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Small Animal Medicine II > Neoplastic Behavior > Flashcards

Neoplastic Behavior Flashcards

1
Q

What does TNM stand for?

A

Tumor
Nodes
Metastisis

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2
Q

How bad is the tumor or what it will do to the host is predicted by…(4 things)

A

Histologic type
Location
Grade
Other prognostic factors

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3
Q

Biologic Behavior Locally:

Primary Effects

A

Hemorrhage (hemangiosarcoma; bleeds)

Pain (osteosarcoma, neurofibrosarcoma)

Destruction of normal function (hepatocellular carcinoma)

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4
Q

Biologic Behavior Locally:

Secondary Effects

A

Pathologic fracture

Neurologic deficits

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5
Q

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Pituitary Adenoma

A

Secretes ACTH

Hyperadrenocorticism

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6
Q

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Pheochormocytoma

A

Secretes catecholomines

Hypertension
Tachycardia

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7
Q

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Insulinoma

A

Secretes insulin

Hypoglycemia

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8
Q

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Sertoli cell tumor

A

Secretes estrogen

Feminization and aplastic anemia

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9
Q

Biologic Behavior Distance:
Secondary Effects (functional tumor)
Thyroid adenoma

A

Secretes T4

Hyperthyroidism

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10
Q

Biologic Behavior Distance:
Secondary Effects (paraneoplastic disorders)
Hypertrophic Osteopathy

A

Associated with lung tumors and large abdominal masses

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11
Q

True or False: Patients rarely die from their primary tumor, they die from metastasis

A

True

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12
Q

Matastasis Cascade

5 Steps

A

Cell detachment and vascular invasion

Transport and survival in the circulation (evasion of host defense mechanisms)

Aggregation with platelets and fibrin and arrest at new location (tumors often have a place they desire but can get lodged in capillary beds)

Extravasation into the surrounding parenchyma

Establishment of a new growth (angiogenesis)

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13
Q

What is late metastasizing?

Examples

A

Spread long after primary tumor appears
Slow rate of growth

TVT, sertoli cell tumor, hemangiopericytoma

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14
Q

Early/Rapid metastasizing

A

Metastasis has occured often before primary tumor is detected

Osteosarcoma, hemangiosarcoma, oral melanoma

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15
Q

Pattern of metastasis

Lymphatic

A

Carcinomas; travel via lymphatics

Perianal gland carcinomas spread to sublumbar lymph nodes

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16
Q

Pattern of metastasis

Hematogenous

A

Sarcomas via blood (osteosarcoma to lung, hemangiosarcoma to liver)

Lymph node involvement tends to be poor prognosis (not typical for hematogenous sarcomas)

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17
Q

Pattern of metastasis

Both-round cell tumors

A

Lymphoma
Mast cell tumors
Histiocytic tumors

18
Q

What are prognostic factors

A

What the pathologist should tell you! Diagnosis (hopefully)

Histologic diagnosis
Margins
Invasiveness

19
Q

Prognostic factors

Invasiveness

A

Tumors invading the basement membrane, blood vessels, or lymphatics, tend to have poorer prognosis

20
Q

Prognostic Factors Histology:

Grade (5 things)

A

Attempt to predict which tumors will metastasize or carry a poorer prognosis

Degree of differentiation (if cannot tell tissue type poor prognosis)

Percent necrosis (higher than rapidly growing)

Invasiveness, presence of markers, vessel invasion

Mitotic index (# mitosis/10 HPF)

Numeric or descriptive

21
Q

Prognostic Factors:
Mitotic Index
Examples

A

Generally expressed as number of mitosis/10 high power (40x) field

3 for melanomas
5-7 for mast cell tumors
20 for soft tissue sarcomas (usually do not metastisize)

22
Q

Prognostic Factors:

Staging

A

TLM (tumor lymph node metastisis method)

Determination of what the tumor has actually done to the patient at the time of diagnostic – will surgery be curative

23
Q

Prognostic Factors:

Staging Uses

A

Aids in prognostication
Aids in treatment planning (surgery only, chemotherapy, radiation, or all 3)
Aids in evaluation of treatment results

24
Q

Initial workup of mass

5 things

A 
PE and History
Always check draining lymph node
CBC, Chem, UA
Thoracic Rads (if meted than may not be worth further diagnostics)
Cytology
25
Q

What is T-Staging

A

Tumor evaluation

Could inform you on prognosis
Measure it (always)
Image it (radiograph, ultrasound -FNA, biopsy-)
26
Q

T-Staging

Advanced Imaging

A

Tumor Evaluation

CT scan:
Best for bones and screening for metastasis

MRI
Best for local soft tissue exam

Can help evaluate treatment

27
Q

What is N-Staging?

A

Evaluation of Lymph Node

May have to image them

Aspiration:
100% sensitive and 96% specific (cellular changes? inflammation?)

28
Q

N-Staging

Front Leg

A

Prescapular

29
Q

N-Staging

Hind leg below knee

A

Popliteal

30
Q

N-Staging

Hind leg above knee, ventral abdomen

A

Inguinal node

31
Q

N-Staging

Anal/perianal area

A

Sublumbar nodes

32
Q

N-Staging

Lungs

A

Hilar nodes

33
Q

N-Staging

Abdomen

A

Sternal node

34
Q

M-Staging

How is this accomplished?

A

Evaluate for metastasis

Where tumor may go depends on tumor histology and grade

Imaging studies:
Thoracic radiographs
\+/- thoracic CT
Abdominal ultrasound/CT
Cardiac ultrasound
35
Q 
M-Staging
Abdominal ultrasound (or CT) indications
A

Intra-abdominal masses or organ infiltration (lymph nodes, GI)

Tumors on caudal half of body with tendency to metastasize; mast cell tumors, perianal gland tumors, mammary tumors

Tumors with high propensity for visceral or lymphatic metastasis (spleen or liver); mast cell tumors, histiocytic tumors, lymphoma, hemangiosarcoma

36
Q

M-Staging

Tumor types commonly found in spleen

A

Mast cell tumor
Histiocytic Sarcomas
Lymphoma

37
Q

M-Staging

Tumor types commonly found in liver

A

Mast cell tumor
Lymphoma
Melenoma

38
Q

Staging

Why is it helpful?

A

Aids in giving a prognosis
Aids in treatment planning
Aids in evaluation of treatment

Avoids the disappointment of discovering pre-existing metastatic disease after expensive and toxic therapy has already been instituted

39
Q

What does Stage I-T1N0M0 Indicate?

A

Tumor limited to site of origin and resectable

Long term prognosis good to excellent

40
Q

What does Stage II - T2N1M0 Indicate?

A

Local spread, involvement of local lymph node

Chance of long term survival 40-60%

41
Q

What does Stage III - T3N2M0 Indicate?

A

Extensive local spread, tumor not resectable

Chance of long term survival 20%

42
Q

What does Stage IV - T4N3M+ Indicate?

A

Distant metastsis, primary not resectable

Chance of survival <5%

Small Animal Medicine II (17 decks)

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