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SA DX & TX I > Exam 1 - Paraneoplastic Syndromes & Cancer > Flashcards

Exam 1 - Paraneoplastic Syndromes & Cancer Flashcards

1
Q

what is paraneoplastic syndrome?

A

alteration in body structure and/or function that occur distant to the tumor

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2
Q

what may be the first sign of malignancy in cancer?

A

presence of paraneoplastic syndrome

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3
Q

paraneoplastic syndromes _______ underlying malignancy

A

parallels

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4
Q

what is paraneoplastic syndrome associated with?

A

noninvasive actions of the tumor

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5
Q

T/F: paraneoplastic syndrome can result in greater morbidity than the tumor itself

A

true

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6
Q

causes of paraneoplastic syndrome is variable, but is most commonly associated with what?

A

production of small molecules (ie, cytokines, hormones) that are released into circulation

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7
Q

T/F: paraneoplastic syndrome may be the first sign of malignancy & may be indicative of certain histology

A

true

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8
Q

how do you treat paraneoplastic syndrome?

A

you must address the primary tumor

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9
Q

what happens if you can’t treat the primary tumor in an animal with paraneoplastic syndrome?

A

supportive care may alleviate some of the clinical signs but complete control of the syndrome is highly unlikely & any improvement is usually short lived

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10
Q

what is cancer cachexia?

A

weight loss & metabolic abnormalities in cancer patients despite adequate nutritional intake

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11
Q

what is cancer anorexia?

A

alterations & abnormalities due to poor nutritional intake

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12
Q

when considering GI manifestations of cancer, what is likely to kill the animal before the primary tumor?

A

cancer cachexia/anorexia

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13
Q

how do you treat cancer cachexia?

A

treat the underlying disease, increase intake!!! calculate RER**, small frequent meals, calorie dense diet, & monitor the animal closely

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14
Q

how do you treat cancer anorexia?

A

treat underlying disease, nausea vs. inappetence (anti-emetics, gastroprotectants, & appetite stimulants), highly palatable (bland) diet, & feeding tube placement (sooner rather than later)

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15
Q

T/F: initially getting a cancer patient to eat something is better than them not eating anything

A

true - keep it bland & once eating again, try to transition to a more balanced diet

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16
Q

why should you consider feeding tube placement in cancer patients?

A

-why is the patient anorexia
-feeding tube likely to be short or long term
-is the patient likely to start eating again once the tumor is treated
-patient temperament
-medication administration

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17
Q

what is PLE as a GI manifestation of cancer?

A

serum proteins are lost into the gi tract leading to hypoproteinemia through either impaired synthesis or increased loss into the gi tract or urine

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18
Q

why is it important to remember that the half-life of serum proteins is long?

A

because it is long, the hypoproteinemia represents a long term protein loss

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19
Q

in PLE, the increase in mucosal serum protein permeability leads to what in the gi tract?

A

erosion, ulceration, & lymphatic obstruction

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20
Q

gastroduodenal ulceration is most commonly seen with what tumor? why?

A

canine mast cell tumors

excess production of histamine & stimulation of gastric acid production

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21
Q

what is a gastrinoma?

A

gastrin-secreting non-islet pancreatic tumor

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22
Q

what clinical signs are associated with gastrinomas?

A

lethargy, blood loss, vomiting, anorexia, & abdominal pain

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23
Q

how would you treat gastroduodenal ulceration as a result of a mast cell tumor?

A

treat underlying disease - MCT causing ulceration are often metastatic, large, & +/- visceral involvement

complete control may not be possible - palliative care

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24
Q

in a dog with a known mast cell tumor, presenting with vomiting, blood loos, & abdominal pain, why would you pick these medications?

A

animal likely has gastroduodenal ulceration as a result of the MCT - essentially palliative care to make the animal more comfortable

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25
Q

what is the most common cause of hypercalcemia in the dog?

A

cancer

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26
Q

hypercalcemia of malignancy is ___ of canine hypercalcemia cases & ___ of feline hypercalcemia cases

A

2/3 of canine
1/3 of feline

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27
Q

what is the most common lab abnormality seen with lymphoma?

A

hypercalcemia

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28
Q

what are some examples of other tumors that may cause hypercalcemia?

A

anal sac apocrine gland adenocarcinoma, thymoma, thyroid carcinoma

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29
Q

what is the most common mechanism of hypercalcemia seen in lymphoma & AGASACA?

A

ectopic production of parathyroid hormone or parathyroid related peptide (PTHrp)

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30
Q

extensive multifocal lytic bone metastasis is seen in what kind of cancer & causes what lab abnormality?

A

multiple myeloma & hypercalcemia

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31
Q

what are 4 examples of other causes of hypercalcemia?

A

-primary hyperparathyroidism
-tumor associated prostaglandins
-interleukin 1b
-transforming growth factor beta (TGF-b)

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32
Q

how is hypercalcemia diagnosed?

A

total serum calcium, ionized calcium, & hypercalcemia panel (michigan state)

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33
Q

T/F: when running diagnostics for hypercalcemia, you don’t have to account for serum albumin

A

true

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34
Q

what would you expect your results to be for a hypercalcemic patient in regards to, PTH, PTH-rp, serum Ca, & serum P?

A

PTH - LOW
PTH-rp - HIGH
serum ca - HIGH
serum P - LOW

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35
Q

why is hypercalcemia considered a medical emergency?

A

renal damage can occur & azotemia may or may not be reversible

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36
Q

what is the mechanism of PU/PD in a hypercalcemic patient?

A

initially occurs due to impaired action of ADH on the tubular cells of the collecting ducts - dehydration is common

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37
Q

what renal damage can occur in hypercalcemic patients?

A

renal vasoconstriction

mineralization of the renal tubules, basement membrane, or interstitium

tubular degeneration or necrosis

interstitial fibrosis

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38
Q

what should your treatment plan focus on in a patient with hypercalcemia?

A

treat the hypercalcemia while trying to make the diagnosis!!!! focus on supporting the kidneys

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39
Q

in a patient with hypercalcemia, what should your treatment plan avoid?

A

treatments that would negatively impact your ability to make a diagnosis (corticosteroids) & anything that would hurt the kidneys (no lasix- would further dehydrate)

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40
Q

your symptomatic treatment for hypercalcemia should address what?

A

promote the loss of calcium

increase renal excretion

inhibit bone reabsorption

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41
Q

where do you start with a hypercalcemic patient?

A

aggressive iv fluid diuresis (saline), no furosemide, supportive meds (anti-emetics, appetite stimulants, gastric protectants)

42
Q

if your patient has lymphoma & is hypercalcemic, what does your treatment plan start with?

A

injection of dex sp, switch to oral pred once eating, & start chemo

43
Q

if your patient has AGASACA & is hypercalcemic, where do you start in your treatment plan? what is your goal?

A

avoid a steroid!!
if more than IV fluids are required, administer bisphosphonates

make patient a surgical candidate

44
Q

what is the most common cancer that causes hypoglycemia?

A

insulinoma

45
Q

what is a pathognomonic finding in a suspect case of insulinoma?

A

hypoglycemia associated with high insulin levels

46
Q

with hypoglycemia as an endocrinologic manifestation of cancer, what are common characteristics of the primary tumor?

A

usually very large, increased use by the tumor, decreased hepatic glycogenolysis/gluconeogenesis, & secretion of insulin, IGF-1, or IGF-2

47
Q

how do you treat hypoglycemia as a manifestation of cancer?

A

emergency!!! can cause hypoglycemic seizures!!

iv catheter & dextrose bolus (0.5ml/kg of 50% dextrose diluted 1:1 with an isotonic crystalloid)

dextrose CRI only if needed (2.5-5%)

treat the patient, not the numbers

48
Q

what is the primary choice when treating an insulinoma?

A

surgical removal - get the nodule out

49
Q

how does prednisone work when used for insulinoma treatment?

A

insulin antagonizing, gluconeogenic, & glycogenolytic

50
Q

how does diazoxide work in treating insulinomas?

A

suppresses insulin release from beta cells, stimulates hepatic gluconeogenesis & glycogenolysis, & inhibits cellular uptake of glucose

51
Q

how does octreotide work in treating insulinomas?

A

somatostatin receptor ligand, & inhibits synthesis & secretion of insulin

52
Q

how does streptozocin work in treating insulinomas?

A

chemo that destroys pancreatic beta cells

53
Q

how does palladia work in treating insulinomas?

A

tyrosine kinase inhibitor

54
Q

hypergammaglobulinemia is an example of what kind of manifestation of cancer?

A

hematological

55
Q

what are monoclonal gammopathies?

A

excessive production of proteins from a monoclonal line of immunoglobulin producing plasma cells or lymphocytes

56
Q

what kinds of cancer can have monoclonal gammopathies?

A

plasma cell tumors mostly

sometimes lymphoma/leukemia - b cell if so

57
Q

if an animal with hyperviscosity of their blood due to a monoclonal gammopathy is in your clinic, what clinical signs would you expect to see?

A

ataxia, dementia, depression, heart disease, heart failure, seizures, & coma

58
Q

cats with hyperviscosity due to a monoclonal gammopathy commonly have heart failure why?

A

heart is working so hard to pump the thick blood

59
Q

if an animal with tissue hypoxia & bleeding due to a monoclonal gammopathy is in your clinic, what clinical signs would you expect to see?

A

poor platelet aggregation, platelets coated in immunoglobulins, & release of platelet factor III

60
Q

if an animal with ocular disorders due to a monoclonal gammopathy is in your clinic, what clinical signs would you expect to see?

A

retinal hemorrhage or detachment (increased ocular pressure)

61
Q

what diagnostic test would you run if you suspect hypergammaglobulinemia?

A

protein electrophoresis

62
Q

what does this result represent?

A

monoclonal protein electrophoresis

63
Q

what does this result represent?

A

polyclonal protein electrophoresis - chronic inflammatory granular issues!!!

64
Q

why may you see anemia as a hematological manifestation of cancer?

A

disordered iron storage & metabolism, shortened life span of RBC,& decreased bone marrow response

65
Q

if a cancer patient presents with IMHA, what should you do?

A

when possible, treat the primary tumor

surgical removal

start immunosuppressive therapy

66
Q

______ ____ anemia & __________ may also be hematological manifestations of cancer

A

blood loss

myelophthisis

67
Q

what tumor types can cause erythrocytosis?

A

renal tumors, lymphoma, lung tumors, liver tumors, cecal leiomyosarcoma, nasal fibrosarcoma, & TVT

68
Q

what are 3 causes of erythrocytosis?

A

overproduction of erythropoietin

erythropoietin from renal hypoxia

increased production of HIF-1

69
Q

T/F: it is important to differentiate primary from secondary erythrocytosis

A

true

70
Q

what tumor types commonly cause neutrophilic leukocytosis? typical cell lines involved?

A

lymphoma, renal tumors, primary lung tumors, rectal polyps, & metastatic fibrosarcoma

G-CSF or GM-CSF

71
Q

in a cancer patient with neutrophilic leukocytosis, do their neutrophils work?

A

function varies - unlikely because it’s disordered

72
Q

what hematological manifestation of cancer is reported to occur in up to 36% of cancer patients prior to starting chemo?

A

thrombocytopenia

73
Q

what are the causes of thrombocytopenia?

A

platelet destruction, platelet sequestration, consumption, decreased production, & ITP

74
Q

what is the most common cause of hypocoagulability in cancer patients?

A

thrombocytopenia & platelet dysfunction

75
Q

what is the most common mechanism of hypocoagulability in cancer patients?

A

release of heparin by MCT which inactivate clotting factors XI, X, & IX

76
Q

which is more common in cancer patients, hypocoagulability or hypercoagulability?

A

hypercoagulability

77
Q

what is the incidence of DIC in dogs with malignant neoplasia? what were the tumor types involved?

A

~10%

hemangiosarcoma, inflammatory mammary carcinoma, thyroid carcinoma, intra-abdominal tumors, & primary lung tumors

78
Q

what is shinny skin syndrome in cats a result of?

A

progressive, non-scarring, acute, bilateral, symmetrical (ventrum & limbs), & glistening skin & hair easily epilates (severe follicular atrophy)

79
Q

what type of cancer is has shinny skin syndrome as a result?

A

pancreatic carcinoma in cats

80
Q

what are the clinical signs of thymoma in cats?

A

nonpruritic scaling & mild erythema on the head & pinnae, & progressively involves the neck, trunk, & limbs

81
Q

pancreatic carcinoma in cats results in what kind of clinical manifestation?

A

cutaneous - alopecia

82
Q

how is thymoma treated?

A

most cats don’t undergo treatment - typically sx removal of the thymoma results in the resolution of skin lesions

83
Q

thymoma in cats has a cutaneous manifestation of what?

A

exfoliative dermatitis

84
Q

what is nodular dermatofibrosis?

A

slowly growing cutaneous nodules associated with bilateral renal cystadenocarcinoma - well differentiated in collagen tissue

85
Q

where is nodular dermatofibrosis most commonly found? what breed is predisposed?

A

limbs

german shepherds - autosomal dominance, mutation in birt-hogg-dude locus

86
Q

superficial necrolytic dermatitis is commonly associated with what tumor type?

A

glucagonoma

87
Q

what is a glucagonoma?

A

glucagon secreting tumors of pancreas or liver - hepatic disease (hepatocutaneous syndrome) & diabetes mellitus

88
Q

what is superficial necrolytic dermatitis?

A

erosive blistering & ulceration

89
Q

what major clinical sign is seen on the foot pads of animals affected with superficial necrolytic dermatitis?

A

fissuring, ulceration, & crusting of the foot pads

90
Q

what clinical signs are seen with animals that have superficial necrolytic dermatitis?

A

erosions & ulcerations with alopecia, exudation & adherent crusts (feet, pressure points, flank, perineal area, muzzle, mucocutaneous junctions, & oral cavity)

91
Q

myasthenia gravis is most commonly seen in dogs with what tumor type?

A

thymoma!!

92
Q

does myasthenia gravis associated with thymoma carry a better or worse prognosis? why?

A

worse - animals typically get megaesophagus +/- aspiration pneumonia

93
Q

hypertrophic osteopathy is most commonly seen with what kind of tumors?

A

primary lung tumors - metastatic osteosarcoma

94
Q

what is hypertrophic osteodystrophy?

A

periosteal proliferation along the shafts of the long bones in response to malignant or non-malignant disease

95
Q

what are the clinical signs of hypertrophic osteodystrophy?

A

shifting lameness, difficulty ambulating, ocular discharge & episcleral injection, pyrexia, lethargy, decreased appetite, heat, pain, & swelling on palpation of limbs

96
Q

what is the treatment for hypertrophic osteodystrophy?

A

removal of primary tumor if possible, NSAIDS, steroids, bisphosphonates, & euthanasia

97
Q

what is this condition known as?

A

hypertrophic osteodystrophy

98
Q

what is this? what tumor is it associated with?

A

superficial necrolytic dermatitis

glucagonomas

99
Q

this is associated with bilateral renal cystadenocarcinomas, what is it?

A

nodular dermatofibrosis

100
Q

what is this?

A

renal cystadenocarcinoma

101
Q

what tumor is this condition associated with?

A

pancreatic carcinomas in cats

102
Q

this skin lesion is commonly seen with thymomas in cats - what is it?

A

exfoliative dermatitis

SA DX & TX I (59 decks)

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