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BVetMed3 POS - Principles Of Oncology > Intro To Clinical Oncology > Flashcards

Intro To Clinical Oncology Flashcards

1
Q

How should you approach communication about cancer?

A

Positive yet realistic approach

Compassionate

Well-informed advice to aid decision making

SEEK HELP if out of your depth

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2
Q

How does quality of life for cancer patients compare to that of those animals with other chronic illnesses?

A

Can sometimes be better

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3
Q

How might pets provide a good model for human disease in oncology?

A

—Outbred population with spontaneous cancers
—Genetically similar
—Shared environment with owners (therefore risks)
—Faster disease progression and time to reach end points therefore quicker progression with clinical studies
— Similar patient size/metabolism

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4
Q

What are the key DDx for patients with a mass lesion?

A

Inflammatory lesion e.g. abscess, granuloma

Haematoma

Seroma (pocket of clear serous fluid, usually post surgical)

Cyst

Neoplasia

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5
Q

What clinical signs might indicate that a lump is an abscess over something neoplastic?

A

Fever (although also seen with some neoplasms)

Sudden onset

Feels fluid filled

Painful to touch

History of trauma

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6
Q

Why should you not wait to see if a lump grows?

A

Because if it is cancerous then you have allowed time for metastasis

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7
Q

What is the first step diagnostically when investigating a lump?

A

Fine needle aspiration

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8
Q

What are the benefits of fine needle aspiration?

A

Quick, cheap, easy to perform, non-invasive

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9
Q

What can you determine from FNA?

A

Cell types
— inflammation vs neoplasia

Cell morphology
— benign vs malignant

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10
Q

How could the appearance of a cellular population indicate whether a lesion is neoplastic?

A

Monomorphic cells more likely to be neoplasia

heterogeneous population of cells more likely to be inflammatory

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11
Q

Outline how you might perform a fine needle aspirate

A

Place 23/25 gauge needle in lesion,
Redirect several times WITHOUT coming out of the skin
Prepare smear

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12
Q

If cytology indicates neoplasm, what about the cells is important to determine?

A

The cell type (therefore tumour type)

E.g. round cells, mesenchymal cells, epithelial cells

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13
Q

What do mesenchymal cells look like cytologically?

A

Spindle shaped,

Usually in connective tissue

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14
Q

What do epithelial cells look like cytologically?

A

Sheets of cells

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15
Q

When can benign masses still cause clinical problems?

A

When they press on delicate structures e.g. meningioma

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16
Q

What cytologically features indicate a malignant mass?

A 
Cellular pleomorphism, anisocytosis
Nuclear pleomorphism (anisokaryosis)
Multinucleation 
Prominent/multiple/aberrantly shaped nucleoli  
High N:C ratio
High No. mitotic figures 
Increased cytoplasmic basophilia
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17
Q

What is meant by the term: cellular pleomorphism?

What does it indicate

A

Variability in the size, shape and staining of cells and/or their nuclei

characteristic of malignant neoplasms

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18
Q

What is meant by the term anisocytosis?

A

Red blood cells of unequal size

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19
Q

What is meant by the term anisokaryosis?

A

Larger than normal variation in the size of the nuclei of cells

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20
Q

What special techniques may be required for a definitive diagnosis?

A

Cytochemical stains
ICC, IHC, flow cytometry

Tests for clonality e.g. PARR

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21
Q

How do you find out a tumour grade in practice?

A

HISTOPATHOLOGIST decides

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22
Q

What does the grade of a tumour depend on?

A 
Mitotic index
Degree of cellular differentiation
Amount of necrosis 
Invasion of surrounding tissues
Invasion of vasculature/lymphatics
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23
Q

Why is tumour grading important?

A

Important for treatment planning, prognosis, communication

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24
Q

How can Mast Cell Tumours be graded?

A

Patnaik system (low, intermediate, high (I,II,III))

Kiupel system (2-tier, low and high)

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25
Q

What are the margins?

A

The border of the tumour excised. Can be assessed by pathologist.

Clean if no cancer cells found at edge of tissue

Dirty if cancer cells at edge of tissue - suggests not all has been removed

26
Q

Who performs the staging of a cancer patient?

A

CLINICIAN

27
Q

What is meant by the term staging?

How is it performed?

A

Assesses the extent of disease

Assess: primary tumour, drainage lymph node, and distant metastasis

28
Q

Outline the TNM system of tumour staging

A

T= primary tumour, size indicated by subscript number

N= evidence of metastasis to regional nodes (subscript 0 = no, 1=yes)

M= evidence of distant metastasis (0=no, 1=yes)

29
Q

How could you determine whether regional metastasis has occurred?

A

Assess regional nodes for size, mobility, relationship to surrounding tissues, texture and consistency

IMAGING required for internal nodes

FNA to decide if metastasis present

30
Q

How could you determine whether distant metastasis has occurred?

A

History and PE
Imaging e.g. thoracic radiograph
Sampling

31
Q

Name a system of staging other than TNM. What is it for?

A

WHO system for lymphoma

** echo

32
Q

What should you check in the patient other than the obvious lump?

A

Presence of concurrent illness and/or evidence of paraneoplastic effects (e.g. the secretion of hormones, cytokines or enzymes)

33
Q

Why are concurrent illness important to consider?

What patients are they more likely to be found in?

A

Can affect prognosis and treatment

Geriatrics

34
Q

What baseline tests should be used to assess a cancer patient?

A

Haematology /CBC
Biochemistry profile
Urinalysis
Potentially coagulation profile

35
Q

Why would you perform haematology/CBC to assess a cancer patient?

A 
General health screen 
Baseline prior to chemo
Cell numbers and morphology - check for:
— anaemia 
— cytopenias e.g. neutropenia, thrombocytopenia 
— abnormal circulating cells
36
Q

What could cytopenias on haematology indicate about a cancer patient?

A

Concurrent immune-mediated disease

37
Q

Why would you perform biochemistry to assess a cancer patient?

A 
General health screen
Assess organ damage/function:
— prior to GA
— for drug metabolism (liver/kidneys) 
— Choice and dose of drugs

Look for paraneoplastic effects
E.g. hypercalcaemia due to PTH-rp secretion

38
Q

Why would you perform urinalysis to assess a cancer patient?

A

General health status

Assess renal function (SG)

39
Q

Why would you perform coagulation profile to assess a cancer patient?

A

Tumours can cause abnormalities in coagulation

Can result in a patient being hyper- or hypo- coagulable

Potential thrombocytopenia

40
Q

What paraneoplastic effects could be presented in the clinic instead of a mass?

A

Hypercalcaemia

Hypoglycaemia

Hyperviscosity with hyperglobulinaemia, polycythaemia

41
Q

Define the term: polycythaemia

A

Abnormally increased concentration of Hb in the blood

Due to:

  • reduction in plasma volume
  • increase in red cell numbers
42
Q

Define the term: hyperviscosity

A

Increased viscosity of the blood.
Causes several clinical signs including:
- spontaneous bleeding from mucous membranes
- visual disturbances due to retinopathy (/retinal detachment) neurologic symptoms (seizures, coma etc)

43
Q

How would you expect a hypocalcaemic patient to present?

A 
PD/PU
Lethargy
Anorexia
Depression
Vomiting 
Weakness
Bradycardia
44
Q

How would you expect a hypoglycaemic patient to present?

A

Weakness
Collapse
Seizures

45
Q

What are the potential goals of cancer treatment?

A

Cure
Remission for a period of time
Reduction in burden for control
Palliative

MAINTAIN GOOD QOL

46
Q

How do treatment schedules for cancer in veterinary species vary compared to those seen in humans?

A

Less intensive due to adverse effects - pet doesn’t understand why

47
Q

What factors should be considered when trying to pick a treatment plan?

A 
Patient temperament 
Patient general health status 
Potential adverse - how will this affect patient and client 
Cost 
Time commitment 
Prognosis
48
Q

When would surgery be considered as a treatment option?

A

Treatment for primary carcinomas and sarcomas as well as MCTs (‘hard’ tumours)

Often used in combination with radiation or chemo

49
Q

When is radiation treatment used?

What is a potential negative?

A

Primary treatment modality especially if surgical resection difficult due to site e.g. nasal tumours

Adjunctive treatment - used when incomplete resection or with neoadjuvant therapy

Need GA so patient stays still

50
Q

When is chemotherapy/drug treatment indicated?

A

Disseminated disease
Tumours with high metastatic potential
Situations where surgery/radiation not possible

51
Q

What tumours would require chemotherapy?

A

Hematopoeitic tumours e.g. lymphoma, leukaemias

Systemic/high grade/ high risk MCTs

Adjunctive treatment for highly metastatic tumours e.g. osteosarcoma, hemangiosarcoma, Soft Tissue Sarcoma

52
Q

What supportive care is required for the cancer patient?

A

Nutrition - ensure adequate caloric intake and monitor BCS, feeding tube may be required but not ideal long term

Hydration - IV fluid therapy

GIT problems may require anti-emetics etc
Antibiotics
Analgesics
Physio therapy

53
Q

What drugs may be required to aid with the gastrointestinal problems associated with cancer treatment?

A

Gastric protectants: e.g. Omeprazole

Anti-emetics: Maropitant, odansetron

Appetite stimulants e.gg mirtazepine

54
Q

Why might antibiotics be required with chemotherapy?

A

If chemo causes neutropenia

55
Q

What analgesics may be indicated?

A

NSAIDs

Paracetamol

Opioids e.g. tramadol, buprenorphine

Gabapentin

56
Q

Why should you be careful around cytotoxic drugs?

A

They interfere with cell growth and division

Can be carcinogenic, mutagenic and teratogenic

57
Q

What group of people need to be particularly careful around cytotoxic drugs?

A

Pregnant women (especially 1st trimester)

Shouldn’t handle drugs or body fluids from patients receiving these drugs

58
Q

What health and safety procedures are necessary for tablets/capsules containing cytotoxic drugs ?

A

Don’t crush/break

If need to be reformulated, should be done by a specialist pharmacy

Wear gloves to administer

Dispense in labelled, childproof container

59
Q

What protective clothing may be required for administering injectable agents?

A

WEAR GLOVES - chemo safe or double glove

Long sleeved water resistant gown

(Face mask and goggles)

60
Q

How should you handle the body waste of a patient receiving chemo?

A

Wear gloves
Double bag waste
Designate toileting area if possible

BVetMed3 POS - Principles Of Oncology (5 decks)

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