Lecture 7

Question 1

Route of spread for sarcomas

Answer 1

blood/hematogenous

Question 2

sarcoma definition

Answer 2

Connective tissue / mesenchymal tumors

Question 3

80 percent of bone tumors are what kind of tumors?

Answer 3

•80% Osteosarcoma
–Others include Fibrosarcoma, Chondrosarcoma, Hemangiosarcoma
–Rare in cats

Question 4

signalment for OSA patient

Answer 4

–mid to older aged dogs, also peak at 18-24 months
–Large / giant breeds
–males > females
–neutered > intact (in Rotties)

Question 5

appendicular OSA means what?

Answer 5

long bones affected

Question 6

location of appendicular OSA

Answer 6

–Most common location, > 75% metaphyseal
–Front legs > back legs
–Away from the elbow and towards the knee

Question 7

axial OSA means what?

Answer 7

flat bones

Question 8

axial OSAs develop where?

Answer 8

Bone of the head, ribs, pelvis, vertebrae

Question 9

cytological stain to dx OSA

Answer 9

Alk Phos staining

Question 10

gold standard diagnostic for OSA

Answer 10

histopath

Question 11

organ with high potential for metastasis

Answer 11

lung

Question 12

most sensitive dx tool to determine if mets to the lung have occured

Answer 12

–Lung radiographs -3 views
•< 5% have radiographic evidence at outset
•Metastasis most likely to grow after primary tumor is removed
–CT is far more sensitive

Question 13

indicators of a poor prognosis

Answer 13

–Lung or bone metastasis at outset
–Lymph node metastasis
–Elevated Alk Phos
–Monocytosis

Question 14

treatment for osteosarcoma

Answer 14

no real treatment; palliative only
•Amputation / no chemo 3-4 mths
•Radiation for pain control 4-6 mths
–External Beam or Radionuclide (Samarium)
•Pain medication (NSAID’s, Opiods) 4-6 mths?
•Bisphosphonates (Alendronate- Fosamax, Pamidronate, Zoledronate)

Question 15

chemo for appendicular osa

Answer 15

•Cisplatin > Carboplatin > Doxorubicin
•Carboplatin alternating with Doxorubicin
Single agent Carboplatin

Question 16

treatment for axial OSA

Answer 16

–When removal is possible + chemotherapy

•survival is probably longer than for long bone tumors because metastasis comes slower

Question 17

feline OSA characteristics

Answer 17

• Rare but it happens
• Metastasis seems to come much slower than in dog
• Amputation is treatment of choice

Question 18

for soft tissue sarcomas, grade is ____ than type

Answer 18

more important

Question 19

signalment of dogs with soft tissue sarcomas

Answer 19

Usually larger, older dogs- but any age and breed

Question 20

biologic behavior of soft tissue sarcomas

Answer 20

–Locally aggressive, invasive, poorly defined margins
–Slow to metastasize
•Spread to lungs more than LN’s

Question 21

important consideration of soft tissue sarcomas

Answer 21

Grade should be predictive
•Mitotic index (mitosis per 10 high per field) may be most important prognostic indicator
–10-19 grade II
–>20 is grade III

Question 22

interpretation of the mitotic index for SSA

Answer 22

–10-19 grade II

–>20 is grade III

Question 23

Dx of SSA

Answer 23

Cytology suggestive
•Incisional biopsy
–Required for true diagnosis and grade
•Excisional biopsy- be sure you know margins

Question 24

parameters for surgical removal of SSA

Answer 24

•Surgery- aggressive
–3 cm in all directions
–Submit all tissue for histopathology !!!

Question 25

How to use radiation for SSA

Answer 25

– Best for minimal disease
(incomplete surgical margins)
– Gross tumor may require higher
dose
– High dose difficult to achieve in
some locations

Question 26

chemotherapeutics for SSA

Answer 26

– Doxorubicin
– VAC (Vincristine, Doxorubicin, Cyclophosphamide)
– DTIC and Doxorubicin
metronomic therapy

Question 27

VAC stands for what

Answer 27

(Vincristine, Doxorubicin, Cyclophosphamide)

Question 28

treatment for low grade SSA

Answer 28

– Surgery alone can be curative (done properly!)
– Surgery with follow-up radiation when margins not
adequate

Question 29

treatment for high grade SSA

Answer 29

– High potential for metastasis (at least 40%)

– Surgery +/- radiation +/- chemotherapy

Question 30

rule of 1,2,3 for SSA

Answer 30

remove a mass at a vaccine site
when
– Still growing at 1 month
– Greater than 2 cm in size
– Still present at 3 months post vaccination

Question 31

biologic behavior of SSA in cats

Answer 31

– Locally extremely aggressive

– 10-25 % metastasize

Question 32

treatment for feline SSA

Answer 32

•Surgery- remove with margins the first time!
–5 cm or 2 facial planes required for cure
•Radiation most helpful as follow-up when margins are clean but < 5 cm