Exam 1 - Canine Hemangiosarcoma Flashcards
what kind of tumor is hemangiosarcoma?
neoplastic endothelial cells
what risk factors are there for canine hemangiosarcoma?
middle aged to older dogs
large breed dogs - GSD, goldens, labs
possible hormone association
what are the steps of formation & spread of hemangiosarcoma?
- dysregulated maturation of bone marrow progenitor cells
- movement to peripheral vasculature
- malignant cells can lay dormant
- tumors in different organs can develop simultaneously or metastasize from one tumor
- bone marrow progenitor cells
what is the importance of angiogenesis in hemangiosarcomas?
the dysregulation of angiogenic pathways is what allows for the spread/growth
what are the angiogenic activators?
VEGF, bFGF, PDGF, & angiopoietin-2
what is the importance of angiogenic activators in hemangiosacomas?
upregulated in the tumor & circulating blood in patients with hemangiosarcoma
what is the most common primary site for hemangiosarcomas?
spleen
what is the rule for splenic masses in dogs?
50% of splenic masses are malignant & 50-75% of malignant splenic tumors are hemangiosarcomas
63-70% of non-traumatic hemoabdomens are caused by what?
ruptured hemangiosarcomas
how does metastasis of hemangiosarcomas occur?
hematogenously or intracavity implantation following rupture
what is the second most common site of hemangiosarcomas?
heart - right atrium or auricle
what is the most common heart tumor?
cardiac hemangiosarcoma
what are the most common sites for metastasis with hemangiosarcomas?
liver, omentum, peritoneum, & lungs
what is the most common tumor that metastasizes to the brain?
hemangiosarcoma
what are the common physical exam findings of a patient presenting with hemorrhagic shock & has a ruptured hemangiosarcoma?
tachycardia, poor pulse quality, pale mucus membranes, & abdominal fluid wave
what arrhythmias are commonly seen in animals present with hemorrhagic shock due to a ruptured hemangiosarcoma?
ventricular tachycardia & premature ventricular complexes
cardiac tamponade is commonly present in what kind of hemangiosarcoma?
ruptured cardiac hemangiosarcoma
what physical exam findings are common in a patient with a ruptured cardiac hemangiosarcoma?
muffled heart sounds, pulsus paradoxus (exaggerated drop in blood pressure upon inspiration), ascites, & circulatory collapse
if you palpate a splenic tumor and feel that it is very large, does this make you more or less concerned about malignancy?
less - the bigger tumors are typically not malignant, hemangiosarcomas are harder to diagnose prior to rupture
ultimately, what is the only treatment of hemangiosarcoma?
surgical removal of the bleeding mass
what are the diagnostic techniques & work-up that should be used for hemangiosarcoma?
chemistry, UA, coag panel, blood type, VCM
thoracic rads - 3 views
abdominal ultrasounds - limitation, you can’t make a histological diagnosis
echocardiogram - some patients present with v tach & VPC
CT scan
what does T1 mean?
tumor is less than 5cm in diameter & is confined to the primary site
what does T2 mean?
tumor is 5cm or greater or ruptured & is invading subcutaneous tissues
what does T3 mean?
tumor is invading adjacent structures, including muscle
what does N1 mean? N2?
N1 - regional lymph node involvement
N2 - distant lymph node involvement
for a visceral hemangiosarcoma, what surgeries are indicated?
splenectomy, liver lobectomy, & nephrectomy
full abdominal explore & biopsy of abnormal tissue
is surgery ever possible for cardiac hemangiosarcoma?
possible in some cases - right atrial appendage masses
what are the indications for surgical removal of intramuscular & subcutaneous hemangiosarcomas?
wide margin is required because they are locally invasive & cause edema & hemorrhage
chemotherapy is indicated in all cases of hemangiosarcoma because it is highly metastatic except in what type?
dermal hemangiosarcoma
what is the primary drug used in chemotherapy for hemangiosarcoma?
doxorubicin based chemotherapy protocols +/- metronomic cyclophosphamide (goal to achieve anti-angiogenesis)
hypofractionated (palliative) radiation therapy is used in what types of hemangiosarcoma?
cardiac, subcutaneous, & intramuscular hemangiosarcoma
what radiation therapy is used for metastatic disease?
whole lung/whole abdomen radiation therapy
what is the prognosis for splenic hemangiosarcoma with surgery alone?
extremely poor - 19-86 days
what is the prognosis for splenic hemangiosarcoma with surgery & chemotherapy?
5-7 months
T/F: stage is important in predicting survival in hemangiosarcoma
true
stage 1 - 239-355 days
stage 2 120-148 days
T/F: 1 year survival of hemangiosarcoma is less than 10%
true
what is the prognosis for primary renal hemangiosarcoma?
9 months
what is the prognosis for retroperitoneal hemangiosarcoma?
37.5 days
what is the prognosis of subcutaneous & intramuscular hemangiosarcoma?
surgery & chemo ~3 years for subcutaneous vs. 9 months for intramuscular
inoperable tumors treated with chemo alone may offer palliation
what is the prognosis for cardiac hemangiosarcoma when treated with surgery & chemotherapy?
175 days
T/F: a pericardiectomy is considered palliative & has no survival benefit
true
chemotherapy alone has a ___ objective response rate for ~4 months
41%
