Intro to Oncologic Surgery Flashcards
What are some examples of haemopoietic tumours?
lymphoma and leukemia
What are some examples of solid tumours?
- sarcoma - skeletal and connective tissue
- carcinoma - organs
What are some examples of round cell tumours?
mast cell tumour and melanomas
What is a benign tumour?
one that does not spread
What are malignant tumours?
ones that are at risk of spreading
What are metastatic tumours?
secondary tumours that frow in a different location to the primary tumour
What is a haemoatopoietic tumour also known as?
liquid tumour
Where do acute and chronic leukemia tumours occur?
in the blood forming tissues
Where do lymphoma tumours occur?
in cells that makeup part of the immune system
What type of cells are lymphomas?
B-cell and T-cells
How do you treat haemopoietic tumours?
chemotherapy
How are sarcomas classified?
according to their parent tissue
How do you treat osteosarcomas?
chemotherapy, bisphosphonates, radiation therapy, surgery to remove affected limb
Where are osteosarcomas often found?
distal radius or the top of the femur
How are haemoangiosarcomas treated?
combination of surgeyr and chemotherapy
Where are haemangiosarcomas found?
spleen, heart (blood vessels)
Where are soft tissue sarcomas found?
different places, muscle tendon
Where are carcinomas found?
tissue that covered the body surfaces, lines a body cavity or makes up an organ
What species are squamous cell carcinomas common in?
cats
Where are squamous cell carcinomas often found?
nose, mouth and ears
How do you treat squamous cell carcinomas?
surgery, radiation therapy or chemotherapy
What are mast cells tumours?
most common malignant tumour in dogs, involved with inflammatory and allergic mechanisms
What do mast cell tumours range from?
highly malignat with a high rate of spread or almost benign
How do you treat mast cell tumours?
surgery to remove with appropriate margins or chemotherapy or radiation therapy
How can melanomas look?
pigmented black
Where can you often find melanomas?
mouth, toes or skin
How do you slow down the spread of melanomas?
- melanoma vaccine
- human melanoma proteins given transdermally
- immune system develop antibodies to melanoma proteins
- immunotherapy
What are benign tumours?
slow growing
What are examples of benign tumours?
lipoma, haemangioma, adenoma
What is paranneoplasic syndrome?
cancer associated with alterations not directly related to the tumour or metastesis
What can you expet to see with patients that have a lymphoma?
hypercalcaemia, anaemia, neutrophilic leucocytosis, thrombocytopaenia
What does reucrrence of paraneoplastic sydrome signify?
return of tumour
What does occurence of paraneoplastic sydrome signify?
malignancy
How might a tumour affect treatment?
- if it is benign or malignant
- if surgery is the best option
- the staging and grading of the tumour
Which tumours have high sensitivity to chemotherapy?
lymphoma and some leukaemias
Which tumours have moderate sensitivity to chemotherapy?
high grade sarcomas and mast cell tumours
What tumours have low sensititivy to chemotherapy?
slow grading sarconomas, carcinomas and melanomas
What does a low sesnitivity to chemotherapy mean??
not responsive to chemotherapy and may opt for surgery instead
How might the different tumours affect treatment?
- location
- resectable or non-resectable
- owner expectations
- disfiguring surgery
- cost of treatment
- patient temperament
- ability to cope with repeated therapies such as chemotherapy administration or repeated anaesthetics for radiation therapy
How can you provide chemotherapy?
on its own or in conjunction with other therapies
What can the patient get if they are given chemotherapy?
chemosensitivities
What are the disadvantages of giving radiation therapy?
- rediation induced cellular injury
- dividing cells more susceptible to injury
- requires specific equipment
What options other than chemotherapy and radiation therapy are there?
- cryotherapy
- hyperthermic therapy
- photodynamic therapy
- immunotherapy
What are the surgical options for removing a tumour?
- complete excision, wide, radical
- excisional biopsy
- incisional biopsy
- trucut biopsy
- fine needle aspirate
What are some examples of emergency surgery?
bleeding, pathologic fracture, infection, bowel perforation, bowel obstruction
What is excisional biopsy?
debulking surgery, taking away the main mass of the tumour but potentially leaving behind the local invasion into the surrounding tissues
What is incisional biopsy?
wedge of tissue taken from the tumour
What is a trucut biopsy?
core of tissue taken from the mass
What is a fine needle aspirate?
cells collected from the mass using a needle and syringe
Why might surgery be done?
to be curative, to debulk and palliative surgery for comfort
What is an example of a preventative surgery?
testicular removal or pinnae removal
Why might you stage a tumour?
- to find out how much tumour there is present in the body at that particular moment
- gives a picture of patients overall health e.g concurrent conditions or paraneoplastic conditions
- forms decisions for treatment
What is the TNM system?
T = primary tumour size
N = level of lymph node involvement
M = presence of metastesis
When does staging occur?
before treatment, to assess response to treatment or before recommencing treatment after relapse
How do you stage a tumour?
- perform physical exam of the patient and take history
- urinalysis
- bloods - complete blood count, chemistry profile and specialised bloods
- chest x-ray
- abdominal ultrasound - aspirate the liver,spleen,lymph nodes
- specialised imaging such as CT, MRI, echocardiogram
What does grading a tumour depend on?
- histological findings
- appearance under microscope
- mitotic index
- how well organised the cells are
- evidence of cancer cells invading blood vessels
- low, intermediate, high
- important prognostic indicator
What are the 3 grades for grading a tumour?
low, intermediate, high
What is mitotic index?
number of cells currently dividing that are in mitosis
How would you form a nursing care plan for an oncologic patient?
(everything in a normal care plan)
- set goals for the patient
- specific, measureable, attainable, relevent and timely
- prioritise nursing interventions
- be really specific about what you are documenting
What is the normal cell life cycle?
interphase, mitosis phase, mitosis-metaphase, mitosis-anaphase, mitosis-telophase, mitosis-cytokenesis and starts over again
What is cancer?
phenotypic end result of a whle series of changes that may have taken a long time to develop
How does cancer arise?
it is a slow process of genetic mutations that may not arise in the lifetime of the animal, they eleminate normal cell constraints
What are the chemical carcinogen environmental causes of cancer?
tobacco smoke, pesticides, herbicides and insecticides and clycophasphamide
What are the physical environmental causes of cancer?
sunlight, trauma/chronic inflammatio, magnetic fields, radiation, surgery and implanted devices, asbestos
What are cancer causing viruses?
papilloma virus and retrovirus (FeLV)
What is the normal cell cycle?
- sustain proliferative signalling
- evade growth suppressors
- resist cell death
- enable replicative immortality
- induce angiogenesis
- activate invasion and metastisis
What is the minimum critical mutations required to cause cancer?
5-6
What does the word “tumour” mean?
refers to neoplasm, benign or malignant (inflammatory: latin)
What does the word “neoplasia” mean?
formation of new abnormal growth that is not responsive to normal physiologic control mechanisms, malignant or benign
What does the word “cancer” mean?
metastatic neoplasms
What is a “benign tumour”?
space occupying and can cause tissue distortion
What is a “malignant tumour”?
locally destructive and may metastesise and cause death if untreated
What is the national cancer institute 1955?
they set the framework for cancer chemotherapy development
What does chemotherapy do?
- targets dividing cells
- classes of drugs work at various stagesin cellular DNA replication and cell division
- other agents interfere with cell signalling
What are the goals for chemotherapy?
- primary induction chemotherapy
- primary neoadjuvant chemotherapy
- adjuvant chemotherapy
- consolidation chemotherapy
- maintenance chemotherapy
- rescue or salvage chemotherapy
- palliative chemotherapy
What are multimodal treatment plans?
- maximal cell kill within the range of tolerable host toxicity
- broader range of interaction between drugs and tumour cells
- slows development of tumour drug resistance
- only drugs with single use efficacy against tumour type
-preferabledrug with no overlapping toxicities - use drugs at optimal doses and schedule
- use consistent intervals
What are alkylating agents made of?
action binds alkyl groups to cellular macromolecules cross linking DNA
What are examples of alkyating agents?
chyclophasphamide, chlorambucil, lomustine
What are antitumour antibiotics used for?
multimodal action of cellular toxicity
What are examples of antitumour antibiotics?
doxorubicin and mitoxantrone
What do antimetabolites do?
inhibit use of cellular metabolites in cellular growth and division
What do antimicrotubule agents do?
interfere with cellular function and replication
What are examples of antimicrotubule agents?
vinca alkalooids such as vincristine and vinblastine
What are corticosteroids?
induction of apoptosis in haematologic cancers
What is an example of a corticosteroid?
prednisolone
What does platinum bind to?
DNA
What are examples of platinum?
cisplatin and carboplatin
What is L-Asparginase used for?
induction of apostosis in tumour cells
What are Targeted agents?
tyrosine kinase inhibitors
What do targeted agents do?
block receptors on the cell surface
What are examples of targented agents?
palladia and masivet
What is a lymphoma?
a diverse group of neoplasma common origin from lymphocytes
Where are lymphomas commonly found?
lymph nodes, spleen and bone marrow, any tissue in the body
What form of lymphoma do 80% of dogs have?
multicentric form
What presentation do cats normally have with lymphoma?
intestinal
