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Clinical Foundations > Clinical Oncology > Flashcards

Clinical Oncology Flashcards

1
Q

List the 3 phases of multistage carcinogenesis

A
  1. Initiation
  2. Promotion/progression
  3. Metastasis
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2
Q

Define oncogene

A

Mutations in genes that result in a gain of function

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3
Q

Define tumor suppressor gene

A

Mutations in genes that result in a loss of function

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4
Q

List 3 types of oncogenes & their description

A
  1. Viral oncogene (retroviral sequences that cause mutations)
  2. Cellular oncogenes (cellular homologues of viral oncogenes)
  3. Proto-oncogenes (cellular oncogenes that do not have mutating potential in their native state until altered)
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5
Q

List 4 mechanisms of oncogene activation

A
  1. Chromosomal translocation
  2. Gene amplification
  3. Point mutations
  4. Viral insertions
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6
Q

Oncogenes are __, whereas tumor suppressor genes are __

Think about genetic inheiritence

A

Oncogenes are dominant (only one allele needs to be affected)
Tumor suppressor genes are recessive (both alleles need to be affected)

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7
Q

List the 7 acquired capabilities of a cancer cell

A
  1. Self sufficient growth
  2. Insensitivity to anti-growth signals
  3. Evasion of apoptosis
  4. Limitless replicative potential
  5. Sustain angiogenesis
  6. Invade & metastisise
  7. Evasion of the host immune system

AM I SARI

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8
Q

How do you describe a tumor using the TNM staging system

I.e., what do the letters stand for?

A

T - size & invasiveness of tumor
N - status of nodual metastasis
M - status of distant metastasis

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9
Q

Which tumors would you NOT use the TNM staging system for?

A

Brain or spinal cord tumors, lymphoma or leukaemia

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10
Q

What is the incidence of cancer in dogs?

A

1 in 3-4

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11
Q

What is the incidence of cancer in cats?

A

1 in 5-6

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12
Q

List 3 treatment modalities for cancer

A
  1. Surgery
  2. Chemotherapy
  3. Radiotherapy
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13
Q

Define the stage of a tumor

How is this different from grade?

A

The clinical extent of disease

Grade is the pathological description of the tumor

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14
Q

What are you looking for on a physical exam of a solitary tumor or lymph nodes?

List 3-5 things

A

Size, mobility, ulceration, texture/consistency, & relationship with neighbouring structures

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15
Q

Which tumors is contrast radiography best at identifying?

A

GI or CNS tumors

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16
Q

Which tumors is CT best at identifying?

A

Bony or pulmonary lesions

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17
Q

Which tumors is ultrasound best for identifying

A

Tumors on internal lymph nodes

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18
Q

List 4 things biopsy’s are good at identifying

A
  1. The presence of neoplastic disease
  2. Tumor type
  3. Tumor grade
  4. The adequacy of surgical exicsion
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19
Q

List 4 advantages of cytology

A
  1. Easily recovered
  2. Collected with little disruption
  3. Multiple sites can be sampled
  4. Preparations can be rapidly mounted and stained
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20
Q

What type of tumors should you use a skin punch biopsy for?

A

Skin & superficial soft tumors

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21
Q

Which tumors should you use a needle biopsy for?

A

Solid tumors from internal organs or bone

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22
Q

What is an incisional biopsy, and when would you use it?

A

It is the surgical removal of a solid piece of tissue
Where a substaintial amount of tissue is required for histopathology, the lesion is too large to easily excise, or treatment will be based on the results

Not usually worth it, but it depends

23
Q

What is an exicisonal biopsy, and when would you use it?

A

It is the complete surgical removal of a tumor
Should be used when pre-treatment histopathology does not change the treatment (ex. mammary carcinoma)

24
Q

For which conditions would you take a bone marrow biopsy?

Provide 3 examples

A

Conditions affecting the lymphoid & myeloid systems
1. Non-regenerative anaemia
2. Secondary immune mediated hemolytic anaemia
3. Haematopoietic tumors

25
Q

List 1 advantage and disadvantage of needle biopsy’s

A

Adv: Inaccessbile sites can be accessed without surgery
Disadv: Can have a greater incidence of complications compared to FNAs

26
Q

List 1 advantage and disadvantage of incisional biopsy’s

A

Adv: exposes tumor site to allow accurate selection of sample
Disadv: requires general anaesthesia

27
Q

List 5 tumors of round cells

Think about each round cell (there’s 5)

A
  1. Lymphoma
  2. TVT tumor
  3. Mast cell
  4. Plasmacytoma
  5. Histiocytic tumor
28
Q

Which system is MRI best used for evaluating?

A

The CNS

29
Q

Define a dirty margin

A

The tumor is touching the cut edge of the sample

30
Q

Define a clean margin

A

Normal tissues are touching the cut edge of the sample

31
Q

Define a paraneoplastic syndrome

A

One or more clinical signs induced by a tumor distant from its primary site

32
Q

List 2 ways in which PNS’s can arise

Think about what the tumor does

A
  1. Through secreted factors (hormones, cytokines, enzymes etc.)
  2. By dysregulation of the immune system
33
Q

Define a orthotopic/topic PNS

Provide an example

A

PNS arising from the functional tumors of endocrine tissue (i.e., there is excess hormone production)

Tumors of pancreatic islet cells cause hypoglycaemia

34
Q

Define an ectopic PNS

Provide an example

A

PNS arising from non-endocrine tumors that produce active factors which mimic the effects of hormones

Large hepatic tumors cause hypoglycaemia

35
Q

In which species is paraneoplastic hypercalcaemia more common?

A

Dogs

Rare in cats

36
Q

Which disease is most commonly associated with paraneoplastic hypercalaemia?

A

Lymphoma (mostly T cell tumours)

37
Q

List 3 clinical signs of hypercalaemia

A
  1. PU/PD (and associated hypovoluaemia)
  2. Neuromuscular weakness
  3. CNS depression
38
Q

List 5 differential diagnosis’s for hypercalcaemia

A
  1. Primary hyperparathyroidism
  2. Primary renal disease
  3. Hypervitaminosis D
  4. Hypoadrenocorticism
  5. Malignancy (most common)
39
Q

Which 2 hormones should you look at when diagnosing hypercalcaemia, and how will they be changed in neoplastic disease?

A

PTH and PTHrP
PTH will be decreased and PTHrP will be increased in neoplastic disease

40
Q

Why should you avoid furosemide as a treatment option for hypercalcaemia?

A

It may worsen hypovoluaemia and azotemia (nitrogen in the blood)

41
Q

Which treatment option for hypercalcaemia should only be used short term?

A

Calcitonin

42
Q

How do bisphosphonates work to treat hypercalcaemia?

A

They mimic pyrophosphates, which regulate the precipitation and removal of minerals from bone

43
Q

List 3 clinical signs of hypoglycaemia

A
  1. Nervous system dysfunction
  2. Tachycardia
  3. Dilated pupils
44
Q

List 5 differential diagnosis’s for hypoglycaemia

A
  1. Age/breed factors
  2. Sepsis
  3. Liver failure
  4. Insulinoma
  5. Drug side effects
45
Q

List 3 treatment options for hypoglycaemia

A
  1. Revmoval of tumor
  2. Frequent small meals + glucocorticoid therapy
  3. Pre-surgical IV dextrose (severe cases)
46
Q

What are the 2 forms of paraneoplastic hypoglycaemia, and what causes them?

A
  1. Topic hypoglycaemia (insulinoma is most common cause)
  2. Ectopic hypoglycaemia (large hepatic tumors or haemangiosarcomas)
47
Q

Define cancer cachexia

A

Weight loss despite adequate caloric intake

48
Q

List 2 causes for neoplastic hyperviscosity

A
  1. Increased plasma proteins (B cell tumors)
  2. Increased cell number (renal tumors)
49
Q

List 3 clinical signs of neoplastic hyperviscosity

A
  1. PU/PD
  2. CNS depression
  3. Ocular changes
50
Q

Describe the pathophysiology of neoplastic hyperhistaminaemia

A

Tumors of mast cells cause mast cell degranulation and histamine release, histamine stimulates H2 (and H1) receptors, which increases gastrin production causing hyperacidity, hypermobility and ulceration
H1 receptor activation causes vasodilation (increasing permeability) and hypotension (flushing)

51
Q

Which disease is neoplastic myasthenia gravis associated with?

A

Thyomas

Also immune mediated diseases

52
Q

In which species do we most commonly see cutaneous paraneoplastic syndromes?

How does it present?

A

Cats

Presents as alopecia or exfoliative dermatitis

53
Q

List 4 tumors with which you will see peripheral neuropathies

A
  1. Insulinoma
  2. Carcinoma
  3. Sarcoma
  4. Melanoma

Clinical Foundations (5 decks)

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