Oncology Flashcards
what are the basic tumor types seen in animals?
haematopoetic or liquid
solid
round cell
what are the main types of haematopoetic or liquid tumors?
lymphoma
leukemia
what are the main types of solid tumors?
sarcoma
carcinoma
what tissues do sarcomas affect?
skeletal
connective tissue
what tissues do carcinomas affect?
organs
what are the main types of round cell tumor?
MCT
melanomas
what is a benign tumor?
one that will not spread
what is a malignant tumor?
one with risk of spread
what is a metastatic tumor?
one which grows in a different locations to the primary tumor
what areas of the body are commonly affected by metastasis?
those with high blood flow as cancer cells are carried from the primary tumor in the blood stream to other sites
where does leukaemia occur?
blood forming tissues
what are the two main types of leukaemia?
acute
chronic
what is acute leukaemia?
presents with clinical signs directly relating to leukaemia
what is chronic leukaemia?
incidental finding when investigating other illness
where does lymphoma occur?
cells that make up the immune system
what are the main types of lymphoma?
B cell
T cell
how are haematopoetic tumors normally treated?
chemo as highly responsive
what are sarcomas classified according to?
parent tissue
what are the main sarcoma types seen in animals?
osteosarcoma
haemangiosarcoma
soft tissue sarcoma
where are osteosarcomas often found?
distal radius
top of femur
what has usually occurred by the time a patient presents with osteosarcoma?
metastasis either obvious or sub clinical
what is involved in treatment of osteosarcoma?
surgery to remove affected limb
chemotherapy
bisphosphates
radiation therapy
what is the aim of amputation in osteosarcoma patients?
palliation as tumors are painful
metastasis has already occurred so unlikely curative
where are haemangiosarcomas located?
spleen
heart
blood vessels
how are haemangiosarcomas treated?
surgery
chemo
where are haemangiosarcomas commonly found?
spleen
what is soft tissue sarcoma a tumor of?
connective tissue
what is consistent about soft tissue sarcomas?
all behave the same despite their different locations
what is a carcinoma?
tumor that is made of tissue that covers any body surface, lines a body cavity or makes up an organ
what are carcinomas that arise from a gland known as?
have prefix ‘adeno’
what is a common carcinoma type?
squamous cell carcinoma
what animals are squamous cell carcinomas common in?
cats
where are squamous cell carcinomas seen often in cats?
mouth
nose
ears
where are more aggressive squamous cell carcinomas found?
mouth
how are squamous cell carcinomas treated?
surgery to remove if superficial / possible
radiation or chemo useful
what is the most common malignant skin tumour in dogs?
mast cell tumor
what are mast cells involved with in the body?
inflammatory and allergic mechanisms
how may mast cell tumors present?
many different ways
may be highly malignant or almost benign
how do mast cell tumors appear within the skin?
hard and firm
how do mast cell tumors appear if under the skin layers?
mobile and soft - lipoma like
how may mast cell tumors present in cats?
splenic
GI
how are mast cell tumors often treated?
surgical removal with appropriate margins
radiotherapy
chemotherapy
how does melanoma often appear?
pigmented black tumor
where on the body is melanoma found?
mouth
toes
skin
where are more aggressive melanomas found?
mouth or toes
how is melanoma treated?
surgery to improve QOL
immunotherapy to slow spread
how does immunotherapy for melanoma work?
melanoma vaccine given
immune system develops antibodies to melanoma proteins
if melanoma recurs the immune system can remove them
what is in the melanoma vaccine?
human melanoma proteins
how is the melanoma vaccine given?
transdermally
do benign tumors always lead to malignant tumors?
no
squamous cell carcinoma might
what are the most common benign tumors?
lipoma
haemangioma
adenoma
what is haemangioma a tumor of?
blood cells
what is paraneoplastic syndrome?
cancer associated alterations to the body structure or function that are not directly related to the tumor or metastasis
what are the common PNS seen with lymphoma?
hypercalcaemia
anaemia
neutropenic leukocytosis
thrombocytopenia
what effect can successful treatment of a tumor have on PNS?
may lead to disappearance of many PNS
what may be signified by return of PNS that had reduced with tumor treatment?
tumor return
what may be signified by PNS?
malignancy
what can be predicted by the PNS seen?
tumor type as PNS are specific
what can be the result of PNS?
greater morbidity than with the tumor itself
what is the best curative option for tumors?
surgery
what is the purpose of staging and grading of tumors?
gives an idea of available treatment options
what varies between tumors?
sensitivity to chemo
what cancers have high sensitivity to chemo?
lymphoma
some leukaemias
what cancers have moderate sensitivity to chemo?
high grade sarcomas
MCT
fast growing
what cancers have low sensitivity to chemo?
slow growing sarcomas
carcinomas
melanomas
what are the main treatment options for low sensitivity tumors?
no chemo, surgery if an option
how may location of a tumor affect treatment?
may affect if it is resectable
is it resectable with margins?
how may owner factors influence tumor treatment?
may not want disfiguring surgery/radical resection
may not have finances for treatment
how may patient temperament affect treatment?
ability to cope with radical surgery (e.g. OA on other limbs or size)
ability to cope with repeated vet visits / treatment /GA
how may chemotherapy be used for treatment?
stand alone therapy
conjunction with other therapies
what may affect if chemotherapy is used?
chemosensitivity of cancer - high, moderate or low
how does radiotherapy treat tumors?
radiation induced cellular injury
targets fast growing cells
what are the issues with radiation treatment?
specific expensive equipment needed
what other treatments are available for tumors?
cryotherapy
hyperthermic therapy
photodynamic therapy
immunotherapy
what are the surgical treatment options for tumors?
complete resection with margins
excisional biopsy
incisional biopsy
trucut biopsy
FNA
what is involved in complete tumor resection?
removal of tumor and margins in order to try and cure patients
radical and wide surgery
what are the margins needed for MCT removal?
2cm normal tissue around
1 tissue plane below
what is involved in an excisional biopsy of a tumor?
main mass removed
no excess tissue taken
what may excisional biopsy be used for?
diagnosis
treatment as debulking surgery
what are the main surgical diagnostic techniques?
incisional biopsy
trucut biopsy
FNA (not rly surg)
what are the main goals of surgery for tumor treatment?
curative
debulking and additional treatment
palliative for comfort
what preventative oncology surgery is seen?
removal of retained testicles
what oncologic emergency surgeries are there?
bleeding management (splenic mass)
pathological fracture
infection
bowel perforation
bowel obstruction
what is the purpose of tumor staging?
to find out how much tumor is present in the body at the time of staging
get an over view of patients health
what may be picked up during tumor staging that can inform treatment?
concurrent conditions
PNS
what is the information gathered during staging used for?
formulation of treatment decisions
what system is used to stage tumors?
TNM
what does the T of TNM stand for?
tumor size (primary)
what does the N of TNM stand for?
level of lymph node involvement
what does the M of TNM stand for?
presence of metastasis
when is staging performed?
before start of treatment
assessment of response to treatment
before recommencing treatment after relapse
what are the tests involved in tumor staging?
physical exam
history
urinalysis
bloods
chest xray
abdominal ultrasound
imaging
what blood tests will be used for tumor staging?
CBC
biochem
specific and relevant to patient (e.g. t4?)
what views of the chest are needed to check for metastasis?
3 inflated views
what mets can be seen on chest x-ray?
over 4/5mm
what is involved in abdominal US for tumor staging?
check common metastasis sites
FNA of liver, spleen and LN
what specialised imaging may be used during tumor staging?
echo
CT
MRI
what is echo used for during tumor staging?
check for any signs of CHF or cardiac issue before doxorubicin given
what is CT used for during tumor staging?
checking tumor invasion and spread
more sensitive to lung mets
surgical planning
what is MRI used for during tumor staging?
neuro based tumors
tumors in soft tissue obscured by bone
when is tumor grading done?
during histology after biopsy or tumor resection
what information is used to grade tumors?
appearance under microscope
mitotic index
organisation of cells
evidence of invasion of blood vessels
what are the tumor grades?
low
intermediate
high
what is the value of tumor grading?
useful for prognosis
what is mitotic index?
number of currently dividing cells seen across 10 high power fields
what does a high mitotic index indicate?
high level of malignancy
when may a cancer patient present in hospital?
initial investigation
staging
illness (e.g. after chemo)
palliative care at end of life
what nursing model should be used to support inpatients?
ability model
what are the areas of the Ability model/
eat
drink
urinate
defecate
breathe normally
maintain temp
groom and clean itself
mobilise adequately
sleep and rest
expression of normal behaviour
who designed the ability model?
Orpet and Jeffries
what is involved in patient assessment when designing the care plan?
information gained about patients normal routine
owner questionnaire
face to face discussion
team members
when is the assessment phase of the ability model revisited?
regularly e.g. ward rounds, handover, checks such as pain scoring
what is involved in the planning stage of the ability model?
setting SMART goals
identify actual and potential problems
identification of nursing interventions
prioritisation of interventions
what are SMART goals?
Specific
Measurable
Acchievable
Realistic
Timely
what is crucial when patients are receiveing nursing interventions?
document clearly - how much, what it is, how often
what are the interventions involved in medical models?
physiological issues
medications needed
what are the interventions involved in nursing models?
medical interventions
eating
drinking
urination needs
defecating
psychological
environmental
sociocultural
what are some of the potential psychological, environmental and sociocultural nursing interventions?
nervous patients
bitch on heat being accommodated
enrichment
patient as an individual
what is the purpose of evaluation of nursing care plans and interventions?
show that nursing interventions are working
show goals are being accheived
what must take place in order to evaluate nursing care plans and interventions?
assessment of the patient to pick up on any other issues as well as those that are resolving
what may change around evaluation of nursing care plans and interventions?
depending on the intervention some assessments may be done sooner than others (e.g. pain more rapidly assessed than feeding/grooming)
what will happen after evaluation of nursing care plans and interventions?
plan adjusted accordingly
what are some specific nursing considerations for onco patients?
enrichment as may be hospitalised for a long time
anorexia - may need to TTE and look for cause
may have impaired immune function - reverse barrier nurse
care with waste and chemo drugs
care with chemo administration
where are chemo drugs excreted?
may be in all body fluids particularly urine, faeces and vomit
how long are chemo drugs excreted for?
3-5 days
what is required to keep caregivers of chemo patients safe?
barrier nursing
what are the stages of mitosis?
prophase
metaphase
anaphase
telophase
cytokensis
what are the number of mitotic cycles controlled by?
cell nucleus
what do cells spend most of their time in?
interphase
what occurs during interphase?
cell matures
makes DNA copies
what occurs during prophase?
preparation for cells to split
chromosomes form
what happens during metaphase?
chromosomes line up down the centre of the cell
what happens during anaphase?
chromosomes split
what happens during telophase?
chromosomes stretch out
what happens during cytokinesis?
cell splits into two new cells
what is apoptosis?
cell death
what triggers apoptosis?
shortening of telomeres
cell only replicates a certain number of times
how does the body suppress cancer formation?
cell cycle is regulated
cells respond to growth and environmental signals
tumor suppressor genes exist
cell is repaired or goes into apoptosis if cell malfunctions
how does cancer arise?
accumulation of genetic mutations that eliminate normal cell constraints
what effect has increased longevity had on cancer?
allows more time for mutations to accumulate and develop into cancer
what are the main environmental causes of cancer?
chemical carcinogens
physical agents
hormonal
cancer causing viruses
inherited (not recognised in animals)
what are the main chemical carcinogens?
tobacco smoke
pesticides
herbicides and insecticides
cyclophosphomide
what are the main physical agents that can cause cancer?
sunlight
trauma/chronic inflammation
magnetic fields
radiation
surgery
implanted devices
asbestos
what are the hormonal influences on cancer?
neutering may be protective against some (e.g. mammary cancer) but may increase risk of others (e.g. lymphoma)
what are examples of cancer causing viruses?
papilloma virus
retroviruses (FeLV)
what are the main DNA mutations that cause deviation from the normal cell cycle?
sustaining proliferative signalling
evasion of growth suppression
resist apoptosis
enable replicative immortality
induce angiogenesis
activation of invasion and metastasis
what is the minimum number of mutations required to cause cancer?
5-6
how is replicative immortality of cells enabled?
telomeraze produced by cells which prevents shortening of telomeres
this prevents signalling for normal apoptosis so cells survive
define tumour
neoplasm either benign or malignant
define neoplasia
formation of new abnormal growth that is not responsive to normal physiologic control mechanisms
benign or malignant
define cancer
metastatic neoplasm
define benign tumor
can be space occupying and cause tissue distortion but no metastasis
what is the impact of malignant tumors on the surrounding tissue?
locally invasive
what cells does chemotherapy work on?
rapidly dividing cells at various stages in DNA replication and cell division
cell signalling
what are the main ways chemo is used?
primary induction
primary neoadjuvant
adjuvant
consolidation
maintainance
rescue or salvage
palliative
what is primary induction chemotherapy?
initial chemotherapy a person receives before undergoing additional cancer treatment
what is primary neoadjuvant chemotherapy?
chemo before surgery used to shrink tumor size to allow resection
what is adjuvant chemotherapy?
used after surgery to mop up any remaining cells
what is consolidation chemotherapy?
used after initial treatment (of whatever type) to target additional cells and reduce likelihood of relapse
what is maintenance chemotherapy?
ongoing treatment of cancer with medication after the cancer has responded to the first recommended treatment
what is rescue / salvage chemotherapy?
change to different protocol due to failure to respond to other chemo type
what is palliative chemotherapy?
aimed at reducing disease signs and pain to improve quality of life
what type of chemo treatment plan is best?
multimodal
what are the benefits of multimodal chemo schedules?
broad range of interaction between drugs and tumor cells
slows development of tumor drug resistance
what is the aim when choosing chemo doses?
maximal cell kill within range of tolerable host toxicity
what drugs should be used for chemo?
only those with known single use efficacy against tumor type
non-overlapping toxicity
what is crucial when choosing chemo timings?
doses should be given at consistent intervals
why is it important that chemo drugs do not have overlapping toxicities?
so treatment can continue without having to wait for symptoms to reduce
what are the main types of chemotherapy agent?
alkylating agents
antitumor antibiotics
antimetabolites
antimicrotubule agents
corticosteroids
platinum
L-asparginase
targeted agents
how do alkylating agents work in chemo?
binds alkyl groups to cellular macromolecules cross linking DNA
what are the main types of alkylating agents?
chyclophosophomide
chlorambucil
lomustine
how do antitumor antibiotics work in chemo?
multimodal action of cellular toxicity
what are some examples of antitumor antibiotics?
doxorubicin
mitoxantrone
how do antimetabolites work in chemo?
inhibit use of cellular metabolites in cellular growth and division
how do antimicrotubule agents work in chemo?
interfere with cellular function and replicaition
what are the main types of antimicrotubule drugs?
vincristine
vinblastine
how do corticosteriods work in chemo?
induction of apoptosis in haematologic cancers
how does platinum work in chemo?
binds DNA
what are examples of platinum chemo agents?
cisplatin
carboplatin
how does L-Asparginase work in chemo?
induction of apoptosis in tumor cells
how do targeted agents work in chemo?
block receptors on the cell surface
what are some examples of targeted chemo agents?
palladia
masivet
what is lymphoma?
diverse group of neoplasms with common origin from lymphocytes
what tissues can be affected by lymphoma?
almost any in the body
particularly lymphoid tissues (nodes, spleen, BM)
what is one of the most common tumors in dogs?
lymphoma
what is the most common type of lymphoma?
multicentric
what presentation of lymphoma is commonly seen in cats?
intestinal
what is the treatment for lymphoma?
chemo cycles until remission
what is average life expectancy if undergoing lymphoma treatment?
up to 2 years
what protocol is used to treat lymphoma?
CHOP
what are the components of the CHOP protocol?
Cyclophosphomide
Hydroxydaunorubicin (Doxorubicin)
Oncovin (vincristine)
Prednisolone
what drug may be given instead of doxorubicin?
epirubicin
what is the benefit of epirubicin over doxorubicin?
reduced risk of cardiotoxicity
but increased risk of GI toxicity
what part of the CHOP protocol is not always given?
preds may only be given if the patient is systemically unwell
what type of protocol is CHOP?
discontinuous
what is a discontinuous protocol?
has a set time limit and will end
what is seen as a side effect of chemo?
toxicity
why are toxicities seen as a side effect of chemo?
chemo drugs target all cells that are dividing not just cancer cells
why are toxicities seen in certain areas of the body?
due to the presence of rapidly dividing cells
what are the main areas of the body affected by chemo toxicity?
bone marrow
GI
what are the main areas to consider when nursing chemo patients?
feeding
toileting
barrier nursing (or reverse)
what may you need to consider for a chemo patient pre diagnosis?
PNS
nausea
reduced energy
inappetance
what may you need to consider for a chemo patient who is unwell during treatment?
reverse barrier if neutropenic
chemo drug excretion
what may you need to consider for a chemo patient during end of life care?
palliation
comfort
how are chemo clinics usually performed?
patients admitted for treatment only and then home
how can chemo be administered?
bolus injection
infusion
tablet
what is essential about chemo IVC placement?
clean stick to avoid extraversation
how should chemo drugs be drawn up?
PPE worn
in a fume cabinet to reduce risks if spills or any spray
use connectors on bottles and syringes
describe the process of chemo administration
check IVC placement with saline
draw back to check presence of blood
connect syringe
administer over correct time
check IVC placement with saline every 1-2 mins
how can you increase confidence in discussing chemo with owners?
increase knowledge and understanding
experience
understanding of owners needs (emotional/physical)
can all patients be helped?
yes even with financial / time / disease constraints
supportive care
curative treatment
palliative care
hospice care
euthanasia
how may owners be kept involved with the treatment of their pet?
chemo leaflets to read through at home
chemo passport filled in at each appointment to keep owner up to date
give owners things they can do to support their pet a home
what may be experienced by staff/client when dealing with chemo patients?
compassion fatigue
reduction in empathy
burnout
how can clients/staff be supported to alleviate compassion fatigue?
change chemo nurses
admit patient for respite
owner groups
when is neutropenia nadir seen?
2-5 days post treatment
how long does a CHOP cycle last?
16 weeks
what advice should be given to owners about managing waste from their pet receiving chemo?
wear gloves to handle waste
double bag then dispose of in normal waste
encourage urination away from common areas or walkways
urination in the garden shoul be washed away to help dilute it
for how long after treatment do owners need to manage waste from their pet receiving chemo?
4-5 days
where is chemo waste excreted?
urine and or faeces
what should happen if drugs extravasate?
leave IVC in place
aspirate
inject hylauronidase around the area
apply heat compression
what are the grade 1 vesicants?
vincristine
epirubicin
what specific toxicity is seen with vincristine?
mild myelosuppression
peripheral neurotoxicity
GI effects (ileus)
what specific toxicity is seen with cyclophosphomide?
neutropenia
GI toxicity
sterile haemorrhagic cystitis
what specific toxicity is seen with chlorambucil?
myelosupression
what specific toxicity is seen with epirubicin?
anaphylaxis
myelosuppression
GI toxicity
cardiotoxicity
what toxicity is seen with doxorubicin?
cardio
can lead to CHF
