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Y4 SA - Oncology > Canine lymphoma > Flashcards

Canine lymphoma Flashcards

1
Q

What is lymphoma?

A

A diverse group of neoplasms that arise from the lymphoreticular cells (T or B cells).
Normally arises from lymphoid tissue but it can arise from virtually any tissue as lymphoid cells will be present

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2
Q

Which dogs are most affected by lymphoma?

A

IT CAN AFFECT VIRTUALLY EVERY DOG!!!
Most commonly:
- Middle age to old dogs.
- Gender – less common in entire females? Oestrogen protective effects
- Breed predispositions and familiar traits.

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3
Q

Name the 5 anatomical presentations of lymphoma - which is the most common

A

Multicentric (80%)
Craniomediastinal
Gastrointestinal
Cutaneous
Extra-nodal forms (CNS, renal, heart, bladder)

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4
Q

Describe the clinical presentation and signs of multicentric lymphoma in dogs

A

Generalized peripheral lymphadenopathy +/- other clinical signs.
- Some dogs clinically well
- Rapid deterioration
- Non-specific signs (weight loss, inappetence/anorexia, lethargy, pyrexia).
- More specific signs (diarrhoea, vomiting, cough, ocular signs)
- Regional oedema if lymph drainage impaired

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5
Q

Describe the clinical presentation and signs of cranial mediastinal lymphoma in dogs

A
  • Can occur as solitary lesion or part of multicentric form
  • Tachypnoea, dyspnoea.
  • Signs of hypercalcaemia (T cell form)
  • Occasionally pre-caval syndrome
  • Altered position of PMI for cardiac auscultation, displacement of apex beat
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6
Q

What signs of hypercalcaemia may be seen in dogs with cranial mediastinal lymphoma

A

PU/PD, vomiting/diarrhoea, muscle tremors, anorexia, weight loss

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7
Q

What is pre-caval syndrome?

A

Impaired lymphatic drainage due to the mass location at the cranial mediastinum – ventral aspect of the neck is oedematous

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8
Q

List the clinical signs of GI (alimentary) lymphoma in dogs

A
  • Vomiting, diarrhoea, weight loss, anorexia, pan-hypoproteinaemia (hypoalbuminemia), evidence of malabsorption.
  • Abdominal masses or diffuse.
  • Lymphadenopathy (abdominal and less commonly peripheral)
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9
Q

Describe the forms of cutaneous lymphoma in dogs

A
  1. Epitheliotrophic
    - T cell
    - Solitary or generalized
  2. Non-epitheliotrophic
    - More frequently B cell
    - More likely to have lesions elsewhere
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10
Q

Describe the clinical signs and presentation of cutaneous lymphoma

A

Different appearances.
Progression to raised, erythematous plaques/nodules.
Variable pruritus

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11
Q

Describe extranodal hepatosplenic lymphoma

A

Aggressive, no peripheral lymphadenopathy
T cell

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12
Q

Describe extranodal CNS lymphoma

A
  • Mass lesion or diffuse. Variable neurological deficits but commonly signs of multicentric or diffuse lesions.
  • Commonly ocular involvement.
  • Generally T cell
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13
Q

Define paraneoplastic syndrome

A

It is a syndrome (set of signs and symptoms) that it is a consequence of the tumour but it is not due to the presence of tumour cells in that location.

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14
Q

List some features of paraneoplastic syndromes

A
  1. Hypercalcaemia (PTHrp) – tumour produces a similar protein to PTH which increases the levels of calcium - mediastinal and GI forms
  2. Immune mediated diseases: IMHA, IMTP and Pemphigus foliaceous
  3. Monoclonal gammopathies (B-cell)
  4. Neuropathies
  5. Cachexia
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15
Q

Describe diagnosis of lymphoma

A
  • In multicentric forms differential diagnosis = Infectious disease
  • Variable in other forms.
  • Diagnosis always cytology or histology
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16
Q

Describe histological grading of lymphoma

A
  • Different classification systems. Overlap.
  • Unclear significance of certain subtypes in terms of guiding treatment of prognosis
  • Features with clinical or prognostic implications
  • Grade (low, intermediate or high).
  • Immunophenotype (B-cell, T-cell or null phenotype).
17
Q

Describe the 5 stages of lymphoma

A

I = involvement limited to a single lymph node or single lymphoid tissue in a single organ
II = involvement of LNs in a regional area +/- tonsils
III = generalised lymph node involvement
IV = hepatic and/or splenic involvement
V = manifestations in the blood and involvement of bone marrow and/or organ systems

18
Q

Describe the haematology results seen for lymphoma

A

Thrombocytopenia: 30 – 50%
Neutrophilia: 25 – 40 %
Lymphocytosis: 20%
Abnormal cells on smear

19
Q

Describe the MST is dogs with lymphoma arent treated?

A

MST 4 – 6 weeks for asymptomatic dogs.
Consider euthanasia on symptomatic dogs.

20
Q

Describe prednisolone alone therapy for lymphoma

A

Response rate ~ 30%
Median response duration 1 – 2 months.
More likely to make the patient resistance to chemotherapy

21
Q

What is the gold standard for lymphoma treatment?

A

Multidrug chemotherapy

22
Q

Describe multidrug chemotherapy for lymphoma

A
  • Survival time varies depending on protocol and individual response.
  • Lower doses of drugs and prolonger interval between doses compared to humans -> Less side effects.
  • Rarely curative and very prolonged survivals in ~20% of cases.
23
Q

Describe high dose COP therapy for lymphoma

A
  • Prednisolone + vincristine + cyclophosphamide
  • Well tolerated protocol
  • Easily and safely administered in general practice setting
  • Hematology performed prior to each treatment
  • Urine sample prior to each cyclophosphamide
  • Overall response rate 60 % – 80 %
  • Median survival around 6 – 9 months
24
Q

Describe discontinuous CHOP/CEOP therapy for lymphoma

A
  • Prednisolone + vincristine + cyclophosphamide + doxorubicin or epirubicin
  • Response rate 90 – 95%
  • Median survival time 10 – 12 months
  • No advantage to continuous treatment
  • Same drugs as COP with Doxorubicin or Epirubicin added
  • Much stronger protocol
25
Q

List the general side effects of chemotherapy

A

GI toxicity: Vomiting diarrhoea, nausea.
Myelosuppression: Neutropenia, thrombocytopenia and anaemia

26
Q

List the drug specific side effects of chemotherapy

A
  • Sterile haemorrhagic cystitis: Cyclophosphamide -> Furosemide, encourage urination.
  • Cardiotoxicity: Doxorubicin and Epirubicin
  • Lomustine: Hepatotoxicity
27
Q

When might radiation be used in lymphoma cases?

A

Stage I disease
Palliation of local disease
Mass lesion on CNS

28
Q

Describe some CNS anatomical considerations of treating lymphoma

A

Many drugs do not penetrate the blood brain barrier
- Cytarabine
- Lomustine (CCNU)
- Steroids
- L-asparaginase

29
Q

Describe some anatomical considerations of treating cutaneous lymphoma

A

Epitheliotrophic lymphoma
Typical protocols are COP or lomustine + prednisolone.
- No proven extension of life span (6-8 months).
- May improve QoL.
- Response to treatment can be hard to gauge due to natural behaviour of disease.

30
Q

How can you assess the response of lymphoma to treatment?

A
  • Palpation of lymph nodes/other lesions prior to every treatment.
  • Resolution of clinical signs.
  • Repeating imaging (restaging) for internal lesions.
  • Monitoring blood parameters (Ca, ALT etc.).
31
Q

Why is achieving a complete response to lymphoma treatment vital?

A

Increases time to relapse
Increases survival time

32
Q

Describe the DMAC rescue protocol for lymphoma patients

A

Dexamethasone
Melphalan
Actinomycin-D
Citarabine

33
Q

Describe the LPP rescue protocol for lymphoma patients

A

Lomustine
Procarbazine
Prednisolone

34
Q

When should lymphoma be re-staged?

A
  • When there are no sentinel lymph nodes to follow
  • When patient not doing as well as expected or all clinical signs do not resolve
  • At the end of the induction phase
  • At the end of a discontinuous protocol

Y4 SA - Oncology (12 decks)

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