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Small Animal Med > Exam 2 Spring > Flashcards

Exam 2 Spring Flashcards

1
Q

What is cancer?

A

o Rapidly growing due to Oncogene/tumor supresssor gene mutations

OR

o Not dying appropriately due to apoptosis resistance

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2
Q

Stem Cell Theory of Cancer

A

o Tumors contain a small subset of pluripotential stem cells capable of indefinite self-renewal
o Most tumor cells are actively dividing, differentiating, & have a defined life-span
o Stem cells are the sustaining population

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3
Q

Malignant Transformation

A

o Mutation in DNA or epigenetic change ->
o alter the genetic code of a somatic cell ->
o limitless replicative potential or another growth or survival advantage
o Initiation, Promotion, Progression

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4
Q

Aberrant Differentiation

A

o Activation of oncogenes

o Inactivation of tumor suppressor genes

o Altered repair capacity of DNA

o Defective apoptosis

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5
Q

Benign Vs Malignant

A

Benign
 Well differentiated, organized like tissue of
 Defined, can be encapsulated
 Rare mitosis
 Slow growth
 No metastasis
 Can have Local compression, hormone production, disfigurement

Malignant
 Undifferentiated, cells lack organization (can be unrecognizable)
 Poorly defined, invasive
 Common mitosis
 Fast growth
 Common metastasis
 Can have Local compression, hormone production, disfigurement

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6
Q

Names for Benign & Malignant Tumor Types

A

Epithelial (glandular)
 Benign – adenoma
 Malignant – Adenocarcinoma

Epithelial (surface)
 Benign - Polyp, epithelioma, pappilloma
 Malignant – carcinoma

Connective Tissue
 Benign – tissue type + oma
 Malignant - tissue type + sarcoma

Hemolymphatic
 Benign – none
 Malignant - Leukemia and Lymphoma/lymphosarcoma

Mixed
 Benign – teratoma
 Malignant - Teratocarcinoma; Teratosarcoma

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7
Q

Sexual Predispositions for Cancer

A

Male Dogs
 Benign perianal adenomas (Intact),
 testicular tumors (Intact),
 prostate (Castrate
 Osteosarcoma

Female Cats & Dogs
 Ovarian,
 uterine,
 vaginal,
 mammary

Female Dogs
 Uroepithelial carcinoma

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8
Q

Criteria for Malignancy

A

o Anisokaryosis
o Anisocytosis
o Multiple , irregular , large nucleoli
o Mitotic figures
o Altered/variable N:C ratio

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9
Q

3 Basic Cell Types & their Cancer

A

Round
 Lymphosarcoma,
 Mast cell,
 Transmissible vanereal tumor
 some Melanomas,
 Histiocytic sarcomas

Mesenchymal
 Soft tissue sarcomas,
 Osteosarcoma,
 hemangiosarcomas

Epithelial
 Adenomas,
 carcinomas,
 adenocarcinomas

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10
Q

Cytologic Characteristics of Epithelial Cells

A

o City dwellers
o exfoliate in clumps
o cell-to-cell attachments
o cell walls visible

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11
Q

Cytologic Characteristics of Round Cells

A

o Free spirits
o exfoliate singly
o cell walls easily visible
o round cells with round nuclei

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12
Q

Cytologic Characteristics of Mesenchymal Cells

A

o Small town types
o Exfoliate poorly
o cell borders indistinct
o cells elongated and
o spindle-shaped
o nucleus elongated

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13
Q

Incisional Vs Excisional Biopsy

A

Incisional
 removal of a small portion of the tumor
 Important when treatment would be altered by knowing tumor type or other characteristics

Excisional
 Removal of entire tumor in one procedure

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14
Q

Metastasis Cascade

A

o Cell detachment and vascular invasion ->
o Transport and survival in the circulation (evasion of host defence mechanisms) ->
o Aggregation with platelets and fibrin and arrest at new location ->
o Extravasation into the surrounding parenchyma ->
o Establishment of a new growth

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15
Q

Routes of Metastasis

A

Lymphatic
 Carcinomas (city dwellers) via lymphatics
 perianal gland carcinomas spread to sublumbar nodes
 Can still go to lung

Hematogenous
 Sarcomas (small town types) via blood
 osteosarcoma to lung
 hemangiosarcoma to liver
 Lymph node involvment tends be to very poor prognosis

Both
 round cell tumors (free spirits)
 lymphoma, mast cell tumors, histiocytic tumors

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16
Q

Grade of a Tumor

A

o Degree of differentiation
o Percent necrosis
o invasiveness
o Mitotic index
o Results on a small piece aren‘t always the same as the whole tumor

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17
Q

Mitotic Index

A

o Generally expressed as the number of mitosis/10 high power fields
o 3 for melanomas
o 5-7 for mast cell tumors
o 20 for soft tissue sarcomas

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18
Q

Steps to Staging a Tumor

A

o Tumor, Lymph Nodes, Metastasis
o Aids in prognostication
o Aids in treatment planning
o Aids in evaluation of treatment results

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19
Q

Imaging Tumors

A

Radiographs
 always a good first step
 can be diagnostic

Ultrasound
 best for soft tissue masses
 can be used for finding LNs
 best for directing biopsies

CT scan
 best for boney masses
 best for screening for metastasis

MR
 extremely good detail
 but best for local soft tissue exams

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20
Q

Cancer Cachexia; Basics, Treatment

A

o Profound state of malnutrition and weight loss despite adequate nutrition
o Not common in vet med
o Due to cancer using glucose for energy

Treatment
 Controversial
 Very low carb diet

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21
Q

Paraneoplastic Hypercalcemia; Tumor Types, Mechanisms, Clinical Signs, Treatment

A

Tumors
 Lymphosarcoma
 Anal sac tumors
 Multiple myeloma
 Many more

Mechanisms
 PTHrp production
 PTH production
 Vit D production
 Osteoclast activity
 Bone lysis

Clinical Signs
 Anorexia
 PU/PD
 Vomiting
 Muscle weakness

Treatment
 0.9% NaCl diuresis
 Furosemide
 Glucocorticoids (only if diagnosis)
 Bisphosphonates

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22
Q

Paraneoplastic Hypoglycemia; Tumor Types, Clinical Signs, Treatment

A

Tumors
 Insulinoma
 Hepatic tumors
 Leiomyoma / Leiomyosarcoma
 more

Clinical Signs
 Weakness
 Tremors
 Seizures

Treatment
 Feed frequently - high protein better than high carbohydrate
 Glucose solutions IV or orally (only in emergency, feeding better)
 Glucocorticiods (increase hepatic gluconeogenesis)
 Diazoxide
 Hydrochlorthiazide
 Propanalol
 Somatostatin

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23
Q

Bisphosphonates

A

o Inhibit bone resorption by binding to hydroxyapatite crystals ->
o inhibit calcium and phosphorus dissolution
o Causes apoptosis of osteoclasts
o Depository effect on bone reabsorption

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24
Q

Treatment of insulinoma

A

 Remove tumor

Streptozotocin
 nephrotoxic
 can induce diabetes

Toceranib
 worth a try

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25
Q

Paraneoplastic Polycythemia; Tumor Types, Clinical Signs, Treatment

A

Tumor
 Renal cell tumors
 Lymphosarcoma
 Hepatic tumors
 Nasal fibrosarcoma

Clinical Signs
 motor or sensory depression, dullness, lethargy, seizures
 Epistaxis
 hyphema

Treatment
 Phlebotomy
 Remove or treat primary tumor
 Hydroxyurea

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26
Q

Paraneoplastic Hypertrophic Osteopathy; Tumor Types, Clinical Signs, Treatment

A

Tumor
 large thoracic or abdominal cavity mass

Clinical Signs
 Pain, reluctance to move
 “swollen legsor swollen joints”
 Periosteal proliferation of new bone along the shafts of long bones

Treatment
 Treat or remove primary tumor
 Corticosteroids
 NSAIDS
 Bisphosphonates
 Vagotomy

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27
Q

Region of Body Connected to Which Lymph Nodes

A

prescapular node
 Front leg

popliteal node
 Hind leg below knee

inguinal node
 Hind leg above knee
 ventral abdomen

sublumbar (intenal iliac) nodes
 Anal
 perianal area

hilar nodes
 Lungs

sternal node
 Abdomen

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28
Q

Reasons to Do Abdominal Ultrasound or CT in Cancer Patient

A

o Intra-abdominal masses or organ infiltration

Tumors on caudal half of body w/ tendency to metastasize via lymph
 MCT, perianal gland tumors, mammary tumors

Tumors w/ high propensity for vascular or lymphatic metastasis
 spleen and liver
 grade III MCT, histiocytic tumors, lymphoma, hemangiosarcoma

o Unknown primary

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29
Q

When to Sample Spleen & Liver in Cancer Patients

A

Spleen
 Mast cell tumor
 Histiocytic Sarcomas
 lymphoma

Liver
 Mast cell tumor
 lymphoma
 MSA in cats

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30
Q

Hypergammaglobulinemia & Cancer; Clinical Signs, Tumors, Diagnosis

A

Clinical Signs
 PU/PD
 Neuro signs
 Bleeding

Tumors
 Plasma cell
 LSA/leukemia

Diagnosis
 Monoclonal gammopathy
 Protein electrophoresis
 Bence-jones proteinuria

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31
Q

Myasthenia gravis & Cancer; Tumor, Diagnosis

A

Tumor
 thymoma

Diagnosis
 Anti Ach receptor antibody test

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32
Q

Chemo Related Neuro Toxicity

A

5 Flurouracil
 seizures and death

Vincristine
 peripheral neuropathy

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33
Q

Derm Issues & Cancer; Neoplasias that cause flushing, nodular dermatofribrosis, alopecia, shiny skin

A

Cutaneous flushing
 Pheochromocytoma
 Mast cell tumors

Nodular dermatofibrosis in German Shepherd dogs
 Linked to renal cysts or cystadenocarcinomas

Alopecia
 Pancreatic carcinoma in cats
 thymoma

Shiny skin in cats
 Pancreas tumors

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34
Q

Key Points & Limitations of Surgery for Cancer Treatment

A

o Benign & malignant tumors recur if incompletely excised
o Surgery alters vascularity, immune system, and tissue planes which allows recurring tumors to be more
o Second surgery is not a replacement for good first surgery

Limitations
 not useful if tumor has or will metastasize
 Cosmesis and functionality, removed tissue must be expendable

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35
Q

Radiation Treatment for Cancer; Basics, Limitations

A

o Deposition of energy on or near DNA
o Direct and indirect actions
o Breakage of DNA
o Cells die when they try to divide
o Kills a constant proportion of cells
o Damages normal and cancer cells

Limitations
 Must be Local disease
 Surrounding normal tissue must tolerate radiation
 Radiation sensitive tumor type
 Anesthesia requirements

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36
Q

4 R’s of Radiation Therapy

A

Repair
* Normal cells will repair their DNA ~6hrs after radiation

Repopulation
* Normal cells tell neighbors to start divide
* “wound healing”

Re-oxygenation
* Need oxygenation up front but re-oxygenation probably doesn’t happen

Redistribution
* Those in mitosis are more sensitive
* Cells not in mitosis withstand radiation better

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37
Q

Goal of Fractionation

A

 Time period which allows reoxygen and redistribution in tumor, & repopulation and repair in normal cells
 Large total dose (tumor control)
 Small fraction (less late effects)

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38
Q

Superficial Vs Deep Radiation

A

Superficial
* Use electrons

Deep
* Use photons

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39
Q

Acute Clinical Effects of Radiation

A

 Hair loss
 Moist dermatitis
 Mucositis (conjunctiva, oral cavity, nasal passages)
 Intestine or bladder inflammation
 Nervous tissue inflammation/edema
 Crusting, oozing skin

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40
Q

Stereotactic Radiation

A

o A few very large doses of radiation versus many small ones
o May kill cells not rapidly dividing better than traditional therapy.
o May damage blood supply almost more than tumor
o Can only be done if dose is very closely conformed to the tumor

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41
Q

Chemo; Mechanism

A

 Only therapy for systemic or metastatic dz
 Act on rapidly dividing cell populations by interfering w/ DNA synthesis or cell division
 Variety of drugs with a variety of mechanisms
 Works via log kinetics
 kills a constant proportion of cells with each dose
 Highly non-specific
 exploits a macro difference in cells (rapid growth)
 Randomly developed

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42
Q

Chemo; Drugs

A

Alkylating Agents
* Chlorambucil,
* Cyclophosphamide,
* Lomustine,
* Melphalan

Antimetabolites

Antitumor Antibiotics
* Bleomycin,
* Doxorubicin
* Mitoxantrone,

Spindle Cell Poisons
* Vinblastine
* Vincristine
* Vinorelobine
* Taxols

Platinum drugs
* Carboplatin
* Cisplatin

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43
Q

Chemo; Limitations

A

 Multiple drug resistance develops over time due to cell mutation or inherent characteristics
 Drug delivery/drug getting to tumor
 Side effects to Bone marrow, Alopecia/ Hair loss, Allergic reactions, GI

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44
Q

Chemo Drugs & Which Negatively Affects Kidneys, heart, bladder, pancreas, nervous, hepatic, lungs

A

Kidney
* Cisplatin,
* Doxorubicin (cat),
* Lomustine

Heart
* Doxorubicin

Bladder
* Cyclophosphamide

Pancreas
* Elspar
* Doxorubicin

Nervous System
* Vincristine
* 5 FU (especially cats)

Hepatic
* Lomustine

Lungs
* Cisplatin (cat),
* Bleomycin,
* Lomustine,
* Tanovea

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45
Q

Advantages of Multiple Chemo Drug Therapies

A

o single drugs are unlikely to cure bulky disease
o multiple drugs may help fight development of resistance
o toxicity may be less with low doses of multiple drugs versus large doses of single drugs

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46
Q

Primary Use of Chemo Vs Adjuvent Use

A

Primary
 Only curative for germ cell tumors, lymphoma, venereal tumors

Adjuvent
 Chemo combined with something else to reduce tumor burden.
 Important when tumor is not rapidly growing or sensitive to drugs
 Greatest chance for cure is shortly after surgery

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47
Q

Chemo Administration

A

o Quick IV
OR
o Slow Infusion to decrease cardiac toxicity
o Severe tissue reaction if extravasated
o Catheter wrapped so that vein is clearly visible

48
Q

Cryotherapy, Thermodynamic Therapy, & Electrochemotherapy

A

Cryotherapy
 Only successful when tumor is small and superficial

Photodynamic Therapy
 Combination of a photosenzitizing agent and light
 Superficial tumors only (limited by diffusion of light)

Electrochemotherapy
 traditional chemotherapy drugs (commonly Bleomycin)
 PLUS pulsed electricity to facilitate drug uptake

49
Q

Signal Transduction in Cancers

A

o Mutated signal proteins often oncogenic
o Increased potential for proliferation, invasion, metastasis
o Increased angiogenesis
o Shortened survival of patients
o Poor response to standard chemotherapy
o Poor prognosis

50
Q

Receptor Tyrosine Kinases (RTKs); What are they, How do they Cause Cancer

A

o main mediators of the signaling network that transmit extracellular signals into the cell
o control cellular differentiation and proliferation

How do they cause cancer
 Overexpression of RTK proteins
 Functional alterations caused by mutations in the corresponding genes -> Gain of function
 Abnormal stimulation by autocrine growth factor loops -> Increased stimulation

51
Q

RTK Inhibitors; Mechanism, Drugs

A

Mechanism
 Block signalling
 Must be used for life or signal starts again

Drugs
 Toceranib phosphate (Best)
 Masitinib (not available in US)
 Significant GI and potential bone marrow suppression from both

52
Q

Targeting Tumor Blood Supply; 2 Strategies

A

o Most effective in prevention of metastasis or regrowth

Vascular disrupting agents (VDAs)
 Given only intermittently
 designed to induce rapid and selective vascular shutdown in tumors

Suppression of endothelial cell growth and recruitment from bone marrow
 given continously
 Most useful when tumor burden is low

53
Q

Targeting Tumor Blood Supply; Drugs

A

Small molecules that exploit differences between tumor & normal endothelium to induce severe vascular dysfunction
* Toceranib**
* Thalidomide

Metronomic Chemo
* Low dose daily dosing of traditional drugs
* Theory- stop endothelial cells from multiplying in, and homing to neoplastic tissues

54
Q

Metronomic Chemo; Drugs

A

Chlorambucil
* Urothelial carcinomas
* MCT, STS, Thyroid

Cyclophosphamide
* soft tissue sarcomas
* inflammatory immune response as well as anti-angiogenisis

Lomustine
* Don’t use
* renal and hepatic toxicty

Satraplatin (oral platinum agent)

55
Q

Active Nonspecific Vs Active Specific Vs Passive Immunotherapy

A

Active Nonspecific
 Bacteria, cell components, or chemical agents
 Increase immune system generally

Active Specific
 Genetically engineered antigen source designed to stimulate an immune response against an established tumor
 Tumor vaccine to activate T-cells

Passive
 Monoclonal antibodies specific for tumor
 None work in vet med so far

56
Q

Immune Therapy to Target T-Regulatory Cells

A

o Destroy immunosuppressive environment around the tumor
o Metronomic chemo
o Cimetidine

57
Q

Targeted Gene Therapy for Cancer

A

o Correct the genetics of the tumor
o Stimulate cytokine production
o Limited by transduction efficiency (ability to get into cell)

58
Q

Cox-2 Inhibitors & Cancer

A

o Many tumors have up-regulation of Cox-2
o Especially carcinomas
o Meloxicam easiest for cats
o Selective Cox-2 might be better than general (Firocoxib)

59
Q

Canine Lymphosarcoma; Basics, How to Diagnose/Phenotype

A

o One of the most common cancers seen in the dog
o Can occur in any organ in the body
o Majority are B cell in origin
o Extremely sensitive to chemotherapy but usually not curable
o 85-90 % will achieve remission with chemotherapy
o Average survival is ~ 1 year
o May cure more patients if we allowed more side effects

Diagnosis & Phenotyping
 Flow cytometry (best but difficult)
 Immunocytochemistry
 PARR assay
 Histopathology
 Immunohistochemistry

60
Q

Canine Lymphosarcoma; Staging

A

 I- Single node (or organ)
 II- Group of nodes on one side of diaphragm
 III- Generalized lymph node involvement
 IV- Spleen or liver involvement
 V- Bone Marrow, CNS, or other organs

Sub-stages
 a- no symptoms
 b- symptoms / sick

61
Q

Canine Lymphosarcoma; Factors associated with poorer prognosis

A

 Substage b
 Stage greater than III
 T-cell
 Hypercalcemia
 Icterus
 Hypoproteinemia
 Prior prolonged treatment with glucocorticoids

62
Q

Canine Lymphosarcoma; Survival / Duration of first remission Dependent on Therapy

A

No therapy
* ~1mo

Prednisone
* ~2mo

Cyclophosphamide, Vincristine, & Prednisone (COP)
* ~4-6mo

Elspar + COP
* 4-6mo

COP + Doxorubicin +/- Elspar (Madison Wisconsin Protocol)
* ~8-9mo

63
Q

Canine Lymphosarcoma; Other Treatment Options

A

Surgery
* Only if we are sure it is a single node / organ

Radiation therapy
* Selected locations, particularly nasal LSA in cats (careful staging)
* Half body radiation therapy
* Whole body radiation therapy and bone marrow transplantation

64
Q

Feline Lymphosarcoma; Treatment of High Grade

A

 COP +/- Elspar (intermediate grade)
 Madison Wisconsin 6 month protocol (internal forms)
 Single node or nasal radiation therapy useful but be sure the cat has stage I disease only
 More side effects than in dogs

65
Q

Feline Lymphosarcoma; Survival/Remission & Treatment

A

No treatment
* 1-2 months

With chemotherapy
* 3-8 months

Nasal LSA
* 18-24mo

Stage V (CNS or bone marrow)
* Poor prognosis

FeLV (+)
* 6 mo

66
Q

Leukemia; Clinical Signs

A

 Weakness/ depression/ lethargy / anorexia
 Fever
 Bleeding
 hypercalcemia
 lymphadenopathy,
 splenomegaly
 neurologic signs
 ocular signs- uveitis or hyphema
 bone pain, lameness, joint swelling

67
Q

Leukemia; Diagnosis

A

 Flow cytometry of blood or anticoagulated bone marrow
 Bone marrow exam

Acute
* Presence of blasts and very high numbers (100,000- 800,000)
* May require cytochemical stains or flow cytometry to determine cell origin

Chronic
* Over abundance of one mature cell type in high numbers (>30,000)
* Most commonly lymphocytic

Aleukemic
* anemia, thrombocytopenia, or pancytopenias

68
Q

Leukemia; Therapy

A

Acute Lymphocytic Leukemia
* more aggressive treatment than solid forms
* Anthracycline and Elspar +/- Cytosar

Acute Non-Lymphocytic Leukemia
* Prognosis is extremely poor
* Combinations of cytosine arabinoside and an anthracycline ASAP
* lots of support!

Chronic Lymphocytic leukemia
* Chlorambucil (2-6 mg/m2) every other day alternating with prednisone
* Survivals can be quite long-1-3 years

69
Q

Plasma Cell Tumors Vs Multiple Myeloma

A

Plasma cell tumors
 localized and benign
 skin, oral cavity, GI tract, anywhere
 local surgery, radiation or electrochemotherapy
 Need to rule out systemic disease

Multiple myeloma
 metastatic plasma cell tumors
 Presents as punched out bone lesions (diagnosed via aspirate of BM or lesion)
 Hypergammaglobulinemia
 Treat systemically w/ Melphalan and Prednisone
 Can have very long survivals if managed properly (1.5 years)

70
Q

Mast Cell Tumors; Clinical Signs, Diagnosis

A

Clinical Signs
 Can look like anything
 Often present w/ flushing & swelling (Darier’s sign)
 Dogs w/ external skin masses
 Cats w/ systemic signs or skin masses
 GI ulceration
 impaired healing locally
 coagulopathy
 hypotensive shock- rare
 urticaria
 eosinophilia, basophilia

Diagnosis
 Cytology w/ round granular cells
 Histo required for grading

71
Q

Mast Cell Tumors; Grades & Stages

A

 No grades for SQ but usually less aggressive

Grade 1
* Well differentiated
* superficial
* Prognosis nearly always good
* Stage w/ Lymph node check, CBC, Chem

Grade 2
* Well to medium differentiation
* SQ involvement
* Variable prognosis
* Stage w/ Lymph node check, CBC/Chem, ultrasound, spleen/liver aspirate

Grade 3
* Poorly differentiated
* Prognosis nearly always very poor
* Stage w/ Lymph node check, CBC/Chem, ultrasound, spleen/liver aspirate, bone marrow aspirate

<5 mitotic index
* less likely to recur or metastasize

> 5 mitotic index
* More likely to recur or metastasize

72
Q

Mast Cell Tumors; Therapy Based on Stage & Grade

A

Low grade and stage & surgically approachable
* should be treated with surgery
* 3cm margins is best.

Low grade and stage but not surgically removable
* Electrochemotherapy
* Radiation therapy- but the tumor needs to be dividing for this to work

Intermediate grade
* usually treatable as local disease
* if metastases are found or mitotic index is high -> chemotherapy

High grade regardless of stage
* chemotherapy as part of therapy.

73
Q

Mast Cell Tumors; Symptomatic Therapy

A

H1 blocker
* diphenhydramine
* Prevent bronchoconstriction, vasodilation

H2 blocker
* cimetidine, ranitidine, famotidine
* omeprazole
* Prevent gastric ulceration

Corticosteroid
* Prednisone
* Decrease immune reaction to histamine

74
Q

Mast Cell Tumors; Chemo

A

 Vinblastine, Lomustine, prednisone (WSU)

Toceranib
* Decent response
* Long-term
* Toxicity

Tigalate injection
* Causes major local inflammatory reaction to blast hole into skin and destroy tumor

75
Q

Feline Mast Cell Tumors; Basics, Treatment

A

o Can be on skin (less common)
o Splenic/Visceral
o Gastrointestinal
o Often present for vomiting
o Mass in abdomen, aspirate yields mast cells (3rd most common intestinal mass in cats)
o Often circulating mast cells in blood (Buffy coat smear or on CBC)

Treatment
 Corticosteroids, H1 and H2 blockers
 Remove tumor- spleen or intestine
 Splenic form- stop therapy after surgery (longer survival than GI)
 Intestinal form may require therapy for life

76
Q

Histiocytic Sarcomas; Cell Type, Clinical Signs, Diagnosis, Treatment

A

o Round Cell Tumors
o macrophages or dendritic antigen presenting cells

Clinical Signs
 Masses often associated with muscle groups or joints but can be anywhere
 Quite painful

Diagnosis
 May require IHC stain
 Granular, round, multinucleated cell on cytology

Treatment
 Surgery if removable with minimal morbidity and no metastatic disease found
 Radiation therapy (palliative protocol)
 Chemotherapy with Lomustine as follow up to local control or as only therapy

77
Q

Histiocytomas

A

o Langerhans cell proliferation
o Presents for dermal nodule in a young dog, often on extremities.
o Spontaneously regress or removal curative

78
Q

Histiocytic Sarcomas – Hemophagocytic Form

A

o Malignant Histiocytosis
o Most likely phagocytic macrophages
o Most common in Bernese Mountain dog, but can occur in other breeds
o Present for severe anemia
o Coombs’s negative
o No effective treatment at this time

79
Q

Soft Tissue Sarcoma; Basics, Biologic Behavior, Diagnosis, Staging

A

o Arise from supportive tissue
o Grade maybe more important than type

Biologic Behavior
 Locally aggressive, invasive, poorly defined margins
 Slow to metastasize
 Spread to lungs more than LN’s
 Mitotic index may be most important prognostic indicator
 10-19 grade II
 >20 is grade III

Diagnosis
 Cytology (suggestive)
 Incisional or excisional biopsy (definitive)

Staging
 Tumor measurement w/ US, CT, MR
 Lymph nodes
 Thoracic rads for metastasis

80
Q

Soft Tissue Sarcoma; Treatment

A

Surgery
* 3cm margins in all directions
* Submit all tissue for histo

Radiation
* Best for minimal disease or incomplete surgical margins
* Gross tumor requires higher total dose or coarse fractioned therapy (more dose each fraction)
* High dose difficult to achieve in some locations

Chemo
* Doxorubicin
* VAC (Vincristine, Doxorubicin, Cyclophosphamide)
* Doxorubicin and DTIC

Metronomic Chemo
* Low dose cyclophosphamide or chlorambucil plus NSAID

81
Q

Soft Tissue Sarcoma; Grades & Treatment Options

A

Low grade tumor
* Surgery alone can be curative (done properly!)
* Surgery with follow-up radiation or metronomic chemo when margins not adequate

High grade tumors
* High potential for metastasis (at least 40%)
* Surgery +/- radiation +/- chemo

Non-resectable tumors
* Palliative radiation + metronomic therapy?

82
Q

Feline Soft Tissue Sarcomas; Rule of 1-2-3, Biologic Behavior, Staging, Prevention

A

o Associated w/ vaccines

Rule of 1-2-3
 remove a mass at a vaccine site when…
 1 - Still growing at 1 month
 2 - Greater than 2 cm in size
 3 - Still present at 3 months post vaccination

Biological Behavior
 Locally extremely aggressive
 10-25%metastasize

Staging
 Tumor needs to be measure w/ MR

Prevention
 Never use killed virus vaccines in a cat which has had a VAS (including family members)
 Vaccinate low on limbs or over abdominal fat to facilitate tumor removal
 Always record where vaccine was given and lot number- Drug companies will pay for therapy.
 Remove any thing suspicious promptly with margins

83
Q

Feline Soft Tissue Sarcomas; Treatment Options

A

Surgery
* be careful, plan well, remove with margins the first time!
* 5 cm or 2 facial planes required for cure
* If the first surgery leaves dirty margins the cat may have no hope for long term tumor control!

Radiation
* Most helpful pre or post surgery as adjuvant therapy when margins are clean but < 5 cm.
* Radiation of gross disease or dirty margins use palliative protocols

Chemo
* May help shrink tumor (not much evidence)

84
Q

Primary Bone Tumors; SIgnalment, Clinical SIgns, Diagnosis

A

Signalment
 mid to older aged dogs, also peak at 18-24 months
 Large / giant breeds
 males > females
 neutered > intact

Clinical Signs
 Lameness
 Swelling

Diagnosis
 Rads initially
 Cytology w/ Alk Phos staining
 Histo is gold standard but difficult to get biopsy

85
Q

Canine Osteosarcoma; Metastasis

A

 Lung rads & CT (better) for mets
 Bone scan or rads for mets
 Poor prognosis w/ lung, bone, or lymph node mets or elevated Alk Phos

86
Q

Canine Osteosarcoma; Prognosis based on Treatment

A

No therapy
o pain

Amputation / no chemo
o 4-6mo

Radiation for pain control, or pain meds
o 4-6mo

Bisphosphonates
o 6mo+

87
Q

Canine Osteosarcoma; Treatment

A

Appendage tumors
o Amputation & chemo (Doxorubicin)
o Vx against Her-2/Neu/EGFR
o Radiation and then amputation
o Losartan for dirty margins

Axial Tumors
o Difficult to treat
o Removal if possible +/- chemotherapy
o survival longer than for long bone tumors because metastasis comes slower
o palliative radiation and chemo for oral osteosarcomas

88
Q

Feline Osteosarcoma

A

o Rare
o Mets much slower than dogs
o Amputation is treatment of choice

89
Q

Hemangiosarcoma; Origin, Signalment, Biologic Behavior

A

Origin
 Arises from vascular endothelial cells (may be of bone marrow origin)
 Common on spleen!

Signalment
 Large breed dogs (German shepherd, golden retriever and Labs)
 Mean age 8-13 years (as young as 3 years)
 Possible male predominance

Biologic Behavior
 Extremely aggressive tumor that has a high rate of early development of metastasis
 Endothelial cells can go anywhere they want to and can arise in multiple sites simultaneously.
 25% have right atrial involvement at diagnosis
 14% can have brain metastasis at diagnosis

90
Q

Hemangiosarcoma; Clinical Signs, Diagnosis

A

Clinical Signs
 Mass on Spleen, liver, right atrium, Kidney, SQ tissues/muscle, oral cavity, urinary bladder, pericardium and peritoneum, bone.
 Bleeding
 sudden collapse, weakness, pallor
 sudden cardiac tamponade
 Sudden enlargement of a mass

Diagnosis
 requires histo but many suggestive features can point to the diagnosis
 Splenic lesions
 Evidence of splenic bleeding or rupture
 Right atrial masses with pericardial hemorrhage
 Ultrasound appearance of cellular fluid filled masses- any location.
 Aspiration for cytology, or biopsy yielding only blood.
 Schistocytes or Acanthocytes in blood smear
 Evidence of DIC- elevated coags or D-dimers or FDP’s
 Plasma troponin 1 concentration high in pericardial fluid

91
Q

Hemangiosarcoma; Treatment, Prognosis

A

Treatment
 Surgical removal of spleen, right atrial mass, some SQ masses
 Radiation for SQ or heart base masses
 Chemo w/ Doxorubicin
 Metronomic chemo w/ cyclophosphamide or chlorambucil
 Usually always need some type of systemic treatment

Prognosis
 Poor
 Better if SQ

92
Q

Hemangiosarcoma; Staging

A

CBC, Chemistries, UA
* normocytic normochromic anemia, NRBC, fragmented red cells (schistocytes, acanthocytes)
* neutrophilia, thrombocytopenia

Thoracic rads- essential
* Identify mets
* Identify cardiac lesions

Cardiac Ultrasound
* Identify cardiac lesions (better than rads)

93
Q

Cutaneous Hemangiosarcoma

A

o Light coat color, thin skin dog and cat disease
o Likely it is sunlight induced
o If the tumor does not invade into deeper tissues this a surgically curable disease
o If a patient keeps getting cutaneous lesions it can metastasize internally and cause serious disease

94
Q

Mammary Carcinomas; Signalment, Clinical Signs, Biologic Behavior

A

Signalment
 Female
 Intact
 Spayed late
 Use of synthetic progestins
 obesity

Clinical Signs
 Mammary mass
 inflamed plaque like lesions or multiple nodules in the skin
 diffuse edema in the mammary area.
 respiratory, neurologic signs or bone pain secondary to metastasis (rare)

Biologic Behavior
 50% are malignant
 50% of malignant are low grade
 Most important factors are size, completeness of removal, and presence of ulceration
 Inflammatory are extremely aggressive

95
Q

Mammary Carcinomas; Diagnosis, Staging, Treatment

A

Diagnosis
 Cytology is never diagnostic for malignant versus benign but can help diagnose something other than a mammary tumor
 Requires histopathology

Staging
 Evaluate local tumor
 Lymph node palpation, aspiration, removal and histopathology
 Thoracic rads!!
 Aggressive mammary tumor can have widespread metastasis- liver, bone, CNS

Treatment
 Lumpectomy still means usually one gland ahead and one behind allowing for good margins to be taken (BIG margins)
 Chemo w/ Doxorubicin
 Radiation if local control is difficult

96
Q

Feline Mammary Carcinomas; Basics, Signalment, Clinical Signs, Biologic Behavior

A

o More than 75% of feline mammary neoplasms are malignant
o Mammary tumors are at least the third most frequent tumor seen in the cat
o Any cat presenting with a mammary mass must be taken very seriously.

Signalment
 Female
 10-12yrs
 Short haired
 Spayed at later age
 Synthetic progestins

Clinical Signs
 Mammary mass
 Met lesion of LN, lungs, or bone

Biologic Behavior
 Most are adenocarcinoma
 Highly aggressive
 Mets very common

97
Q

Feline Mammary Carcinomas; Diagnosis, Treatment, Prognosis

A

Diagnosis
 Requires histo

Treatment
 Complete radical mastectomy
 Include At LEAST closest LN
 May need bilateral mastectomy
 MAYBE radiation
 Chemo w/ doxorubicin (more helpful than dog)

Prognosis
 Survival of 10-12 months
 Smaller tumor = better survival
 Aggressive surgery is important

98
Q

Anal Sac Tumors, Most Common Tumor Types, Staging

A

Most Common Tumor
 Perianal adenoma (benign)
 Perianal gland carcinomas (malignant)
 Apocrine Gland Anal Sac Adenocarcinomas (malignant)

Staging
 CBC, Chem, UA look for hypercalcemia
 Thoracic rads
 Image the abdomen for liver & spleen mets

99
Q

Anal Sac Carcinoma; Treatment

A

 Surgery to remove mass & LNs
 Radiation of mass & LNs
 Chemo w/ carbo/cisplatin or tyrosine kinase inhibitors

100
Q

Nail Bed Tumors (Melanoma); Staging, Treatment, Prognosis

A

Staging
* Aspiration of local node
* Thoracic rads

Treatment
* Surgery
* Melanoma vaccine

Prognosis
* Better than oral
* can go 1-2 years before metastasis develops

101
Q

Nail Bed Tumors (Squamous Cell Carcinoma); Staging, Treatment, Prognosis

A

Staging
* aspiration of local node
* thoracic imaging

Treatment
* Surgery

Prognosis
* Can be cured/controlled long term if single digit
* Some dogs develop tumors in multiple toes (Black standard poodles, Giant schnauzers, Russian terriers and this can lead to poor quality of life

102
Q

Bladder Tumors; Type, Signalment, Causes, Clinical Signs

A

o Uroepithelial Carcinoma

Signalment
 Usually small breed older dog,
 Female>Male,
 Neutered> Intact
 Scottish terriers and Shelties may be overrepresented

Possible causes
 older flea control products (dips),
 lawn chemicals,
 obesity

Presentation
 Pollakiuria,
 stranguria,
 dysuria,
 urinary obstruction

103
Q

Bladder Tumors; Biologic Behavior, Staging & Diagnosis

A

Biologic Behavior
 Generally cause signs locally and can cause the death or euthanasia of the animal
 Uroepithelial carcinoma can metastasize but generally not detected initially and often not the cause of death

Staging & Diagnosis
 Thoracic rads
 Abdominal ultrasound
 CT- only needed if planning radiation
 Trans-abdominal aspiration & Cytology
 BRAFF mutation in urine

104
Q

Bladder Tumors; Treatment & Survival

A

Surgery alone
* 12-13 months

Radiation intra-operatively
* 15 months

Stereotactic radiation
* 10 - 21 months

NSAID alone
* 6 months

Chemotherapy plus NSAID
* Piroxicam plus Mitoxantrone
* 12 months

105
Q

GI Tract Tumors; Presentation, Staging, Treatment

A

Presentation
 Palpation of mass in abdomen
 Gastric- weight loss, vomiting, melena
 Small intestine- melena, diarrhea, weight loss
 Colon- diarrhea, weight loss, hemtochezia
 Hepatobilliary- weight loss, inappetance, vomiting, PU/PD

Staging
 Abdominal ultrasound
 Thoracic rads
 +/- Cytology of mass and all other masses found
 Exploratory

Treatment
 Chemo for lymphoma
 Surgery on adenocarcinomas & hepatic tumors
 Surgery & Chemo on leiomyoma/sarcoma
 Tyrosine kinase inhibitors for GI stromal tumors

106
Q

Thoracic Tumors; Clinical Signs, Diagnosis & Staging

A

Clinical Signs
 Labored breathing or cough/dyspnea, tachypnea
 Difficulty swallowing/ regurgitation
 Poor blood circulation (low blood pressure, sudden collapse)
 Paraneoplastic association of hypertrophic osteopathy

Diagnosis & Staging
 Thoracic rads
 Thoracic CT
 Cardiac or trans-esophageal ultrasound
 Biopsy & needle aspirates very difficult and risky

107
Q

Primary Lung Tumors; Treatment

A
  • Depends on size of tumor, type of tumor and presence or absence of metastasis
  • Surgery is generally the treatment of choice
  • Chemotherapy minimally effective but Vinorelbine may be better
  • Maybe NSAID’s +/- metronomic chemotherapy
108
Q

Primary Lung Tumors; Good & Bad Prognostic Indicators

A

Good
o adenocarcinoma or papillary carcinoma,
o low grade tumors
o < 5cm diameter
o Peripheral location
o negative node
o no clinical signs
o 1-2yr survival

Bad
o squamous cell carcinoma
o poorly differentiated tumors
o high grade tumors
o > 5cm diameter
o pleural effusion
o presence of clinical signs
o positive nodes
o evidence of metastasis
o 1-8mo survival

109
Q

Canine Oral Melnoma; Basics, Diagnosis/staging, Therapy/Prognosis

A

o Fleshy friable mass
o May be black (can be amelanotic)
o Most common oral tumor in dogs

Diagnosis/Staging
 Thoracic rads
 Lymph node aspiration or biopsy
 Tumor biopsy
 Tumor imaging

Therapy/Prognosis
 Surgery- 7-9 months
 Radiation- 8 months
 Chemo – doesn’t really work
 Melanoma vx may or may not work

110
Q

Canine Oral Squamous Cell Carcinoma; Basics, Locations, Diagnosis, Staging, Treatment

A

o Ulcerated inflamed mass
o Second most common canine oral mass

Locations
 Rostral mandible unlikely to metastasize
 tongue 50% metastasize
 tonsils VERY likely to metastasize

Diagnosis
 Cytology can be diagnostic
 Recommended to do biopsy

Staging
 Thoracic rads
 Rads of tumor/ CT/ MR
 May need imaging to identify lymph nodes and to sample them

Treatment
 Surgery- small, superficial, and rostral
 Radiation- small, superficial, and rostral
 Surgery + radiation occasionally necessary

111
Q

Canine Oral Fibrosarcoma; Basics, Treatment

A

o Flat, boring
o Metastasis VERY uncommon
o Difficult to treat because often impossible to get 3cm margins
o Biopsy for grade, invasiveness, bone involvement
o Stage w/ thoracic rads & CT of mass

Treatment
 Surgery - must have 3cm margins
 Radiation - must dose higher than 50 Gy or large fraction size
 Surgery + Radiation is best approach, but still rarely curative

112
Q

Canine Oral Acanthomatous ameloblastoma; Staging, Treatment

A

Staging
* Biopsy
* Thoracic rads
* Local rads / CT

Treatment
* Surgery w/ small margins
* Radiation

113
Q

Feline Oral Squamous Cell Carcinomas; Basics, Treatment

A

o Inflamed proliferative mass, or ulcer, or facial distortion
o Most common oral tumor

Treatment
 Sx only if VERY small
 Radiation
 If in tonsil, it’s often cured with radiation

114
Q

Feline Oral Fibrosarcoma; Basics, Treatment

A

o Diffuse proliferative tissue
o Bone involvement common
o Metastasis rare

Treatment
 Sx but hard to achieve clean margins
 Radiation can shrink tumor

115
Q

Nasal Tumors; Clinical Signs, Biologic Behavior, Diagnosis, Staging, Treatment

A

Clinical Signs
 Nasal discharge & bleeding
 Cats w/ deformed faces

Biologic Behvaior
 Locally aggressive
 Metastasis 50%

Diagnosis
 Image prior to biopsy w/ rads, CT, or MRI

Staging
 CBC, Chemistries, UA
 Thoracic radiographs
 Lymph node palpation and aspiration
 CT of the tumor

Treatment
 Surgery (doesn’t work well)
 Maybe chemo
 NSAIDs help
 Curative radiation usually best

Small Animal Med (10 decks)

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