Apporach to cancer

Question 1

what is cancer?

Answer 1

an uncontrolled proliferation of cells independent of the normal requirement for new cells

Question 2

do cancers spontaneously resolve?

Answer 2

no

Question 3

what are the AVMAs signs of cancer?

Answer 3

abnormal swelling that persists or continues to grow
sores that don’t heal
unexplained weight loss
loss of appetite
bleeding/discharge from body opening
bad odour (especially mouth)
difficulty eating/swallowing
reluctancy to exercise
difficulty breathing, urinating, defecating
change in behaviour

Question 4

what should be done when examining a mass?

Answer 4

record size, shape and location of lesion
assess invasiveness and attachment to underlying tissue
look for characteristics of malignancy

Question 5

what cancer is haematology useful for diagnosing?

Answer 5

leukaemia

Question 6

what is cytology used for in cancer cases?

Answer 6

guiding diagnostics and treatment prior to surgery

Question 7

what is histopathology used for in cancer cases?

Answer 7

making a final diagnosis and guiding post-surgical treatments

Question 8

when doing a FNA what tips would you give someone?

Answer 8

don’t go through the lesion (can get seeding)
vigorous in multiple directions
cover needle hub when withdrawing

Question 9

what are the best things to sample using needle off FNA?

Answer 9

lymph nodes
suspected round cell tumours
(exfoliate well)

Question 10

what are the contraindications of FNA sampling?

Answer 10

bleeding (check coagulopathy/platelets)
risk of pneumothorax, urine/abscess leakage
tumour transplanting into deeper tissue

Question 11

what is the risk of FNA sampling the chest?

Answer 11

pneumothorax

Question 12

what are some cases which direct impression smears are useful for?

Answer 12

intra-operative or post-mortem samples
ulcerative superficial lesions
nasal biopsies
airway lesions

Question 13

what are the issues with FNA?

Answer 13

not always diagnostic (20% aren’t)
can be non-representative sample (take multiple samples)

Question 14

what are some tissue biopsy techniques?

Answer 14

needle core biopsy
incisional biopsy
surface/pinch biopsy
punch biopsy
excision biopsy

Question 15

what are the risks of taking a biopsy of cancer?

Answer 15

haemorrhage
transplantation of tumours
compromise future surgery
damage to adjacent tissue

Question 16

what are the advantages of needle core biopsy?

Answer 16

larger sample than an aspirate (some architecture)
inaccessible tissues can be sampled percutaneously
multiple samples easily taken
superficial biopsies can be sampled under sedation

Question 17

what is a needle core biopsy also known as?

Answer 17

trucut

Question 18

how should a needle core biopsy be removed from the needle?

Answer 18

flush with saline (don’t shake because the architecture will break up)

Question 19

what is the main risk of bone core biopsies?

Answer 19

damaging cortex which could lead to a pathological fracture

Question 20

what is an incisional biopsy?

Answer 20

surgical removal of a segment of solid tissue

Question 21

what is the most common incisional biopsy used?

Answer 21

wedge

Question 22

what are the advantages of incisional biopsy?

Answer 22

good architecture evaluation
can do histopathological grading
can select the sample taking
more tissue to carry out diagnostics on

Question 23

what are the disadvantages of incisional biopsy?

Answer 23

GA required
time/cost

Question 24

regarding the position of an incisional biopsy, where should it be?

Answer 24

in a position that the entire tract can be removed during subsequent surgery

Question 25

what are some structure that a pinch biopsy can be used for?

Answer 25

respiratory, GI, urogenital tracts

Question 26

what needs to be done before taking a pinch biopsy of the nasal tract?

Answer 26

radiograph and measure how far in to put your instruments (don’t go beyond cribriform plate)

Question 27

what should be done when taking a punch biopsy to reduce the artefacts?

Answer 27

only rotate in one direction

Question 28

what is an excision biopsy?

Answer 28

removal of the extirpation of a lesion or mass followed by removal of biopsies from it for histopathological evaluation

Question 29

what cases can excision biopsies be used in the absence of pre-treatment diagnosis?

Answer 29

haemorrhaging splenic mass
mammary tumours
pulmonary tumours

Question 30

what should be done before excision biopsies? (in most cases)

Answer 30

staging

Question 31

what are some contraindications for using excision biopsies for the skin/subcutaneous masses?

Answer 31

rapidly growing
poorly demarcated
peritumoural oedema/erythema
skin ulceration
injection site masses in cats
suspicion of MCT or STS
non-diagnostic FNAs