Approach to Cancer Patient Flashcards
what breeds are predispoed to osteosarcomas
giant/large breeds
great dane, deerhound, lurcher, rottweiler
what breeds are predisposed to histiocytic sarcoma
bernese mountain dogs
flat coated retriever
rottweiler
min schnauzer
what breeds are predisposed to lymphoma
boxer
golden retreiver
lab
what breeds are predisposed to mast cell tumours
boxer
pug
sharpei
weimeraner
what breeds are predisposed to bladder transitional cell carcinomas
scottish terriers
what breeds are predisposed to CNS tumours
brachycephalic dogs – glioma
dolicocephalic – meningioma
boxer
g retreiver
french bull dog
boston terrier
what breeds are predisposed to nasal tumours
dolicocephalic breeds
what breeds are predisposed to hemangiosarcoma
german shepherd dog
golden retriever
what are the tumour incidences in male cats
what are the tumour incidences in female cats
what are the tumour incidence in male dogs
what are the tumour incidences in female dogs
what are the presentations of cancer patients
- superficial mass/lump
- non-specific clinical signs as direct effect of internal tumour – ex. obstruction, compression
- vomiting
diarrhea
weight loss/wasting (GI mass)
dyspnea, weight loss (thoracic mass)
- non-specific clinical signs/medical presentation due to indirect effect of internal tumour due to secreted peptide/cytokine/hormone
what is a paraneoplastic syndrome
systemic, metabolic and endocrinological effects associated with some tumour types
what are endocrine disease paraneoplastic syndromes
- hyperthyroidism (thyroid adenoma in the cat)
- hyperadrenocorticism (pituitary adenoma ACTH/adrenal tumour)
- acromegaly (pituitary adenoma GH in cats)
what is the most common paraneoplastic syndrome
hypercalcemia
what are other paraneoplastic syndromes (9)
- hypercalcemia
- hyperhistaminemia (MCT)
- hypoglycemia
- hyperestrogenemia (feminization)
- hypergastrinemia - rare
- immune mediated syndromes
- hyperviscosity syndrome
- hypertrophic osteopathy
- cachexia syndrome
what are normal controllers of serum calcium
PTH, 1,25 vitD3 increase
Calcitonin decreases
what are cancer increasers of seurm calcium
PTH, PTH-rP (PTH related protein 70% sequence homology to PTH)
Local factors/cytokines (IL1, IL6, TNF)
describe how hypercalcemia occurs
what are hypercalcemia of malignancy (5)
- lymphoma/leukaemia - most common cause of hyperca (PTHrp induced)
- apocrine gland adenocarcinoma of the anal sac (25-55% of cases)
- bone tumours/multiple myeloma (local osteolysis)
- other malignant tumours (mammary, thryoid, lung, thymoma)
- parathyroid adenoma (bening) – PTH induced
what are non neoplastic causes of hyperca (5)
- endocrine: hypoadrenocorticism (parathyroid adenoma)
- renal: severe primary renal failure
- poisoning: vit D toxicity (rodenticides, diet)
- inflammatory: infections/granulomatous inflammatory disorders (osteomyelitis, osteoporosis, blasto or coccidiomycosis)
- lab error: lipemia, hemolysis, hemoconcentration, hyperproteinemia
how do hyperca patients present (4)
Hypercalcemia may cause numerous clinical sign —> together they form a syndrome to suggest underlying hypercalcemia:
- Renal: PUPD
- Gastrointestinal: anorexia, vomiting, constipation
- Neuromuscular: muscle weakness, tumours, lethargy
- Cardiovascular: hypovolemia, bradycardia, dysrhythmias
what is the normal serum calcium in the dog and what would be considered hyperca
Normal serum calcium (doh) = 2.34-3.0 mmol/l
Hypercalcemia > 3mmol/l
what is the normal ionized calcium in the dog and what would be considered ionized hyperca
Ionized calcium (active form) (dog) = 1.2-1.4 mmol/l
Ionized hypercalcemia > 1.4 mmol/l
what is the main ddx of hypercalcemia in the dog
cancer
~2/3 in dogs
~1/3 in cat
what is the approach to to hyperca (3)
- is the hyperca real? (repeat the test to exclude lab error, is it affected by protein levels/hemoconcentration, check ionized calcium is elevated, check age of animal – young, growing?)
- rule out non-neoplastic causes – blood results (ACTH, renal), access to poisons, dietary supplements
- hunt for a tumour
how do you hunt for the tumour in hyperca patients in your clinical exam (5)
- lymphoma most common –> check lymph nodes enlarged
- apocrine adenocarcinoma of the anal sac –> rectal exam
- parathyroid tumour/adenoma –> US neck/PTH gland
- multiple myeloma –> bone pain, ocular changes
- metastatic bone tumours –> bone pain