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SMALL ANIMAL > 5.4.3: Oncology 2 > Flashcards

5.4.3: Oncology 2 Flashcards

1
Q

Paraneoplastic syndrome

A

=condition caused by cancer that presents in another way.
Examples
* Hypercalcaemia
* Hyperviscosity
* Hormones e.g. oestrogen and bilateral alopecia
* Mast cell tumours -> histamine causes vasodilation

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2
Q

What two main methods of structuring chemotherapy are shown here?

A

1 - maximum tolerated dose chemotherapy - large bolus given at a stated interval, with time in between given to enable the body to recover. We are moving away from this.
2 - metronomic chemotherapy - modulating the body’s immune system in the hope that it wil be able to recognise the cancer. No longer targets the rapidly dividing cells: CD8 T lymphocytes are intact, T regs are got rid of as they allowed the cancer to continue. Becoming more common.

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3
Q

True/false: When divising a chemotherapy protocol, it is a good idea to try to choose drugs that have the same side effects.

A

False
* Choose drugs with different side effects e.g. one suppresses the immune system, another spares it.
* These means every other/ every few weeks the animal has a chance to recover whilst still fighting the cancer.

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4
Q

General side effects of chemotherapeutic agents

A
  • Rapidly dividing tissues
  • Bone marrow: neutrophils turnover in days so these are the main ones to worry about
  • Fur/whiskers: poodles and bichons lose fur, cats lose whiskers
  • GI tract: gut cells have high turnover hence vomiting and diarrhoea
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5
Q

Which neutrophils are affected by chemotherapy?

A
  • Adult neutrophils are unaffected
  • Teenage neutrophils are affected by chemo (day 5-7)
  • Baby neutrophils are unaffected but need time to develop -> this will be accelerated once the body realises it does not have enough neutrophils
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6
Q

What is this graph showing us? What happens when neutrophil count is 1?

A
  • Neutrophils are affected by chemo; there is a gradual drop off and then resurgence
  • Neutrophil count of 1 = would not be able to fight off any infection and could get sepsis
  • Below 0.5 = own bacteria could get into bloodstream and would get sepsis
  • Human chemo = get as close to 0.5 as possible
  • Animals = 1.5+ for 3 weekly chemo, 3 or above for weekly chemo
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7
Q

What principles should you follow when delivering chemotherapy IV?

A
  • Use first stick catheter and do not proceed if the vein has blown even a tiny bit
  • Utilise appropriate restraint e.g. sedation, anxiolytics - this will require many vet trips so don’t traumatise the patient
  • Use extreme care - extravasation has dire consequences!
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8
Q

Which drugs could cause issues if extravasation occurs?

A
  • Vincristine and Vinblastine - will cause nasty tissue reactions, ulceration -> will eventually heal
  • Doxorubicin (!!) - binds to DNA and does not go away. Antidote must be given in 24-72hrs.
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9
Q

Which chemotherapy drug can cause sterile haemorrhagic cystitis?

A

Cyclophosphamide

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10
Q

Which chemotherapy drug can cause cardiotoxicity and what does this mean with regards to delivery?

A

Doxorubicin
Sedate the animal and give over 30 mins, otherwise can cause cardiac arrhythmias.

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11
Q

Which chemotherapy drug can renal toxicity in cats?

A

Doxorubicin
Basically don’t give this to cats, but if you do, check renal values

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12
Q

How can you mitigate the chances of an animal developing sterile haemorrhagic cystitis?

A
  • Occurs when given cyclophosphamide
  • Is horrible, very uncomfortable and continues even after the drug has stopped being given
  • Mitigation: encourage the animal to urinate with diuretics (furosemide), by letting the animal outside a lot
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13
Q

How can you mitigate the cardiotoxic effects of doxorubicin?

A
  • After 5-6 doses, can affect how heart muscle contracts -> most lymphoma protocols only include 4 doses
  • Doxorubicin is not given in Boxers, Dobermans due to risk of DCM
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14
Q

How do tyrosine kinase inhibitors work?

A
  • Every cell has receptors and they need constant feedback otherwise the cell will die
  • Tyrosine kinase inhibitors interrupt this, tell the cell it is lonely, and so it will die
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15
Q

Side effects of tyrosine kinase inhibitors?

A

Can have off-target receptor blocking
* Pacemaker cells of gut -> flatulence, loss of intestinal motility and get vomiting and diarrhoea
* Myelosuppression -> keep an eye on RBCs and WBCs
* Damage to glomeruli -> protein leakage, kidney damage and loss of haemostasis (check urine!)

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16
Q

How do we classify lymphoma?

A

Based on anatomical location
* Multicentric = affecting multiple LNs
* Nodal = affecting a single LNs; less common in dogs, more common in cats
* Mediastinal = remnants of thymus
* Hepatosplenic = liver and spleen, v. aggressive
* Alimentary = GIT

17
Q

What is the immunophenotype of lymphoma?

A

Whether it is B cell or T cell.

18
Q

Characteristics of B cell lymphoma

A
  • Better outcome vs T cell lymphoma
  • High doxorubicin sensitivity
  • More common in dogs = diffuse large B cell lymphoma
  • CHOP protocol is good for this
19
Q

Characteristics of T cell lymphoma

A
  • Worse prognosis vs B cell lymphoma
  • Doxorubicin may not be as effective in T cells as in B cells
20
Q

True/false: staging of lymphoma in dogs and cats is different.

A

True
In cats staging includes description of whether it is resectable or not

21
Q

How can you stage/ diagnose lymphoma

A
  • Haematology: see if there are circulating lymphoid cells
  • Biochemistry: look for liver values, hypercalcaemia
  • Ultrasound: look at liver, spleen, abdo LN, intestinal involvement; can sample at the same time
  • Radiographs: need to rule out other types of cancer; also check thoracic rads for enlarged LNs, mediastinal lymphoma
  • CT/MRI: generally not needed for lymphoma except treatment of nasal tumours in cats where you want CT to see where you radiotherapy beam can go, and MRI if dog has neuro signs
22
Q

If you have a finite amount of money for a patient with lymphoma, which should you prioritise: treatment or staging?

A

Treatment - although this can catch you out if you later find other tumours mid-treatment

23
Q

Which drugs are part of the CHOP protocol?

A
  • Cyclophosphamide
  • Doxorubicin (H - horrible drug)
  • Vincristine (O)
  • Prednisolone (reducing dose each week)
24
Q

What is the relationship between prednisolone and chemotherapy, for example if you start on prednisolone and then opt for chemo?

A
  • Steroids will treat lymphoma, improving appetite and demeanour in the short term without many side effects. Survival time approx. 2 months with preds alone
  • Prednisolone induces a drug exporter (P glycoprotein) that will reduce the effectiveness of chemo
  • Make sure the owner is very sure they do not want chemo before they commit to giving preds
25
Q

What is the general protocol and response rate for lymphoma?

A
  • Multi-agent protocol
  • Response rate can be 90-95% = good outcome :)
  • Very involved - come back in almost every week for up to 25 weeks
  • Very time-consuming!
26
Q

Lymphoma in dogs
1

A
27
Q

Lymphoma in dogs
3

A
28
Q

Lymphoma in dogs
5

A
29
Q

Lymphoma in cats
1

A
30
Q

Lymphoma in cats
3

A
31
Q

Lymphoma in cats
5

A
32
Q

True/false: PARR can tell a B cell from a T cell lymphoma.

A

False
It can differentiate lymphoma as a whole from other diseases, but if you already know you have lymphoma, there is no need to run PARR.
PARR is a test of clonality not phenotype.

SMALL ANIMAL (90 decks)

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