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ACVIM: SAIM Specialty boards study 2023 > Oncology > Flashcards

Oncology Flashcards

1
Q

When preparing, administering, or disposing of chemotherapeutics, or when cleaning up waste from patients that have received chemo, what PPE is recommended?

A
  • Chemotherapy rated double gloving
  • Long sleeved, coated impermeable gowns with back closure
  • Eye/face shield
  • Shoe and hair coverings to maintain sterility (if needed)
  • Respirator if there is potential for aerosolization
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2
Q

Animals receiving chemo at home should not be allowed to urinate/defecate in community areas, areas where children may be exposed, or areas that are difficult to clean for how many hours after administration?

A

48 hours

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3
Q

What is the mechanism of action of alkylating agents?

A
  • Bind to DNA strands and insert an alkyl group, which creates cross links in DNA => strand breaks
  • Act in all phases of the cell cycle
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4
Q

Name 5 alkylating agents

A
  • Cyclophosphamide
  • Chlorambucil
  • Melphalan
  • Lomustine (CCNU)
  • Mustargen
  • Procarbazine
  • Dacarbazine
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5
Q

What is the mechanism of action of mitotic inhibitors? Name 3

A
  • Inhibit the assembly (vinca alkaloids) or disassembly (paclitaxel) of the mitotic spindle - arrest cell division in metaphase
  • Vincristine, vinblastine, vinorelbine
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6
Q

What is the mechanism of action of platinum compounds? Name 2

A
  • Create cross links in DNA (like alkylating agents)
  • Cisplatin, carboplatin
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7
Q

Why is cisplatin fatal when given to cats?

A

Causes pulmonary edema

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8
Q

What is metronomic chemotherapy?

A

Uses small doses of chemotherapy drugs frequently (daily or EOD) rather than conventional chemotherapy, which uses maximum tolerated doses at intervals of weeks

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9
Q

What is the mechanism of action of metronomic chemotherapy?

A
  • Anti-angiogenic (targets tumor endothelial cells)
  • Immunomodulatory (inhibits Tregs)
  • NOT cytotoxic, like conventional chemo
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10
Q

After giving chemotherapy, the patient’s neutrophil count should be checked at the expected nadir or before the next dose of myelosuppressive chemotherapy. If the neutrophil count is <1,000, what should be done?

A

Patient is afebrile, healthy
- Consider prophylactic antibiotics at home
- Reduce future dose by 25%

Patient is febrile or sick
- Hospitalize for IV antibiotics, fluids - treat for sepsis

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11
Q

If the neutrophil count is 1,000-3,000, what should be done?

A

Delay scheduled chemotherapy until the neutrophil count is >3,000. Recheck CBC in 3-7 days

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12
Q

One common mechanism of tumor resistance to chemotherapy is the P-glycoprotein transmembrane pump, which can efflux chemo out of the tumor cells. What chemo drugs are NOT substrates for this pump and will still be effective?

A

Alkylating agents - mainstay of treatment for patients with this type of resistance

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13
Q

What oral chemotherapy drug is used for the treatment of multiple myeloma?

A

Melphalan

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14
Q

If vincristine is given outside of the vein, what should be done?

A

Dilute and WARM compress

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15
Q

What is the mechanism of action of doxorubicin and mitoxantrone?

A

Inhibit topoisomerase II => inhibition of DNA synthesis
S phase specific

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16
Q

If doxorubicin is given outside of the vein, what should be done?

A

COLD compress

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17
Q

What chemotherapeutic can cause a red color in the urine up to 2 days post-administration?

A

Doxorubicin

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18
Q

What chemotherapy drug can cause anaphylaxis within 30 minutes of administration and the patient should be pretreated with dexamethasone and/or Benadryl?

A

L-asparaginase

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19
Q

Name 3 chemotherapeutics that cross the blood brain barrier

A

CCNU, procarbazine, cytarabine

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20
Q

What drug can be given to reduce cardiotoxicty from doxorubicin? How does it work?

A

Dexrazocane (Zinecard)

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21
Q

What is the mechanism of action of L-asparaginase?

A

Catalyzes the conversion of L-asparagine to aspartic acid and ammonia. This deprives myeloproiferative cells of circulating asparagine because they cannot synthesize it on their own, which leads to cell death

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22
Q

What detoxification system is upregulated by many cancer cells to remove chemotherapeutic drugs?

A

Glutathione system

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23
Q

What is multidrug resistance-related protein?

A

Protein that excretes detoxified products of the glutathione system - unregulated in some cancer cells

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24
Q

What cell type expresses CD1?

A

Antigen presenting cells - useful for diagnosing histioproliferative disorders

25
Q

Describe the staging system for lymphoma

A
  • Stage 1: single LN
  • Stage 2: multiple LNs in a regional area
  • Stage 3: generalized LN involvement
  • Stage 4: Liver and/or spleen involvement (with OR without LN involvement)
  • Stage 5: bone marrow or blood involvement and/or any non-lymphoid organ (with OR without any of the other stages)

Substage a: no clinical signs
Substage b: clinical signs

26
Q

Describe acute radiation toxicity. What types of tissue are most affected?

A
  • Affects rapidly proliferating tissues (skin, mucous membranes)
  • Generally reversible changes that occur during or shortly after therapy
  • Increase with dose, dose rate, and dose per fraction
27
Q

Describe late radiation toxicity

A
  • Affects tissues that have limited to no renewing capabilities (bone, nerve, muscle)
  • Occurs 3-6 months after radiation
  • Severity dependent on dose per fraction
  • Progressive and irreversible changes
28
Q

What radiation protocols are more likely to cause acute toxicity? Late toxicity?

A

Acute toxicity - definitive intent protocols
Late toxicity - palliative intent protocols

29
Q

What is the typical schedule and dosing for definitive intent radiation?

A
  • Large number of fractions with a low dose/fraction
  • Goal is to achieve long term control while limiting late toxicity
30
Q

What is the typical schedule and dosing for palliative intent radiation?

A
  • Fewer number of fractions, but a high dose per fraction
  • Intent is to improve QOL (improve function, decrease pain/bleeding)
31
Q

In a study of malignant solid tumors treated with palliative intent radiation, what tumor types had the best overall response rate? What was the overall response rate?

A
  • Sarcoma (87%), primary bone tumors (85%), melanoma (73%)
  • Overall response rate 75%
32
Q

In a study of malignant solid tumors treated with palliative intent radiation, what was the MST? What factors influenced MST?

A

134 days - did not vary with tumor location, but dogs that had a positive clinical response or maintained stable disease after radiation had longer MSTs

33
Q

In a study of malignant solid tumors treated with palliative intent radiation, what percent of dogs developed acute toxicity? Late toxicity?

A
  • Acute - 55% (dermatitis, alopecia, mucositis most common)
  • Chronic - 12% in dogs that lived at least 3 months - neuropathy, blindness, laryngeal paralysis, etc
34
Q

What is thought to cause feline injection site sarcomas?

A

Pathogenesis not fully known, but it is thought that local irritation (especially from adjuvants) stimulates fibroblasts - chronic inflammation leads to malignant transformation

35
Q

What vaccines are more at risk of inducing feline injection site sarcomas?

A

Adjuvanted, killed vaccines (rabies, FeLV), although any vaccine and injections of long acting drugs (glucocorticoids, etc) can

36
Q

What temperature of vaccine is more likely to induce feline injection site sarcomas?

A

Cold vaccines - bring to room temperature for 15 minutes before injection

37
Q

What are the most common presenting characteristics of dogs with B cell CLL?

A

Peripheral lymphadenopathy or splenomegaly (50%)
Anemia (26%)

38
Q

English bulldogs are at increased risk of B cell CLL and have a unique presentation. What is it?

A
  • Younger (6 yrs vs 11 yrs)
  • Lower class II MHC and CD25
39
Q

Over 50% of gliomas occur in what dog breeds?

A

Brachycephalics

40
Q

What are the diagnostic criteria for B cell CLL?

A
  • Usually >5000 to 6000 lymphocytes/uL in the blood
  • B cell expansion by immunophenotyping
  • Small cell morphology
41
Q

What dog breed has a shorter survival time with B cell CLL than other breeds? Why?

A

Boxers - BCLL in these dogs preferentially rearrange unmated immunoglobulin heavy variable region genes - poorer outcome in people

42
Q

What are negative prognostic indicators in B cell CLL cases?

A
  • Ki67 - greater than 40% of Ki67 expression had a shorter MST (173 days vs not reached)
  • High lymphocyte count: >60,000 lymphocytes
  • Clinical signs at presentation
43
Q

Describe the staging scheme for canine splenic hemangiosarcoma

A
  • Stage I: <5 cm diameter tumor, no mets
  • Stage II: >5cm diameter tumor OR evidence of rupture, +/- regional LN involvement
  • Stage III: distant mets
44
Q

In dogs with stage II splenic hemangiosarcoma, what histologically determined score correlated with survival?

A

Mitotic index: <11 mitoses/10 hpf did better

45
Q

Of dogs undergoing splenectomy for nonruptured splenic masses or nodules (no hemoperitoneum), what percent were benign?

A

70%

46
Q

Are thoracic radiographs sensitive or specific for heart base masses?

A

Specific, but not very sensitive

47
Q

What percent of cats treated for small cell GI lymphoma develop large cell GI lymphoma? When does it occur?

A

10% - developed large cell 540 days after small cell diagnosis

48
Q

What clinicopathologic findings were more common in cats with large cell vs small cell GI lymphoma?

A

Lower hematocrit, albumin, and total protein - cats with small cell lymphoma that develop these signs should be screened for large cell

49
Q

What was the MST for feline large cell GI lymphoma?

A

25 days

50
Q

What subset of dogs with mammary carcinoma benefit from OHE at the time of tumor removal?

A

Dogs with high peri-surgical serum estradiol concentrations or expression of estrogen receptors on tumor IHC

51
Q

What dog breed may be more predisposed to pulmonary histiocytic sarcoma?

A

Miniature schnauzers

52
Q

What are the clinical findings in dogs with doxorubicin induced cardiotoxicity?

A
  • Decreased systolic function, resembling DCM
  • Arrhythmias
53
Q

What factors were associated with doxorubicin induced cardiotoxicity in the JVIM paper?

A
  • Higher cumulative dose (144 vs 121 mg/m2)
  • Higher body weight
  • Decreases in fractional shortening after 5 doses
  • Development of VPCs
  • Boxers
54
Q

In dogs with previously untreated, peripheral nodal lymphoma treated with prednisone alone, what was the MST? What factors were associated with survival

A
  • 50 days
  • Substage (a vs b) and immunophenotype
55
Q

In dogs with lymphoma, what tumor mutation was associated with decreased survival time?

A

p53 mutation: 67 days vs 264 days

56
Q

What sample type yielded the best sensitivity and specificity for PARR in canine lymphoma?

A

FNA (100% S&S) > FFPE > flow cytometry pellets

57
Q

Bernese Mountain dogs with what other condition were at increased risk of developing histiocytic sarcoma? What decreased their risk?

A
  • Orthopedic condition = increased risk
  • Administration of anti-inflammatory meds = lower risk

Inflammation may be a risk factor?

58
Q

In dogs with genitourinary carcinoma treated with NSAIDs, mitoxantrone, and RT, what factors influenced survival?

A
  • Shorter survival in dogs with moderate to severe clinical signs
  • Shorter in dogs with prostatic involvement
59
Q

n dogs with genitourinary carcinoma treated with NSAIDs, mitoxantrone, and RT, what percent developed permanent urinary incontinence? When did it develop?

A

31% - median of 70 days post-irradiation

ACVIM: SAIM Specialty boards study 2023 (38 decks)

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