Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 SA - Oncology > Approach to the cancer case 1 + 2 > Flashcards

Approach to the cancer case 1 + 2 Flashcards

1
Q

What is cancer?

A

An uncontrolled proliferation of abnormal cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What proportion of dog/cats will develop cancer in their lifetime?

A

1 in 4 dogs
1 in 6 cats
Will develop a malignant tumour during their lifetime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

For what reasons do patients die of cancer?

A
  • Delayed / erroneous diagnosis
  • Failing to treat properly: Primary disease, Metastatic spread
  • Ineffective treatment
  • Owner decides not to treat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List the main oncology principles to be aware of as a vet

A
  • Cancers do not go away
  • Know what you are treating
  • Work to understand owner goals
  • Treat early for best chance of cure
  • Plan treatment well
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the basic diagnostics available for cancer cases

A
  1. History
  2. Physical examination
  3. Minimum database (CBC, Biochem, UA) - Usually for assessment of co-morbidities, some px markers
  4. Biopsy
    - Cytology
    - Histology - Grading
  5. Imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List some advanced diagnostic tools available for cancer cases

A
  • Immunochemistry: cytochemistry and histochemistry
  • Flow cytometry
  • PCR
  • Electrophoresis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

List the 10 AVMAs signs of cancer

A
  • Abnormal swelling that persists or continues to grow
  • Sores that do not heal
  • Unexplained weight loss
  • Loss of appetite
  • Bleeding or discharge from a body opening
  • Bad odour, especially from the mouth
  • Difficulty eating or swallowing
  • Reluctance to exercise
  • Difficulty breathing, urinating or defecating
  • Change in behaviour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What information would you gather on the history of an animal with suspected cancer?

A
  1. General - Diet, travel, medications
  2. When was it noticed?
  3. Behavioural information
    - Size
    - Growth rate?
    - Changes in appearance?
    - Any other masses?
  4. Other clinical signs / co-morbidities?
    - Changes e.g. pu/pd, swollen limbs, petechaie, pale gums, swelling or ecchymoses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the steps involved in a lesion examination

A
  • Measure and record size and location of all lesions
  • Assess invasiveness and attachment to underlying tissues (Feeling of mass not a good indicator of lesion type)
  • Look for characteristics associated with malignancy
  • Pain: skin tumours rarely painful cf inflammatory lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the steps involved in a general physical examination

A
  • General condition and BCS assessment
  • Palpation over the whole body for other lesions.
  • Palpation of lymph nodes especially draining nodes
  • Palpation looking for signs of pain, especially over bones and spine.
  • Oral and rectal examination
  • Assessment of CVS and respiratory systems.
  • Abdominal palpation
  • Mentation and neuro assessment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Haematology can only be used to diagnose which cancer?

A

Leukaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Haematology is required before which treatment is given?

A

Chemotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Can biochemistry be used to diagnose cancer?

A

No
- Poorly sensitive to organ infiltration
- Paraneoplastic syndromes
- Concurrent disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cytology samples are obtained using?

A

FNAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Histopathology samples are obtained using?

A

Tissue biopsys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Before treatment what should all cancer patients have?

A

A pre-treatment diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

List the main features of cytology and its benefits

A
  • Relatively non-invasive
  • Often requires minimal restraint
  • Minimal tissue disruption
  • Rapidly performed
  • Rapid results
  • Cheaper
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which features of cytology are not useful?

A
  • No architectural detail
  • Small numbers of cells examined - ?representative
  • Limited assessment of tumour type/grade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the benefits of histopathology?

A

Architecture apparent
Larger sample size = More representative
More accurate tumour type/grade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the disadvantages of using histopathology?

A

More invasive
GA (or sedation) required
Moderate tissue disruption
More time consuming
Delay in results
More expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

When might FNA and biopsy be useful?

A

Examples include: tumours requiring high morbidity surgery or when cytology result does not align with clinical picture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the main considerations when performing an FNA

A

Do not go through the lesion (seeding)
1 cc of negative pressure is enough
Be vigorous sampling in multiple directions
Cover needle hub as you withdraw.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

In which tumours/tissues is it best to use the needle off FNA approach?

A

Lymph nodes
Suspected round cell tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe how to correctly make spears once you have an FNA sample

A
  • Use 5ml of air to rapidly expel the sample
  • Slide must be clean
  • Use weight of the slide to spread the sample
  • Smear without excessive downward pressure
  • Stain slide with less material and check there are intact cells (before dog is woken up if sedated/GA)
  • Label with penicl
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In which situations is an FNA contra-indicated?

A
  • Bleeding
  • Risk of pneumothorax, urine or abscess leaking after sampling
  • Tumour transplantation deeper into tissue: care not to go through lesion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

If a patient is bleeding, when may if be ok to perform an FNA?

A

If platelet count normal and no evidence of coagulopathy then usually OK
Monitor patients afterwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

FNA is best for tumors with which characteristic?

A

Better for tumours which don’t exfoliate well but risk of cell damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Describe when an impression smear/brush is indicated?

A

Intra-op or post-mortem samples
Ulcerated superficial lesions
Nasal biopsies
Airway lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe the impression smear technique

A
  • Collect sample
  • Blot surface: remove debris if ulcerated lesion, remove blood
  • Dab against slide - make multiple spots
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some problems with using FNA

A
  • Non-diagnostic samples (around 20%): always check before sending away
  • Non-representative samples
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

List the 5 different tissue biopsy techniques

A

Needle core biopsy
Incisional biopsy
Surface and pinch biopsies
Punch biopsy
Excisional biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the risks of biopsy?

A
  • Haemorrhage
  • Transplantation of tumour cells
  • Compromise future surgery
  • Damage to adjacent structures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a needle core biopsy?

A

Cylinder of tissue is removed from the lesion by a specialised needle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Describe the two needle types available for needle core biopsies

A
  1. Trucut needles
    - Two handed operation
    - Need assistance
    - Can be cold sterilised
  2. Cook’s/Arnolds Biopsy Needles
    - Semi automated
    - Can be cold sterilised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the advantages of a needle core biopsy?

A
  • Larger sample than aspirate -> some evaluation of architecture
  • Comparatively inaccessible tissues can be accessed percutaneously
  • Multiple samples can easily be taken
  • Superficial lesions can be biopsied under sedation and local anaesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the disadvantages of a needle core biopsy?

A
  1. Small samples size compared to other biopsy - might not be sufficient to view architectural change
  2. Greater risk of complications compared to FNA - esp for intracavitatory biopsies
  3. NOT GOOD FOR LYMPH NODES
    - Insensitive to metastatic disease
    - Inadequate for architectural assessment in lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Describe the procedure for a needle core biopsy

A
  • Adequate restraint
  • Clip, prepare site aseptically
  • Make small stab incision in skin (essential or will blunt needle)
  • Immobilise mass and introduce needle (ultrasound guided very useful)
  • Once embedded in tissue..
  • Advance central obturator, do not go through far border of lesion
  • Rotate through 90o
  • Briskly advance outer cannula over central obturator
  • Remove from mass
  • Retract outer cannula
  • Handle biopsy with care
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When biopsying which tissues is ultrasound guidance most useful?

A

Hepatic biopsy
Renal biopsy
- Need to be careful
- Needle parallel to medulla
- Not without risk
Thoracic mass

39
Q

A jamshidi needle is used for which biopsy type?

A

Bone core biopsy

40
Q

What must you be careful not to do when performing a bone core biopsy?

A

Do not penetrate far cortex
Risk of pathological fracture

41
Q

What is an incisional biopsy?

A

Surgical removal of a segment of solid tissue

42
Q

Which type of incisional biopsy is used most commonly?

A

Wedge biopsy
- inverted wedge allows easy closure

43
Q

What are the advantages of an incisional biopsy?

A
  • Good evaluation of architecture
  • Histopathological grading
  • Surgical approach allows selection of biopsy site
  • More tissue: can carry out special stains etc
44
Q

What are the disadvantages of an incisional biopsy?

A

GA normally required
Increased time
Both increase costs

45
Q

What are the main considerations when performing an incisional biopsy?

A
  • Plan your site
  • Avoid major structures
  • Avoid necrotic, haemorrhagic or infected areas
  • Position incision and biopsy so that entire biopsy tract can be removed during subsequent surgery
  • Make the incision large enough to harvest the sample without excessive tissue manipulation
  • Include a portion of normal tissue only if easy to do so
46
Q

Surface pinch and grab biopsies can be used for which tissues?

A

Accessible surfaces:
- Respiratory tract
- Gastrointestinal tract
- Urogenital tract

47
Q

Describe how you would use the surface pinch and grab biopsy technique for nasal tumours

A

Measure distance to insert grabs from radiograph
Do not insert further than medial canthus
For cats use cut-off urinary catheter and aspiration

48
Q

When can punch biopsies be used?

A

Cutaneous and other superficial lesions only
NOT for lymph nodes

49
Q

How should a punch biopsy be carried out?

A

Sedation (+/- local)
Rotate punch continuously in SAME direction so don’t shear layers apart

50
Q

What is an excisional biopsy?

A

(Attempted) surgical extirpation of a lesion or mass, followed by removal of biopsies from it for histopathological evaluation or submission of whole sample if possible

51
Q

In which 3 exceptions can excisional biopsies be performed without a pre-treatment diagnosis?

A

Haemorrhaging splenic masses
Mammary tumours
Pulmonary tumours

52
Q

What must be done before an excisional biospy?

A

Staging of the tumour

53
Q

Excisional biopsies are widely used to treat which tumours?

A

Skin tumours

54
Q

List the contraindications for excisional biopsy for skin and s/c masses

A
  • Rapidly growing mass
  • Ill-defined or poorly demarcated lesion
  • Peritumoural oedema or erythema
  • Skin ulceration
  • Injection site masses in cats
  • FNA suspicious for MCT or STS
  • Non-diagnostic FNA
55
Q

What should happen to all excised excisional biopsies?

A

Submitted for histopathological evaluation - only way to assess adequacy of excision

56
Q

Once cancer has been diagnosed in a patient what are the next steps to consider?

A

Client communication
Active monitoring
Staging
Tumour related complications
Comorbidities and general health

57
Q

What are some general tips when communicating with clients after a cancer diagnosis

A
  • Clients often find a diagnosis of cancer very distressing
  • May remember only a minority of the information you give them
  • Some clients benefit from having time to come to terms with the diagnosis
  • The client may need more time than you can give them in the middle of a busy surgery
  • Explains the knowns and unknowns clearly
  • Be clear if the disease is likely to be fatal but dont prognosticate too early
58
Q

What are some common unknowns after a cancer diagnosis

A
  • Sometimes exact type
  • Stage
  • Co-morbidities
  • Owners willingness to treat
  • Uncertainty about outcomes of treatment
59
Q

What is clinical staging?

A

Process by which we assess the extent of the disease

60
Q

Describe the 3 clinical stages of solid tumours

A

T = primary tumour
N = metastatic disease in local and regional lymph nodes
M = Distant metastatic disease

61
Q

How can you clinically stage a T lesion

A
  • Clinical exam
  • Location and palpable extent
  • Fixation: to deep tissues, to skin
  • Ulceration
  • Imaging
  • Direct visualisation
62
Q

Describe how you can stage T tumours using imaging in first opinion practice

A
  • Plain films
  • Contrast radiography: urogenital, GI and CNS tumours
  • Ultrasonography: abdominal masses, parenchymatous organs
63
Q

What % of mineral content of bone must be lost for lysis to become apparent on plain radiography?

A

More than 60%

64
Q

How can stage T tumours be diagnosed using direct visualisation

A

Endoscopy
- Gastrointestinal tract
- Urogenital tract
- Respiratory tract
Laparoscopy
Thoracoscopy
Exploratory surgery

65
Q

What is the use of CT scanning for stage T lesions

A

Great for bony lesions
Radiation planning

66
Q

What is the use of MRI scanning for stage T lesions

A

Best for CNS lesions
Many more shades of grey in soft tissue compared to radiography

67
Q

Tumour metastasis is divided into which two broad categories?

A

Haematogenous
Lymphatic

68
Q

Describe haematogenous metastasis

A

Dissemination via the circulatory system
Sarcomas
Malignant melanoma

69
Q

Describe lymphatic metastasis

A

Dissemination via the lymphatic system
Local and regional lymph node spread
Mast cell tumours
Carcinomas
Malignant melanomas

70
Q

Can imaging alone be used to diagnose neoplasia?

A

No
Need Biopsy and histopathology OR suitable sampling and cytology

71
Q

Describe how you can clinically stage N lesions

A

Palpation
Imaging
Cytology/histology
Imaging
FNA
Biopsy

72
Q

Describe palpation for stage N lesions

A

Relatively insensitive to metastatic disease
Any palpable abnormalities
- Size
- Texture esp increased firmness
- Fixation

73
Q

How can thoracic radiography be used for stage N lesions

A

Moderate to marked enlargement of nodes detectable
- Lateral thorax: Suprasternal, cranial mediastinal, tracheobronchial
- DV thorax: Increases sensitivity

74
Q

How can abdominal radiography be used for stage N lesions

A

Medial iliac (sublumbar) lymph node enlargement
Very unlikely to detect enlargement of mesenteric nodes unless massively enlarged

75
Q

How can ultrasound be used for stage N lesions

A

Esp useful for subtle enlargement of the iliac (sublumbar) and mesenteric lymph nodes

76
Q

What is Lymphangiography?

A

The use of imaging, such as X-ray or MRI , to visualize the body’s lymphatic system.

77
Q

How is Lymphangiography used to stage N lesions

A
  • Detection of sentinel nodes
  • Inject contrast into the tumour to find out which nodes drain it
  • Does not tell you if they are affected by metastases
  • Only tells you which are draining nodes
78
Q

How are FNAs used to stage N lesions

A

More sensitive than palpation or needle core biopsy
Not infallible
- Can have –ve aspirate from +ve node
- Use needle only technique

79
Q

Describe biopsying lymph nodes to stage N lesions

A

Lymph node excision best
Trucuts are poor

80
Q

Describe the main features of lymph node metastasis

A
  • Most tumours which spread by the lymphatic route go to the nearest node towards the centre of the body i.e. towards thoracic duct
  • Normal lymph nodes act as a barrier to tumour spread
  • Once node is grossly affected by metastatic disease probably contributes little to defence against metastasis
81
Q

A cranial abdominal tumour is most likely to metastasise to which LN?

A

Sternal lymph nodes

82
Q

A thyroid carcinoma is most likely to metastasise to which LN?

A

Retropharyngeal

83
Q

List the common sites of stage M lesions

A

Lung
Parenchymatous organs e.g. Liver, spleen, kidney
Bone
Skin
CNS
Distant nodes

84
Q

How can a clinical exam be used in diagnosing stage M lesions

A

Skin mets may be obvious
Pulmonary metastatic disease is very difficult to pick up on examination
- History helps
- Adventitious sounds uncommon
- May pick up if concurrent effusion
Cough is uncommon

85
Q

How is clinical pathology used in staging M lesions

A

Organ dysfunction secondary to metastatic invasion
Not terribly sensitive or specific

86
Q

How is advanced imaging used for stage M lesions

A

More imaging leads to increased lesion identification

87
Q

How are most stage M lesions diagnosed?

A

Inflated Xrays x 3 views +/- ultrasound good enough for the majority of cases

88
Q

How can metastasis to parenchymatous organs be diagnosed?

A

Ultrasound generally superior to radiography

89
Q

In older dogs, which conditions can be mistaken for metastatic spread to parenchymatous organs? How can you confirm?

A
  • Nodular hyperplasia in the liver
  • Nodular hyperplasia, lymphoid hyperplasia, haematomas in the spleen
  • Confirm by FNA
90
Q

List the limitations of the TNM system?

A
  • Animals do not always present with the primary disease
  • Metastatic disease: Bony mets, LN mets in tonsillar carcinoma
  • Paraneoplastic syndromes
  • Biological behaviour of the tumour must be in mind: some very aggressive tumours are always at a more advanced stage than is clinically detectable
91
Q

When should cancer cases be referred?

A

Most oncology cases can be managed well in general practice.
Referral for:
- Specialist expertise
- Advanced treatments
- Odd tumours / uncertain diagnoses
- Tricky clients
- More aggressive tumours

92
Q

List some examples of highly metastatic tumours

A
  • Oral/mucosal malignant melanoma
  • Haemangiosarcoma
  • Appendicular osteosarcoma (dog)
  • High grade MCTs
  • Subungual malignant melanoma (dog)
  • Poorly differentiated mammary tumours (dog)
  • Most mammary carcinomas in cats
93
Q

Name some tumours with a low metastatic potential

A
  • Oral fibrosarcoma
  • Non-tonsillar oral squamous cell carcinoma
  • Most ST sarcomas
  • Sebaceous adenocarcinoma
  • Low grade MCTs
  • Multilobular osteoma /osteosarcoma of bone
  • Intranasal tumours
94
Q

List some tumours which don’t metastasise

A
  • Oral acanthomatous ameloblastomas: Aka basal cell carcinomas or acanthomatous epulids
  • Haemangiopericytoma
  • Schwannoma/neurofibroma
  • BENIGN TUMOURS

Y4 SA - Oncology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions