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Oncology Final (14-24) > Lecture 19: Feline Lymphoma > Flashcards

Lecture 19: Feline Lymphoma Flashcards

1
Q

Describe the clinical presentation of the most common anatomic forms of feline lymphoma:

A

Anatomic Locations:
-Alimentary (GI) Lymphoma
- Most common
- Signalment: Older, FeLV- cats (Siamese may be predisposed)
- Clinical signs: Anorexia, vomiting, diarrhea, weight loss
- High-grade: generally acute, palpable abdominal mass, focal or multifocal masses
- Low-grade: generally chronic, thick/ropey intestines, diffuse thickening
- 4x more likely to affect small intestine than large intestine
- Mediastinal, Nasal*, Multicentric/Nodal, Other extranodal- renal, CNS, Subcutaneous, Tarsal, Upper respiratory

(important info. to know when to call in the oncologist)

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2
Q

What is the role of viral infections (FeLV and FIV) in the development of feline lymphoma?

A

FIV -> 5-fold increase in relative risk of developing Feline Lymphoma
FeLV -> Cats naturally infected w/ FeLV have a greater risk (62x) of developing lymphoma than FeLV- cats
- Most common anatomic locations: mediastinal, multicentric, CNS
- Median age of affected animals: 2-4 years
- Insertional Mutation (direct mechanism)
- Insertion of FeLV into cellular genome near oncogene (Myc most common)
- Leads to activation of genes and uncontrolled cell proliferation

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3
Q

Clinical presentation

A
  • Only 4-10% of lymphoma diagnosed in cats will involve peripheral lymph nodes (multicentric)
    - Cats will come in very sick
  • Anatomic Locations: Alimentary, mediastinal, Nasal, Multicentric/Nodal (important info. to know when calling in the oncologist)
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4
Q

Diagnostic recommendations:

A
  • CBC, chemistry profile, UA +/- FeLV/FIV
    • Anemia
    • Hypercalcemia: uncommon
    • Hyperglobulinemia: cats>dogs
    • Hypoalbuminemia: common w/ low-grade GI lymphoma
  • Thoracic radiographs
  • Abdominal ultrasound
    - Alimentary (GI) Lymphoma
    - Low-grade GI Lymphoma: thickened muscularis
    - High-grade: Transmural wall thickening with loss of normal layering
  • +/- Bone marrow aspiration
  • +/- Immunophenotyping (B-cell vs T-cell)
    - NOT prognostic in cats
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5
Q

Treatment:

A

Alimentary (GI) Lymphoma
- Treatment for High-Grade GI Lymphoma
- Aggressive multi-agent chemotherapy -> CHOP or COP (Cytoxan, Vincristine/Vinblastine, and Prednisolone) protocol (H= Doxorubicin, can cause renal toxicity in cats)
Other Treatment options:
- CCNU (Lomustine) single-agent chemotherapy
- Oral, given every 4 weeks
- Prednisolone- only therapy - any response tends to be short-lived (Days to weeks)

Treatment for Low-Grade GI Lymphoma:
- Oral chemotherapy (chlorambucil) + prednisolone
- Tends to be life-long therapy
- Aims to improve clinical signs over weeks

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6
Q

Patient outcome

A
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7
Q

Prognostic Factors in cats diagnosed with Lymphoma and How it Compares to Dogs:

A

Alimentary (GI) Lymphoma: Prognosis for High-Grade -> CO/CHOP chemo
Dogs: about 1 year
Cats: Median Survival Times: 6-8 months
- 1/3 achieve a complete response
- 40% disease free ar 1 year
- 30% disease free at 2&3 years
Response to treatment is the best prognostic factor

The prognosis for low-Grade GI Lymphoma:
- Good
- 95% remission
- MST about 2 years

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8
Q

Term:
The malignant proliferation of lymphocytes

A

Lymphoma

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9
Q

What is the most common neoplasm seen in the cat?

A

Feline Lymphoma
- accounts for 30% of all feline tumors
- Siamese

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10
Q

(T/F) INCREASE in the prevalence of lymphoma in cats is due to increased relative frequency of alimentary (GI) lymphoma

A

True
- Median age: 11 years

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11
Q

Feline Lymphoma: Viral Factors
- Tends to involve multiple organ systems
- Indirect mechanism: chronic immunosuppression
- Typically older cats
- Usually B-cell lymphoma

A

FIV associated lymphoma

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12
Q

Feline Lymphoma: Viral Factors
- Mediastinal, multicentric, CNS
- Direct mechanism: insertional mutagenesis
- Typically younger cats
- Decreased incidence since 1980 (vaccines, lifestyle changes)
- Usually T-cell lymphoma

A

FeLV

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13
Q

Histologic/cytologic classification: Determined by the maturity of the cells
- Large, immature lymphocytes (aka lymphoblastic)
- Most cases of multicentric, extranodal, and mediastinal forms
- about 50% of alimentary lymphoma
- Dx with FNA and cytology
- +/- FLOW cytometry
- +/- PCR for antigen receptor rearrangement (PARR)

A

High-Grade

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14
Q

Histologic/cytologic classification: Determined by the maturity of the cells
- Small, mature lymphocytes
- about 50% of alimentary lymphoma
- Dx with biopsy

A

Low-grade

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15
Q

Many cats are substage ___ ate presentation

A

b

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16
Q
  • An uncommon variant of high-grade GI lymphoma in cats
  • Arises from *cytotoxic CD3+ T-Cells
  • Most cats are FeLV/FIV negative
  • Similar clinical signs to other high-grade GI Lymphoma
  • More aggressive process
    • Chemotherapy:
      • <30% respond
      • MST 57 days
A

Large Granular Lymphoma (LGL)

17
Q

Prognosis for Mediastinal Lymphoma:

A
  • MST 2-3 months if FeLV+
  • Older FeLV- cats show overall MST of about 1 year
18
Q

What is the treatment of choice if the disease in confined to the nasal cavity?

A

Radiation therapy
- Response rate 75-95%
- MST: 1.5 - 3 years

19
Q

Lymphoma is classified based on ____________ and ____________

A

anatomic location, histologic grade

20
Q

(T/F) Most common form of lymphoma in cats in Gastrointestinal lymphoma

A

True
- 50-70% of cats with high-grade GI lymphoma will respond to therapy
- Average duration of response is 4-6 months
- However, those that achieve CR can have long-term survival

21
Q

__________ is not considered as effective in cats as dogs

A

Doxorubicin

22
Q

List the things that are prognostic in dogs with high-grade lymphoma but NOT prognostic in cats with high-grade lymphoma

A
  • Immunophenotype (B vs T)
  • Pre-treatment with glucocorticoid
23
Q

Lymphoma is considered a SYSTEMIC disease, and surgery is rarely indicated EXCEPT:

A
  • To obtain biopsies for diagnosis
  • Relive intestinal obstruction
24
Q

When is radiation therapy most commonly used?

A
  • Nasal
  • Mediastinal
  • CNS lymphoma

Oncology Final (14-24) (10 decks)

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