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Oncology Flashcards

1
Q

What is cancer?

A

Persistent, purposeless proliferation of host cells, often to the detriment of the host

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2
Q

What are overactive oncogens?

A

Tumour promoting genes that are secondary to mutation

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3
Q

What is the most common gene alteration in human cancer?

A

Loss of P53

Is a tumour suppressor gene that stops mitosis if there is any DNA damage

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4
Q

What does neoplasia mean?

A

New/abnormal growth

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5
Q

What are the two features that tumours are described according to?

A

Tissue of origin

Status

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6
Q

What are benign squamous epithelial tissue tumours called?

A

Papilloma

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7
Q

What are benign glandular epithelial tissue tumours called?

A

Adenoma

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8
Q

What are malignant squamous epithelial tissue tumours called?

A

Squamous cell carcinoma

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9
Q

What are malignant glandular epithelial tissue tumours called?

A

Adenocarcinoma

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10
Q

What are benign bone mesenchymal tissue tumours called?

A

Osteoma

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11
Q

What are benign blood vessel mesenchymal tissue tumours called?

A

Haemangioma

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12
Q

What are malignant bone mesenchymal tissue tumours called?

A

Osteosarcoma

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13
Q

What are malignant blood vessel mesenchymal tissue tumours called?

A

Haemangiosarcoma

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14
Q

What are lymphocyte tumours called?

A

Lymphoma

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15
Q

What is the growth fraction?

A

The proportion of actively dividing cells in a tumour

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16
Q

When is a tumour most susceptible to treatment?

A

When the cells are rapidly dividing rather than when the growth fraction reaches a plateau

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17
Q

What type of tumour is an exception bcos it maintains a high growth fraction?

A

Lymphoreticular tumour - lymphoma

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18
Q

What stage of the cell cycle is resistant to drugs/radiation?

A

G0 - resting

Important as reservoir of cells can repopulate tumour

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19
Q

In what stage of the cell cycle is chemotherapy most effective?

A

M phase - mitotic

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20
Q

What stage of the cell cycle is most radioresistant?

A

S phase

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21
Q

What does the tumour grade depend on?

A

The mitotic rate

Cellular and nuclear characteristics

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22
Q

What are clues of local invasion of the tumour?

A

Indistinct boundaries
FIxed in more than one plane
Thickened adjacent tissue
Spontaneous bleeding

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23
Q

What are the 4 methods of metastatic spread?

A

Blood
Lymphatics
Transcoelomic - across pleural/peritoneal spaces
Iatrogenic - seeding

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24
Q

What are paraneoplastic syndromes?

A

Signs arising fron the indirect effect of tumours production and release of biologically active substances

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25
Q

What is a haematologic paraneoplastic syndrome?

A

Anaemia

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26
Q

What is myelophthisis?

A

When neoplastic invasion directly affects the bone marrow

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27
Q

What does myelophthisis cause?

A

Cytopenias - decreased production of WBC, RBC etc

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28
Q

What is leukaemia?

A

When abnormal cells are released into the blood from the bone marrow

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29
Q

How can tumours affect blood cell production?

A

Myelofibrosis - Replacement of bone marrow with scar tissue

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30
Q

What are 3 causes of blood loss form tumours?

A

Local haemorrhage
Gastric ulcer from mast cell tumour
Bleeding disorder - thrombocytopenia

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31
Q

What can mast cell tumours cause?

A

Hyperhistaminaemia

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32
Q

What local effects does hyperhistaminaemia cause?

A

Oedema
Localised bleeding
Delayed wound healing

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33
Q

What systemic effects does hyperhistaminaemia cause?

A

Anaphylactic shock

Gastroduodenal ulcer

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34
Q

What is an immune mediated reaction that cancer can cause?

A

Cross reactivity between cancer cells and healthy cells

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35
Q

What is the most common paraneoplastic syndrome in dogs?

A

Hypercalcaemia

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36
Q

What causes hypercalcaemia as a paraneoplastic syndrome?

A

Tumours release a substance called parathyroid hormone-related peptide

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37
Q

What are 3 clinical signs of hypercalcaemia?

A

PUPD
Muscle weakness
Dehydration/renal failure

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38
Q

What are the two kinds of biopsy?

A

Cytology

Histopathology

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39
Q

What can cytology determine?

A

The nature of the tumour eg. Epithelial, mesenchymal

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40
Q

What are some types of cytological methods?

A

Fine needle aspirates
Touch preparations
Cytospins

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41
Q

What are the features of malignancy?

A 
degree of differentiation 
cell pleomorphism 
multiple nuclei 
anisocytosis 
nuclear : cytoplasmic ratio 
mitotic figures 
clumping of chromatin 
nuclear pleomorphism 
multiple nucleoli
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42
Q

What are some types of histological examination?

A

Surgical - incisional and excisional
Needle
Punch biopsy

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43
Q

What is an incisional surgical biopsy?

A

Where a piece of the tumour and some healthy tissue is removed

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44
Q

What is an excisional surgical biopsy?

A

Remove entire cancer plus healthy tissue around it

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45
Q

What are 3 rules of biopsy?

A

Avoid superficial ulceration/inflammation/necrosis
Ensure adequate depth
Try to include a boundary

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46
Q

What does clinical staging aim to identify?

A

Cytological grade
Local invasion
Metastatic spread

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47
Q

What is the most common staging system used for cancer?

A

TNM
T - primary Tumour
N - regional lymph Nodes
M - Metastasis

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48
Q

What determines T in the TNM staging system?

A

Size and extent of the primary Tumour - up to T4

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49
Q

What determines N in the TNM staging system?

A

The amount of involvement of the regional lymph Nodes - up to N4

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50
Q

What does M determine in the TNM staging system?

A

Whether Metastasis is present or not - up to M2

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51
Q

What is M1 and M2 in the TNM staging system?

A

M1 - single metastasis

M2 -multiple metastasis

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52
Q

What is remission?

A

When all clinical evidence of cancer has disappeared, but occult cancer cells remain and relapse will occur at some point

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53
Q

What is the only thing that has a chance of curing cancer?

A

Complete surgical excision

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54
Q

When is local excision used?

A

Only for truly benign tumours

eg. Fibroma, lipoma

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55
Q

What constitutes wide local excision?

A

Wider margins - 1 cm

In two tissue planes

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56
Q

When is wide local excision used?

A

Locally invasive tumours
eg. basal/squamous cell carcinoma
Mast cell tumour

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57
Q

What is compartmental excision?

A

Resection - removes every tissue compartment with the tumour involves

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58
Q

When is compartmental excision used?

A

Solid soft tissue sarcomas that infiltrate wider than 1-2cm

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59
Q

What is the most common type of radiation therapy?

A

External beam radiation therapy

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60
Q

What is brachytherapy?

A

Radioactive substance emits gamma rays or beta particles close to the tumour
Either on surface or implanted into tumour

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61
Q

What type of brachytherapy is used to treat thyroid tumour?

A

Radioiodine treatment

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62
Q

What is the most common source of external beam in external beam radiation therapy?

A

Linear accelerator

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63
Q

When should radiation therapy be used?

A

Malignant primary tumour with no local/distant metastasisq

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64
Q

What does the response to radiation of the cancer cells depend on?

A

Radiosensitivity of the cells - rapidly dividing cells are more sensitive
Dose and energy of radiation

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65
Q

What are some acute reactions to radiation therapy?

A 
Skin reddening 
Vesiculation 
Desquamation 
Severe exfoliative dermatitis 
Localised hair loss
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66
Q

What are some late toxicity symptoms of radiation therapy?

A 
Depigmentation 
Dermal fibrosis 
Osteonecrosis 
Neural necrosis 
Blindness (enucleation) 
Neurologic signs
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67
Q

When should chemotherapy be used?

A

In the early stages - depends on growth fraction as rapidly dividing cells are most susceptible

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68
Q

What does the response to chemo depend on?

A

Tumour growth rate

Drug resistance

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69
Q

What does fractional cell kill mean?

A

Cytotoxic drugs only kill a constant fraction of cancer cells - according to first order kinetics

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70
Q

What is the consequence of fractional cell kill?

A

Difficult to fully eradicate all cancer cells - if start with low number, an even lower number still remain

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71
Q

How do you get around the issue of fractional cell kill?

A

Use chemotherapy protocol - multiple doses

Surgical debulking

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72
Q

What is primary cytotoxic drug resistance?

A

Cancer is resistant in the first place

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73
Q

What is secondary cytotoxic drug resistance?

A

Cancer develops resistance due to mutations and selection of resistant clones

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74
Q

What is multidrug resistance I?

A

Mutation of the gene encoding the ATP binding cassette export pump
Leading to accumulation of the drug in the cells

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75
Q

Which chemo drugs are affected by multidrug resistance I?

A

Ivermectin
Doxorubicin
Vincristine
Vinblastine

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76
Q

What are some safety issues with chemo drugs?

A 
Cause DNA damage so 
Carcinogen - cause cancer
Teratogen - damage foetus 
Irritant
Mutagenic
77
Q

How does coat change during chemo?

A

Cats only lose whiskers
Some dog breeds susceptible to coat loss
Others just lose beard

78
Q

What are two other side effects of chemo other than coat loss?

A

GI toxicity

Myelosuppression - neutropenia

79
Q

What is myelosuppression?

A

Decreased bone marrow activity

80
Q

When is myelosuppression an issue? What should you do?

A

When neutrophil count is <2x10^9 - at risk of sepsis

Stop chemo, give antibiotics

81
Q

What can happen if given topically/extravascular?

A

Phlebitis - tissue necrosis

82
Q

What does vesicant mean?

A

Severe irreversible tissue injury and necrosis

83
Q

What are some drugs that are vesicants?

A

Vincristine
Cisplatin
Doxorubicin

84
Q

How to reduce chance of extravasation/perivascular leakage?

A

Administer through IV catheter

Flush catheter with saline

85
Q

What is sterile haemorrhagic cystitis?

A

Metabolites in urine are bladder irritant

86
Q

What are acute and chronic cardiotoxicities due to chemo?

A

Acute - tachyarrhythmias

Chronic - cardiomyopathy

87
Q

How often do you give chemo drugs?

A

3 week cycles

88
Q

What are the 3 phases of chemotherapy protocol?

A

Induction
Maintenance
Rescue

89
Q

What is the aim of induction in the chemotherapy protocol?

A

Aim to reduce tumour burden into remission

90
Q

When is rescue phase of the chemotherapy protocol?

A

When the tumour relapses or doesnt respond to initial therapy

91
Q

What tumours are highly sensitive to chemotherapy?

A

Lymphoma

Myeloma

92
Q

What tumours are poorly sensitive to chemotherapy?

A

Slow growing sarcomas
Carcinomas
Melanomas

93
Q

What are the two most common chemotherapy protocols used for lymphoma?

A

COP - cats
CHOP - B cell dogs
LOP - T cell dogs

94
Q

What drugs are in the COP protocol?

A

Cyclophosphamide
Prednisolone
Vincristine

95
Q

What drugs are in the CHOP protocol?

A

Cyclophosphamide
Prednisolone
Vincristine
Hydroxydaunorubicin - doxorubicin

96
Q

What is first-line chemotherapy?

A

When chemo is used at first in systemic diseases that cant debulk
Might respond well as have high growth fraction

97
Q

What is adjunctive chemotherapy?

A

Used alongside surgery/radiotherapy

98
Q

When is adjunctive chemotherapy used?

A

For solid tumours eg. carcinoma, sarcoma

99
Q

What is metronomic chemotherapy?

A

Palliative daily low doses of chemotherapy drugs

100
Q

What is chemoembolisation?

A

When chemo drugs are injected into blood vessel supplying tumour
Then block tumour with synthetic material

101
Q

What are the main mechanisms of chemotherapy drugs?

A

Alkylating agents
Platinum compounds
Plant alkaloids
Antibiotics

102
Q

How do alkylating agents work to be cytotoxic?

A

They add an alkyl group to guanine which damages DNA

Cause inter/intra strand crosslinks

103
Q

When do alkylating agents work in the cell cycle?

A

They are not cell cycle specific

104
Q

What are some examples of alkylating agent chemo drugs?

A

Cyclophosphamide
Chlorambucil
Melphalan

105
Q

How do platinum compounds woth to be cytotoxic?

A

They covalently bind to DNA causing DNA damage
Cause inter/intra strand crosslinks
(Similar to alkylating agents)

106
Q

What are some examples of platinum compounds chemo drugs?

A

Cisplatin

Carboplatin

107
Q

What type of tumour are platinum compounds used for?

A

Osteosarcoma

108
Q

What is important to note about platinum compounds?

A

They are nephrotoxic to cats - dont use

109
Q

How do anti-metabolites work?

A

Inhibit the use of cellular metabolites during the cell growth/division

110
Q

What are 5 examples of anti- metabolites?

A 
Cytarabine
Methotrexate
5-fluorouracil
Azathioprine
Hydroxyurea
111
Q

What is cytarabines mechanism of action?

A

Cytosine analogue

112
Q

What phase does cytarabine damage DNA in?

113
Q

What type of tumour is cytarabine used for?

A

Lymphoma/leukaemia

114
Q

What is methotrexates mechanism of action?

A

Folate analogue - folate is necessary for purine and pyrimidine synthesis so DNA synthesis cant occur

115
Q

What type of tumour methotrexate used for?

A

Lymphoproliferative disorders

116
Q

What is 5-fluorouracils mechanism of action?

A

Uracil incorporates into DNA interfering with function/synthesis

117
Q

What are the sides effects of 5-fluorouracil?

A

Myelosuppression

Neurotoxicity

118
Q

What is azathioprines mechanism of action?

A

Inhibits purine/DNA synthesis

119
Q

What is azathioprine used to treat?

A

Lymphoma
Leukaemia
IMPA

120
Q

What are the main side effects of azathioprine?

A

Myelosuppression
Liver disease
Pancreatitis

121
Q

What can you give azathioprine to?

A

Most dogs

NOT cats

122
Q

What is hydroxyureas mechanism of action?

A

Inhibits DNA synthesis

123
Q

What is hydroxyurea used to treat?

A

Polycythaemia vera

124
Q

What is polycythaemia vera?

A

Tumour of RBC precursors producing excess RBCs

125
Q

What are some examples of cytotoxic antibiotics?

A

Doxorubicin
Mitoxantrone
Actinomycin D

126
Q

What is the most effective agent for most cancers?

A

Doxorubicin

127
Q

What is doxorubicin mechanism of action?

A

Multimodal
eg. DNA intercolation
Alkylation of DNA
Inhibits DNA polymerase

128
Q

Are some examples of plant alkyloids?

A

Vincristine

Vinblastine

129
Q

What is vincristine used to treat?

130
Q

What is vinblastine used to treat?

A

Mast cell tumours

131
Q

What is the mechanism of action of vincristine/vinblastine?

A

Inhibits microtubule formation

Interferes with mitotic spindle

132
Q

What are tyrosine kinase inhibitors used to treat?

A

Tumours expressing c-kit mutation

eg. Mast cell tumours

133
Q

What is the main adverse effect of tyrosine kinase inhibitors?

A

GI toxicity

134
Q

What are the two tyrosine kinase inhibitors?

A

Toceranib

Masitinib

135
Q

What is the main enzyme used as a chemotherapeutic drug?

A

L-asparaginase

136
Q

What is the mechanism of action of L-asparaginase?

A

Destroys circulating asparagine necessary for protein synthesis

137
Q

What is important about administering L-asparaginase?

A

Inactivated by rubber so give immediately after reconstitution
from powder
Must be given SC or IP

138
Q

How do NSAIDs help with chemotherapy?

A

Induce apoptosis

139
Q

What are glucocorticoids used to help treat?

A

Lymphomas

Decrease inflammation and swelling

140
Q

What are the 4 haematopoietic tumours?

A

Lymphoma
Lymphoid leukaemia
Myeloproliferative disorders
Myeloma/plasma cell tumours

141
Q

What is a viral cause of lymphoma?

142
Q

What is a lymphoma?

A

A neoplastic disease arising from the lymphoreticular system

143
Q

Where do lymphomas primarily affect dogs?

A

Lymph nodes

144
Q

How are lymphomas diagnosed?

A

Cytology

Histological appearance of lymph node/organ

145
Q

How are lymphomas classified?

A

Histological classification and grade
Anatomical area
Immunophenotype - B or T cell

146
Q

How are lymphomas histologically classified?

A

Cell size, mitotic rate

147
Q

What does flow cytometry tell you about the lymphoma?

A

What surface proteins there are - ‘cluster of differentiation molecules’
Whether it is B cell or T cell

148
Q

What type of lymphoma is more likely to cause hypercalcaemia?

A

T cell lymphoma

149
Q

What anatomical form of canine lymphoma is the most common?

A

Multicentric - lots of lymph nodes

150
Q

What type of system do you use to stage canine lymphoma?

A

WHO
Anatomical site
Stage
Substage

151
Q

What are the 5 anatomic sites of lymphoma?

A 
Generalised
Alimentary
Thymic
Skin
Leukaemia
Extra-nodal
152
Q

What are the stages of the WHO staging system of lymphoma?

A

Go from only involving one lymph node to generalised to blood/bone marrow involvement

153
Q

What are the substages of the who staging system of lymphoma?

A

Clinically well

Clinically unwell

154
Q

Which type of lymphoma has a poorer prognosis?

A

T cell
Large cell
Stage V substage b
Male dog

155
Q

What can be given palliatively to treat lymphoma?

A

Prednisolone - corticosteroids

156
Q

What is the most effective drug against lymphoma?

A

Doxorubicin

Used in CHOP protocol or alone

157
Q

What is the name for cutaneous lymphoma?

A

Mycosis fungoides

158
Q

What is the best treatment for cutaneous lymphoma?

A

Lomustine and prednisolone

159
Q

What is the most common anatomical form of lymphoma in cats?

A

Alimentary

160
Q

What chemotherapy protocol is better tolerated in cats?

A

COP

Cats dont like doxorubicin

161
Q

What is the remission rate for feline lymphoma?

A

Only 50-70%

162
Q

What is the median survival time for feline lymphoma?

A

8 months with COP protocol

163
Q

What is leukaemia?

A

Neoplastic proliferation of haematopoietic stem cells

164
Q

How are leukaemias classified?

A

Stem cell origin - lymphoid or myeloid

Degree of differentiation

165
Q

What type of leukaemia has a poorly differentiated form?

A

Acute leukaemia - poor prognosis

And vice versa

166
Q

How is leukaemia diagnosed?

A

Bone marrow evaluation
Blood smear examination
Imaging
Flow cytometry

167
Q

What type of stem cell origin is more common in leukaemia?

A

Lymphoid more common than myeloid

168
Q

What type of degree of differentiation is more common?

A

Poorly differentiated - acute leukaemia more common

169
Q

What is a key marker of acute lymphoid leukaemia?

A

Marked lymphoblast population in the blood and bone marrow

170
Q

What is aleukaemic leukaemia?

A

Bone marrow infiltration but absent peripheral lymphoblast

171
Q

What age is chronic lymphoid leukaemia most common in?

A

Older patients compared to acute

172
Q

What type of cells are a marker of chronic lymphoid leukaemia?

A

Mature lymphocytes - peripheral lymphocytosis

173
Q

What is a myeloproliferative disorder?

A

Rare nonlymphoid bone marrow cell disorder

174
Q

What is the most common myeloproliferative disorder?

A

Polycythaemia vera

175
Q

What is the prognosis for chronic myeloproliferative disorders?

A

Guarded

May undergo a blast crisis - fatal leukaemia phase

176
Q

What is polycythaemia vera?

A

Abnormal proliferation of erythroid precursor in the bone marrow

177
Q

What does polycythaemia vera cause?

A

Hyperviscosity - high PCV

178
Q

What are the clinical signs of polycythaemia vera?

A

Neuro signs
Blindness
Heart failure

179
Q

What are plasma cell tumours?

A

When plasma cells/immunoglobulin producing B cell precursor cell lineage transforms into a neoplastic population

180
Q

What are the 3 most important plasma cell tumours?

A

Multiple myeloma
IgM macroglobulinaemia
Solitary plasmacytoma

181
Q

What is a multiple myeloma?

A

Monoclonal proliferation of malignant plasma B cells

182
Q

What is a sign of multiple myeloma?

A

Abnormal amounts of one type of immunoglobulin

183
Q

What are the clinical signs of multiple myeloma?

A

Hypercalcaemia
Renal failure
Anaemia
Bone lesions

184
Q

What do solitary plasmacytomas progress to?

A

Multiple myelomas

185
Q

What are histocytes?

A

Migrate from bone marrow to blood and differentiate to macrophages and dendritic cells

186
Q

What should the margin be for surgical excision of carcinomas?

A

1 cm margins - metastasis more of a problem

187
Q

What should the margin be for surgical excision of sarcomas?

A

3cm margins - local invasion more of a problem

188
Q

What should the margin be for surgical excision of round cell tumours?

A

1-3cm margins - variable

189
Q

What can excessive tension cause?

A

Compromise to circulation
Ischaemia
Dehiscence
Necrosis

CVSOH BVSc3 (60 decks)

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