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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
What are the margins?
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
Who performs the staging of a cancer patient?
CLINICIAN
27
What is meant by the term staging? How is it performed?
Assesses the extent of disease Assess: primary tumour, drainage lymph node, and distant metastasis
28
Outline the TNM system of tumour staging
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
How could you determine whether regional metastasis has occurred?
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
How could you determine whether distant metastasis has occurred?
History and PE Imaging e.g. thoracic radiograph Sampling
31
Name a system of staging other than TNM. What is it for?
WHO system for lymphoma ** echo
32
What should you check in the patient other than the obvious lump?
Presence of concurrent illness and/or evidence of paraneoplastic effects (e.g. the secretion of hormones, cytokines or enzymes)
33
Why are concurrent illness important to consider? What patients are they more likely to be found in?
Can affect prognosis and treatment Geriatrics
34
What baseline tests should be used to assess a cancer patient?
Haematology /CBC Biochemistry profile Urinalysis Potentially coagulation profile
35
Why would you perform haematology/CBC to assess a cancer patient?
``` General health screen Baseline prior to chemo Cell numbers and morphology - check for: — anaemia — cytopenias e.g. neutropenia, thrombocytopenia — abnormal circulating cells ```
36
What could cytopenias on haematology indicate about a cancer patient?
Concurrent immune-mediated disease
37
Why would you perform biochemistry to assess a cancer patient?
``` 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
Why would you perform urinalysis to assess a cancer patient?
General health status | Assess renal function (SG)
39
Why would you perform coagulation profile to assess a cancer patient?
Tumours can cause abnormalities in coagulation Can result in a patient being hyper- or hypo- coagulable Potential thrombocytopenia
40
What paraneoplastic effects could be presented in the clinic instead of a mass?
Hypercalcaemia Hypoglycaemia Hyperviscosity with hyperglobulinaemia, polycythaemia
41
Define the term: polycythaemia
Abnormally increased concentration of Hb in the blood Due to: - reduction in plasma volume - increase in red cell numbers
42
Define the term: hyperviscosity
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
How would you expect a hypocalcaemic patient to present?
``` PD/PU Lethargy Anorexia Depression Vomiting Weakness Bradycardia ```
44
How would you expect a hypoglycaemic patient to present?
Weakness Collapse Seizures
45
What are the potential goals of cancer treatment?
Cure Remission for a period of time Reduction in burden for control Palliative MAINTAIN GOOD QOL
46
How do treatment schedules for cancer in veterinary species vary compared to those seen in humans?
Less intensive due to adverse effects - pet doesn’t understand why
47
What factors should be considered when trying to pick a treatment plan?
``` Patient temperament Patient general health status Potential adverse - how will this affect patient and client Cost Time commitment Prognosis ```
48
When would surgery be considered as a treatment option?
Treatment for primary carcinomas and sarcomas as well as MCTs (‘hard’ tumours) Often used in combination with radiation or chemo
49
When is radiation treatment used? What is a potential negative?
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
When is chemotherapy/drug treatment indicated?
Disseminated disease Tumours with high metastatic potential Situations where surgery/radiation not possible
51
What tumours would require chemotherapy?
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
What supportive care is required for the cancer patient?
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
What drugs may be required to aid with the gastrointestinal problems associated with cancer treatment?
Gastric protectants: e.g. Omeprazole Anti-emetics: Maropitant, odansetron Appetite stimulants e.gg mirtazepine
54
Why might antibiotics be required with chemotherapy?
If chemo causes neutropenia
55
What analgesics may be indicated?
NSAIDs Paracetamol Opioids e.g. tramadol, buprenorphine Gabapentin
56
Why should you be careful around cytotoxic drugs?
They interfere with cell growth and division Can be carcinogenic, mutagenic and teratogenic
57
What group of people need to be particularly careful around cytotoxic drugs?
Pregnant women (especially 1st trimester) Shouldn’t handle drugs or body fluids from patients receiving these drugs
58
What health and safety procedures are necessary for tablets/capsules containing cytotoxic drugs ?
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
What protective clothing may be required for administering injectable agents?
WEAR GLOVES - chemo safe or double glove Long sleeved water resistant gown (Face mask and goggles)
60
How should you handle the body waste of a patient receiving chemo?
Wear gloves Double bag waste Designate toileting area if possible

BVetMed3 POS - Principles Of Oncology (5 decks)

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