Lymphoma Flashcards
List five staging tests for lymphoma and what you are looking for on each.
- CBC
- non-regenerative anemia
- thrombocytopenia
- lymphocytosis
- Serum biochemical profile
- hypercalcemia
- organ (esp. liver) dysfunction
- Urinalysis-but this is mostly for obtaining baseline values before treatment since some drugs have urinary tract toxicity
- Bone marrow aspirate
- if blasts are in circulation; determine if lymphoma or leukemia
- if cytopenias are present
- Chest rads
* abnormalities, diffuse pulmonary infiltrates - Abdominal imaging
- organomegaly
- lyphadenopathy
What are the minium staging requirements prior to treatment for lymphoma
Chest rads & abdominal ultrasound
(from old guide)
_____% of canine lymphomas involve lymph nodes
80
What is the most prognostic factor for dogs with lymphoma?
Substage
- A-animal doesn’t show signs
- B-animal shows signs of disease; feels bad
Differential diagnoses for lymphoma
- can look like most anything; e.g. inflammatory skin disease, infectious(tick-born), immune-mediated, other hematopoetic tumors such as leukemia
Lymphoma accounts for ____% of all canine neoplasms [excluding benign skin tumors)
25
Name some breed predilections for lymphoma
- Golden retriever
- Labrador retriever
- Rottweiler
- Boxer
- Bassett hound
- Scottish terrier
- Bulldog
What sex is predisposed to canine lymphoma?
no sex predilection
T/F lymphoma risk increases with age
True
What genetic/epigenetic factors can affect risk for canine lymphoma?
- gain of chromosomes 13, 31
- loss of chromsome 14
- p53
- N-ras
- hypomethylation
______ is a known contributor to gastric lymphoma in ferrets
Helicobacter
What are some environmental factors that may contribute to canine lymhoma?
- 2,4-D herbicides
- paint thinner
- living near factories, incinerators, toxic waste sites, highly populated areas
- magnetic fields
What are two cases of immune system dysfunction/suppression that are associated with canine lymphoma?
- ITP
- post-transplant lymphoma
80% of canine lymphoma is ____________
multicentric
PPV for FNA cytology dx for lymhpoma
98%
____% of dogs are “sick” at time of lymphoma diagnosis
40%
40% of canine lymphoma is what type?
diffuse lymphoblastic B-cell lymphoma
The majority of dogs have what grade lymphoma?
intermediate to high
Characteristics of low grade lymphoma
- small cell, lymphocytic, “indolent”
- low mitotic rate
- progress slowly
- may not need treatment
Characteristics of intermediate to high grade lymphoma
- large cell, lymphoblastic
- high mitotic rate
- likely to respond to chemotherapy
What percentage of dogs with intermediate to high grade lymphoma die of their disease?
90%
Circulating blasts means what about the lymphoma
Stage V
T-cell lymphomas are more likely to be where in the body?
- cutatneous
- mediastinal
What lymphoma type is more likely to be associated with the paraneoplastic syndrome hypercalcemia?
T-cell
What is the mechanism of hypercalcemia?
PTHrp secretion by neoplastic lymphocytes
PARR stands for _______
PCR for Antigen Receptor Rearrangements
Three common CBC findings with canine lymphoma
- non-regenerative anemia
- thrombocytopenia
- lymphocytosis
Diffuse pulmonary infiltrates on chest radiographs of a lymphoma patient may look like ________
pneumonia
____% of dogs with multicentric lymphoma will have diffuse pulmonary infiltrates
30
What is the standard of care for the majority of canine lymphoma?
chemotherapy
When might surgery be warranted in a case of canine lymphoma?
Example: if there is a solitary obstructive intestinal lesion
About how long is the CHOP protocol?
25 weeks
What is the remission rate and MST for CHOP protocol treatment of multicentric, high grade lymphoma?
- 75-94% remission; generally strong remission
- 10-14 months MST
What is the remission rate and MST associated with single agent chemo (doxorubicin) for multicentric, high grade lymphoma?
- 80-85% remission rate
- 6-8 months MST
What is the MST for no treatment of canine multicentric high grade lymphoma?
1-1.5 months
Prednisone alone can have a remission rate of _____% when used to treat canine multicentric high grade lymphoma
50-60%
What does “CHOP” stand for?
C=cyclophosphamide (Cytoxan)
H=hydroxydaunorubicin (Doxorubicin/Adriamycin)
O=vincristine (Oncovin)
P=prednisone (+/- L-asparaginase; Elspar)
MST for canine B-cell lymphoma treated with CHOP
12-14 months
MST for canine T-cell lymphoma treated with CHOP
4-6 months
How are indolent lymhpomas diagnosed?
only by histopathology
What percentage of all canine lymphomas are indolent?
29%
Treatment of indolent lymphomas
- mild chemo e.g. pred/cholorambucil
- CHOP
- may not even need treatment
Survival times of over _____ are not uncommon for dogs with indolent lymphoma
4 years
Feline lymphoma accounts for _____ of feline neoplasms
1/3
FeLV increases a cats risk of developing LSA by how much?
66 times
What percent of cats with LSA are FeLV+ today?
13%
____% of FeLV+ cats will develop LSA
25-50%
The risk of developing LSA is increased 77x in cats that have ______
FeLV + FIV infection
What is a risk factor for cats developing lymphoma besides FeLV and FIV?
Smoking households
What is the most common form of lymphoma in the cat?
alimentary
Clinical signs of alimentary lymphoma in the cat
- chronic, progressive anorexia & weight loss
- +/-diarrhea, vomiting
- palpable mass or thickened intestines
- hematochezia or tenesmus if colon involvement
Lymphocytic lymhphoma (cats) is important to distinguish from _____
IBD; full-thickness, surgically obtained biopsy
Recommended treatment for lymphocytic alimentary lymphoma in cats? What is the response rate and remission time?
- pred + chlorambucil
- 95% response rate
- median remission = 2 years
Which form of alimentary lymphoma (cats) usually present with palpable mass lesions vs. thickened bowel loops?
- lymphoblastic—mass lesions
- lymphocytic—thickened bowel
What is a very important differential for multicentric lymphoma in a young cat?
Benign peripheral lymph node hyperplasia of cats
How is a diagnosis of benign peripheral lymph node hyperplasia made in a cat?
have to have histopathology
How does viral status (FeLV+) affect the response to therapy and survival time in cats with multicentric lymphoma?
- usually no influence on therapy response
- may influence the survival time
Differential for mediastinal lymphoma
thymoma
Clinical signs of mediastinal lymphoma in cats
- acute onset dyspnea
- dysphagia
- Horner’s syndrome
A non-compressible cranial thorax in a cat is a good indicator of _____
mediastinal lymphoma
If an FNA/cytology is not able to differentiate thymoma from mediastinal lymphoma, what can you do?
histopathology, flow cytometery
Treatment for mediastinal lymphoma?
Chemo
+/- RT
What is a situation where you might not have to treat a case of mediastinal lymphoma in cats?
young, FeLV negative
Should you remove a kidney of a cat that you find lymphoma in? why or not?
No, there is almost certainly lymphoma in the other, even if not detectable yet
