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SMALL ANIMAL > 5.4.3: Oncology > Flashcards

5.4.3: Oncology Flashcards

1
Q

Grade

A

features of a tumour on cytology/histopathology which allow predictions to be made about the tumour’s behaviour.

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2
Q

Stage

A

an assessment that combines features of the primary tumour and a measurement of where it has spread.

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3
Q

What groups can we put tumours in and how does this help us?

A

Group tumours as one of the following - this allows us to predict how the tumour will behave: how it will metastasise and how to approach treatment. The more neoplastic the cells become, the more undifferentiated they will become.
* Epithelial cell
* Mesenchymal: tumours of connective tissue and bone
* Round cell: all cells of the immune system

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4
Q

Characteristics of epithelial cell tumours

A
  • Tend to be locally invasive with peritumoural inflammation
  • Tend to metastasise later on
  • Tend to require less complicated surgical removal
  • Can respond to chemo but often don’t so surgery is required
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5
Q

Examples of epithelial cell tumours

A
  • Papilloma
  • Squamous cell carcinoma
  • Transitional cell carcinoma a.k.a. urothelial cell carcinoma
  • Adenoma (often small unproblematic skin lumps)
  • Adenocarcinoma
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6
Q

Characteristics of mesenchymal cell tumours

A
  • Mesenchymal = tumours of connective tissue and bone
  • More metastatic -> spread through blood vessels much quicker than epithelial
  • More locally invasive
  • Can respond to chemo but often don’t -> surgery is required
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7
Q

Examples of mesenchymal cell tumours

A
  • Fibroma/ fibrosarcoma
  • Osteoma/ osteosarcoma
  • Haemangioma/ haemangiosarcoma
  • Lipoma/ liposarcoma
  • Chondroma/ chondrosarcoma
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8
Q

Characteristics of round cell tumours

A
  • Large group that covers all cells of the immune system
  • This group responds well to chemo
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9
Q

Examples of round cell tumours

A
  • Lymphoma
  • Mast cell tumour
  • Plasma cell tumour
  • Histiocytic sarcoma
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10
Q

How do sarcomas metastasise?

A

Via blood

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11
Q

How do carcinomas metastasise?

A

Via lymphatics

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12
Q

How do melanomas metastasise?

A

Random metastasis - however they want (via blood or lymphatics)

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13
Q

How do mesenchymal cell tumours metastasise?

A

Via lymphatics

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14
Q

How do epithelial tumours metastasise?

A

Via blood

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15
Q

How do round cell tumours metastasise?

A
  • The immune system is in many areas of the body all the time
  • MCTs tend to spread with lymphatics, so are often seen in the LNs
  • All other round cell tumours tend to spread systemically: the liver and spleen are lymphoid organs so common sites for metastases
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16
Q

If a tumour spreads by blood, where are metastases likely to end up?

A
  • Look at organs with small vessels where the tumour cells will get stuck
  • e.g. lungs, liver, or very fine vascular systems in the paw pads of cats
17
Q

Chemo ± surgery is the treatment plan for which type of tumour?

A

Round cell tumour

18
Q

Surgery ± chemo is the treatment plan for which type of tumour?

A

Epithelial cell tumour
Mesenchymal cell tumour

19
Q

What are your diagnostic options for a mass? What are the pros and cons for each?

A
  • FNA
    ✅ Easy, can be done conscious
    ❌ May get non-diagnostic sample if tumour cells very tightly bonded to one another
    ❌ May not be able to reach definitive diagnosis - only gives you cytology results
  • Incisional biopsy
    ✅ Can look at cellular architecture
    ✅ Histopathology can give definitive diagnosis
    ❌ Requires heavy sedation/ short GA
  • Excisional biopsy
    ✅ Aims to remove the mass
    ✅ Can send for histopathology and get definitive diagnosis
    ❌ Requires GA
    ❌ In practice, leave tumour cell extensions behind
20
Q

What should should remember to do if doing an excisional biopsy of a mass?

A
  • Take a picture before, during, and after the op to show your oncologist
  • This allows revision surgery, radiation etc. once definitive diagnosis has been reached and we know more about the tumour
21
Q

When do you have the best chance of success with regards to removing a tumour entirely?

A
  • At the first surgery
  • Thereafter cancerous cells have been moved away from their original position so are much harder to relocate and remove
22
Q

True/false: it is a good idea to biopsy a thyroid carcinoma, or better still, take a biopsy.

A

False
They will bleed life-threateningly

23
Q

True/false: with an osteosarcoma, if you remove the primary tumour, the metastases, if present, will worsen more rapidly.

A

True
This must be balanced with patient welfare (often bone pain is the most significant welfare concern and taking a leg off might benefit the patient)

24
Q

Features of a higher grade tumour

A
  • Higher mitotic count
  • Nuclear/ cellular atypia
  • Poorly differentiated
  • Necrosis: tumours need blood supply -> the faster growing will quickly outstrip their blood supply and get necrotic fast
  • Locally invasive
25
Q

Grade vs stage

A

Grade = what does the tumour look like under the microscope?
Stage = a bit of what it looks like under microscope + where has it gone in the body?

26
Q

What system do we use to stage solid tumours?

A

TNM
* Tumour: size, ulceration
* Lymph node: is there tumour here?
* Distant metastasis: any organ that is not the nearest lymph node

27
Q

Describe TNM staging for soft tissue sarcomas

A
  • Stage I: small superficial, low/ intermediate grade tumours without nodal/ distant metastases
  • Stage II: superficially large or deep small tumours (any grade) without nodal/ distant metastasis
  • Stage III: large deep tumours without nodal/ distant metastasis
  • Stage IV: any tumour with nodal or distant metastasis
28
Q

What is more important for predicting prognosis with a soft tissue sarcoma: grade or stage?

A

Grade

29
Q

1

A

Entire compartment or structure containing mass (limb, muscle, bone)

30
Q

2

A
31
Q

3

A
32
Q

4

A
33
Q
A

Curative intent

34
Q
A

Marginal excision

35
Q
A

Cytoreductive
* Used to be called debulking
* Often done to reduce clinical signs

36
Q

Thoughts on this tumour - treatment and prognosis

A
  • Stage IV - spread to liver and spleen - bad news
  • High grade - bad news
  • Majority of MCTs can be cured with surgery, but if you leave behind a single cell of a high grade tumour, it will come back. In this case, it has already spread.
  • Complete excision = good news
  • Treatment: chemo and radiotherapy to prevent local reoccrence and slow down spread

SMALL ANIMAL (90 decks)

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