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ACVIM General Boards - 2022 > Oncology > Flashcards

Oncology Flashcards

1
Q

Vincristine and Vinblastine MOA

A

Antimicrotubule agents

Inhibit microtubule assembly (disruption of the mitotic spindle)

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2
Q

VinCRISTINE use

A

Lymphoma

Transmissible venereal tumors

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3
Q

VinBLASTINE uses

A

Canine mast cell tumors

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4
Q

Which chemotherapeutic agents are topoisomerase inhibitors?

A

Epipodophyllotoxins (Etoposide and Teniposide)

But also mitoxantrone (inhibits topoisomerase II)

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5
Q

Steroids MOA

A

Induces killing of hematopoietic cancer
cells through interaction with the glucocorticoid receptor and the
induction of apoptosis

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6
Q

Platinum (Carboplatin and Cisplatin) MOA

A

Covalent binding to DNA through displacement reactions resulting in bifunctional lesions and interstrand
or intrastrand cross-links.

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7
Q

Toxicity with cisplatin

A

Nephrotoxicity

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8
Q

Cisplatin/carboplatin use

A

Cisplatin - Canine osteosarcoma (OSA)

Carboplatin - Better tolerated - OSA, other sarcomas and carcinomas

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9
Q

Why is carboplatin preferred to cisplatin?

A

Carboplatin is preferred to cisplatin because of the reduced incidence of
nausea/vomiting, the absence of nephrotoxicity, and ease of administration.

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10
Q

Hydroxyurea MOA

A

Inhibitor of ribonucleotide reductase - inhibition of DNA synthesis

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11
Q

Hydroxyurea clinical use

A

bone marrow disorders such as polycythemia vera and granulocytic
leukemias

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12
Q

L-asparginase MOA

A

Hydrolysis of L-asparagine to L-aspartic acid&raquo_space; depletion of L-asparagine&raquo_space; inhibition of protein synthesis&raquo_space; apoptosis

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13
Q

L-asparginase use

A

Lymphoproliferative disorders

Relapsed lymphoma

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14
Q

Mechlorethamine MOA

A

Alkylating agent (Nitrogen mustard) - DNA cross-linking

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15
Q

Mechlorethamine Use

A

Lymphoma in dogs

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16
Q

Melphalan MOA

A

Alkylating agent (nitrogen mustard) - direct alkylating activity

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17
Q

How is melphalan transported into the cell?

How is transport into the cell blocked?

A
  1. Transported into tumor cells by amino acid transporters.

2. Blocked by the amino acid leucine.

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18
Q

Melphalan use

A

Myeloma

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19
Q

Cyclophosphamide MOA

A 
Alkylating agent (nitrogen mustard)
Bifunctional alkylation and cross-link production.
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20
Q

What is the active metabolyte of cyclophosphamide?

A

Phosphoramide mustard

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21
Q

What is a major side effect of cyclophosphamide?

A

Hemorrhagic cystitis

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22
Q

Cyclophosphamide USE

A

Multiagent protocols for lymphoma in both dogs and cats.

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23
Q

Chlorambucil MOA

A 
Alkylating agent (nitrogen mustard derivative)
Direct bifunctional alkylating ability
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24
Q

Chlorambucil clinical use

A

Dogs - control of chronic lymphocytic leukemia (CLL)

Cats - Low-grade GI lymphoma in cats.

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25
Q

Lomustine (CCNU) MOA

A

Nitrosureas-based agent.
DNA alkylation and DNA-DNA and DNAprotein
cross-links

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26
Q

Chronic CCNU administration side effect

A

Hepatic dysfunction

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27
Q

Lomustine (CCNU) use

A

Dogs - multicentric lymphoma, epitheliotropic lymphoma, mast cell tumors, and histiocytic sarcoma.

Cats - Mast cell tumors and lymphoproliferative
disorders.

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28
Q

Streptozotocin MOA

A

DNA alkylation and inhibition of DNA synthesis. Uses GLUT 2 transporter for uptake into cell

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29
Q

Streptozotocin use

A

Streptozotocin is used to manage malignant

insulinoma.

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30
Q

Doxorubicin MOA

A

Antitumor antibiotic. Multiple effects

  1. DNA intercalation and inhibition of RNA and DNA polymerases and topoisomerase II,
  2. alkylation of DNA, reactive oxygen generation,
  3. perturbation of cellular Ca2+ homeostasis,
  4. inhibition of thioredoxin reductase,
  5. interaction with plasma membrane components
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31
Q

Doxorubicin toxicity in dogs and cats?

A

Dogs and cats- cumulative dose-related cardiotoxicity

Cats may develop renal tubular damage following repeated dosing

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32
Q

Doxorubicin use

A

Lymphoma, osteosarcoma, (OSA), and most mesenchymal and epithelial neoplasms

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33
Q

What is Dexrazoxane (Zinecard)?

A

Used to reduce cardiac toxicity from doxorubicin use.

Binds to iron in myocardium to prevent free radicals

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34
Q

What is mitoxantrone chemically?

A

Synthetic doxorubicin analog

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35
Q

Mitoxantrone MOA

A

Similar to Doxorubicin but does not cause oxidative. Has anti topoisomerase II.
damage to cells and less likely to generate reactive oxygen species

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36
Q

Mitoxantrone use

A

The clinical indications for mitoxantrone include

lymphoproliferative disorders and, most recently, transitional cell carcinoma (TCC) of the bladder and urethra

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37
Q

Therapeutic index

A

ratio of the dose of drug required to produce a given probability of toxicity and the dose required to give a defined effect against a tumor

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38
Q

○ Induction therapy

A

more intensified therapy -

Goal is to ↓ the # of cancer cells & induce a complete remission

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39
Q

○ Consolidation therapy

A

less intensive than induction therapy
- Designed to diminish further the number of cancer cells and to achieve a CR in patients who did not go into CR after induction therapy

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40
Q

○ Maintenance therapy

A

continuation of less intensive chemotherapy protocol to maintain a remission & prevent relapse

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41
Q

○ Salvage (rescue) therapy

A

reinduction chemo for patients who fail one standard protocol

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42
Q

○ Stable disease (SD

A

stable disease at 4 weeks post chemotherapy

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43
Q

Cell cycle

A

○ G0 phase- resting cells
○ G1 phase- RNA and protein synthesis/ cell grows
○ S phase- DNA synthesis
○ G2 phase- 2nd period of RNA and protein synthesis
○ M-phase- mitosis occurs

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44
Q

True or False: Cells in resting phase are resistant to chemotherapy

A

TRUE

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45
Q

Progressive disease

A

Increase in tumor volume of >25% or increase of tumor maximum diameter of >20%; appearance of new lesions

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46
Q

Function of the MDR1 (ABCB1) gene

A

Adenosine triphosphate (ATP)-binding cassette (ABC) transporter family who play a primary role in active efflux of drugs from cells.

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47
Q

How is chronic myeloid leukemia diagnosed?

A

Diagnosis of CML is accomplished by detecting marked
and persistent leukocytosis in the absence of infection, inflammation,
or other neoplasia.

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48
Q

What are cats with chronic myeloid leukemia usually positive for?

A

Feline leukemia virus (FeLV).

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49
Q

Characteristics of acute myeloid leukemia

A

More than 20% blast cells (of whatever lineage is proliferating)
in the blood and bone marrow.

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50
Q

Prognosis for acute myeloid leukemias

A

prognosis for these diseases is grave, and survival is usually measured in weeks

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51
Q

Typical treatment of chronic myeloid leukemia?

A

CML typically is treated with hydroxyurea.

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52
Q

Prognosis for chronic myeloid leukemia

A

Approximately 1 year, although some patients live longer

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53
Q

What chemo drugs can you use in MDR1 mutation at-risk breeds?

A

A non-P-glycoprotein substrate chemotherapy drugs (eg. Alkylators) e.g. cyclophosphamide

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54
Q

Does the size of an oral melanoma correlate with prognosis?

A

Yes, a tumor <2 cm is correlated with better prognosis

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55
Q

Tonsillar SCC

A

more aggressive and metastatic variant of this disease, with a higher rate of metastasis to local lymph nodes (>40%). MST 7-9 months.

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56
Q

What breed is at increased risk for AGASACA

A

Cocker Spaniel

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57
Q

What percentage of dogs with AGASACA have hypercalcemia

A

30%

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58
Q

What are the reported MST for AGASACA

A

Reported survival times range from 6 to 31 months with varying treatments. Best with RT and chemo (mitoxantrone)

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59
Q

What is the metastatic rate of transitional cel carcinoma (urinary)

A

TCC metastasizes to distant sites in approximately 50% of
cases.
Regional lymph nodes, lung, liver, spleen, and, less commonly, kidney, bone, and other organ

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60
Q

Is there a sex predilection for transitional cell carcinoma (urinary)?

A

Females are more affected

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61
Q

What is the most common chemotherapy for transitional cell carcinoma (urinary)

A

mitoxantrone combined with piroxicam

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62
Q

What is the MST treating TCC with mitoxantrone and piroxicam

A

291 days.

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63
Q

What is the risk of developing mammary tumors in dogs as compared to their heat cycles and spay?

A

Spay before first estrus - 0.5%
Spay before second estrus - 8%
Spay after second estrus - 26%

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64
Q

What is the malignancy rate of mammary tumors? How many of the malignant tumors will metastasize?

A

50%/50%

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65
Q

Tamoxifen as hormonal therapy for canine mammary tumors

A

Decrease in tumor burden. Other studies did not have measurable responses. Risk of pyometra/stump pyometra.

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66
Q

What chemotherapy agents are used for metastatic mammary tumors?

A
  1. fluorouracil and cyclophosphamide - 24 months (sx and chemo) vs. 6 months (sx alone)
67
Q

Is surgery indicated in inflammatory mammary carcinoma?

A

Surgery is contraindicated. Wound dehiscence, ventral and limb edema, and disseminated intravascular coagulation all are potential complications of IMC, which is unlikely to be amenable to complete surgical excision.

68
Q

What percentage of feline mammary tumors are malignant?

A

The majority (80% to 96%) are malignant.

69
Q

What cell type do plasma cell neoplasms arise?

A

Well-differentiated B lymphocytes that have undergone malignant transformation.

70
Q

What are the most common gammopathies in myeloma (which immunoglobulins)?

A

IgG and IgA

71
Q

What is Bence Jones/light chain myeloma

A

Production of pure light chains (κ or λ type)

72
Q

What are the diagnostic criteria for multiple myeloma?

A

TWO of the following need to be met:

  • Monoclonal gammopathy or paraproteinemia
  • Radiographic lytic bony lesions
  • > 5% neoplastic or >10-20% plasma cells in bone marrow
  • Light chain (bence jones) proteinuria
  • CATS: Plasma cell infiltration of visceral organs
73
Q

Which cell type does osteosarcoma come from?

A

Osteoblasts

74
Q

What percentage of dogs with osteosarcoma have gross pulmonary metastasis on presentation? What percentage will develop pulmonary metastasis?

A

Only a small percentage of dogs (~10%) have radiographic
evidence of macroscopic pulmonary metastases at initial
presentation; however, the vast majority (>90%) eventually
develop radiographically evident pulmonary metastatic
disease

75
Q

Where are primary long bone tumors localized usually?

Where are metastatic long bone tumors localized usually?

A

Primary bone tumors - Metaphisis

Metastatic bony tumors - Diaphisis

76
Q

Synchronous disease

A

Multiple primary tumors (e.g. hemangiosarcoma in heart and spleen)

77
Q

What are some common CBC findings in HSA?

A

Findings suggestive of microangiopathic process:
Regenerative anemia
Thrombocytopenia
Fragmented RBC (schitocytes)

78
Q

What are the two cell types of the thyroid gland?

A
  1. Thyroid epithelial cells - Synthesis of thyroid hormones

2. Parafollicular cells (C cells) - Secrete calcitonin

79
Q

The majority of canine thyroid tumors are malignant (True or False)

A

True

80
Q

What two types of carcinomas can arise from the thyroid in dogs?

A

Follicular carcinoma -

Medullary thyroid carcinoma (C-cell carcinoma)

81
Q

What is the metastatic rate of soft tissue sarcoma according to grade?

A

Grade I - < 10%
Grade II - 20%
Grade III - 50%
(regional lymph nodes and lung)

82
Q

What are the most common nasal tumors in dogs?

A

Adenocarcinoma, SCC, fibrosarcoma, chondrosarcoma and osteosarcoma

83
Q

What are the most common nasal tumors in the cat?

A
  1. Lymphoma
  2. Carcinoma
  3. Sarcoma
84
Q

What is the incidence of primary lung tumors? What is the behaviour? What is the most common primary lung tumor?

A

Low incidence. The majority of tumors are malignant, and the most frequently reported tumor type is adenocarcinoma in the dog and cat.

85
Q

What are positive prognostic indicators for primary lung tumors?

A
  1. Solitary nodules
  2. Peripheral location
  3. <5 cm in diameter
86
Q

What are negative prognostic indicators of primary lung tumors?

A
  1. Lymph node involvement
  2. More than one nodule
  3. Central location
  4. > 5 cm in diameter
  5. High histologic grade
87
Q

Benign vs. malignant thymoma

A
  1. Benign - Well encapsulated and noninvasive

2. Malignant - Locally invasive and aggressive

88
Q

What is thymoma’s metastatic rate?

A

Rare

89
Q

What is the signalment for cats with mediastinal lymphoma?

A

Young (mean 2 y/o) and positive for FeLV

90
Q

Carmustine ( BCNU, BiCNU, Gliadel) metabolism

A
  1. Highly lipid soluble

2. Excellent CNS concentrations w/ IV administration

91
Q

Mesna (sodium-2-mercaptoethanesulfonate) - What is it?

A

Uroprotective agent agent used in humans treated with cyclophosphamide or ifosfamide

92
Q

Ifosfamide metabolims

A
  • Isomer of cyclophosphamide
  • Excreted through the urinary tract
  • Must be given with mesna (2-mercaptoethane sulfonate) to prevent hemorrhagic cystitis
93
Q

Lomustine toxicity

A

Dogs may develop potentially fatal hepatotoxicit

94
Q

9 year old dog with Coombs negative hemolytic anemia, hypoalbuminemia, hypochloresteronemia, mildly elevated bilirubin? What is the diagnosis?

A

Histiocytic disease

95
Q

What chemotherapy drugs cross the blood brain barrier (BBB)

A

Cytosar (Cytarabine), Lomustine (CCNU), procarbazine, 5-FU

96
Q

What chemo can you give a Collie while waiting MDR gene mutation test results?

A

Cyclophosphamide - In general any drug produced by a plant or organism will be a P-glycogen substrate and should not be given to MDR mutated dogs

97
Q

What drugs do you NOT want to give an MDR mutated dog?

A

Do not give vincristine, doxorubicin, mitoxantrone.

GIVE cyclophosphamide

98
Q

What phase of the cell cycle does Vincristine work on?

A

M-phase (Microtubule formation)

99
Q

What are paraneoplastic syndromes?

A

signs, symptoms, and clinical effects associated with underlying neoplasia, but not directly due to physical presence of tumor (humoral, cytokines, immune response)

100
Q

Bleeding diathesis

A

Coagulation abnormalities due to coating of platelets by paraprotein (hypergammaglobulinemia)

101
Q

Most common cause of hypercalcemia in dogs and cats

A

Dogs - Cancer

Cats - Idiopathic or renal

102
Q

What hormones lead to hypercalcemia of malignancy?

A

PTH-rp - Mimics parathyroid hormone
IL-1B - Osteoclast activating factor

Other: TGF-B, RANKL, Prostaglandin E1/2, extensive bony lysis

103
Q

How does hypercalcemia cause PU/PD?

A

It decreases response to ADH

104
Q

Paraneoplastic syndrome - Nodular dermatofibrosis

A

Associated with renal neoplasia (as well as renal cysts)

- Renal tumors may produce collagen stimulating factors?

105
Q

How does metronomic chemotherapy work?

A

Inhibits t –regulatory cells (immunomodulation), inhibits angiogenesis

106
Q

Vincristine side effects

A

GI ileus, neurotoxicity, peripheral neuropathy

107
Q

What is the toxic metabolite for cyclophosphamide?

A

Acrolein

108
Q

What are some environmental factors for lymphoma?

A 
2,4 D (pesticide) 
urban environment
paints
solvents
magnetic fields
109
Q

What is the most common cutaneous tumor in cats?

A

Basal cell tumor (slow growing, rarely metastasis, sx often curative)

110
Q

What is the most common oral neoplasia in a dog?

A

Melanoma

111
Q

What is the behaviour of melanoma in the dog based on the location?

A

Haired skin - Usually benign

Mucocutaneous, oral, nail bed - Malignant (Metastatic rate 30-75%)

112
Q

What is the behavior of melanoma based on dog breed?

A

Doberman - Usually benign

Mini Poodles - Usually malignant

113
Q

Characteristics of hemangiopericytoma?

A

Usually benign, locally invasive

- Recurrence often after surgical removal

114
Q

Squamous cell carcinoma treatment in cats?

A

Early aggressive therapy with surgery and RT is best

Chemo not rewarding

115
Q

Squamous cell carcinoma treatment in dogs?

A

Surgery alone is initial therapy.

1 and 2 year survival is 90% and 75%

116
Q

What is the mechanism of mitoxantrone?

A

Inhibits topoisomerase II and causes DNA intercalation

117
Q

What chemotherapeutic agents are vesicants?

A

Vinca alkcaloids, doxorubicin, and actinomycin D

118
Q

What are the nitrogen mustard derivative chemotherapeutics?

A 
Mechloretamine
Cyclophosphamide
Chlorambucil
Melphalan
Ifosfamide
119
Q

Which chemotherapy agents are nitrosureas?

A

Lomustine (CCNU)

Streptosozin

120
Q

What are the antitumor antibiotics?

A

Doxorubicin (Adriamycin)
Mitoxantrone (synthetic derivative of DOX)
Actinomycin D

121
Q

What are the antimetabolite antibiotics?

A

cytarabine (cytostar)
5-FU
Methotrexate
Gemcitabine (Gemzar)

122
Q

What are the antimicrotubule agents?

A 
Taxanes (Paclitaxel and Docetaxel)
Vinca alkaloids (Vincristine, vinblastine)
123
Q

Birt-Hogg-Dube gene

A

Associated with renal cystadenocarcinoma and nodular dematofibrosis (RCND). German shepherds predisposed.

124
Q

Bowen’s carcinoma

A

Squamous cell carcinoma in situ at multiple sites - primarily in cats

125
Q

What is actinic keratosis?

A

Squamous cell carcinoma in situ due to UV exposure

126
Q

What is the most common tumor of the digit?

A

Squamous cell carcinoma (both dogs and cats)

Dogs: SCC most common, followed by melanoma

Cats: SCC, fibrosarcoma, adenosarcoma

127
Q

What IHC marker predicts malignancy in melanoma?

A

Ki67 IHC predicts potential malignant behavior

128
Q

What do mast cell tumor granules stain with?

A

Giemsa

Toulidine Blue

129
Q

What is Darier’s sign in mast cell tumors?

A

Mechanical manipulation of a MCT that causes degranulation and subsequent erythema and wheal formation in surrounding tissues

130
Q

What are paraneoplastic syndromes of leiomyomas and leiomyosarcomas?

A

HYPOGLICEMIA, nephrogenic DI, secondary erythrocytosis

131
Q

How often is malignant melanoma amelanotic?

A

1/3 of the time

132
Q

Most common pituitary tumors in dogs and cats

A

Dogs - Corticotrophic adenoma - causes ADH (release of ACTH)

Cats - GH-secreting somatotroph adenoma (acromegaly, diabetes)

133
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism from an adrenal tumor

134
Q

Pheochromocytomas are tumors of what cells?

A

Chromaffin cells in the adrenal medulla

135
Q

What is the most common primary brain tumor?

A

Meningioma, followed by glioma

136
Q

What is the most common tumor that mets to the brain in the dog and cat?

A

Dog - Hemangiosarcoma

Cat - Lymphoma

137
Q

What is the double 2/3 rule for hemangiosarcoma?

A

2/3 dogs with splenic masses have malignant tumors, 2/3 of those have HSA

138
Q

What does the Birt-Hogg-Dube gene encode?

A

Folliculin - tumor suppressor gene

139
Q

Most common digit tumor in both dogs and cats?

A

Squamous cell carcinoma

140
Q

What IHC predicts malignancy in melanoma?

A

Ki67

141
Q

What stain is needed for mast cell tumors that do not stain with DiffQuik?

A

Giemsa

142
Q

In what dog breeds is mast cell tumor more benign?

A

Boxer
Pugs
Bulldog

143
Q

What are the surgical margins for mast cell tumor?

A

3 cm around, 1 fascial plane deep.

Low grade 1-2 cm may suffice

144
Q

Are wide margins necessary for feline cutaneous mast cell tumor?

A

No

145
Q

What parasite has been associated with esophageal soft tissue sarcoma?

A

Spirocerca lupi

146
Q

What are paraneoplastic of leiomyosarcomas and leiomyomas?

A

HYPOGLYCEMIA
Nephrogenic DI
Erythrocytosis

147
Q

What intestinal tumor is associated with C-kit mutation (CD117)?

A

GIST

148
Q

What STS has a higher rate of lymph node metastasis as compared to other STS?

A

Synovial cell sarcoma

149
Q

What is the 3-2-1 rule for suspected injection site sarcoma in cats?

A

Treat if:

  • Mass still present >3 months after vaccine
  • Larger than 2 cm
  • Or increasing in size >1 month after vaccine
150
Q

What is a feature of oral fibrosarcoma?

A

Histologically low grade, but biologically high grade

151
Q

What is the more common hepatobiliary tumor in cats?

A

Bile duct carcinoma

152
Q

What is a carcinoid?

A

Tumors that arise from the diffuse endocrine system in the GI rather than the epithelium

Enterochromaffin cells - Secrete serotonin, somatostatin, etc

153
Q

What additional therapy is recommended with perianal adenoma?

A

Castration

154
Q

How do you differentiate osteosarcoma (histo) from other connective tissue tumors?

A

ALP stain

155
Q

What is codman’s triangle?

A

As tumor invades the cortex and the periosteum is elevated, new bone is laid down on the cortex at the periphery in a triangle-fashion

156
Q

What is multiple cartilaginous exostosis in cats associated with?

A

FeLV

157
Q

What is the treatment and prognosis in cats with multiple cartilaginous exostosis?

A

Amputation - Guarded prognosis as local recurrences are common and no known effective treatment

158
Q

What is a medical therapy for pheochromocytoma?

A

Phenoxybenzamine

159
Q

What is the most common metastatic brain tumor in dogs? Cats?

A

Dogs - hemangiosarcoma

Cats - Lymphoma

160
Q

Brain meningiomas are extra-axial. What does this mean?

A

attach outward and move in

161
Q

Surgically, how do feline and canine brain meningiomas differ?

A

Cats - Generally peel away easily

Dogs - Harder to predict

162
Q

What are common locations for peripheral nerve sheath tumors?

A

CN - V

Spinal - Brachial plexus

163
Q

What CD markers are expressed by B cells?

A

CD79a
CD20
CD21

ACVIM General Boards - 2022 (16 decks)

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