Oncology Flashcards
can paraneoplastic signs be associated with local tumour growth?
no
signs of paraneoplastic syndrome
Paraneoplastic signs = cachexia, hypercalcaemia, hypoglycaemia, hypergammaglobinaemia, polycythaemia, anaemia, coagulopathy, fever
hypercalcaemia
- causes: hyperadrenocortisim, renal failure, D hypervitaminosis
- most common cause = malignancy: lymphoma (mediastinal form), anal gland carcinoma, thyroid carcinoma, mammary tumour, multiple myeloma
- tumour secretion of parathormone or PTH
- for mild: no clinical signs, perform rehydration and monitor Ca, P and creatinine daily
- moderate: clinical signs present, patient should be rehydrated, induce diuresis, in well hydrated patient, can add furosemide after diagnosis prednisolone
- severe: prominent clinical signs, emergency, in refractory cases add calcitonin, biphosphonated
hypoglycamia
- blood glucose conc below 3.5mmol/L
- occurs with multiple disorders (hypoadrenocorticism, liver failure, starvartion, sepsis) + PNS
- signs: patients weak, disoriented with seizures, coma and death
- insulin should be suppressed: isotonic glucose infusion of hypertonic glucose bodies, administration of corticosteroids and adapted diet
hypergammaglobinema
- increased levels associated with multiple myeloma, although can occur in lymphomas or chornic leukaemia
- Biochem: high concentration of TP with low or normal albumin
- electrophoresis
polycythemia
- increase in total number of erythrocytes usually due to: dehydration, hyperadrenocorticism, malignant proliferation, or arising from PNS
anaemia
- occurs in 25% of vet oncology patients
- majority of anaemia that accompany oncologic conditions; 1. anaemia of chronic disease, 2. autoimmune haemolytic anaemia, 3. micro angioma haemolytic anaemia, 4. bleeding
fever
- need to distinguish whether it’s cancer patient who’s developed a concurrent infection or it’s a cancer patient with fever as part of PNS
diagnosis of paraneoplasitc syndrome
anaemia, leukopenia, thrombocytopenia
treatment of paraneoplastic syndrome
Removal of the tumour and might need to do symptomatic therapy due to hypercalcaemia
definition of hyper viscosity syndrome
increase in protein concentration makes blood hyper-viscous, thickening of the blood
predisposition of hyper viscosity syndrome
occurs in 20% of dogs with IgM or IgA monoclonal proteins if the protein level in blood are high – more common in older dogs
cause of hyper viscosity syndrome
multiple myeloma and plasma cell tumours, lymphocytic leukaemia or lymphoma, marked polycytemia, chronic autoimmune disease
signs of hyper viscosity sydnrome
epistaxis, hypoxia nystagmus, ataxia, coma, retinal bleeding, renal impairment, myocardial hypoxia, cardiomyopathy, anorexia, depression, blindness
diagnosis of hyper viscosity syndrome
is a syndrome, not a final diagnosis
- physical exam, background history
- CBC, biochemistry and urinalysis
- look at total plasma protein count
treatment of hyperviscosity
fluid supplementation, based on if it’s caused by a cancer or only inflammatory condition
cause of anaemia of chronic diseases
- may be due to decreased red cell production and/or increased red cell destruction
- multi factorial anaemia due to impaired Fe metabolism, shorter erythrocyte life and in rare cases, bone arrow suppression by tumour cytokines
- Indicates the presence of a chronic problem, such as chronic infection, autoimmune disease, kidney disease or cancer
- indicated disseminated and metastatic tumours
cause of anaemia of chronic diseases
- may be due to decreased red cell production and/or increased red cell destruction
- multi factorial anaemia due to impaired Fe metabolism, shorter erythrocyte life and in rare cases, bone arrow suppression by tumour cytokines
- Indicates the presence of a chronic problem, such as chronic infection, autoimmune disease, kidney disease or cancer
- indicated disseminated and metastatic tumours
signs of anaemia of chronic disease
most commonly related to the underlying disease, lethargy and poor performance, weight loss, depression, pallor
diagnosis of anaemia of chronic disease
bone marrow exam exhibits no significant change
anaemia of chronic disease treatment
removing the tumour if neoplasia, correct any deficiency, treat underlying cause
prognosis of anaemia of chronic disease
good
microangiopathic haemolytic anaemia (cause, diagnosis, treatment)
Cause: as a consequence of blood vessel endothelium damage and fibrin deposition. occurs most commonly with hemangiosarcoma
Diagnosis: schistocytes and haemolysis
Treatment: tumour removal, adj. therapy and supportive transfusion whole blood therapy
malignant lymphoma predisposition
- most frequent of haematopoietic system in dogs, arising from lymphoid tissue
Predisposition: golden retrievers, GSD, Scottish terriers,
classification of malignant lymphoma
(by anatomical location): multi centric, alimentary, mediastinal, extranodal (lungs, kidneys, skin, eyes etc)
forms of malignant lymphoma
Multicentric
- occurs in 85% cases
- manifested: bilateral painless swelling of superficial LN, hepatosplenomegaly, spreading to other organs and tissues
- signs: depression, gross lymphadenopathy
- 3 stages:
o 1. initial lymphadenopathy without change in general condition
o 2. moderate weight loss and loss of appetite
o 3. sudden onset of anorexia, weakness, exhaustion and death
Alimentary form
- occurs in 7% cases
- common in cats
- enlargement of intestinal and mesenteric LN (superficial usually unchanged)
- clinically manifested: by progressive weight loss, diarrhoea
Mediastinal form
- occurs in 5% cases
- manifested: by enlarging the mediastinal LN, form characterised by hypercalcaemia
- poor exercise intolerance, respiratory distress
staging of malignant lymhoma
- single LN
- regional lymphadenopathy
- generalised lymphadenopathy
- liver and/or spleen involvement +/- LN
- blood, bone marrow and other organ involvement
diagnosis of malignant lymphoma
history, clinical findings, immunocytochemical exams, pathophysiology and immunohistochemical examination
- cytology: FNA
- CBC: thrombocytopenia in 30-50% cases, neutrophilia 25-40%, lymphocytosis in 20% cases
- biochemistry: - lymphoma may result in hypercalcaemia
- X-ray + contrast
treatment of malignant lymphoma
combined chemotherapy, vets use: L-asparaginase, vincristine, prednisolone, cyclophosphamide, doxorubicin, surgery and radiation therapy
prognosis of malignant lymphoma
poor if not treatment for intermediate/high grade, fair for indolent lymphomas
- if no treatment: average survival 4-6 weeks
- if prednisolone only: average survival 2-3 months
- chemotherapy: survival 4.5-8months
differentials of malignant lymphoma
Alimentary form
- malabsorption, inflammatory bowel disease, Addison’s disease, parasites, other cancers
Thymic form
- causes of dyspnoea, thymoma, metastatic disease, ectopic thyroid tumour
Multicentric form
- leukaemia, lymphadenopathy
hemangiosarcoma predisposition
- from blood vessel endothelium
- most usual in the spleen and near the heart
Predisposition: mostly middle aged, GSD, golden retriever
signs of hemangiosarcoma
weakness, enlargement of spleen, bleeding, if cardiac form = cardiac tamponade, bruising, arrhythmias
diagnosis of hemangiosarcoma
histopathology, X-ray (thorax), US abdominal and cardiac and CT of abdomen
- CBC
q
treatment of hemangiosarcoma
surgery, if no metastatic, transfusion before, Adj, th = doxorubicin every 2-3 weeks for total of 5 treatments, blood transfusion, radiotherapy, immunotherapy
differentials of hemangiosarcoma
abdominal mass, coagulopathies, benign idiopathic pericardial effusion if cardiac tamponade is present
prognosis of hemangiosarcoma
survival time 5- 7 months
predisposition of osteosarcoma
middle age to older (7 years), Great Dane, rottweiler, intact males and females have increased risk, Large and giant breeds
cause of osteosarcoma
unknown, hereditary basis
pathogenesis of osteosarcoma
Malignant tumour of bone cells, fast growing, primary bone tumour, usually limbs, high mtc potential (lung)
signs of osteosarcoma
depends on location, lameness, swelling, pain
diagnosis of osteosarcoma
x-ray
bone biopsy
treatment of osteosarcoma
surgery, radiation, chemo, doxorubicin every 2-3 weeks for total of 5 treatments, analgesia
prognosis of osteosarcoma
very poor without treatment, pain of primary tumour usually euthanasia
predisposition of soft tissue sarcoma
generally in older animals, but can be younger of large breeds, golden retriever = fibrosarcoma
cause of soft tissue sarcoma
unknown, occasionally associated with chronic inflammation
pathogenesis of soft tissue sarcoma
from connective, muscle and nervous tissue
signs of soft tissue sarcoma
related to location, firm, fibrous mass
diagnosis of soft tissue sarcoma
biopsy and histopathology
treatment of soft tissue sarcoma
surgery and radiation, chemo, NSAIDs
prognosis of soft tissue sarcoma
based on histological grade, mitotic index and evaluation of margins, medial survival times following surgery range from 480-1796 days
predisposition of transitional cell carcinoma
occurs most in female dogs, Scottish terriers, west highland, beagles and Shetland sheepdogs
pathogenesis of transitional cell carcinoms
occurs in bladder and urethra
transitional cell carcinoma
micro-macro haematuria, decreased urine
diagnosis of transitional cell carcinoma
CBC, physical exam, biochemistry, urinalysis, Xray, abdominal US and urinalysis, biopsy
treatment of transitional cell carcinoma
surgery if possible, chemo, palliative care, NSAIDs, radiotherapy
prognosis of transitional cell carcinoma
dependent on the progression, without treatment most die from complications within a few to several months
predisposition of mammary tumours
most affected in middle age and older, rare in younger than 5
cause of mamamry tumours
increased or prolonged exposure to growth promoting hormonal influences
signs of mammary tumours
lump, advanced stages ulcerated, inflamed
diagnosis of mammary tumours
CBC, biochemistry, FNA, 5 stages
treatment of mammary tumours
surgery, NSAIDs
prognosis of mammary tumour
good if low stage grade
anal gland carcinoma predisposition
intact male dogs, female, most common 7-12 years, GSD, cockers, daschunds, springer spaniel
pathogenesis of anal gland carcinoma
High mtc rate (regional LN, liver, lung)
signs of anal gland carcinoma
swelling, painful defecation, PUPD due to hypercalcaemia, bleeding, bum scooting
diagnosis of anal gland carcinoma
CBC, urinalysis, x-ray, CT, US of abdomen, histopathology
treatment of anal gland carcinoma
surgery, radiation and chemo, corticosteroid, stool softeners, increased fibre
prognosis of anal gland carcinoma
multimodal treatments 544 days
differentials of anal gland carcinoma
anal sacculitis, perianal gland adenoma, other causes of hypercalcaemia
predisposition of melanoma
Common in skin, digit and oral cavity, less common in iris and ciliary body of eye
Predisposition: middle age to older, Scottish terrier, dachshund
pathogenesis of melanoma
malignant proliferation of melanocyte, mts to regional LN, lungs
signs of melanoma
black-brown pigmented mass, friable, ulcerated, haemorrhagic, hallitosis
diagnosis of melanoma
cytology, histopathology (FNA), X-ray, CT
treatment of melanoma
surgery, radiation, immunotherapy, chemo (carboplatin)
prognosis of melanoma
majority of skin melanomas are benign, melanomas of digits and oral cavity are malignant
- oral = 5 months, feet + lips = 22.5 months, cutaneous = 24.2 months
- stage 1 = 17-18 months, stage 2 = 5-6months, stage 3 = 3 months
predisposition of mast cell tumour
Most common malignant skin tumour of dog
Predisposition: mean 8.5 years but can be seen in dogs of all ages, bull breeds + brachycephalic, beagle, Boston terrier, boxer
pathogenesis of mast cell tumour
most common malignant skin cancer, mts: LN, liver, spleen
signs of mast cell tumour
hairless mass, vomiting, melena, skin mass
diagnosis of mast cell tumour
cytology or histopathology, CBC (eosinophilia/basophilia)
treatment of mast cell tumour
surgery, tyrosine kinase inhibitors, H2 blockers (famotidine)
prognosis of mast cell tumour
good for low-grade tumours; guarded to poor for high -grade
differentials of mast cell tumour
other skin neoplasia, granuloma, urticarial reaction
predisposition of multiple myeloma
is rare in cats, around 11 years
pathogenesis of multiple myeloma
proliferation of plasma cells
signs of multiple myeloma
lethargy, pain, spleen enlargement, bleeding, weight loss, neurological signs, lameness, PUPD, pyrexia
diagnosis of multiple myeloma
biochemistry (chronic kidney disease), spike on serum protein electrophoresis, anaemia, urinalysis (often normal), X-ray, histopathology
treatment of multiple myeloma
chemo, melphalan, prednisolone
prognosis of multiple myeloma
max survival time = 15 months
differentials of multiple myeloma
lymphoma, hyper viscosity caused by polycytemia, SLE, drug reaction
TNM
T = primary tumour
- T0 = no evidence of tumour
- T1= tumour < 1cm + non-invasive
- T2 = 1-3cm +/or locally invasive
- T3 = < 3cm +/or locally invasive
N = regional lymph node
- N0 = no evidence of involvement
- N1 = firm + enlarged
- N2 = firm, enlarged + fixed to tissue
- N3 = involvement beyond regional LN
M = metastasis
- M0 = no evidence
- M1 = to 1 organ system
- M2 = to more than 1 organ system
signs of leukaemia
weakness, pale MM, lethargy, non specific due to consequences of disease process, inappetence, weight loss, PUPD, bleeding, fever, pallor, petechial haemorrhage
diagnosis of leukemia
peripheral blood smears, bone marrow aspirate, flow cytometry, CBC (anaemia), biochemistry (renal, hepatic, proteins, calcium), urinalysis, US
treatment of leukemia
VM protocol, supportive, symptomatic, specific cytotoxic agents
prognosis of leukaemia
poor, favourable chronic (>18 months), grave for acute (1-2 months)
differential of leukemia
myelodysplasia, other cause of anaemia, lymphocytosis
L-asparagina
- inhibits tumour protein synthesis
vincristine
- blocks mitosis and can cause PNS side effects
cyclophosphamide
- works at level of DNA replication
- PO/IV
- endoxan
prednisolone
- decrease inflam edema around tumours
- adverse effects: secondary adrenal insufficiency, GI disorders, liver damage, blood clotting disorder
doxorubicin
- V strong cytotoxic
- slow IV infusion over 20 minutes too fast = facial edema + shivering – STOP
- paravenous = severe tissue irritation, can cause cardiomyopathy, wear protection (gloves, apron, glasses)
lymphoma protocol
Week 1
- L-asparaginase 10,000 IV
- vincristine 0.7mg/m2 IV
- prednisolone 40mg/m2 q 24 hr + famotidine
Week 2
- cyclophosphamide 250mg/m2 PO + diuretic
- prednisolone 30mg/m2 q 24 hr
Week 3
- vincristine 0.7mg/m2 IV
- prednisolone 20mg/m2 q 24 h + famotidine
Week 4
- doxorubicin 30mg/m2 or 1mg/kg if < 15kg IV
- prednisolone 10mg/m2 q24 + famotidine
Next 4 weeks = repeat of first 4 but have a break on week 10
