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Surgical Oncology > Gastrointestinal Tumours > Flashcards

Gastrointestinal Tumours Flashcards

1
Q

What is the general behavior of Gastrointestinal Tumours? General outcome?

A

Aggressive with a poor outcome

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2
Q

In some cases there can be a favorable prognosis with extensive therapy in dogs with what neoplasia of the large intestine? (2)

A

Adenocarcicoma
Lymphoma

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3
Q

In some cases there can be a favorable prognosis with extensive therapy in cats with what neoplasia of the large intestine? (1)

A

Low grade lymphoma

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4
Q

How many of canine/feline neoplasms are gastrointestinal?

A

2%

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5
Q

Which dog breed has an increased risk for a gastric carcinoma?

A

Belgian Shepherd

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6
Q

Which cat breed is at increased risk of an intestinal adenocarcinoma and lymphoma?

A

Siamese

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7
Q

Which feline virus has been suggested to be an underlying factor in developing feline GI lymphoma?

A

FeLV

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8
Q

Which bacteria has been associated with gastric neoplasia in humans? (But no established link in cats/dogs)

A

Helicobacter

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9
Q

Dog average age for GI neoplasms?

A

6-9years

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10
Q

Cat average age for GI neoplasms?

A

10-12 years

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11
Q

When do gastric leiomyomas occur?

A

Older dogs - 15 yr

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12
Q

Sex predisposition in dogs and cats for GI neoplasia?

A

Male

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13
Q

Generally, GI neoplasms - benign vs malignant?

A

Malignant

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14
Q

Most common gastric and large intestinal neoplasm in dogs?

A

Adenocarcinoma

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15
Q

Most common small intestine tumour in dogs?

A

Lymphoma

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16
Q

Which gastric and small intestine tumours frequently metastasis to the lungs? (1)

A

Adenocarcinoma

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17
Q

Which gastric and small intestine tumours frequently metastasis to the liver? (1)

A

Adenocarcinoma

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18
Q

Where do adenocarcinomas frequently effect in the stomach?

A

Lower 1/3 e.g. lesser curvature/pylorus region

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19
Q

Other than the liver and lungs, where else do gastric and small intestinal tumour metastasise to?

A

Regional LN

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20
Q

At the time of adenocarcinoma diagnosis, how many of the following have metastasised:
A) Intestinal?
B) Gastric?

A

A) 58%
B) 95%

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21
Q

Where does GI lymphoma most commonly effect?

A

Small intestine

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22
Q

What lymphoma immunophenotype are predominant in colo-rectal lymphoma?

A

B

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23
Q

Other than colo rectal lymphoma, what is the most common phenotype?

A

T

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24
Q

How many low grade GI lymphoma transition into high grade lymphoma?

A

10%

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25
Q

Is canine GI lymphoma mainly high or low grade?

A

High

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26
Q

GI stromal tumours:
A) Origin?

A

A) Mesenchymal

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27
Q

On immunohistochemistry how are GI stromal tumours diagnosed?

A

positive KIT (CD117) reaction on immunohistochemistry.

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28
Q

Where do GI stromal tumours typically occur? (2)

A

Caecum
Large intestine

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29
Q

Where for leiomyosarcomss typically occur? (2)

A

Stomach
Small intestine

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30
Q

What is the growth rate of GI stromal tumours?

A

Slow

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31
Q

What is the growth rate of leiomyocarcoma?

A

Slow

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32
Q

What is the most common and then 2 next most common GI tumour in cats?

A
  1. Lymphoma
  2. Adenocarcinoma + MCT
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33
Q

Cat low grade GI lymphoma:
A) immunophenotype?
B) Where?

A

A) T cell
B) Small intestine

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34
Q

What is the immunophenotype of SI high grade lymphoma?

A

B or T cell

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35
Q

Where is adenocarcinoma commonly found in feline GI tract? (2)

A

jejunum
Ileum

36
Q

What is the met rate of feline adenocarcinoma?

A

High

37
Q

Where do feline GI adenocarcinomas commonly met to? (2)

A

LN
Lungs

38
Q

In cats, carcinomatosis is seen following GI adenocarcinoma in what %?

A

30%

39
Q

What hematology finding may be present in cats with GI neoplasia?

A

Microcytic anaemia

40
Q

What biochem finding is common with leiomyma/leiomoyosarcoma?

A

Hypoglycaemia

41
Q

Paraneoplastic hypercalcaemia is seen with what GI neoplasia? (2)

A

Lymphoma
Adenocarcinoma

42
Q

What non specific biochem findings can be seen in some non lymphomatous neoplasia? (2)

A

Hypercholesterolaemia
Increased ALKP

43
Q

What may be seen on plain film Xrays with intestinal neoplasia? (2)

A

Mass like effect
Obstructive bowel sign

44
Q

What would be seen on contract abdo xrays with intestinal neoplasia? (2)

A

Mass lesions
Ulceration

45
Q

What imaging may reveal focal or diffuse thickening of the GI tract and loss of normal layering?

A

U/S

46
Q

Why are endoscopic biopsies limited for diagnosis?

A

Small biopsy size
Superficial biopsy

47
Q

In a recent study, which intestinal biopsies have been shown to aid diagnosis of feline lymphoma/GI disease compared with duodenal biopsy?

A

Ileal

48
Q

What PCR can aid lymphoma diagnosis?

A

PARR - PCR for Antigen receptor rearrangement

49
Q

What margins are taken for surgical resection of solitary intestinal tumours?

A

4cm

50
Q

During intestinal surgery; what staging type should take place (2) and where (4)?

A

Biopsies + impression smears:
Adjacent intestine
LN
spleen
Liver

51
Q

Careful preoperative discussion is needed before surgery because the perioperative mortality rate is reportedly as high as ______% in cats with intestinal carcinoma.

A

50%

52
Q

What is the most common tumour of dog stomach?

A

Gastric adenocarcinoma

53
Q

What is the breed predilection for gastric tumours? (2)

A

Belgian shepherd
Rough collies

54
Q

Why is haematoemeis and melana common with gastric adenocarcinomas?

A

Most tumours extend to or through the serosa from the mucosa, creating deep ulcers

55
Q

What might be seen on plain abdo +/- contrast xrays for gastric adenocarcinoma? (4)

A
  • thickening of the gastric wall;
  • absence of rugal folds;
  • filling defects;
  • An intraluminal mass.
56
Q

How is gastric adenocarcinoma diagnosed? (2)

A

Surgical biopsy
Endoscope biopsy

57
Q

Where in particular do gastric carcinomas affect?

A

Pylorus

58
Q

How many gastric carcinomas have visible met lungs at diagnosis?

A

30%

59
Q

Why are most gastric adenocarcinomas not resectable? (2)

A

Size
Invasiveness

60
Q

Most dogs die within ?? months of surgery from local recurrence or metastases despite wide resection

A

4

61
Q

Most common intestinal adenocarcinoma met sites? (3)

A

LN
Liver
Lung

62
Q

What are the 4 histological classifications of intestinal adenocarcinomas?

A

Acinar
Solid
Mucinous
Papillary.

63
Q

Papillary carcinoma:
A) Spread direction
B) Distant met?

A

A) Horizontal
B) few

64
Q

Acinar, solid, and mucinous adenocarcinoma:
A) Growth direction?

A

Vertical growth and extend into bowel wall, serosa, and other organs.

65
Q

Feline carcinoma – met sites? (4)

A

Abdominal serosa
LN
Liver
Lung

66
Q

What is the survial time of leiomyosarcomas and GIST if surgical resection with no mets?

A

Long; mean 37 mo

67
Q

How do tyrosine kinase inhibitors work for GIST and MCT?

A

specifically target aberrantly expressed proteins such as KIT

68
Q

What are the 2 morphological forms of GI lymphoma?

A

Diffuse
Nodular

69
Q

What is diffuse lymphoma characterised by?

A

Extensive infiltration of the lamina propria and submucosa with neoplastic lymphocytes

70
Q

What does nodular form of lymphoma cause?

A

causes a segmental thickening of the bowel, most often in the ileocolic region, with resultant luminal narrowing and partial intestinal obstruction.

71
Q

Why is gastric lymphoma often treated with adjuvant chemo?

A

Rarely confined to stomach

72
Q

What adjuvant therapy is good for lymphoma due to sensitivity?

A

Radiotherapy

73
Q

Which of the following statements regarding gastrointestinal lymphoma are true?

Select all that apply.

A) In cats, lymphoma is the most common GI neoplasm.

B) Most cats with gastric lymphoma are positive for feline leukaemia virus.

C) Metastasis to regional lymph nodes is common with both diffuse and nodular forms of the disease.

D) Gastric lymphoma in cats is confined to the stomach surgical excision is often curative.

E) Adjuvant chemotherapy is often recommended following surgical excision of a lymphomatous mass.

F) All cats with GI lymphoma will have a history of either vomiting or diarrhoea.

A

A) In cats, lymphoma is the most common GI neoplasm.

C) Metastasis to regional lymph nodes is common with both diffuse and nodular forms of the disease.

E) Adjuvant chemotherapy is often recommended following surgical excision of a lymphomatous mass.

74
Q

Where are rectal polyps most commonly found in the dog? (2)

A

Rectum
Descending colon

75
Q

Where are rectal plyps most commonly found in cats?

A

Small intestine

76
Q

What ancestry do 50% of cats with rectal polyps have?

A

Asian

77
Q

Benign polypoid rectal lesions rarely undergo malignant transformation.

True or false?

A

False - Fifty percent of the canine rectal tumours showed transition from benign polypoid lesions to adenocarcinoma in one study.

78
Q

What are the 2 appearances of rectal polyps?

A

Pedunculated
Sessile base

79
Q

Polyps with 2cm of anus can be treated how? (3)

A

Surgical
Electrosurgery
Cryosurgery

80
Q

How are the majority of colorectal adenocarcinomas found?

A

rectal exam

81
Q

What may contrast xrays show with colorectal adenocarcinomas? (2)

A

mucosal abnormalities
obstructive lesions.

82
Q

What U/S changes would be seen with colo rectal carcinomas? (3)

A

Bowel thickening
Local ileus
Enlarged mesenteric LN

83
Q

What is the 3rd most common intesntial cat tumour?

A

Mast cell

84
Q

Where are the common intestinal MCT met sites?

A
  • LN
  • Liver
  • Spleen
  • Lung
  • Bone marrow
85
Q

What medication should be administered following diagnosis intestinal MCT?

A

Ranitidine (1 to 2 mg/kg orally q12h)

85
Q

If intestinal MCT surgery is feasible, what are the recommended surgical margins?

A

5-10cm of normal bowel proximal and distal to the tumour.

85
Q

How long should corticosteroids be withheld for after MCT surgical removal?

A

14 days post op

Surgical Oncology (10 decks)

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