Pediatric Oncology Overview
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Questions and Answers

What is the cornerstone of cancer diagnosis and treatment?

  • Clinical examination
  • Histopathological examination (correct)
  • Imaging
  • Laboratory analyses

    • What is the significance of HER2 positive status in cancer?

  • It is a positive prognostic factor.
  • It is a positive predictive factor. (correct)
  • It is a negative predictive factor.
  • It is a negative prognostic factor. (correct)

    • What is the main difference between predictive and prognostic factors in cancer?

  • Prognostic factors indicate the likelihood of responding to treatment, while predictive factors indicate the likelihood of survival.
  • Prognostic factors are always positive, while predictive factors are always negative.
  • Predictive factors are always positive, while prognostic factors are always negative.
  • Predictive factors indicate the likelihood of responding to treatment, while prognostic factors indicate the likelihood of survival. (correct)

    • What is a common feature of cachexia in advanced cancer?

    <p>Muscle wasting (A)</p> Signup and view all the answers

    What is a possible cause of anemia in cancer?

    <p>Rapid tumor proliferation using up existing folate stores (D)</p> Signup and view all the answers

    What is a possible complication of cancer treatment that can affect blood clotting?

    <p>Decreased platelet count (D)</p> Signup and view all the answers

    What is a characteristic finding in the peripheral blood of patients with leukoerythroblastic anemia?

    <p>Immature myeloid cells and nucleated red blood cells (C)</p> Signup and view all the answers

    What is a common symptom of advanced cancer?

    <p>Unexplained weight loss (D)</p> Signup and view all the answers

    When can treatment be initiated without a histological confirmation of malignancy?

    <p>When the patient is receiving palliative care (B)</p> Signup and view all the answers

    What are the three key steps in the diagnostic process of cancer?

    <p>Histopathology, staging, and biomarker analysis (B)</p> Signup and view all the answers

    What is the most common type of brain tumor in children?

    <p>Pilocytic astrocytoma (D)</p> Signup and view all the answers

    Which of the following diagnostic steps emphasizes family history?

    <p>History taking (C)</p> Signup and view all the answers

    What age group is associated with a bimodal peak incidence of cancer in children?

    <p>15 years (D)</p> Signup and view all the answers

    Which rhabdomyosarcoma type has the worst prognosis?

    <p>Orbital type (B)</p> Signup and view all the answers

    Which condition is associated with Wilm’s tumor due to genetic mutations?

    <p>Denys-Drash syndrome (A)</p> Signup and view all the answers

    During which stage of rhabdomyosarcoma is the best prognosis observed?

    <p>Stage I (D)</p> Signup and view all the answers

    What is the overall 10-year survival rate for childhood cancers?

    <p>80% (A)</p> Signup and view all the answers

    What is a significant side effect of cancer treatment in children?

    <p>Stunted growth (B)</p> Signup and view all the answers

    At what age should men and women begin participating in screening for colorectal cancer?

    <p>50 years (A)</p> Signup and view all the answers

    What is the primary benefit of annual or biennial screening with faecal occult blood testing?

    <p>It reduces colorectal cancer mortality by 16-27%. (C)</p> Signup and view all the answers

    Which screening method for lung cancer is recommended for heavy smokers aged 55-74 years?

    <p>Low dose CT scan (B)</p> Signup and view all the answers

    Which of the following screening methods is considered ineffective?

    <p>Prostate-specific antigen (PSA) testing (C)</p> Signup and view all the answers

    What is length-time bias?

    <p>A statistical distortion that can affect the results of screening. (D)</p> Signup and view all the answers

    What is the significance of lead-time bias in medical screening?

    <p>It measures the effectiveness of a screening test in early detection. (C)</p> Signup and view all the answers

    What is the recommended frequency for conducting a colonoscopy for colorectal cancer screening?

    <p>Every 10 years (D)</p> Signup and view all the answers

    Which screening method is NOT effective for breast cancer in women under 50 years old?

    <p>Mammography (B)</p> Signup and view all the answers

    At what age is HPV testing recommended for women?

    <p>30 to 65 years of age (C)</p> Signup and view all the answers

    What is the primary purpose of the Pap test?

    <p>To identify early cell changes and treat them (D)</p> Signup and view all the answers

    Why does the American Cancer Society no longer recommend annual Pap tests?

    <p>Annual testing leads to unnecessary procedures (B)</p> Signup and view all the answers

    Which group of women may require more frequent cervical cancer screening?

    <p>Women at high risk for cervical cancer (D)</p> Signup and view all the answers

    What is the effectiveness of mammography screening for women over 50 years of age?

    <p>It reduces breast cancer mortality by 25% (A)</p> Signup and view all the answers

    What is a key consideration regarding mammography screening for women under 50 years of age?

    <p>It is of uncertain value (D)</p> Signup and view all the answers

    What is one benefit of using the HPV test during cervical cancer screening?

    <p>It finds infections that can lead to cell changes and cancer (A)</p> Signup and view all the answers

    What leads to a false positive result in HPV testing for young women?

    <p>Presence of a strong immune response (C)</p> Signup and view all the answers

    What staging system is used for female reproductive system cancers?

    <p>FIGO system (C)</p> Signup and view all the answers

    In lung cancer staging, which of the following represents Stage IIIA?

    <p>All of the above (D)</p> Signup and view all the answers

    What is an important prognostic factor in the Ann Arbor classification for lymphoma?

    <p>Presence of B symptoms (B)</p> Signup and view all the answers

    How is small cell lung cancer primarily categorized?

    <p>Limited and extensive disease (D)</p> Signup and view all the answers

    Which factor is NOT mentioned as a parameter influencing treatment and prognosis?

    <p>Ethnicity (C)</p> Signup and view all the answers

    What does a Stage IIIB classification in Hodgkin’s lymphoma indicate?

    <p>Involvement of nodal stations on both sides of the diaphragm and B symptoms present (C)</p> Signup and view all the answers

    Which ECOG performance status describes a patient who is asymptomatic and fully active?

    <p>0 (A)</p> Signup and view all the answers

    What should be considered a risk factor for not tolerating aggressive treatment?

    <p>Poor performance status or significant weight loss (D)</p> Signup and view all the answers

    Which of the following cancers is most commonly associated with hypercalcemia as a paraneoplastic syndrome?

    <p>Breast cancer (A)</p> Signup and view all the answers

    What is a characteristic symptom of Cushing syndrome?

    <p>Hyperadrenal corticism (A)</p> Signup and view all the answers

    In Lambert-Eaton syndrome, which symptom differentiates it from myasthenia gravis?

    <p>Increased muscle strength with exercise (C)</p> Signup and view all the answers

    What is a common feature of hypertrophic osteoarthropathy?

    <p>Finger clubbing (D)</p> Signup and view all the answers

    Which symptom is typically associated with lung cancer?

    <p>Hemoptysis (A)</p> Signup and view all the answers

    Which syndrome is characterized by elevation of the diaphragm in a chest X-ray?

    <p>Superior vena cava syndrome (B)</p> Signup and view all the answers

    What is a key characteristic of the B-symptoms related to lymphomas?

    <p>Night sweats (C)</p> Signup and view all the answers

    What symptom can indicate advanced gastric cancer?

    <p>Jaundice (D)</p> Signup and view all the answers

    Which of the following symptoms is commonly associated with colorectal cancer?

    <p>Blood in stool (B)</p> Signup and view all the answers

    What is the initial indication for treatment of superior vena cava syndrome?

    <p>Immediate oncological treatment (B)</p> Signup and view all the answers

    During what stage does the TNM system indicate the cancer has been confirmed via histology or cytology?

    <p>p stage (D)</p> Signup and view all the answers

    What is a common paraneoplastic dermatologic syndrome associated with gastric cancer?

    <p>Acanthosis nigricans (A)</p> Signup and view all the answers

    What symptom indicates cervical cancer in its advanced stage?

    <p>Swelling of limbs (C)</p> Signup and view all the answers

    Flashcards

    Tumor Stage Grouping

    Categorization of malignancies from Stage I to IV based on prognosis.

    Stage IIIA in Lung Cancer

    Includes multiple TNM stages like T4N0M0, indicating advanced local disease.

    FIGO system

    Staging system for female reproductive cancers based on invasion and spread features.

    Ann Arbor classification

    Staging for lymphoma that measures lymph node involvement and presence of B symptoms.

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    B symptoms

    Symptoms like night sweats, fevers, and weight loss critical for lymphoma staging.

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    Small Cell Lung Cancer Staging

    Divided into limited or extensive disease based on radiation treatment candidates.

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    Performance Status

    Measure of a patient's overall health, affecting treatment decisions and outcomes.

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    Tumor Grade

    Assessment of how aggressive a tumor is, influencing treatment choices and prognosis.

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    Colorectal Cancer Screening

    Annual or biennial screening with faecal occult blood testing reduces mortality by 16-27%.

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    Colonoscopy Frequency

    Colonoscopy is performed every 10 years for checking colorectal cancer.

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    Lung Cancer Screening

    Low-dose CT for heavy smokers aged 55-74 reduces mortality but isn't a substitute for quitting smoking.

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    Ineffective Screening Methods

    Prostate PSA, chest X-ray, and self-examinations for breast and testis show poor effectiveness.

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    Length-Time Bias

    A statistical distortion affecting results, can lead to incorrect conclusions about screening effectiveness.

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    Lead-Time Bias

    Time between early detection and usual diagnosis affecting the perceived effectiveness of screening.

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    Colorectal Cancer Risk Group

    Men and women over 50 years old are at increased risk for colorectal cancer.

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    Poor Screening Methods for Women

    Testing for ovarian cancer using Ca125 and ultrasound lacks effectiveness.

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    Co-testing

    Combines HPV testing and Pap smear for cervical cancer screening in women aged 30-65.

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    HPV testing

    Test for human papillomavirus infections which may lead to cervical cancer, not recommended under 30.

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    Pap test

    Screening test that detects early cell changes and cervical cancer.

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    Cervical cancer screening guidelines

    American Cancer Society advises not to have Pap tests annually; frequency extends based on age and risk.

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    Mammography screening

    X-ray imaging used to detect breast tumors at undetectable stages, primarily for women over 50.

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    Breast cancer mortality reduction

    Mammography reduces breast cancer deaths by 25% in women over 50.

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    Mammography for women under 50

    The effectiveness and value of mammography in women under 50 is uncertain.

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    High-risk screening

    Women at high risk for cervical cancer may need more frequent screening.

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    Cranial RT and IQ

    Cranial radiation therapy before age 5 may lower IQ.

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    Histopathological Proof

    Histologic confirmation is essential for cancer diagnosis and treatment.

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    Palliative Care

    Treatment can begin without histopathological confirmation in cases of palliative care.

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    Cachexia symptoms

    Cachexia involves progressive weakness, malaise, anorexia, and muscle wasting.

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    TNF-a in Cachexia

    Tumor necrosis factor-alpha contributes to cachexia through muscle wasting.

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    Anemia causes in cancer

    Anemia in cancer may arise from rapid tumor growth or treatment-induced myelosuppression.

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    HER2 and prognostic factors

    HER2 positive status is a negative prognostic factor but positive predictive factor for treatment response.

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    Oropharyngeal tumors

    p16 positive oropharyngeal tumors indicate a positive predictive factor for radiotherapy response.

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    Leukoerythroblastic anemia

    Presence of immature myeloid cells and nucleated RBCs indicates tumor invasion in the bone marrow, common in breast cancer.

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    Coagulation abnormalities

    Common issues include thrombocytosis, thrombocytopenia, and a hypercoagulable state in cancers.

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    Cancer in children

    Second leading cause of death in children, after accidents.

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    Bimodal peak age

    Cancer occurrence peaks at two ages: 15 years old.

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    Acute Lymphoblastic Leukemia (ALL)

    Most common type of childhood leukemia, often affecting younger children.

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    Rhabdomyosarcoma

    Most common soft tissue sarcoma in children with favorable prognosis in stages I/II.

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    Pilocytic astrocytoma

    Most common brain tumor in young children, usually benign.

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    Medulloblastoma

    Common brain cancer seen primarily in children, with a survival rate of 80%.

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    Blueberry muffin sign

    Skin manifestation indicating metastatic disease in children, specifically infantile neuroblastoma.

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    Denys-Drash syndrome

    Genetic condition associated with Wilms tumor, caused by WT1 mutation.

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    Malignancy

    A cancerous growth that invades surrounding tissues.

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    Hypercalcemia

    Elevated calcium levels in the blood, often linked to malignancy.

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    Cushing Syndrome

    A condition causing excessive ACTH production, related to malignancies.

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    Lambert-Eaton Syndrome

    A paraneoplastic syndrome resembling myasthenia gravis, with muscle weakness.

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    Dermatomyositis

    An inflammatory disease causing muscle weakness and skin rash, linked to cancer.

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    Hypertrophic Osteoarthropathy

    Bone formation and joint pain often associated with lung cancer.

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    Superior Vena Cava Syndrome

    Obstruction of the superior vena cava often caused by lung cancer.

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    Paget’s Disease

    A form of breast cancer where the nipple area changes, often associated with other cancers.

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    B-symptoms of Lymphoma

    General symptoms indicating lymphoma: weight loss, night sweats, fever.

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    Virchow’s Node

    A left supraclavicular lymph node indicating abdominal cancer.

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    Kruckenberg Tumor

    A metastatic tumor on the ovary, often from gastric cancer.

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    TNM Staging System

    A system to classify cancer stages based on tumor size, lymph node involvement, and metastasis.

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    Blumer’s Shelf

    A metastatic tumor felt in the rectal examination indicating pelvic cancer.

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    Sister Mary Joseph Sign

    A palpable nodule in the umbilicus indicating intra-abdominal cancer.

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    Study Notes

    Epidemiology

    • Cancer is the second leading cause of death in children, accidents being first.
    • Peak incidence is observed in children under 5 years old and older than 15.
    • Acute lymphoblastic leukemia (ALL) is most common, except in infants under 1 year old, where neuroblastoma is more prevalent.

    CNS Tumors in Children

    • Primarily low-grade glial tumors.
    • 50% of brain tumors are infratentorial, 40% supratentorial, and 5% spinal cord tumors.
    • Most common location of low-grade astrocytomas is the cerebellum, followed by hemispheric, midbrain, and central nervous system locations.
    • Pilocytic astrocytomas appear in younger patients and fibrillary astrocytomas in older children.
    • 85% of medulloblastomas occur in patients under the age of 15 years.

    Soft Tissue Sarcomas (STS)

    • Rhabdomyosarcoma is the most common subtype (70%).
    • Orbital rhabdomyosarcomas have a worse prognosis.
    • Common locations: Head and neck > parameningeal region > extremities.
    • Best prognosis with botryoid or spindle-cell RMS histology.
    • Intermediate prognosis with embryonal types, and the worst with alveolar, undifferentiated or anaplastic types.
    • Neurogenic, synovial, and Ewing sarcoma and primitive neuroectodermal tumors (PNET) account for minority of soft tissue tumors in children.

    Other CNS Tumors

    • Unfavorable prognosis if resection is less than 75%, cerebrospinal fluid (CSF) affected, metastases, brain stem infiltration, age less than 4 years, chemotherapy needed.
    • 40-80% 5-yr survival in other CNS tumors.
    • Brain stem tumors comprise around 10 % with 20-30% 5-yr survival, with endophytic or exophytic development.
    • Craniopharyngiomas have 80% 5-year survival and surgery may be curative in 60-80% of cases.

    Lymphomas

    • Non-Hodgkin lymphoma (NHL) is usually chemosensitive.
    • B-cell type NHL is common in the abdomen, facial bones, and bone marrow.
    • T-cell type NHL usually involves the mediastinum.
    • Hodgkin lymphoma subtype characterized by more favorable prognosis following combination chemotherapy and radiotherapy, with 90% cure rate.

    Leukemia

    • Acute lymphoblastic leukemia (ALL) accounts for around 80%.
    • Acute myeloid leukemia (AML) is present in approximately 17% of cases.
    • Chronic myelogenous leukemia (CML) is found in 2-5% of cases.
    • Common genetic accompanying factors include Down syndrome and Fanconi anemia.
    • Treatment involves induction, consolidation, and sustaining remission chemo-therapy regimens, including prophylactic cranial irradiation.

    Additional Information (from later pages)

    • Genetic Syndromes: Certain genetic syndromes, like familial retinoblastoma, Li-Fraumeni, or HNPCC, increase risk of various childhood cancers.
    • Bone Sarcomas: Typically in adolescents, close to the knees, and are often treated with chemotherapy, surgery, and further chemotherapy.
    • Wilms Tumor: Most cases occur in children 3-4 years old and preceeding 7 years. Treatment usually includes chemo, radical surgery, and post-op chemo and radiation therapy.
    • Neuroblastoma: Primarily 1-2 years old and often involves the retroperitoneal region. Treatment generally includes chemo, surgery and/or radiotherapy.
    • Specific Symptoms: The study notes provide various symptoms associated with different cancers and tumor locations (e.g., cough, pain).
    • Cancer Location: Cancers are located in specific areas, affecting certain parts of the body.
    • Diagnosis and Treatment: Information on diagnostic steps, treatment options (chemo, radiotherapy, surgery), and staging, is included.
    • Specific Cancer Types: Information is provided on various specific cancers, such as lung cancer, cervical cancer, gastric cancer, colorectal cancer, breast cancer, head and neck cancer.
    • Screening Programs: Recommendations concerning the detection of specific cancers by various methods, like papsmear or mammogram, are present.

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