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Specialty Medicine (Ophthalmology, Oncology, Dermatology) > Oncology > Flashcards

Oncology Flashcards

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Dermatology Board Prep flashcards
1
Q

Breed dispositions for cancer-

A

Pugs, Boston terriers, Boxers–> MCT
Bernese Mountain Dogs–> Histiocytic sarcoma
Boxers, Basset Hounds, Bulldogs–> lymphoma
Belgian Tervurens, chows–> gastric adenocarcinoma
GSD–> hemangiosarcoma, Nodular dermatofibrosis– renal carcinoma and uterine leiomyoma

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2
Q

Intact male dogs are predisposed to what tumor? What about neutered male dogs? What about female dogs?

A

Male intact is usually perianal adenoma

Neutered males is usually prostatic carcinoma (usually an adenocarcinoma)

Females is usually urinary tumors like TCC

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3
Q

How do P-glycoprotein substrate chemo drugs work and what are some examples?

A

They are called “immunomodulators” which are used to harness the body’s own immune system to respond to cancer cells with minimal SE as compared to chemotherapy/radiation

they are usually not stand-alone therapies

Examples are: Vincristine, Vinblastine, Vinorelbine, Doxorubicin, +/- Mitoxantrone

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4
Q

Unique SE to 5-Fluorouracil-

A

Fatal neurotoxicity in cats (and in dogs with very high doses)

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5
Q

Unique SE to Vincristine

A

peripheral neuropathy – interferes with microtubule formation so interferes with neuron transmission/transduction pathways. Patients may have pins and needle feelings in paws

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6
Q

Unique SE to Cisplatin–

A

Fatal pulmonary edema in cats

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7
Q

Unique SE to Mechlorethamine-

A

severe vesicant which means sloughing of the skin when outside of the vein

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8
Q

Unique SE to Cyclophosphamide-

A

sterile hemorrhagic cystitis because one of the byproducts ends up in urine and is caustic to bladder wall so give in the morning and make sure p is well hydrated
May need to also give Furosemide with it and if you see any cystitis STOP THE DRUGGG

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9
Q

Unique SE to CCNU–

A

hepatotoxicity and this is one of the ones we need to really watch the neutrophils

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10
Q

Unique SE to Doxorubicin-

A

Severe vesicant and will slough skin if outside of the vein, Hypersensitivity/anaphylaxis, cumulative cardiotoxic in dogs, arrhythmogenic, cumulative nephrotoxicity in cats

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11
Q

What chemotherapy drugs cross the BBB?

A

5-FU
Cytosar
Hydroxyurea
CCNU
Procarbazine

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12
Q

Sensitivity to radiation therapy (RT) of cancers in order

A

Round cell tumor> carcinoma> sarcoma

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13
Q

What is the TOC for LSA and what is the % response rate?

A

Chemo is the TOC for LSA and there is a 80-90% response rate

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14
Q

Hypercalcemia, mediastinal LN enlargement, and boxers/ wolfhounds/ huskies/ shih tzu’s = ____ cell Lymphoma

A

T cell Lymphomas

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15
Q

T cell is usually in dogs/cats and B cell is usually in dogs/cats

A

T cell is usually in dogs and B cell is usually in cats

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16
Q

There is an approx. 60X increase risk of cats getting lymphoma if they are ___ positive and it is usually ___ cell secondary to….

A

FeLV positive; it is usually T cell secondary to viral integration into the genome

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17
Q

____ has approx. 5x the increased risk in cats who have it for ___ cell LSA secondary to…

A

FIV; B cell; secondary to immunosuppression

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18
Q

What is acute lymphoid leukemia in cats?

A

Neoplastic blast cells taking over the bone marrow resulting in pancytopenia (decreased RBCs, WBCs, and platelets)

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19
Q

pancytopenia means…

A

low RBCs, WBCs and platelets

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20
Q

evans syndrome is…

A

IMHA and immune-mediated thrombocytopenia

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21
Q

MCT in dogs

A

do not need chest rads, need FNA of liver and spleen, TOC is surgery and chemotherapy
MCT is the number one most common cutaneous tumor of dogs

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22
Q

MCT in cats

A

cats get internal MCT and MCT are not as common in cats as they are in dogs, 3 unique variations are cutaneous, splenic/visceral, and intestinal
TOC is splenectomy/sx and chemo

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23
Q

Hepatobiliary tumors in cats are usually ____ but are ____ in dogs

A

Benign; malignant

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24
Q

50% of canine liver tumors are _____ tumors and usually have no mets if _______

A

Hepatobiliary; usually no mets if they are massive/solitary

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25
Q

AGASACA

A

cocker spaniel is the poster child, occurs in females and males but is more common in those that are spayed/neutered, mets are 50-80% of cases and include the LN, liver, spleen, lungs, and bones
LN mets are common at presentation but DISTANT mets are uncommon
TOC is multimodal

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26
Q

Nasal tumors in dogs from most common to lesser commonality

A

Adenocarcinoma>SCC> Fibrosarcoma> osteosarcoma

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27
Q

Oral tumors in dogs from most common to lesser commonality

A

Melanoma> SCC> Fibrosarcoma> osteosarcoma

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28
Q

Nasal tumors in cats from most common to lesser commonality

A

SCC> lymphoma

RT is the TOC like with in dogs, cats have a lot worse of a prognosis

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29
Q

elevated globulins usually point toward what cancer types?

A

Multiple myeloma and plasma cell tumors

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30
Q

ISS

A

Injection site sarcomas
4 months to 3 years post vaccine, may be genetic bc higher incidence found in siblings
3-2-1 rule
Still present after 3 months after the vaccine
>2 cm in diameter
still growing 1 month post-vaccination
INCISIONAL biopsy only
locally invasive, non painful, firm, deeper than what we can palpate, slow/late mets but mets to lungs after awhile
TOC is sx and RT +/- chemo if confirmed mets or “hot” tumors which are tumors with high mitotic count, vascular invasion, etc.

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31
Q

Dolichocephalic dogs get this type of brain tumor whereas brachycephalics get this type of brain tumor

A

Dolichocephalic dogs get meningiomas whereas brachycephalics get this gliomas

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32
Q

Hemangiosarcoma predilection sites

A

Spleen, right atrium, skin

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33
Q

Hemangiosarcoma notes

A

Early, aggressive mets
to the liver, lung, mesentery, brain, mets in > 80% of P with HSA on presentation
HSA is the most common tumor to met to the brain, hematogenous spread or can have direct implantation

Sarcoma= cancer of connective tissue cells
Carcinoma= cancer of epithelial cells

Remember, HSA is sarcoma of the conn. tissue around the blood vessels

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34
Q

Double 2/3’s rule

A

2/3 of splenic masses in dogs are neoplastic
2/3 of those neoplastic masses are hemangiosarcomas

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35
Q

What is definitive diagnosis and TOC for HSA?

A

Definitive diagnosis is biopsy and TOC is chemo (Doxorubicin aka red death)

Chemo is not a front line but can hopefully slow down any metastatic disease

Prognosis for HSA
-with no tx- days to weeks
-with sx alone 1-3 months because mets get them
-sx for mass and chemotherapy- may double your time so MST 6-8 months

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36
Q

____ % of thyroid tumors are bilateral and bleed a lot so AVOID incisional biopsies

A

60%

37
Q

Midline mass on the neck of an older dog is what until proven otherwise?

A

Thyroid carcinoma until proven otherwise despite what cytology might say

38
Q

Pheochromocytoma

A

mets rate is about 40%, they are uncommon and are usually hidden masses with a lot of CS
Hormone testing may find metanephrine which is a break down product of epinephrine and norepinephrine and if it is 4X the normal range means likely has a pheochromocytoma

39
Q

what is the TOC for pheochromocytoma? What is the prognosis? What is NOT a tx option for them?

A

sx if adrenal mass is more than 2cm and is causing CS, can also do RT

Will NOT respond to CHEMO; Prognosis is MST 2-3 YEARS with sx resection, otherwise variable to guarded (if tumor is more than 5cm and/or caudal vena cava invasion)

40
Q

________ , ______ and _____ are cancers that may be very Palladia responsive

A

thyroid carcinomas; renal adenocarcinomas; and insulinomas

41
Q

What are the staging tests recommended for oral tumors?

A

Cytology of both mandibular LN and thoracic radiographs

42
Q

How do canine oral melanomas differ from SCC and fibrosarcoma in regard to behavior and Tx?

A

Melanomas that have no pigment resemble sarcomas on histopathology

Requires immunohistochemistry to differentiate the two

Needed because they act different and tx is different- for melanoma, it responds fairly well to definitive curative RT with 4 fractions, and we need systemic disease Tx unlike sarcomas which TOC is surgery

43
Q

“High/Low” Fibrosarcomas

A

Golden ret. is the post child, histologically low grade but biologically high grade
usually are on the hard palate between the canine and carnassial teeth

44
Q

Steps of cleaning- chemo protocol

A

Step 1 deactivation (bleach/Clorox wipes)
saline/water
Step 2 Deconamination (alcohol, water, peroxide, bleach)
saline/water
Step 3 clean to remove organic debris (bleach/Clorox)
saline/water
Step 4 Disinfecting (Bleach/Clorox, oxidizing agent, phenols, etc.)

45
Q

uveal melanoma

A

arises from the anterior segment, is BENIGN in dogs and MALIGNANT in cats

CS are heavy pigmentation (but sometimes tan/white), dyscoria- abn pupil shape, blindness, ocular pain, iris thickening

46
Q

___ melanoma is ALWAYS benign in dogs and is seen mostly in what breed?

A

Limbus melanoma; seen in GSD

47
Q

Lymphoma mets to the eye

A

via hematogenous spread to the uveal tract, causing anterior uveitis and hyphema (bleeding into the eye), usually stage 5 bc this is mets to distant sites (eyes), more likely to be B-cell and usually presents as nodular lesions within the eye

48
Q

Histiocytic tumors predisposed breeds

A

Bernese mtn. dog, flat coated retriever, mini schnauzers

49
Q

What are the subtypes of histiocytic sarcoma?

A

Localized- lung, periarticular (stifle and elbow mostly), spleen

Hemophagocytic - rare but bad prognosis, usually has hypocholesterolemia, hypoalbuminemia, thrombocytopenia, regenerative anemia

Disseminated- has affinity for lymphocytic regions like lymphoma (LSA)- liver, spleen, lungs, BM, etc.

50
Q

CCNU patients need to also be on what supplement?

A

Denamarin

51
Q

What characteristic lab work do we see with hemophagocytic histiocytic sarcoma?

A

hypocholesterolemia, hypoalbuminemia, thrombocytopenia, regenerative anemia

52
Q

Histiocytoma

A

Langerhans cells in origin, avoid immunosuppression DO NOT put these p on pred
looks like button ulcer, benign usually in younger dogs and will spontaneously regress

53
Q

What is a good ddx in a patient that has symptoms that seem out of the normal to the disease esp. if the lesion is in a typical location and a predisposed breed?

A

Histiocytic sarcoma

54
Q

Keep what form of cancer on your radar for evans syndrome (where immune system makes antibodies against the body’s own RBC and attacks its own blood cells) or IMHA dogs, remember to look at all bloodwork abnormalities

A

Hemophagocytic Histiocytic sarcoma

55
Q

What test is a good GP test to run if you suspect a patient has TCC (recurrent UTI’s and older p/maybe predisposed breed)

A

BRAF test can also do traumatic catheterization

56
Q

What is the most common type of renal cancer?

A

Renal adenocarcinoma
MANY of them express KIT so use Palladia which a receptor kinase inhibitor

57
Q

What are the top 4 at risk breeds for TCC/UC?

A

Scottie terrier
Sheltie
Westie
Eskimo dog

Veggies are protective, ayoooo

58
Q

Why are NSAIDs effective against TCC/UC?

A

Do chemo indefinitely (do not expect tumor to shrink

59
Q

why do NSAIDS help?

A

Because they are COX-2 inhibitors and these tumors way over express COX

60
Q

What are the pros and cons and limitations of surgery for TCC/UC?

A

For most cases, exlap and biopsy is the diagnostic test of last resort because super invasive, high risk of seeding and costly since such a major sx

Pros- can do in GP, get histopath, potentially therapeutic if away from the trigone

Cons- anesthesia, INVASIVE, VERRRYYY high risk of seeding, will not usually be curative

61
Q

what is the general approach to therapy for TCC/UC and general prognosis?

A

Do BRAF testing (need 40mL free catch urine)

Can do traumatic catheter if in GP

Can scope/biopsy if in referral setting

EXlap/surgery is last resort, very high risk of seeding, major surgical procedure/invasive

62
Q

Do not have to worry about neutrophil count with what chemo drug? Otherwise, we need neutrophils to be above what level?

A

Elspar aka L-asparginase; Neutrophils need to be more than 2,000 on CBC

63
Q

MCT are most common where in dogs and where in cats?

A

In the skin of dogs (the most common cutaneous mass of dogs), and GI tract of the cat

64
Q

explain PARR for differentiating lymphoma types

A

Cancer cells originate along the same cellular line and proliferate so they would all originate from the same cell and that would mean they should all have the same DNA
So with PARR, we are looking to see if this is the same cell line proliferating based off the same origin “monoclonal” = suggestive of a neoplastic process

65
Q

Dogs with generalized lymphadenopathy rule outs–

A

Ehrlichia, Blastomycosis, Lymphoma
+/- chronic pyoderma or atopy

66
Q

What is flow cytometry and how is it used to aid the diagnosis of lymphoma?

A

Flow cytometry- run all cells through a laser and establish the different sizes and
Regularity. Same as with CBC where the cells are brought into single file line
Through a laser “they FLOW past a laser horizontally/perpendicular to the cells)
And based off the make up inside of the cell, the laser will pick up the size of the cells
And that is how we know WBC which are bigger than RBC which is bigger than a platelet and looks at nucleus inside of WBC to see what type of WBC it is

67
Q

Lymphocytosis with diffuse lymphadenopathy likely means…

A

LSA In the bone marrow

68
Q

Stages of Lymphoma–

A

Stage 1- single LN
Stage 2- multiple regional LN (on one side of the diaphragm)
Stage 3- generalized lymphadenopathy (both sides of the diaphragm)
Stage 4- spleen and/or liver involvement +/- lymph nodes
Stage 5- bone marrow, ocular, cutaneous, renal, nasal, CNS, GI, anything other than LN/spleen/or liver

69
Q

Negative prognostic factors of LSA?

A

T cell, hypercalcemia, substage B (has CS), prolonged prior pred use, young age, hepatosplenic, high stage

70
Q

“B is bad but T is terrible”

A

///

71
Q

Remission definition

A

elimination of all clinically evident disease

72
Q

Rescue chemo

A

chemo done after the initial protocol fails to bring the p into remission

73
Q

T zone lymphoma

A

Indolent, low grade variant primarily affecting the LN and bone marrow, 85% have lymphadenopathy and more than 50% have lymphocytosis, usually feeling fine but may be slightly off, really good prognosis (MST like 2-3 years)

74
Q

Darrier’s sign

A

Palpation of the tumor may cause wide release of Histamine and can double to triple in size, give Benadryl to make it smaller and less irritated looking again. May also see bruising because heparin released from MCT along with histamine, proteolytic enzymes, etc.

75
Q

Diagnosis of MCT

A

FNA- can get a diagnosis easily on FNA usually, MCT is a round cell tumor and round cells do exfoliate pretty well

76
Q

____ dogs are predisposed to MCT but are usually low grade and have better prognosis

A

Brachycephalic breeds

77
Q

any dog with one ____ will have a higher risk of more in the future

A

MCT

78
Q

Grades of MCT explained…

A

The lower the grade, the better they do so grade 1 has no to very slow rate of mets (low cellular turnover rate so low mitotic index score). Grade 3 has high mitotic count, growing fast, invading deep tissues, and worse prognosis overall. About 80% of MCT you find in practice will come back as Grade 2, not all grade 2’s are created equal– may be closer to grade 1 or closer to grade 3 which does not help us a ton because in the middle of good and bad prognosis, which is frustrating for tx and future discussion with the owners. Use low grade and high grade two tier/Kiupel to see if it is closer than grade 1 or grade 3 if it is grade 2

79
Q

TOC for MCT

A

Surgery is the most important TOC for all MCT of ALL grades!!!

Second best option is chemotherapy because first most common site to mets is all draining LN so radiation therapy (RT) is only good for localized lesions

80
Q

Where do MCT like to metastasize????

A

Usually mets to draining LN and then liver and spleen and rarely bone marrow

81
Q

_____ MCT Are usually LESS aggressive than ____ tumors

A

Subcutaneous; cutaneous

82
Q

What anatomical locations of MCT carry a WORSE prognosis???

A

Subungual (nails), digits, muzzle, oral, preputial/scrotal, GI tract, mouth

haired skin and eye conjunctiva are some locations that have good prognosis

83
Q

What two long term drugs for p with MCT???

A

Diphenhydramine and proton pump inhibitors

84
Q

what is the second most common feline skin tumor?

A

cutaneous MCT in felines with the head and neck being the most common location

85
Q

What is the most common cause of feline splenic disease and are usually sick on presentation?

A

Splenic/Visceral MCT

86
Q

What is the post child breed for HSA? What is the second runner-up???

A

Top poster child is GSD and the second runner up is Golden Retriever

87
Q

If you have a dog with an undiagnosed splenic mass that is causing hemoabdomen, do you autotransfuse the patient after removing the splenic mass even though you do not know if it is a benign splenic mass (splenic hematoma or hemangioma) or malignant (hemangiosarcoma)????

A

Yes, still transfuse it because likelihood of you causing metastasis is super low bc cells are already in circulation and you will save them and do not have to worry about finding blood that is compatible and do not have to worry about the speed in which you give it because you know the patient is hypovolemic anyway. The downside of autotransfusion is you are only giving back the red blood cells, not the clotting factors or anything like that.
!!!!!!
Throw in some whole blood/plasma if they are going into DIC

88
Q

What is the difference between SQ and cutaneous/dermal HSA in relation to their different MST????

A

sun exposure

89
Q

HSA layers of the skin different prognosis—–

A

The dermal hemangiosarcoma has a fair prognosis as long as it is removed before it can invade to the subcutaneous tissues. Hemangiosarcomas that develop in the subcutaneous tissue (not on the skin but under it) or spread to the subcutaneous area from the outer skin behave more malignantly.

Specialty Medicine (Ophthalmology, Oncology, Dermatology) (4 decks)

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