Module 17 Wk3 Flashcards
(Approach to the cancer patient & paraneoplastic syndromes)
What are non specific clinical signs as direct effect of internla tumours?
- vomiting, diarrhoea, weigh loss/wasting for a GI mass
- Dyspnoea, weight loss for a thoracic mass
What kind of tumour can cause hyperthyroidism in the cat?
Thyroid adenoma
What kind of tumour can cause hyperadrenocorticism?
- pituatary adenoma
- ACTH/adrenal tumour
What kind of tumour can cause acromegaly?
Pituatary adenoma
What rea the normal controllers of Ca?
- PTH and 1,25 vitD3 increases
- Calcitonin decreases
Does cancer increase or decrease serum Ca?
It increases it
The normal serum level of calcium is?
2.24-3mmol/l
What is the normal level of ionised calcium levels?
1.2-1.4mmol/l
What is the levels of serum and ionised levels of calcium in the hypercalcaemic patient?
greater than 3mmol/l and greater than 1.4mmol/l
What are the malignancy causes of hypercalcaemia?
- lymphoma/leukaemia MOST COMMON
- apocrine gland adenocarcinoma of the anal sac
- BOne tumours/multiple myeloma
- other malignant tumours like mammary, thyroid, lung, thyoma)
- parathyroid adenoma
What are the non neoplastic causes of hypercalcaemia?
- endocrine
- renal
- poisoning
- inflammatory
- lab error
How does hypercalcaemia present?
- PUPD
- anorexia, vomiting and constipation
- muscle weakness, tremour and lethargy
- hypovolaemia, bradycardia and dysrthythmias
Describe how on clinical examination you can find certian tumours?
- lymphoma = check lymph nodes
- aprocrine adenocarcinoma of the anal sac = rectal examination
- parathyroid tumour/adenoma = US neck/PTH gland
- multiple myeloma = bone pain and ocular chnages
- metastic bone tumours = bone pain
What are tumour causes of hypoglycaemia?
- Insulinoma (high insulin)
- Hepatic neoplasia (altered glucose metabolism, consumption)
What are non tumour causes of hyperglycaemia?
- Sepsis, Pregnancy toxaemia
- Liver diseases –shunts, cirrhosis, storage diseases
- Hypoadrenocorticism
What syndrome can be associated with Sertoli cell tumours?
Syndrome of bone marrow suppression
What is a Sertoli cell tumour?
A rare testicular tumour that may be associated with bone marrow suppression.
What are the key features of anaemia?
Pallor and weakness.
What are the key features of thrombocytopenia?
Petechiae (small red or purple spots due to bleeding under the skin).
What is the female counterpart of a Sertoli cell tumour?
Granulosa cell tumour.
What is a notable feature of granulosa cell tumours in females?
They may be secretory, producing hormones such as estrogen.
How is the immune system altered in cancer?
Many cancers can cause immune-mediated syndromes, affecting the nervous system, blood, and coagulation.
What immune-mediated neuropathies can occur with cancer?
Neuropathies (seen in lymphoma and other tumour types) can cause immune-mediated nerve changes, neurological deficits, and muscle wastage.
What cancer is commonly associated with myasthenia gravis?
Thymoma and other tumours.
What is the mechanism of myasthenia gravis in cancer
Antibodies are produced against acetylcholine receptors, leading to muscle weakness and collapse during exercise.
What haematological immune-mediated syndromes can occur with lymphoma or other cancers?
Immune-mediated haemolytic anaemia
Immune-mediated thrombocytopenia
What are other haematological effects of cancer?
Anaemia of chronic disease
Vasculitis
DIC or other coagulopathies
Abnormal blood cell counts
What abnormal blood cell changes can occur in cancer?
Neutrophilic leukocytosis (high neutrophil count)
Eosinophilia (high eosinophil count)
Thrombocytosis (high platelet count)
Lymphopenia (low lymphocyte count)
What are the symptoms of haematological abnormalities in cancer?
Pallor, petechiae, haemorrhage, oedema.
What is hyperviscosity syndrome?
A condition where the blood becomes thick and viscous due to increased RBCs or high protein levels.
What are the causes of hyperviscosity syndrome?
Increased RBCs: Polycythaemia vera (neoplastic) or secondary polycythaemia
Increased protein: Overproduction of immunoglobulins by plasma cells (e.g., multiple myeloma) or other B-cell tumours
What does a biopsy of a tumour provide?
Provides tissue architecture and tumour grade
What are the pros and cons of biopsy of tumour?
- pros = most accurate and definitive diagnosis
- cons = sedation/ local or GA needed, more expensive and time-consuming
What are the pros and cons of a FNA
- Pros = Quick, easy, cheap, no GA
- Cons = No tissue architecture (no grade)
what is a soft tissue sarcoma?
A soft tissue sarcoma (STS) is a rare type of cancer that develops in the soft tissues of the body, such as muscles, fat, nerves, blood vessels, tendons, and the lining of joints.
What is the MCT grading based on?
Based on histopathology not cytology
What does the Grade 1 on the MCT grading system say about mast cells?
Well differrentiates mast cells
- with no tissue unvasion
- no mitotic figures
- minimal stromal reaction
What does the Grade 1 on the MCT grading system say about the tumour mastastising??
Low risk of mastastasising
What is the prognosis after surgery of a grade 1 MCT tumour?
good
What does the Grade 2 on the MCT grading system say about mast cells?
Moderately differentiated /pleiomorphic mast cells
- With some local tissue invasion – lower dermis, subcutis and occ deeper
- 0-2 mitoses per hpf
- Some areas of oedema, necrosis
What does the Grade 1 on the MCT grading system say about mast cells?
Poorly diff, pleomorphic mast cells (few /no granules), binucleate or multinucleated cells
- Very cellular
- 3-6 mitoses per hpf
- Extend into subcutis and tissues
- Haemorrhage, oedema, necrosis
What are problems with the patniak scheme
- Pathologists found it difficult to apply dermal MCT with some mitoses – low grade? MCT in subcut tissues but no mitoses – low grade?
- More tan 50% of MCT are deemed called Grade 2 tumours but Grade 2 tumours have 50:50 chance of long survival so not helpful!
What is the kiupel scheme for mast cell tumour?
2 teir classification system - low and high grade only
What is the criteria for a high grade MCT on the kiupel system?
- At least 7 mitotic figures in 10hpf
- At least 3 multinucleated cells in 10hpf
- At least 3 bizarre nuclei in 10hpf
- Karyomegaly
What is staging?
Defining the anatomical extent of the tumour in terms of primary site and distant spread (anatomical staging) -determined by a clinician = clinical assessment
What is the TNM system?
Primary tumour T
Node N
Metastasis M
What should you asses with the primary tumour?
- measure its dimension
- assess wether there is local invasion via palapting, radiograph, US and CT/MRI
When assesing the lymph nodes with TNM what should you do?
asses the sential LN and anatomically draining LN to see if they are enlarged
- palpate
- image
- aspirate
- biopsy
Why do staging?
- To decide whether treatment / what treatment is feasible
- Helps predict clinical behaviour/prognosis
- Provides a precise record of the tumour extent in the body at that time
- To monitor how tumour changes with time and response to treatment
Describe the anatomical site of a grade 1 lymphoma?
single node or lymphoid tissue ina single organ (excluding bone marrow)
Describe the anatomical site of a grade 2 lymphoma?
SEverak nodes in regional area
Describe the anatomical site of a grade 3 lymphoma?
Generalised LN involvement
Describe the anatomical site of a grade 4 lymphoma?
liver and spleen involvemnt
Describe the anatomical site of a grade 5 lymphoma?
BM and or other organ systems involved
(Intro into cytology)
What are the indications to perform cytology?
- skin and subcutaneous masses
- lymphadenopathy
- Intra-thoracic and intra-abdominal masses
- Body cacvity effusions
- urine sediment
- traumatic catheterisation
- prostatic washes, BAL
- BM samples
What are the pros of a non-aspiration (needle only) cytology techique?
- minimal cell distruption
- reduces haemodilution
- excellent for lymph node aspirates
- effective for many skin tumours
What are cons of non-aspirate (needle only) cytology method?
May not yeild a cellular sample
Describe how to perform the aspiration (suction) cytology technique
- Use needle with syringe attached
- suction can be used continuous or intermittently
- can be US guided
What are potential complications of a aspiration (suction)?
- Introduction of infection
- haemorrhage
- pneumothorax
- Tumour seeding
Why might you get a poor cytology sample?
- poor technique
- intrinsic nature of the lesion being sampled
- haemodilution
- dirty slides
- US gel contamination
Describe the staining problems you can incounter?
- sample too thick
2 US gel - Heavilt granulated cells
- background matric
- maintaining stains
What is the basic algorithm for interpreting cytology specimans?
- Is the sample adequate?
- Are the majority of cells inflammatory? If so, which type of cells?
- Are the majority of cells tissue cells? If so, are they round cells, epithelial cells or mesenchymal cells? Do they show features of malignancy?
What may be seen on cytology of a neutrophilic inflammation?
- degenerative change
- bacteria
What cell types might be seen on cytology of a pyogranulomatous inflammation?
macrophages and neutrophils
What can cause a pyogranulomatous inflammation?
FB reactions, fungal infections or chronic injury
What cell type is seen on a grnaulomatous inflammation?
Macrophages and lymphocytes
What type of thing would result in granulomatous inflammation?
Chronic inflammation and specific infections
What causes eosinophiloc inflammation?
allergic/hpersensitivity reactions, parasites and eoisinophilic granulomas
What things can cause a lymphoplasmacytic inflammation?
Allergic/immune reactions or chronic inflammation
With neoplasia are round cells high or low?
high
With neoplasia how are round cells distributed?
evenly
With neoplasia what is the round cell size/shape like?
Round with distinct borders
With neoplasia are epitheial cell count high or low?
high
With neoplasia what is the distribution of the epithelial cells like?
clusters or rafts
With neoplasia what is the epithial cell size and shape like?
Round to cuboidal, cell to cell borders
With neoplasia are mesenchymal cell count high or low?
LOW to high
What is the shape/size of mesenchymal cells like with neoplasia?
spindle shaped with wispy cytoplasmic tails
What is the criteria of malignancy?
- pleomorphism
- increased nuclear:cytoplasmic ration
- Immature chromatin pattern
- Prominent and/or multiple nucleoli
- multinucleation
- nuclear moulding
- increased and/or abnormal mitotic figures
What are the types of round cell tumours?
- Lymphoma
- Transmissible venereal tumour
- mast cell tumour
- plasma cell tumour
- histiocytoma
Describe the cells in a lymphoma?
Cells are typically round, discrete with scant cytoplasm (brown colour), mitotic figures.
Describe how cells appear in a mast cell tumour?
Cells are typically large, round, discrete with abundant purple cytoplasmic granules which often obscure the nucleus. Eosinophils and spindle cells may be present too.
How do cells in a plasma cell tumour?
Cells are typically round, discrete with moderate amounts of blue cytoplsam, sometimes with a perinuclear clear area. Nuclear chromatin may be coarse/clumped. Binucleate cells may be seen.
How do cells appear with a histiocytoma tumour
Cells are typically round, discrete with moderate amounts of pale cytoplasm
How do mesenchymal tumour cells exfoliate?
Poorly; aspiration is generally required.
How do mesenchymal tumour cells appear on cytology?
As non-cohesive aggregates and/or individual spindle to oval-shaped cells with wispy cytoplasmic tails.
What may some mesenchymal tumours produce?
Matrix (appears pink).
What diagnostic method is usually required to classify mesenchymal tumours?
Histopathology
Name three benign mesenchymal proliferations.
Fibroplasia, inflammation (granulation tissue), lipoma.
Give two examples of benign mesenchymal tumours.
Lipoma, fibroma.
Where can epithelial tumours arise?
Skin, respiratory tract, GI tract, urogenital tract, glands, and organs.
How do epithelial tumour cells exfoliate?
In cohesive clumps or rafts with intercellular adhesions forming tight lines.
What shapes can epithelial tumour cells have?
Polygonal, ovoid, round, angular, cuboid, or columnar.
Name four benign epithelial tumours.
Follicular (epidermal inclusion) cysts, basal cell tumours, sebaceous adenoma, epithelioma.
What are malignant epithelial tumours called?
Carcinomas
What are some arrangements seen in carcinomas?
Acinar, palisading, honeycomb, papillary
What diagnostic method is often needed to classify epithelial tumours?
Histopathology
What is a key cytological feature of naked nuclei tumours?
High cellularity with loosely adherent cells and many free nuclei.
How do nuclei appear in naked nuclei tumours?
Round to indented with minimal anisokaryosis.
Name three types of endocrine/neuroendocrine tumours.
Anal sac adenocarcinoma, insulinoma, thyroid tumours.
(oncology surgery)
What is the main indication for oncological surgery in practic?
Skin tumour removal
What surgeries are there to try prevent cancer?
- removal of testicles
- neutering prior to first season to prevent mammary neoplasia
What surgeries are for diagnosing?
- FNA
- Core needle
- Incisional biopsy
- Excisional biopsy
What are the 6 principles of oncological surgeries?
- Resect tumour with an appropriate margin
- Plan biopsy so tract can be resected with tumour
- Consider all scars from previous surgery, biopsies and drains as contaminated and ensure resected in primary incision
- Ligate blood supply early to prevent dissemination
- Limit contamination of the surgical field – change gloves and instruments between resection and reconstruction
- Limit the use of drains
Should all skin masses have a FNA performed?
Yes
What is a larger sample - FNA or core needle?
Core needle
Does core needle preserve tissue architecture?
Yes
What is the radial margin when removing a mass?
The margin of the skin and assocaited fat to be excised
What is the deep margin when removing a mass?
his margin utilises biological barrires to tumour spread - ingluded fascia, peritoneum, bone and muscle belly
Should you assume all scars contain neoplastic tissue and take approipriote margins around them?
Yes
For a lipoma what type of resection should you use?
A marginal resection
For a mammary tumour what type of resection should you use?
A local resection
For a mast cell tumoir what type of resection shoul you use?
A wide local resection
For a feline injection site sarcoma what type of resection should you use?
a radical resection
What is a marginal resection?
It is where you dissect just outside of the pseudocapsule of the tumour with a 1-2mm margin
When should a marginal resection be used?
It is only indicated for very benign masses such as lipoma as may leave residual microscopic disease.
Can be used as cytoreductive surgery but only before radiotherapy.
What is wide local resection used for?
Used for more invasive tumours - sarcomas and mast cell tumours
What does a wide local resection remove and what are the margins like?
Removes deep fascial plane with a 2-3cm border
What is local resection used for?
Used for benign, non invasive masses suchbas mammary tumours or histcytomas
What is the margin for a local resection?
1cm
What is a radical resection used for?
Used for very locally agressive tumours
Radical resection
Used for very locally aggressive tumour
Resection with very wide margins
* Whole limb amputation
* 3-5cm radial margins
* 1-2 deep fascial planes
Amputation
* Limb osteosarcoma fore or hindquarter amputation
* Digit scc/melanoma – Digit amputation
Radical resection surgery
* Feline injection site sarcoma
* 5cm radial margins
* 2 deep fascial planes
* Very aggressive and invasive tumour and equally aggressive surgery
Describe how to perform a splenectomy
- Exteriorise spleen and identify hilus.
- Work from tail to head isolating vessels by blunt dissection.
- Double ligate each vessel close to hilus
- Cut between ligatures.
- Move on to next vessel.
- When the last vessel is ligated the spleen can be lifted out of abdomen.
(Skin Reconstruction Surgery)
State the 6 halstead priniciples
- Strict adherence to aseptic technique.
- Gentle tissue handling.
- Sharp anatomic dissection of tissues.
- Meticulous haemostasis.
- Obliteration of dead space.
- Avoidance of tension.
How, using the halstead prinicples, can you adheare to strict aseptic technique when performing surgery?
- When preping - keeping you, patient and instruments sterile
- Using appropriate, often wide, clipping and draping
- perioperative antibiotic use
- covering wounds post op
What does tissue trauma cause?
Inflammation which can lead to infection and wound dehiscence
How do you make sure you are handling tissue gentle and causing minimal trauma?
- Use appropriote tools for type of tissue
- Keep tissue moist to avoid desiccation during surgeru
- use stay sutures to manipulate skin edges
What are stay sutures used for?
Used to manipulate skin with minimal trauma and also for stomach/bladder surgery
How should you make sure you are performing a sharp anatomical dissection during surgery?
- Use scalpal and not sissors to cut skin
- Limit blunt dissection
- Use metzenbaum scissors for fine sharp dissection
What can haematomas do to wound?
They can increase wound dihiscence and infection
What is dead space?
Area for fluid to collect and seromas to form
How can you reduce dead space?
- careful tissue dissection
- using sutures to close dead space
- using wound drains
Why should you be careful when choosing to place a wound drain?
It can increase risk of infection
Why should you avoid wound drain in oncological surgeries?
can spread the tumour
What are the two types of drains?
- open passive drain
- Active closed drain
How does the open passive drain work?
Via capillary action, overflow and gravity
Is there a collecting device in an open passive drain?
no it drains into to dressing
What does an open passive drain depend on?
Gravity
How should you place an open drain?
- anchor drain internally
- must exit through a seperate incision not the wound
- then secure the drain with sutures as it exits here
- rememeber when placing it to put in garvity dependent position
How should you go about managing an open drain?
- covered with dressing which should be chnaged regulary
- monitor the fluid volume soaking into the dressing and remove when volume reduces
What does a closed active drain rely on?
vacuum
How does fluid drain in an active closed drain?
Through a tube which exits the skin into a collection chamber
How do you place an active closed drain?
- can be placed anywhere
- tube placed and exits through seperate stab insision not wound
- secure with chinease sfinger strap suture
- dressed at drain skin interface
- collection chmaber compressed and attached
Why in a active closed drain should the chmaber be compressed?
To create vacuum
What does tension in wounds lead too?
Leads to wound dehiscence abd is uncomfortable for the patient
How do you avoid tension?
- Plan you incision by considering tension lines and use them to you advantage and be aware of limb movement
- close parallel to tension lines
- close in layers
- distribution tension by using walking sutures
- remove tension via skin flaps
How are tension lines created?
Created by linear arrangement of fibrous tissue in the dermis
Describe tension with layered wound closure?
Layered wound closures distribute tensiom over layers and reduces dead space
What is undermining when it comes to closing wounds?
Undermining is when you undermine below the panniculus muscle if its present or below subcut fat which allows mobilization of the skin and preserves bloood supply
When are walking sutures used?
After undermining
What do walking sutures do?
They help to obliterate dead space by moving wound edge closer together
What do tension relieving sutures do?
Spread tension over larger surface area
What are tension relieveing sutures?
- Cruciate
- Far-near-near-far
- Far-far-near-near
- Horizontal and vertical mattress sutures (not tension relieving, appose wound edges without tension)
How do you avoid dog ears?
Larger incision, parallel to tension lines
(approach to lymphoma and leukaemia)
What tissues are involved in lymphomas?
Lymph nodes and peripheral lymphoid tissue
What tissue type is involved in leukaemia and multiple myeloma?
BM
What are the two main categories of haematopoietic neoplasia?
Lymphoid (Lymphocytes, plasma cells, precursor cells)
Non-Lymphoid (Red cells, platelets, granulocytes, monocytes, precursors)
Name three types of lymphoid haematopoietic neoplasia.
Lymphoma
Lymphoid leukaemia
Multiple myeloma
Name two types of non-lymphoid haematopoietic neoplasia.
Myeloid leukaemia
Myeloproliferative neoplasms (MPNs)
What are some pseudonyms for lymphoma?
Malignant lymphoma
Lymphosarcoma
Non-Hodgkin’s lymphoma
What is lymphoma?
Malignant proliferation of peripheral lymphoid tissues (e.g., lymph nodes)
Can sometimes infiltrate bone marrow (Stage V)
How is lymphoma classified?
Histology
Anatomical location
Immunophenotype
List some predisposing factors for lymphoma.
Genetics
Age
Neutering (Females, dogs)
Virus (Cats)
Environment (Passive smoking – cats, dogs)
Which breeds are prone to specific lymphoma types?
Boxers → T-cell lymphoma
Cocker Spaniels → B-cell lymphoma
What are the clinical signs of lymphoma?
- asymptomatic/clinically well but a palpable mass/lymph node
- Non-specific clinical signs such as malaise, lethargy, inappetence, fever and weight loss
- Paraneoplasti disease - hypercalceamia and hyperviscosity
- organ specific signs
What are the main classifications of lymphomas?
- multicentric = peripheral lymph nodes
- alimentary = GI
- thymic = mediastinal
- cutaneous = skin
- extranodal = sites other than lymph nodes
What is the most common lymphoma in dogs?
Multicentric
What is the most common type of lymphoma in cats?
GI
Where is lymphoadenomegaly usually dervied from?
From B cells of large size ie immature lymphoblasts
What is a b cell derived lymphoma called?
diffuse large b cell lymphoma DLBCL
What clinical signs do you get in GI/Alimentary lymphoma?
Vomiting, diarrhoea, weight loss and anorexia
Does high grade alimentary lymphoma have good or poor prognosis?
Poor
What cell types are involed in high grade alimentary lymphoma?
Large/intermediate cells, often B cells
Does low grade alimentary lymphoma have a poor or good prognosis?
Good
What cell types are involved in low grade alimentary lymphoma
mature lymphocytes, often t cells
What kind of cats is mediastinal (thymic) lymphoma common in?
Common in younger cats that are FeLV positive
T/F younger cats that are FeLV negative have a better prognosis than cats that are positive?
QUI
What is the clinical presentation of mediastinal lymphoma?
Cough, dyspnoea, dull heart/lung sound if there is pleural effusion
On xray what may you find of a patient with mediastinal lymphoma?
Anterior mediastinal mass on xray causing elevated trachea and enalrged tracheobronhial LN
Is a cutaneous lymphoma more common in cats tha dogs?
Dogs
Where is primsary skin lymphoma always dervived from?
T cell derived
What are the two forms of primary skin lymphoma?
Primary cutaneous lymphoma (= Dermal)
Mycosis fungoides (= Epitheliotropic/Epidermal)
Where is a secondary sin lymphoma dervived from?
T or B
Are extranodal lymphomas more common in cats or dogs?
cats
How should you go about diagnosis of lymphoma?
- sample a representative lesion or LN
- Examine representitive fluid
- FNA for cytology for many cases
In terms of cytology what does a high grade/large cell lymphoma look like?
Immature, undifferentiated lymphoblasts, rapidly dividing
In terms of cytology what does a high low/small cell lymphoma look like?
Mature small differentaied lymphocytes, slowly dividing
What is immunohistochemistry (IHC) used for in lymphoma diagnosis?
Uses antibodies to detect B or T cell proteins on the cell surface (CD3, CD79a) or inside the cell (PAX5).
Performed on FFPE biopsy specimens.
How should you treat a high/large cell lymphoma?
Agressive chemo
What are the common markers used in IHC to detect B and T cells?
CD3 → T-cell marker
CD79a → B-cell marker
PAX5 → B-cell marker (intracellular)
What sample type is required for flow cytometry in lymphoma diagnosis?
Fresh aspirates of lymph nodes or lymphoid masses in a cell culture medium/buffer.
Can also use blood or bone marrow if malignant cells are present.
What is the purpose of flow cytometry in lymphoma diagnosis?
Stains cell surface antigens to determine B or T cell phenotype.
What does PCR for Antigen Receptor Rearrangements (PARR) detect?
Extracts DNA from tumour cells (LN, mass, effusion, etc.).
Amplifies B-cell (Ig heavy chain) or T-cell receptor (VDJ) gene segments.
Clonal product (single size) → Suggests lymphoma.
Polyclonal product (multiple sizes) → Suggests inflammatory/reactive cells.
When is PARR particularly useful?
Confirms lymphoma in difficult sites with small FNA samples.
Determines whether the lymphoma is B or T cell based on PCR primers.
What is the role of Thymidine Kinase in lymphoma diagnosis?
Enzyme in the pyrimidine salvage pathway.
Pretreatment values are prognostic and useful for monitoring.
What is the Neoplasia Index (NI) in lymphoma diagnosis?
Combines Thymidine Kinase & CRP.
Is the neoplasia indec higher or lower in lymphoma than in controls?
higher
What is the significance of Lactate Dehydrogenase (LDH) in lymphoma?
Elevated in lymphoma, but not prognostic.
Why should you do bloods as part of staging lymphoma?
- It refects BM cells as baseline prior to chemo and may see circulating LSA cells in blood
- Biochem indicates organ involvement and PNSyndromes
- FeLV and FIV status
Other than bloods what else can you use to aid with staging of lymphpma?
- diagnostic imagaing
- urinalysis
- BM for stage 5
If there is concurrent disease along side lymphoma decribe what this affects?
- Affects prognosis
- Affects treatment options sometimes
- Affects choice in chemo agenst if using them
- May need to extend staging procedures to evaluate disease fully
When treating lymphoma, whats the 1st step?
Stabalise paraneoplasticsyndromes if present
What is the main paraneoplastic syndrome?
Hypercalcaemia in lymphosarcoma
How should you treat the lymphoma?
- steroids - pallative care
- chemo
How do you reduce the level of ionised Ca in blood in a hypercalcaemic patient?
- correct fluid deficit = fluids and loop diuretics
- treat underlying disease - chemo, surgery or non-neoplastic condition
What lymphoma patients have a good prognosis?
- well patients
- low clinical stage (1 or 2)
- low histological grade
- B cell immunophenotype (only dogs)
- nasal sites
- CR to treatment
- Using doxorubicin in protocol
What lymphoma patients have a bad prognosis?
- sick patients
- high clinical stage ( 5 - bone marrow)
- T cell immunophenotype (dogs)
- certain anatomical location ie skin, CNS, ocular
- FeLV/FIV positive cats
- low body weight in cats as often GI
- prior steriod use as multi drug use
What type of malignancy is leukaemia, and where does it originate?
Haemopoietic malignancy that usually ORIGINATES in bone marrow
What does leukaemia usuaully result in?
Increased numbers of specific circulating blood cells (blast cells)
Where can leukaemia spread too?
peripharal lymphoid/haemopoietic organs
Is neoplastic transformation early or late in cell lineage in acute leukaemia?
Early - proliferation of blasts
Is neoplastic transformation early or late in cell lineage in chronic leukaemia?
late - proliferation of mature differentiated cells
What does proliferation of neoplastic cells in BM cause?
- crowding of BM leading to cytopenias
- High numbers of neoplastic cells in circulation
- secondary invasion of other organs
How does a patient with chronic leukaemia appear?
generally well
How does a patient with acute leukaemia appear?
often quite sick
On clinical examination of a patient with chronic leukaemia what would you see?
- clinically normal
- mild lymphadenomegaly
- big spleen/liver
On clinical examination of a patient with acute leukaemia what would you see?
- Big spleen/liver
- mild lymphasedomegaly
- pale mm
On heamatology of a patient with chronic leukaemia whta can you expect to see?
- high wbc
- mild cytopenias of other cell lines
On heamatology of a patient with acute leukaemia whta can you expect to see?
- high/low wbc
- immature circulating cells
- cytopenias common
On biochem of a patient with chronic leukaemia whta can you expect to see?
PNS may be present
On biochem of a patient with acute leukaemia whta can you expect to see?
PNS less likely
What can you expect with bone marrow of a patient with chronic leukaemia?
Increased numbers of well differentaied cells and possibly other lines decreasing
What can you expect with bone marrow of a patient with acute leukaemia?
Increased number of blasts and other cell lines decreased
What are lymphoma and acute lymphoid leukaemia both characterised by?
Proliferation of large blast cells
What us a multiple myeloma?
Neoplastic proliferation of plasma cells in Bone Marrow
What is there an increased/abnormal production of from plasma cells witj multple myeloma?
Intergobulins causing hyperproteinaemia
How can you diagnose multiple myeloma?
- plasma cells in BM sample
- osteolytic bone lesions on radiographs
- myeloma protiens in blood
- myeloma proteins in urine
What one - polyclonal or monoclonal gammopathy - is neoplastic?
monoclona;
How should you about treating myeloma?
Chemo to kill neoplastic cells in BM and other sites BUT before chemo you should adree PNS and other problems
What are other problems often seen with myeloma?
Hyperviscosity (plasmapheresis)
Hypercalcaemia if present (supportive fluids)
secondary infection d/t abnormal Ig (antibiotics)
