or cervical chains), these sites are statistically less frequent than the adrenal gland itself. * **D. Skull:** The skull is a common site for **metastasis** (often presenting as "raccoon eyes" due to orbital infiltration), but it is almost never the primary site of origin. **High-Yield Clinical Pearls for NEET-PG:** * **Age:** Most common in children <2 years; median age of diagnosis is 19 months. * **Markers:** Elevated urinary catecholamines (VMA and HVA) are found in 90% of cases. * **Genetics:** **N-myc amplification** is the most important poor prognostic indicator. * **Staging:** The International Neuroblastoma Risk Group Staging System (INRGSS) uses image-defined risk factors (IDRFs). * **Homer-Wright Rosettes:** Characteristic histopathological finding (pseudorosettes).

Question 1

In which of the following conditions are aniridia and hemihypertrophy most likely present?

Accepted Answer

Wilms' tumour

Answer

Neuroblastoma

Answer

Non-Hodgkin's lymphoma

Answer

Germ cell tumour

Question 2

A 2-year-old male child presents with a lump in the right side of the abdomen. Ultrasound revealed it to be a solid mass. On examination, his right arm and leg were found to be longer. What is the most likely diagnosis?

Accepted Answer

Wilms' tumor

Answer

Neuroblastoma

Answer

Angiomyolipoma

Answer

Nephroblastoma

Question 3

Which of the following are common childhood tumors?

Accepted Answer

Acute lymphoblastic leukemia and Brain tumor

Answer

Chronic lymphoblastic leukemia and Wilm's tumor

Answer

Acute lymphoblastic leukemia and Chronic lymphoblastic leukemia

Answer

Acute lymphoblastic leukemia and Wilm's tumor

Question 4

What is the most common intra-abdominal tumor in children under two years of age?

Accepted Answer

Neuroblastoma

Answer

Wilms' tumor

Answer

Hepatoblastoma

Answer

Lymphoma

Question 5

In a child, which of the following conditions does NOT typically involve CSF examination for diagnosis?

Accepted Answer

Hodgkin's lymphoma

Answer

ALL

Answer

Non-Hodgkin's lymphoma

Answer

AML

Question 6

What is the most common abdominal tumor in children?

Accepted Answer

Wilms tumor

Answer

Neuroblastoma

Answer

Renal cell carcinoma (RCC)

Answer

Teratoma

Question 7

A malignant tumor of childhood that frequently metastasizes to bone marrow most often is:

Accepted Answer

Neuroblastoma

Answer

Wilms' tumor

Answer

Adrenal gland tumors

Answer

Granulosa cell tumor of ovary

Question 8

Neuroblastoma differs from Wilms tumor by all, EXCEPT:

Accepted Answer

Age group

Answer

Calcification

Answer

Aorta and IVC not eroded but pushed aside

Answer

Bone metastasis

Question 9

The following physical appearance is seen in which of the following conditions?

Accepted Answer

Neuroblastoma

Answer

Nephroblastoma

Answer

Retinoblastoma

Answer

Osteoblastoma

Question 10

The most common site of neuroblastoma is

Accepted Answer

Adrenal medulla

Answer

Posterior mediastinum

Answer

Paraveebral sympathetic chain in abdomen

Answer

Skull

Oncology — MCQs

Oncology — MCQs

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