Oncology Practice Questions

Q: What is the most common tumor of the lumbar region in children?

Neuroblastoma. **Explanation:** **Neuroblastoma** is the most common extracranial solid tumor of childhood and the most common tumor found in the **lumbar/retroperitoneal region** in children. It originates from primordial neural crest cells of the sympathetic nervous system. Approximately 65% of neuroblastomas arise in the abdomen, with the adrenal medulla being the most frequent site (40%), followed by the lumbar sympathetic chain. These tumors often present as a firm, irregular, and nodular mass that **crosses the midline**, a key distinguishing feature from Wilms' tumor. **Analysis of Incorrect Options:** * **Dermoid Cyst:** While these can occur in the lumbosacral region (often associated with spinal dysraphism), they are benign congenital anomalies rather than the most common solid neoplastic tumors of this region. * **Wilms' Tumor (Nephroblastoma):** This is the most common primary renal tumor in children. However, it typically presents as a smooth, lateralized flank mass that **does not cross the midline**. Statistically, neuroblastoma is more common in the retroperitoneal space overall. * **Mesenteric Cyst:** These are rare intra-abdominal cystic lesions. They are usually mobile and located within the mesentery of the bowel, not primarily in the lumbar/retroperitoneal space. **High-Yield Clinical Pearls for NEET-PG:** * **Age Factor:** Neuroblastoma is most common in infants and toddlers (median age 2 years), whereas Wilms' tumor peaks slightly later (3–4 years). * **Diagnostic Marker:** Elevated urinary catecholamines (VMA and HVA) are found in 90% of neuroblastoma cases. * **Radiology:** Calcification is common in Neuroblastoma (85% on CT) but rare in Wilms' tumor. * **Opsoclonus-Myoclonus Syndrome:** A classic paraneoplastic syndrome associated with neuroblastoma ("dancing eyes, dancing feet").

Q: All are true about Juvenile CML except?

Presents with anemia, low HbF, leucocytosis. **Explanation:** Juvenile Myelomonocytic Leukemia (JMML), formerly known as Juvenile CML, is a rare and aggressive clonal hematopoietic stem cell disorder of childhood. It is distinct from adult-type Chronic Myeloid Leukemia (CML). **Why Option C is the correct answer (The False Statement):** In JMML, there is a characteristic **elevation of Hemoglobin F (HbF)**, which is often disproportionately high for the child's age. This occurs because the malignant clone exhibits "fetal-like" erythropoiesis. Therefore, the statement "low HbF" is incorrect. Patients typically present with anemia, thrombocytopenia, and significant leukocytosis with monocytosis (>1000/μL). **Analysis of other options:** * **Option A:** Unlike adult CML, JMML is **Philadelphia chromosome (t[9;22]) negative**. It is driven by mutations in the RAS pathway (PTPN11, NF1, NRAS, KRAS, or CBL). * **Option B:** There is a strong clinical association with **Neurofibromatosis Type 1 (NF1)**. Children with NF1 have a 200- to 500-fold increased risk of developing JMML. * **Option C:** JMML is primarily a disease of early childhood, with approximately 75% of cases occurring in children **less than 2 years of age**. **High-Yield Clinical Pearls for NEET-PG:** * **Hallmark finding:** Absolute monocytosis (>1000/μL) and hypersensitivity of myeloid progenitors to Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) in vitro. * **Physical Exam:** Massive hepatosplenomegaly and lymphadenopathy are common. * **Skin findings:** Xanthomas and café-au-lait spots (especially if associated with NF1). * **Treatment:** Hematopoietic stem cell transplant (HSCT) is the only curative treatment.

Q: Which of the following is NOT a common childhood tumor?

Pleomorphic rhabdomyosarcoma. **Explanation:** The correct answer is **Pleomorphic rhabdomyosarcoma** because of its distinct age-related epidemiology. Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children, but it is divided into histological subtypes that occur in different age groups. 1. **Why Option D is correct:** **Pleomorphic RMS** is a subtype that occurs almost exclusively in **adults** (usually >45 years old). In contrast, the subtypes common in children are **Embryonal RMS** (most common overall, seen in younger children) and **Alveolar RMS** (seen in adolescents). 2. **Why Options A, B, and C are incorrect:** * **Wilms' tumor (Nephroblastoma):** The most common primary renal tumor of childhood, typically presenting between ages 2–5. * **Neuroblastoma:** The most common extracranial solid tumor of childhood, arising from the sympathetic nervous system (adrenal medulla or paraspinal ganglia). * **Retinoblastoma:** The most common intraocular tumor in children, often presenting with leukocoria (white pupillary reflex). **Clinical Pearls for NEET-PG:** * **Most common childhood cancer:** Leukemia (specifically ALL). * **Most common solid tumor:** CNS tumors. * **Most common extracranial solid tumor:** Neuroblastoma. * **Small Round Blue Cell Tumors:** This is a high-yield differential for childhood tumors, including Neuroblastoma, Wilms' tumor, Ewing’s sarcoma, and Embryonal Rhabdomyosarcoma. * **RMS Subtype Locations:** Embryonal RMS often occurs in the head/neck or genitourinary tract; Alveolar RMS is more common in the extremities.

Q: Which of the following is a poor prognostic factor in a child with ALL?

Translocations t(9;22), t(4;11), t(1;19). In Acute Lymphoblastic Leukemia (ALL), prognosis is determined by age, initial white cell count, and specific cytogenetic abnormalities. **Why Option C is Correct:** Cytogenetics is the most significant independent prognostic factor in ALL. * **t(9;22) (Philadelphia chromosome):** Associated with the BCR-ABL1 fusion gene; it carries a very poor prognosis and requires TKI (Imatinib) therapy. * **t(4;11):** Involves the KMT2A (MLL) gene rearrangement, typically seen in infant ALL, and is associated with a high risk of relapse. * **t(1;19):** Involves the E2A-PBX1 fusion; while outcomes have improved with intensive therapy, it was historically considered a poor prognostic marker. **Why Other Options are Incorrect:** * **Age 2-8 years (Option A):** This is the **favorable** age group. Age 10 years (adolescents) are considered poor prognostic factors. * **TLC 50,000/µL is a high-risk feature. * **Absent blasts (Option D):** The presence or absence of blasts in the peripheral smear does not define prognosis as much as the **Minimal Residual Disease (MRD)** status after the induction phase of chemotherapy. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognosis:** Hyperdiploidy (>50 chromosomes) and t(12;21) (ETV6-RUNX1). * **Worst Prognosis:** Hypodiploidy (<44 chromosomes) and t(9;22). * **Immunophenotype:** Early Pre-B cell ALL has a better prognosis than T-cell ALL or mature B-cell (Burkitt) ALL. * **Most Important Factor:** The most important predictor of treatment outcome today is the **response to initial therapy (MRD status)** at the end of induction (Day 28).

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.

Question 1

What is the most common tumor of the lumbar region in children?

Accepted Answer

Neuroblastoma

Answer

Dermoid cyst

Answer

Wilm's tumor

Answer

Mesenteric cyst

Question 2

All are true about Juvenile CML except?

Accepted Answer

Presents with anemia, low HbF, leucocytosis

Answer

Philadelphia chromosome is absent

Answer

Associated with Neurofibromatosis-1

Answer

Most common in less than 2 years of age

Question 3

Which of the following is NOT a common childhood tumor?

Accepted Answer

Pleomorphic rhabdomyosarcoma

Answer

Wilms' tumor

Answer

Neuroblastoma

Answer

Retinoblastoma

Question 4

Which of the following is a poor prognostic factor in a child with ALL?

Accepted Answer

Translocations t(9;22), t(4;11), t(1;19)

Answer

Age 2-8 years

Answer

Total leukocyte count < 50,000

Answer

Absent blasts in peripheral smear

Question 5

Which is the most common malignancy in children?

Accepted Answer

Leukemia

Answer

Retinoblastoma

Answer

Wilms tumor

Answer

Neuroblastoma

Question 6

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 7

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 8

What is the most common abdominal mass in children?

Accepted Answer

Neuroblastoma

Answer

Hydronephrosis

Answer

Wilms' tumor

Answer

Rhabdomyosarcoma

Question 9

What is the most common site of metastasis in neuroblastoma?

Accepted Answer

Lymph nodes

Answer

Lung

Answer

Liver

Answer

Vertebrae

Question 10

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

Oncology — MCQs

Oncology — MCQs

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