JVD 2015 Flashcards
What tissue does SCC in cats commonly arise from?
Gingiva and mucosa of the maxilla, mandible, tongue, sublingual or tonsil region.
Oral tumours account for ___% of all feline tumours and approximately ____% of these tumours are malignant.
Oral tumours account for 10% of all feline tumors, and approximately 90% of these oral tumors are malignant
SCC accounts for ______% of feline malignant oral tumours
60-70%
According to a study by Gendler A, Lewis JR, et al. Computed tomographic features of oral squamous cell carcinoma in cats: 18 cases (2002-2008). J Am Vet Med Assoc 2010; 236: 319-325
Metastatic rate of SCC to the mandibular LNs is _____%
35.7%
According to Gendler A, Lewis JR, et al. Computed tomographic features of oral squamous cell carcinoma in cats: 18 cases (2002-2008). J Am Vet Med Assoc 2010; 236: 319-325
What were the two common CT features of oral SCC in cats?
Features of SCC at sublingual and maxillary locations:
marked heterogenous contrast enhancement and osteolysis
According to endler A, Lewis JR, et al. Computed tomographic features of oral squamous cell carcinoma in cats: 18 cases (2002-2008). J Am Vet Med Assoc 2010; 236: 319-325
Do quantatitative CT features such as mass size, attenuation, LN width correlated with survival time?
No. Results of CT did not correlate with survival time.
In endler A, Lewis JR, et al. Computed tomographic features of oral squamous cell carcinoma in cats: 18 cases (2002-2008). J Am Vet Med Assoc 2010; 236: 319-325
What did CT help identify?
CT mass extension and LN enlargement.
What treatment options have shown the longest survival times with SCC cases?
Curative intent sx with radiation tx.
What is the risk of environmental tobacco smoke to cats wrt SCC?
Cats exposed to tobacco smoke seem to be at a two fold risk of developing SCC.
What is p53 protein?
The p53 protein is a tumour supressing protein that regulates cell growth and proliferation, preventing uncontrolled cell division after chromosomal damage.
True or False:
Mutations of p53 protein are common in neoplasms
True
Explain the effect of tobacco smoke on p53.
Tobacco smoke can lead to p53 mutations which results in non functional p53 protein ACCUMULATION within cells, thereby not regulating uncontrolled cell division.
Snyder LA, Bertone ER, et al. p53 expression and environmental tobacco smoke exposure in feline oral squamous cell carcinoma. Vet Pathol 2004; 41: 209-214
Showed that tumour biopsy samples from cats exposed to tobacco smoke were ____times more likely to overexpress p53 than tumours from cats not exposed to tobacco smoke.
4.5 times more likely to exress p53
How much more likely are cats that wear flea collars likely to develop oral SCC?
5.3 times more likely than those that did not wear flea collars.
How much more likely are cats that eat canned food likely to develop oral SCC?
How about cats that eat canned tuna?
- 6 times more likely(canned)
- 7 times more likely (canned tuna)
In one study of 84 cats, biopsies from the oral cavity included 11 tongue, 4 gingival, 4 mandibular, 2 maxillary, 2 tonsillar, 1 hard palate, and 1 from a unspecified oral location, for a total of 25 oral samples.
Papillomavirus was identified in ____% of these samples
8%
What protein in humans is associated with oncogenic papillomavirus?
RB (retinoblastoma) protein dysfunction – which results in the increase of p16 protein.
p16 protein is identified by increased p16 immunoreactivity. This was found in 7% of feline oral SCC tumour samples
(Munday JS, Howe L, et al. Detection of papillomaviral DNA sequences in a feline oral squamous cell carcinoma. Res Vet Sci 2009; 86: 359-361)
True or false:
Altered EGFR (epidermal growth factor rceptor) expression may play a role in development of feline oral SCC.
True
In Looper JS, Malarkey DE, et al. Epidermal growth factor receptor expression in feline oral squamous cell carcinomas. Vet Comp Oncol 2006; 4: 33-40:
What percentage of samples had positive immunoreactivity to epidermal growth factor receptor (EGFR)?
Does this expression significantly alter the outcome for the cat?
69%
No studies have been done on ORAL SCC wrt outcome when samples express EGFR. However, CUTANEOUS SCC samples that express EGFR have a significantly worse outcome.
What are three functions of COX 1
COX 1 catalyzes the synthesis of PG involved in:
|Gastric mucosa protection
vasodilation of the kidneys
synthesis of thromboxane/promotes clotting/plt aggregation
What does COX 2 activation lead to?
COX 2 activation leads to PGE2 production - which is proinflammatory
Inflammation may contribute to carcinogensis.
Are feline maxillary SCC more common in the rostral or caudal area of the maxilla?
Caudal.
True or false:
Fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT has been used for staging in 12 cats with oral SCC. FDG-PET appeared to provide even better delineation of tumor margins than with CT alone
True
True or false:
- Palpation of regional lymph nodes is a good indicator of lymph node metastasis in dogs
- The sensitivity and the specificity of fine-needle aspiration cytology of mandibular lymph nodes were found to be very high in dogs.
- Pulmonary metastasis appears to common, with 15 of 16 cats showing evidence of pulmonary metastasis in one study
- Hypercalcemia may occasionally be associated with feline oral SCC
- Most neoplasms exhibit variable degrees of inflammation (neutrophils, lymphocytes, plasma cells), necrosis, ulceration, and desmoplasia.
- Invasion into the adjacent connective tissue (including nerves), skeletal muscle (in lingual neoplasms), or bone (in gingival neoplasms) is common.
- FALSE. It is a good indicator.
- TRUE
- FALSE – not common; 1/16 showed pulmonary mets in one study
- TRUE
- TRUE
- TRUE
- TRUE
Is SCC responsive to radiation?
Yes however is also radioresistant. It responds quickly but subclones are resistant and tend to re-populate quickly.
What type of radiation is used when treating SCC?
Accelerated or HYPFRACTIONATION radiation doses are used.
It involves 2 doses of radiation per day for 5 days or treating 7 days a week instead of 5.
In Fidel JL, Sellon RK, et al. A nine-day accelerated radiation protocol for feline squamous cell carcinoma. Vet Radiol Ultrasound 2007; 48: 482-485.
Was he accelerated radiation protocol was well tolerated?
Were the median survival times dramatically improved compared to other treatment protocols?
Yes - well tolerated
No - not drastically improved compared to otehr radiation protocols
In Bregazzi VS, LaRue SM, et al. Response of feline oral squamous cell carcinoma to palliative radiation therapy. Vet Radiol Ultrasound 2001; 42: 77-79.
Was coarse fractionation radiation therapy found to be palliative in cats with advanced oral SCC?
What was median survivial time?
NO
Median surviival time was 60 days
In Fidel J, Lyons J, et al. Treatment of oral squamous cell carcinoma with accelerated radiation therapy and concomitant carboplatin in cats. J Vet Intern Med 2011; 25: 504-510.
In this study showing carboplatin combined with accelerated radiation therapy – what were two predicotrs of survival rates?
Significant predictors of survival were tumor location and whether there was a complete response at 30-days
In Fidel J, Lyons J, et al. Treatment of oral squamous cell carcinoma with accelerated radiation therapy and concomitant carboplatin in cats. J Vet Intern Med 2011; 25: 504-510.
What location of oral SCC showed the longest survival times?
Tonsillar SCC despite having metastasized to at least one LN by time of dx.
In Evans SM, LaCreta F, et al. Technique, pharmacokinetics, toxicity, and efficacy of intratumoral etanidazole and radiotherapy for treatment of spontaneous feline oral squamous cell carcinoma. Int J Radiat Oncol Biol Phys 1991; 20: 703-708.
Etanidazole and radiation therapy combination resulted in significant and rapid tumor regression with a median volume regression of ____%, however, the duration of response was _____.
70%
Short
From : Marconato L, Buchholz J, et al. Multimodal therapeutic approach and interdisciplinary challenge for the treatment of unresectable head and neck squamous cell carcinoma in six cats: a pilot study. Vet Comp Oncol 2012 Mar 23. doi: 10.1111/j.1476-5829.2011.00304.x.
What was the weekly medical neoadjuvant medical therapy?
What did they then do for cats that responded well to that tx? For those that did not respond well to neoadjuvant treatment?
What was the response to treatment?
What weere the survival times for cats with lingual SCC?
Neoadjuvant medical therapy consisted of weekly subcutaneous bleomycin injections, oral piroxicam, and oral thalidomide.
Tumors that responded well to induction medical therapy were surgically resected, followed by radiation therapy 1-week later.
Tumors that did not respond to induction medical therapy were irradiated, followed by surgical resection.
Adjuvant medical therapy was resumed after local treatment and continued for 6-months until onset of unacceptable toxicity or development of progressive disease.
Results:
- Five cats showed complete responses (disappearance of all detectable tumor).
- One cat with a maxillary tumor showed a partial response after receiving the above protocol with the exception of radiation therapy.
- Three cats with lingual SCC remained alive at the time of submission, with survival times of 759, 458 and 362-days.
Is COX-2 expression higher in cats or dogs with orall SCC?
COX 2 is higher in dog oral SCC than in cats.
Would cox-2 inhibitors influence the tumour growth for feline oral SCC tumours?
No – only a small percentage of cats have been shown to express cox-2 in oral SCC samples.
True or false:
- Studies suggest that buprenorphine provides analgesia in cats superior to oxymorphone and meperidine and comparable to morphine.
- Among the opioids, buprenorphine has the shortest duration and has higher receptor affinity than other opioids
- TRUE
- FALSE – buprenorphine has the LONGEST duration and highest receptor affinity
What is the mechanism of action for amitriptyline with respect to pain management?
inhibition of serotonin and norepinephrine reuptake at the synapse
What is the mechanism of action for Gabapentin’s analgesic effect?
Gabapentin exerts its effect by interacting with the alpha-2 delta-1 (α2-δ1) subunit of calcium channels, thereby modulating current and inhibiting the release of excitatory neurotransmitters
Define the following according to the World Health Organization (WHO) Tumor Node Metastasis (TNM) system for classification of tumors in domestic animals:
Clinical stage was classified as T1 _____
T2 ______________
T3 _______________
Substage A _____________
Substage B __________________
Clinical stage was classified as
T1 (< 2-cm),
T2 (2 to 4-cm)
T3 ( > 4-cm),
and substage a (no bone invasion),
substage b (bone invasion).
In Evaluation of an Accelerated Chemoradiotherapy Protocol for Oropharyngeal Squamous Cell Carcinoma in 5 Cats and 3 Dogs
What was the carboplatin effect?
Carboplatin was used as a radiosensitizer
In Norhrup NC, Selting KA, et al. Outcomes of cats (21) with oral tumors treated with mandibulectomy: 42 cases. J Am Anim Hosp Assoc 2006; 42: 350-360:
What was the 1 year survival rate?
What was the acute post op morbidity rate?
What was the chronic post op morbidity rate?
What % of cats never regained functional ability to eat?
1 year survival was 43%
Acute morbidity was 98%
Chronic morbidity was 76%
12 % of the cats never regained ability to eat.
Cats with advanced stage disease left untreated or treated with any conventional single treatment modality have survival expectations of ______.
Less than 3 months.
In Hutson CA, Willauer CC, et al. Treatment of mandibular squamous cell carcinoma in cats by use of mandibulectomy and radiotherapy: seven cases (1987-1989). J Am Vet Med Assoc 1992; 201: 777-781.
What was the 1 year survival rate?
What was the median survival tmie?
57%
14 month median survival time
True or false:
Accelerated fractionation radiation treatmetn involves a reduction in overall treatment time with or without change in fraction size and total dose
True
What is the premise of accelerated radiation therapy?
Acceleration is based on the premise that the reduced overall treatment time reduces the opportunity for tumor cells to regenerate
Is there an increase in acute side effects of accelerated radiation therapy vs conventional radiation therapy?
Yes
