Oncology Flashcards
what are the basic tumour types seen in animals?
haemopoietic tumours
solid tumours
round cell tumours
give some examples of haemopoietic tumours
lymphoma
leukaemia
give some examples of solid tumours
sarcoma
carcinoma
what do sarcomas effect?
skeletal and connective tissues
what do carcinomas effect?
organs
give some examples of round cell tumours
mast cell tumours
melanomas
what does benign mean?
will not spread
what does malignant mean?
risk of spreading
what is a metastatic tumour?
secondary tumour that grows in a different location to the primary tumour
where do metastatic tumours typically grow?
in areas of high blood flow e.g. lymph nodes
what type of tumour is leukaemia?
haemopoietic
where does leukaemia occur?
in the blood-forming tissues
what are the main types of leukaemia?
acute and chronic
which type of leukaemia is more commonly diagnosed?
acute - chronic is usually an incidental finding
where does lymphoma occur?
in the cells which make up part of the immune system - B and T cells
how are haemopoietic tumours treated?
chemotherapy - highly responsive
how are sarcomas classified?
according to their parent tissue
where are osteosarcomas typically found?
distal radius
proximal femur
are osteosarcomas typically benign or metastatic?
metastatic - usually has occurred by the time of presentation
how is osteosarcoma treated?
surgery to remove affected limb
chemotherapy, biphosphates, radiation therapy all useful
what are the main types of sarcoma?
osteosarcoma
haemoangiosarcoma
soft tissue sarcoma
where do haemangiosarcomas typically affect?
spleen, heart/blood vessels
how are haemangiosarcomas treated?
combo of surgery and chemotherapy
what is a soft tissue sarcoma?
tumour of the connective tissue
what is a carcinoma?
a tumoiur involving a tissue that covers any body surface, lines a body cavity or makes up an organ
what prefix is used for carcinomas which arise from a gland?
adeno-
what does adeno- refer to?
arises from a gland
which species typically get squamous cell carcinomas?
common in cats
where do squamous cell carcinomas typically affect?
mouth, nose and ears
how are squamous cell carcinomas treated?
surgery to remove
radiation therapy or chemotherapy useful
what is the most common malignant skin tumour in dogs?
mast cell tumour
what do mast cells do?
involved in inflammatory and allergic mechanisms
where do mast cell tumours manifest?
anywhere on the body
how do mast cell tumours manifest (severity)?
range from almost benign to highly malignant with a high rate of spread
what do mast cell tumours feel like in the skin layers?
hard and firm
what do mast cell tumours feel like under the skin layers?
mobile and soft
what are mast cell tumours under the skin often mistaken for?
lipomas
how are mast cell tumours treated?
often need surgical removal - with appropriate margins can be curative
radiation therapy or chemotherapy can be useful
what does melanoma look like?
sometimes pigmented black tumour
where does melanoma typically affect?
mouth, toes or skin
how can melanoma be treated?
surgery to improve QOL - mass painful and can spread
immunotherapy to slow down spread (vaccine)
how does the melanoma vaccine work?
human melanoma proteins given transdermally
immune system develops antibodies to melanoma proteins
what are the most common benign tumour types?
lipoma
haemangioma
adenoma
what is a paraneoplastic syndrome?
cancer-associated alterations not directly related to the tumour or metastasis
what are the paraneoplastic syndromes associated with lymphoma?
hypercalcaemia
anaemia
neutrophilia
thrombocytopaenia
how are paraneoplastic syndromes resolved?
successful treatment of tumour
what can recurrence of paraneoplastic syndromes indicate?
return of tumour
what can occurrence of paraneoplastic syndromes indicate?
may signify malignancy
how can paraneoplastic syndromes affect prognosis?
may result in greater morbidity than the tumour itself causes
which tumour have high sensitivity to chemotherapy?
lymphoma
some leukaemias
which tumours have moderate sensitivity to chemotherapy?
high grade sarcomas
mast cell tumours
which tumours have low sensitivity to chemotherapy?
slow growing sarcomas
carcinomas
melanomas
how does tumour location affect treatment?
determines whether resectable or not
how do owner expectations affect treatment?
ability to accept possibly disfiguring surgery
cost of treatment
how does patient temperament affect treatment?
ability to cope with disfiguring surgery
ability to cope with repeated therapies e.g. chemo admin or repeated GAs for radiation
what is the principle of radiation therapy?
dividing cells are more prone to injury via radiation
what are the concerns with radiation therapy?
requires specific equipment
radiation-induced cellular injury
what are some of the less commonly used non-surgical tumour therapies?
cryotherapy
hyperthermic therapy
photodynamic therapy
immunotherapy
what are the surgical treatment options for tumours?
complete excision - wide and radical
debulking surgery (excisional)
preventative surgery
what types of biopsy might be taken of a tumour?
excisional biopsy
incisional biopsy
trucut biopsy
FNA
when might oncologic emergency surgery be performed?
bleeding
pathologic fracture
infection
bowel perforation
bowel obstruction
when might we perform preventative surgery?
when pre-empting a cancerous change e.g. retained testicles, white cat pinnas
why do we stage a tumour?
to find out how much tumour there is present in the body at that particular moment
information used to formulate rational decisions for treatment
what system is used for staging a tumour?
TNM system
what is the TNM system?
T - primary tumour size
N - level of lymph node involvement
M - presence of metastasis
when is tumour staging performed?
before start of treatment
to assess response to treatment
before recommencing treatment after relapse
what steps are involved in staging a tumour?
physical exam and history taking
urinalysis
bloods
chest x-rays
abdominal US
advanced imaging - echo, CT, MRI
what bloods might be done during tumour staging?
complete count
chemistry profile
specialised bloods
what samples might be taking under AUS for tumour staging?
aspiration of liver, spleen, lymph nodes
why is advanced imaging useful in tumour staging?
echo - doxorubicin can cause cardiac changes
CT for lung mets
MRI for neurological tumours
what is involved in grading a tumour?
histological findings
appearance under the microscope
mitotic index
how well-organised the cells are
evidence of cancer cells invading blood vessels
what can help us achieve a holistic nursing approach to oncologic patients?
nursing ability model - orpet and jefferies
what are the areas of the orpet and jefferies ability model?
eat
drink
urinate
defecate
breathe normally
maintain normal body temperature
groom and clean itself
mobilise adequately
sleep and rest
express normal behaviour
when can the assessment phase of the ability model be revisited?
regularly - ward rounds, handovers, more frequently when needed
what are SMART goals?
specific, measurable, attainable, relevant, timely
what medical model interventions are valuable for the patients?
assessment of body systems, physiological problems
administering medication
what nursing model interventions are valuable for the patients?
EDUF activities
psychological, environmental and sociocultural activities
what is important during the implementation phase of a nursing care plan?
giving and documenting interventions -what it is, how much, how often
why is the evaluation stage of a nursing care plan so important?
to show that nursing interventions are working
to show that goals have been achieved
picking up on any other issues that have developed
which evaluations should be done the most regularly with the care plan?
need for pain relief
ability to feed themselves
ability to groom themselves
what needs to be considered in terms of caregiver safety when interacting with chemotherapy patients?
dangerous - excreted in urine and some bodily fluids for 3-5 days
barrier nursing required
what do we need to consider in terms of patient immunity?
immune function may be compromised - reverse barrier nurse
what are the stages of a normal cell life cycle?
interphase
mitosis
cytokinesis
what is involved in interphase?
cell matures and makes copies of DNA
what are the steps of mitosis?
prophase
metaphase
anaphase
telophase
what occurs during prophase?
preparation to split, chromosomes form
what occurs during metaphase?
chromosomes line up
what occurs during anaphase?
chromosomes split
what occurs during telophase?
chromosomes stretch out
what occurs during cytokinesis?
cell splits into two new cells
how many times do cells replicate?
cells replicate a set number of times in their life cycle and then go into apoptosis
which type of genes help prevent cancer?
tumour suppressor genes
does cancer arise in a simple way?
no - phenotypic end result of a whole series of changes that may have taken a long time to develop
how does cancer arise?
accumulation of genetic mutations - these eliminate normal cell constraints
how quickly does cancer arise?
typically a very slow process, may not arise in the lifetime of the animal
why do older animals tend to get cancer?
increased longevity of life simply allows more of these mutations to accumulate
what are the main categories of cancer-causing agents?
chemical carcinogens
physical agents
hormonal factors
cancer-causing viruses
inherited cancers
what are some examples of chemical carcinogens?
tobacco smoke
pesticides, herbicides and insectisides
cyclophosphamide
what are some examples of physical agents which cause cancer?
sunlight
trauma/chronic inflammation
magnetic fields
radiation
surgery and implanted devices
asbestos
how do hormonal factors affect development of cancer?
neutering - can be protective against some types (e.. mammary cancer) but has been shown to increase risk of others e.g. lymphoma
what are some examples of cancer-causing viruses?
papilloma virus
retroviruses (FeLV)
do we see inherited cancers in animals?
recognised in humans but not animals
how do mutations in DNA cause deviation from the normal cell cycle?
sustain proliferative signalling
evade growth suppressors
resist cell death
enable replicate immortality
induce angiogenesis
activate invasion and metastasis
how does cancer resist cell death?
cell loses ability to recognise damage
how does cancer induce angiogenesis?
promotes growth of blood vessels through the tumour
how does cancer enable replicative immortality?
suppresses telomerase
how many mutations are required to cause cancer?
5-6 critical mutations are the minimum theoretical number required to cause cancer
what does the term ‘tumour’ refer to?
neoplasm - benign or malignant
what does the term ‘neoplasia’ refer to?
formation of new abnormal growth that is not responsive to normal physiologic control mechanisms
what does the term ‘cancer’ refer to?
refers specifically to metastatic neoplasms
what are the hallmarks of a malignant tumour?
locally destructive - may metastasise and may cause death if untreated
how does chemotherapy function?
targets dividing cells - major classes of drug work at various stages in cellular DNA replication and cell division
what was done by the National Cancer Institute (1955)?
set a framework for cancer chemotherapy development - many agents still in clinical use today
what are the different goals of therapy according to type of treatment plan?
primary induction chemotherapy
primary neoadjuvant therapy
adjuvant chemotherapy
consolidation chemotherapy
maintenance chemotherapy
rescue/salvage chemotherapy
palliative chemotherapy
what is the goal of a multimodal treatment plan?
maximal cell kill within the range of tolerable host toxicity
what are the advantages of multimodal treatment plans?
broader range of interaction between drugs and tumour cells
slows development of tumour drug resistance
what are the main principles of multimodal treatment plans for cancer?
only drugs with known single use efficacy against tumour type used
preferably drugs with non-overlapping toxicities
use drugs at optimal doses and schedule
use consistent intervals
how do alkylating agents work?
mode of action is to bind alkyl groups to cellular macromolecules, cross linking the DNA
give some examples of alkylating agents
cyclophosphamide, chlorambucil
lomustine
how do antitumour antibiotics work?
via a multimodal action of cellular toxicity
give some examples of antitumour antibiotics
doxorubicin
mitoxantrone
how do antimetabolites work?
inhibit use of cellular metabolites in cellular growth and division
how do antimicrotubule agents work?
interfere with cellular function replication
give some examples of antimicrotubule agents
vinca alkaloids such as vincristine, vinblastine
how do corticosteroid affect tumour growth?
induction of apoptosis in haematologic cancers
how does platinum affect tumour growth?
binds dna
give some examples of platinum drigs
cisplatin, carboplatin
how does L-asparginase affect tumour growth?
induction of apoptosis in tumour cells
how do tyrosine kinase inhibitors work?
block receptors on the cell surface
give some examples of tyrosine kinase inhibitors
palladia, masivet
where does lymphoma commonly arise from?
lymph nodes, spleen, bone marrow
how common is lymphoma?
one of the most common tumours in dogs
what form of lymphoma is the most common?
multicentric
what type of lymphoma do cats tend to get?
intestinal presentation
what does lymphoma treatment usually consist of?
chemotherapy cycles
what type of cancer is the CHOP protocol used for?
lymphoma
what drugs form the CHOP protocol?
cyclophosphamide
hydroxydaunorubicin (doxorubicin)
oncovin (vincristine)
prednisolone
what is the timeframe of the CHOP protocol?
given via a schedule over a few months - discontinuous protocol
are preds always given as part of the CHOP protocol?
not necessarily given if patient is systemically well
which drug should not be given alongside the CHOP protocol?
care if giving NSAIDs for a concurrent/pre-existing issue
why does chemotherapy have so many side effects?
the drugs do no selectively target tumour cells - all dividing cells are affected by cytotoxic drugs
how do chemotherapy drugs have more of an effect on cancer cells than normal cells?
cancer cells are perpetually dividing, whereas only a small percentage of normal cells are actively dividing
what types of toxicity does chemotherapy produce?
bone marrow toxicity - results in immunosuppression
GI toxicity
during what stages do we need to consider nursing care for chemotherapy patients?
pre-diagnosis
illness during treatment
end of life care
how is chemotherapy administered?
bolus injection or infusion
what are the considerations for preparation of chemotherapy?
quiet area
accurate IVC placement
double check dose
draw up drug carefully
what are the considerations for administration of chemotherapy?
check IVC placement and patency
connect syringe
administer
keep checking IVC placement throughout
what should you do if there is an issue with the IVC and the chemotherapy goes extravascular?
leave IVC in place and aspirate as much as possible
flush thoroughly with saline to dilute
inject hyaluronidase around area
apply heat compression
what advice should we given to an owner about dealing with contaminated urine/faeces?
wear gloves to handle
double bag and dispose of in normal waste
encourage urination away from walkways or areas with high footflow
urination in the garden should be washed away to help dilute it
how can we help support the owner through the treatment of their pet?
keep owners involved in treatment - chemo leaflet, treatment ‘passport’
give owners things they can do at home to support their pet
build confidence to discuss around this topic through good knowledge and understanding of the condition
consider compassion fatigue
