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Surgical Oncology > General Oncological Principles > Flashcards

General Oncological Principles Flashcards

1
Q

What cures cancer more than any other singe modality?

A

Surgery

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2
Q

What are the possible therapeutic goals of surgery? (3)

A

Curative intent
Cytoreduction
Palliation

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3
Q

How does malignancy and age of patient correlate?

A

Malignant tumours in young animals tend to have a more aggressive biologic behaviour compared to the same disease in older animals

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4
Q

What comorbitities may change specific treatment recommendations?

A

renal impairment
hepatic disease
osteoarthritis,
heart disease
BCS

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5
Q

Define “TNM”

A

T - primary tumour (size or extent)
N - Regional LN involvement
M - Mets to distant sites

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6
Q

Define T (of TNM) number system. (X,0,1,2,3,4)

A

TX: Main tumour cannot be measured

T0: Main tumour cannot be found

T1, T2, T3, T4: Size and/or extent of the primary tumour. The higher the number after the T, the larger the tumour or the more it has grown into nearby tissues.

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7
Q

Define N numbering (of TNM):
X, 0, 1, 2, 3

A

NX: Cancer in nearby lymph nodes cannot be measured

N0: There is no cancer in nearby lymph nodes

N1, N2, N3: Refer to the number and location of lymph nodes that contain cancer. The higher the number after N, the more lymph nodes contain cancer.

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8
Q

Define M of TNM
X, 0, 1

A

MX: Metastasis cannot be measured

M0: Cancer has not spread to other parts of the body

M1: Cancer has spread to other parts of the body

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9
Q

Where should be staged for a MCT?

A

LN
Abdo U/S
Thorax x ray

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10
Q

Where should be staged for canine prostate neoplasia?

A

Abdo/pelvic xrays (Bone mets to pelvis and lumbar vert)

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11
Q

Can you assess a LN via palp/size?

A

No - cytology/histo is needed

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12
Q

Why should multiple LN be sampled when staging?

A

LN drainage can be highly variable

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13
Q

What are the next steps if a LN FNA comes back non-diagnostic/cannot be assessed for aspiration?

A

Excisional biopsy

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14
Q

Define distant metastasis

A

Spread of cancer beyond regional lymph nodes to distant organs.

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15
Q

Appropriate planning and adherence to principle of surgical oncology should address the following questions … (6)

A
  • What are the type and stage of the tumour?
  • Do the biopsy results correlate with the clinical presentation?
  • What is the biologic behaviour of the tumour?
  • Is surgery indicated and what is the proper surgical approach?
  • What are the alternatives and adjuncts to surgery?
  • What are the owner’s expectations and are these reasonable?
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16
Q

FNA:
A) Main pro? (2)
B) What does accuracy depend on? (3)

A

A) Minimally invasive, in expensive
B) tumour type, location, inflamm/necrosis

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17
Q

What is the goal for an FNA sample?

A

The goal of FNA is to differentiate between inflammation and neoplasia and if neoplastic to establish whether the mass is benign or malignant

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18
Q

What are the risks of an FNA? (3)

A

Bleeding
FLuid leak
Seeding

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19
Q

What should be used when taking an FNA within body cavity?

A

imaging

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20
Q

What masses are needle core biopsies commonly used for? (3)

A

Soft tissue mass
Visceral mass
Thoracic mass

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21
Q

Why is local anaesthetic not required for needle core biospy? (use a small amount for the skin for stab incision)

A

Poorly innervated

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22
Q

Why are multiple samples taken with needle core biopsies?

A

To ensure representative

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23
Q

When in a punch biopsy used? (5)

A

cutaneous lesions,
Liver
Kidney
Spleen
Oral Subcutaneous masses after the skin has been incised

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24
Q

What is used to sever the base following punch biopsy?

A

Metzenbaum scissors

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25
Q

When are incisional (wedge) biopsies recommended in preferance to FNA? (3)

A

Soft/friable tumour
peripheral LN
Inflammed/necrotic

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26
Q

How is a wedge/incisional biospy performed and what tissue is included?

A

Incisional biopsy is performed using a scalpel blade to obtain a wedge of tissue. The biopsy should include a junction between normal and abnormal tissue.

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27
Q

Why should a wedge biopsy ideally be performed by the surgeon?

A

Surgery can be planned to remove the biopsy tract with the tumour as the biopsy procedure can seed normal tissue and be a source of local tumour recurrence

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28
Q

Where should incisional biopsies not be performed? (3)

A
  • ulceration
  • necrosis
  • Inflammation
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29
Q

What is the benefit of an excisional biopsy?

A

Diagnostic as well as a treatment modality

30
Q

As a minimum what should be performed prior to excisional biopsy?

A

FNA

31
Q

Why is the first surgery the best chance for complete excision?

A

Once an excision is performed, the regional anatomy is altered providing the tumour cells to extend beyond the normal boundaries and seed deeper and wider into the tissues and tissue planes.

32
Q

What is the most appropriate sampling technique for oral/gingival mass?

A

Punch biopsy

33
Q

What is the most appropriate sampling technique for Raised cutaneous mass?

A

FNA

34
Q

What is the most appropriate sampling technique for A grossly enlarged lymph node with non-diagnostic cytology?

A

Wedge biopsy

35
Q

What are the five surgical goals of cancer?

A
  • Prevention
  • Diagnosis
  • Cure
  • Palliation
  • Combination therapy
36
Q

Name 2 preventative surgeries.

A

Early ovariohysterectomy - reduce the incidence of cancers of the ovary, uterus and mammary glands
- Castration to prevent Sertoli cell tumours in cryptorchid dogs and perianal adenoma

37
Q

What is a biopsy diagnostic surgery?

A

safely and simply provide an adequate sample of tissue that will consistently provide an accurate diagnosis

38
Q

Why is palliative tx surgery performed?

A

control clinical signs and secondarily to prolong life.

39
Q

What does combination therapy include?(6)

A

-Surgery
-Chemotherapy
-Radiation therapy
-Immunotherapy
-Tyrosine kinase inhibitors (TKIs)
-Multimodal therapy

40
Q

How is chemotherapy used with surgery?

A

To control/slow the disease and minimise the associated clinical signs

41
Q

Why does chemotherapy carry a significant occupational health risk? (4)

A

Mutagenic
Teratogenic
Fertility impairment
Human carcinogens.

42
Q

What chemo drug agents are not carcinogenic?

A

Antimetabolites (methotrexate (amethopterin) cytarabine (cytosar) 5-fluorouracil (5-FU))

43
Q

Which chemo agents have shown carcinogenic in human and animals?

A

alkylating agents (melphalan, cyclophosphamide, chlorambucil, limestone, dacarbazine)

44
Q

Why can radiotherapy not replace surgery?

A

It is a local Tx option

45
Q

Other than management of caner- what additional benefits does radiotherapy have? Particularly in bone

A

Manage pain from neoplasia

46
Q

2 types of radiotherapy tx

A

Hyperfractionated
Hypo fractionated

47
Q

Hyperfractionated radiotherapy treatment:
A. How are does given?
B. Effect on local tissue?
C. Tumour response?

A

A. Smaller doses given more often, often daily to every other day
B. Less injury to normal tissues, esp. long-term adverse effects
C. Improved tumour response

48
Q

Hypofractionated radiotherapy treatment:
A. How are does given?
B. Nature of treatment?
C. Long term risks?

A

A. Larger doses give traditionally once weekly
B. Palliative
C. Long term adverse effects

49
Q

Dose decided by tumour tissue and adjacent healthy tissue limitation: brain and spinal cord ______ sensitive than bone or muscle.
More vs less

A

More

50
Q

Acute (during or shortly after) radiotherapy adverse effects:
A. Treatment?
B. What tissue is affected?
C. what is the effect on skin? (3)
D. Prevent skin impact (2)

A

A. Self limiting
B. Affect rapidly proliferating tissue: mucosa, epithelium, eyes
C. Skin: Hyperaemia, sensitivity, discomfort
D. pain relief and avoid self trauma

51
Q

Late adverse effects of radiotherapy:
- what is affected?
- how are complications treated?
- possible general complications (3)

A
  • Affect slowly proliferating tissue: heart, lung, bone, kidneys, nervous system
  • Difficult to tx!
  • Tissue necrosis, fibrosis, 2ry tumours (<1-2%)
52
Q

What is immunotherapy mainly used for commercially?

A

Melanoma

53
Q

ONCEPT®: DNA-vaccine against human tyrosinase
How is the course given?

A

2 weeks apart x 4, then 6monthly boosters

54
Q

What immunotherapy is used?

A

ONCEPT®: DNA-vaccine against human tyrosinase

55
Q

ONCEPT®: DNA-vaccine against human tyrosinase contains part of the DNA for human tyrosinase, what is this?

A

An intracellular melanocyte protein essential for melanin synthesis and commonly found in canine melanoma cells.

56
Q

How does the ONCEPT®: DNA-vaccine against human tyrosinase work?

A

The foreign protein triggers an immune response once administered and antibodies against the human tyrosinase protein are produced. These antibodies cross-react with the dog’s own tyrosinase, expressed in the melanoma cells.

57
Q

What are the side effects of melanoma vaccine?

A

Side effects of the melanoma vaccine are minimal to none; a small subset of dogs may experience mild redness or bruising at the injection site, however systemic effects are generally not observed.

58
Q

What does survival time with melanoma vaccine depend on?

A

Presence of metastatic disease at the time of diagnosis.

59
Q

Recent small retrospective analysis showed no significant difference in survival time for dogs with what melanoma type?

A

Oral

60
Q

The melanoma vaccine showed a significant benefit in dogs with what tumour type?

A

Digital melanoma

61
Q

Mutations in the proto-oncogene tyrosine kinase receptor c-kit were shown to lead to constitutive phosphorylation of the gene product and believed to be important in the development and progression of at least some canine…?

A

Mast cell tumours

62
Q

What drug primarily targets c-kit?

A

Masitinib (Masivet/Kinavet

63
Q

What is the human tyrosine kinase inhibitos?

A

Toceranib (Palladia; Pfizer Animal Health)

64
Q

In relation to surgery - when should the potential need for neo/adjuvant therapy be discussed?

A

BEFORE surgical intervention

65
Q

Why is radiotherapy often more beneficial before surgery?

A

vascular supply of the tumour is not disturbed and hence tumour cells are better oxygenated and more radiosensitive

66
Q

How long before surgery should radiotherapy be given?

A

3 weeks

67
Q

When should chemotherapy be given in relation to surgeyr

A

After the animal has recovered from surgery and wound healing has advanced to the remodelling stage

68
Q

What does cytoreductive surgery remove? (3)

A

Drug and radiation resistant tumour cells
Circulating immune complexes
Tumour associated immunosuppressants

69
Q

Match the conditions with the recommended therapy:
A. Oral malignant melanoma
B. Feline vacc associated sarcoma
C. Appendicular osteosarcoma

A

A. Adjuvant chemotherapy
B. Adjuvant radiation therapy
C. Adjuvant chemotherapy

70
Q

Match the conditions with the recommended therapy:
A. Canine haemangiosarcoma
B. Incompletely resected canine MCT or soft tissue sarcoma

A

A. Adjuvant chemotherapy
B. Adjuvant radiation therapy

71
Q

When is adjuvant chemotherapy recommended? E.g. (3)

A

tumours with a high metastatic risk and presumptive disseminated microscopic tumour burden
(e.g. canine hemangiosarcoma, appendicular osteosarcoma, oral malignant melanoma)

72
Q

When is adjuvant radiotherapy recommended? E.g. (3)

A

residual microscopic disease in surgical wounds (e.g. incompletely resected canine MCT or soft-tissue sarcoma; feline vaccine-associated sarcoma)

Surgical Oncology (10 decks)

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