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DMod3 Pt8 Oncology > DM3 Pt8-1 Lymphoma > Flashcards

DM3 Pt8-1 Lymphoma Flashcards

1
Q

What is the most common feline neoplasm?

A

Lymphoma is the most common neoplasm in cats.

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2
Q

What factors affect the presentation, behavior, and prognosis of feline lymphoma?

A

The anatomical location of the lymphoma.

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3
Q

What are the main anatomic classifications of feline lymphoma?

A

Mediastinal, gastrointestinal, extranodal, nodal, multicentric, and leukaemic.

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4
Q

What are some examples of extranodal lymphoma in cats?

A

Nasal, renal, CNS, ocular, larynx, retrobulbar, and skin.

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5
Q

How is lymphoma classified by immunophenotype?

A

As B cell or T cell lymphoma.

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6
Q

Which types of feline lymphoma are typically T cell in origin?

A

Mediastinal and leukaemic lymphomas are usually T cell in origin.

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7
Q

Why is immunophenotyping rarely performed in cats with lymphoma?

A

Immunophenotyping does not typically alter treatment, and prognosis is more dependent on the lymphoma’s anatomical location.

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8
Q

How has the role of FeLV in feline lymphoma changed over time?

A

In the 1960s to 1980s, most cases of feline lymphoma were associated with FeLV infection. However, with the decline of FeLV, fewer cases are linked to it, though the role of FeLV in antigen-negative cases remains unknown.

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9
Q

What diagnostic method has become more sensitive in detecting FeLV in recent years?

A

PCR testing, which may detect FeLV in cases that test antigen-negative.

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10
Q

What areas are commonly involved in mediastinal lymphoma in cats?

A

The thymus and/or mediastinal/sternal lymph nodes.

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11
Q

What is a common feature of mediastinal lymphoma in cats?

A

Pleural effusion.

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12
Q

Which cats are most commonly affected by mediastinal lymphoma?

A

Young, FeLV-positive cats and very young (<1 year) FeLV-negative Oriental/Siamese cats.

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13
Q

What is the clinical presentation of cats with mediastinal lymphoma?

A

Most cats present with dyspnoea, which may worsen due to increasing pleural effusion. Regurgitation may occur from oesophageal compression by the mass.

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14
Q

What are the differential diagnoses for pleural effusion in cats with mediastinal lymphoma?

A

Pyothorax, chylothorax, FIP, congestive heart failure, diaphragmatic rupture, and other neoplastic diseases (e.g., thymoma).

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15
Q

What is a thymoma, and how is it differentiated from mediastinal lymphoma?

A

A thymoma is a tumor of the thymus, often seen in older cats, whereas mediastinal lymphoma is common in young cats. Differentiation can be made based on age, cytology, and additional diagnostics.

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16
Q

What are the recommended diagnostic steps for mediastinal lymphoma?

A
  1. Thoracocentesis and cytology of effusion. 2. Haematology/biochemistry. 3. FeLV antigen and PCR, FIV antibody. 4. Thoracic and abdominal imaging. 5. FNA of any masses or lymph nodes. 6. Biopsy if necessary, especially in older cats.
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17
Q

What treatment is typically used for mediastinal lymphoma in cats?

A

The COP chemotherapeutic protocol (Cyclophosphamide, Vincristine, Prednisolone). Therapeutic thoracocentesis may be needed initially.

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18
Q

What is the prognosis for mediastinal lymphoma in cats?

A

Generally good, especially for young FeLV-negative Oriental/Siamese cats, who can achieve high remission rates with survival commonly exceeding 1 year, and potentially over 2 years, which is considered a cure. FeLV-positive cats tend to have a shorter remission period.

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19
Q

When is a treatment response seen in cats with mediastinal lymphoma?

A

If a response is going to occur, it is typically seen within the first week of treatment.

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20
Q

Where is gastrointestinal lymphoma most commonly located in cats?

A

The small intestine, followed by the stomach, ileocaecocolic junction, and less commonly, the colon.

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21
Q

What is the typical age group for cats with gastrointestinal lymphoma?

A

Most cats with gastrointestinal lymphoma are older and FeLV antigen-negative.

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22
Q

What is diffuse lymphocytic lymphoma associated with?

A

It can be a progression from inflammatory bowel disease (IBD), and may be difficult to distinguish from severe IBD, especially on endoscopic biopsies.

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23
Q

What are the clinical signs of gastrointestinal lymphoma in cats?

A

Diarrhoea, vomiting, weight loss, inappetence, or polyphagia. Some cats may present without gastrointestinal signs, and the disease may be incidentally detected during investigations for other disorders.

24
Q

What are the differential diagnoses for focal gastrointestinal masses?

A

Neoplastic diseases (e.g., adenocarcinomas, mast cell neoplasia) and non-neoplastic diseases (e.g., granulomatous diseases like FIP).

25
Q

What are the differential diagnoses for diffuse gastrointestinal lymphoma?

A

Inflammatory bowel disease (IBD) and systemic causes of gastrointestinal signs or weight loss, such as hyperthyroidism.

26
Q

What are the recommended diagnostics for gastrointestinal lymphoma?

A

Haematology/biochemistry, FeLV antigen and PCR, FIV antibody, abdominal radiographs and ultrasound, and endoscopic or full-thickness gastrointestinal biopsies.

27
Q

How is focal gastrointestinal lymphoma treated?

A

Focal masses may be surgically resectable, but only about 50% of cases can be fully resected. Surgical resection/debulking is followed by chemotherapy for better outcomes.

28
Q

What is the treatment for lymphoblastic (large cell/high-grade) gastrointestinal lymphoma?

A

Chemotherapy using the COP protocol, with staged treatments due to the risk of gastrointestinal perforation.

29
Q

What is the treatment for diffuse lymphocytic (small cell) gastrointestinal lymphoma?

A

A regime of prednisolone and chlorambucil, which can also be used to treat severe IBD, making distinction between the two less critical.

30
Q

What is the prognosis for lymphoblastic gastrointestinal lymphoma?

A

Generally poor, but some cats can do well in the short term, depending on clinical signs, location, and extent of disease.

31
Q

What is the prognosis for diffuse lymphocytic gastrointestinal lymphoma?

A

Generally good, with survival of over a year frequently seen.

32
Q

What is extranodal lymphoma in cats?

A

A type of lymphoma that affects organs outside of the lymph nodes, varying widely in behavior depending on location.

33
Q

What are the common forms of extranodal lymphoma?

A

Nasal lymphoma, renal lymphoma, CNS lymphoma, and nodal lymphoma.

34
Q

What are the common clinical signs of nasal lymphoma in cats?

A

Chronic nasal discharge, epistaxis, and stertor. Signs may be unilateral or bilateral, and may also include nasopharyngeal involvement with retching or stertor.

35
Q

What is the prognosis for nasal lymphoma?

A

Generally good, with remission lasting 1-2 years or longer. It has the best prognosis of all extranodal lymphomas.

36
Q

What is the most common clinical sign of renal lymphoma in cats?

A

Renomegaly (enlarged kidneys), often detected as palpable masses. Around 50% of cats show signs of renal insufficiency, including polyuria/polydipsia, inappetence, vomiting, and weight loss.

37
Q

What is the prognosis for renal lymphoma?

A

Poor, with survival times ranging from 3-6 months. About 60% of cats achieve complete remission, but severe azotaemia worsens prognosis.

38
Q

What is the typical presentation of CNS lymphoma in cats?

A

Neurological signs, which vary based on the location of the lymphoma. CNS involvement may be focal or multifocal.

39
Q

What are the common differential diagnoses for CNS lymphoma?

A

Infectious/inflammatory diseases (e.g., FIP, toxoplasmosis), congenital malformations, disc disease, aortic thromboembolism, trauma, and other neoplasms (e.g., meningioma).

40
Q

What is the prognosis for CNS lymphoma?

A

Generally poor, with survival times ranging from 6 weeks to 13 months. Prognosis may be worse for younger FeLV-positive cats with spinal lymphoma.

41
Q

How is nodal lymphoma different in cats compared to dogs?

A

Peripheral lymph node involvement is rare in cats, unlike in dogs. A distinct form of nodal lymphoma, similar to Hodgkin’s lymphoma, affects solitary or regional lymph nodes of the head and neck.

42
Q

What is the recommended treatment for CNS lymphoma in cats?

A

Cytosine arabinoside due to better CNS penetration, often used with prednisolone or in addition to COP/CHOP protocols. Radiotherapy may be used for focal spinal disease.

43
Q

What are the recommended diagnostics for nasal lymphoma?

A

Intra-oral radiographs, nasal biopsies, FeLV antigen and PCR, and nasal flushes for cytology.

44
Q

What are the recommended diagnostics for renal lymphoma?

A

Haematology, biochemistry, urinalysis, renal ultrasonography, and fine-needle aspiration (FNA) of the kidneys.

45
Q

What are the recommended diagnostics for CNS lymphoma?

A

MRI, CSF cytology, spinal radiography/myelography, and renal ultrasonography/FNA if renal involvement is suspected.

46
Q

What is one of the most useful prognostic indicators for feline lymphoma treatment?

A

The initial response to treatment within the first 1-2 weeks. Cats that respond well are more likely to go into complete remission and have a longer duration of remission.

47
Q

What is the common chemotherapy protocol for feline lymphoma?

A

The COP protocol, which includes vincristine, cyclophosphamide, and prednisolone.

48
Q

What are some chemotherapeutic agents used in feline lymphoma treatment?

A

Vincristine, cyclophosphamide, doxorubicin, methotrexate, cytosine arabinoside, and CCNU.

49
Q

When is doxorubicin added to a lymphoma treatment protocol, and what is its potential side effect?

A

Doxorubicin can be added to the COP protocol but may cause anorexia in cats. Studies on its benefit are inconclusive, and it is not always included in treatment.

50
Q

What is the treatment protocol for diffuse lymphocytic/small cell/low-grade gastrointestinal lymphoma?

A

Prednisolone and chlorambucil, either continuous low dose (2 mg PO every other day) or pulse high dose (15 mg/m² once daily for 4 consecutive days every 3 weeks).

51
Q

What chemotherapy agent is recommended for CNS lymphoma in cats?

A

Cytosine arabinoside, due to its better CNS penetration, often combined with COP or CHOP protocols.

52
Q

What supportive treatments may be necessary during lymphoma treatment in cats?

A

Appetite stimulants, anti-emetics, and nutritional support, although side effects like anorexia and vomiting are uncommon with COP protocols.

53
Q

What is the typical duration of lymphoma treatment in cats?

A

If the treatment is well-tolerated and the cat is in remission, treatment typically continues for one year, after which it may be stopped if remission persists.

54
Q

What is a high-dose COP protocol for feline lymphoma?

A
  • Vincristine: 0.75 mg/m² IV weekly for 4 weeks, then every 3 weeks. - Cyclophosphamide: 200-300 mg/m² IV every 3 weeks OR 50 mg/m² PO q48h. - Prednisolone: 1 mg/kg PO BID, reducing to 1 mg/kg SID.
55
Q

What is the CHOP-based protocol for feline lymphoma?

A

A protocol using vincristine, cyclophosphamide, doxorubicin, L-asparaginase, and prednisolone, typically administered over 25 weeks with specific dosing intervals.

56
Q

What are the key diagnostics required before each chemotherapy treatment in feline lymphoma?

A

A complete blood count (CBC) to ensure normal neutrophil counts.

57
Q

How long should treatment continue after complete remission is achieved in feline lymphoma?

A

Treatment can be stopped if the patient remains in complete remission at the end of the protocol, but continued monitoring for recurrence is advised.

DMod3 Pt8 Oncology (4 decks)

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