Oncology Flashcards
Rescue therapy for feline LSA:
–Lomustine, methotrexate, cytarabine
–Mustargen, vinc, melphalan, and pred (MOMP)
–Mustargen, vinc, procarbazine, pred (MOPP)
For each protocol:
–% responders?
–Adverse effects?
–PFS?
LMC and MOMP were similar
– ~half
–Occ neutropenia, thrombocytopenia
MOPP:
–70%
–Occ GI, neutropenia
Median PFS:
LMC 2mo (up to 2yrs)
MOMP 3wks (up to 1yr)
MOPP 5.5mo (up to 2yrs)
**Note – MOPP was the largest paper and was mostly GI LSA. LMC and MOMP were much smaller and more heterogenous.
JFMS 2021 Smallwood
JFMS 2019 Martin
JFMS 2020 Maloney
What proportion of cats with GI SCLSA go on to develop large cell LSA?
On average, what is the time interval between the two diagnoses?
9%
1.5yrs
JFMS 2019 Wright
For cats with FeLV associated multicentric or mediastinal LSA treated with the novel LOPH protocol (lomustine, vinc, pred, doxo):
–% with partial or complete response?
–MST? Better or worse than previous studies of non-FeLV large cell LSA?
–Frequency and severity of bone marrow suppression?
95%
6mo – better
100%, usually mild or moderate
JFMS 2021 Horta
What is Tanovea’s generic name and MoA?
Overall response rate for LSA (studies included naive and relapsed dogs)?
Tanovea has the usual chemo “BAG” AEs. Name two additional more peculiar AEs, their frequency, and timing of when they show up.
Rabacfosadine
Nucleotide. Cell cycle specific (S phase). Inhibits DNA polymerase.
75-100%
Derm >50%, usually later in tx (prob cumulative effect)
Pulmonary fibrosis 4%, by mean 3mo, usually fatal
JVIM 2021 Weishaar
How does mitoxantrone compare with doxorubicin in terms of efficacy (as part of an LSA protocol) and cardiotoxicity?
Equal efficacy, less cardiotoxic
JAVMA 2019 Marquardt
What is the importance of the ATP-binding cassette transporter?
Expressed in high levels in T cell and hypercalcemic lymphomas. Associated with chemo resistance.
JSAP Angelo 2019
Are the following at the time of LSA diagnosis positive, negative, or not prognostic indicators for response rate and survival in dogs:
Neutrophilia
Neutrophil:lymphocyte ratio
Neutrophilia – negative
Neutrophil:lymphocyte ratio – not prognostically significant
JAVMA 2021 Veluvolu
How do the following affect prognosis in dogs with B cell CLL?
Breed
Ki67
Lymphocyte count
CS at presentation
What is the overall MST?
Worse px if:
–Boxer
–High (>40%) Ki67
–High (>60K) Lymphs
–CS at presenation
MST 10mo
JVIM 2021 Rout
Answer the following about ALL in cats based on a small study (N=6).
–CS?
–Common CBC findings?
–MST?
Nonspecific
Anemia, thrombocytopenia, variable WBC count, variable numbers of circulating blasts. TAKEAWAY – always consider ALL if there are blasts, even if just a few!
MST 2mo
JSAP 2018 Tomiyasu
Answer the following regarding cutaneous LSA in dogs.
–Difference between epitheliotropic and nonepitheliotropic?
–Proportion with LN or visceral involvement?
–Prevalence of T vs B cell?
–Are dermal lesions consistent or variable?
–Is clinical course consistent or variable?
Epith –> just in dermis, more common.
Nonepith –> diffuse throughout dermis and SQ.
Most have LNs affected, half visceral
Half T, half B
Lesions and clinical course are highly variable, can mimic other dermatopathies, can do well (>3yrs) or horrible (1 week) with chemo
JAVMA 2021 Watton
MST for canine CNS LSA that received any kind of tx (chemo, sx/radiation, etc)?
6mo (range 1d - 4.3yr)
JSAP 2018 LaRue
What proportion of cats with discrete intermediate or large cell GI LSA will perforate post starting chemo (no sx)?
Approximate timing?
Any risk factors?
17%
2mo
Higher magnitude of weight loss at dx
JFMS 2018 Crouse
What is the MST for feline renal lymphoma using pred vs L-CHOP?
Pred 2mo, L-CHOP 6mo. BUT both had extremely wide ranges (some of the pred only cats did well for years).
JFMS 2021 Williams
How dose LN cytology perform in the following areas?
–Ability to rule in/out LSA in LNs aspirated for any reason
–NPV for cases suspected of LSA
–More detailed classification (high vs low grade, T vs B cell)
–Good – high sens/spec/PPV/NPV
–Low – so don’t rely on a neg cytology alone if you think it’s LSA
–Worse for this
JVIM 2021 Martini
What are the most common findings in dogs with renal LSA?
–Clinically well vs sick
–RBCs low, normal, high
–One vs both kidneys affected
–Presence of abdominal lymphadenopathy
MST with chemo?
Sick, erythrocytosis, bilateral renomegaly, abdominal lymphanopathy
MST 6 wks
JSAP 2019 Taylor
How does PARR perform for differentiating LSA vs non-LSA in dogs for bx, flow cytometry pellets, and FNA?
Fairly high sens/spec for all – so any sample type is fine
JVIM 2019 Ehrhart
What does CHOP stand for?
Cyclophosphamide
Doxorubicin (hydroxydaunorubicin)
Vincristine (Oncovin)
Pred
You have a patient hospitalized with a new diagnosis of lymphoma. You recommend L-asparaginase to stabilize him pending onco transfer. The owner is concerned because they have a family member who received that drug and became encephalopathic.
In basic terms, how does this complication happen? What can you tell the owner about this complication in dogs? Any known risk factors?
L-asparaginase –> incr breakdown of asparagine and glutamine –> incr deamination and ammonia production –> overwhelms urea cycle –> hyperammonemic encephalopathy
Rare complication in people. In a canine study, subclinical hyperammonemia was common (no apparent risk factors) but none became encephalopathic.
JVECC 2019 Sepas
You are treating a dog with high grade lymphoma. He is clinically doing well. You submit a serum TK1 level as routine monitoring and it returns much higher than it was last month. What is the significance?
TK1 is associated with cellular proliferation and is higher in dogs with LSA vs healthy.
A significant increase of TK1 during LSA tx is predictive of early relapse.
JVIM 2019 Boye
Chemotherapy commonly causes bone marrow suppression. Your LSA patient is thrombocytopenic prior to his scheduled vincristine dose. Should you postpone it?
No – vinc increases plt count in LSA dogs, not contraindicated
JSAP 2019 Campbell
Answer the following regarding T-zone LSA.
–Characteristically lacks which cell surface marker?
–High levels of which two markers? What does this imply about potential risk factors?
–Overrepresented breed?
–Do omega-3 FAs increase, decrease, or not affect risk?
CD45
CD21, CD25 - activated phenotype. A study showed association with a handful of inflammatory conditions. Inflammation may potentiate T-zone LSA.
Goldens
Decrease
JVIM 2019 Labadie
How do disease stage and plt count affect prognosis of HSA?
Stage 3 (distant mets) and thrombocytopenia –> worse px
JAVMA 2021 Masyr
Compare the MST for periarticular histiocytic sarcoma vs non-periarticular vs hemophagocytic.
Two studies found that pred tends to help or hurt?
Periarticular 1yr
Non-periarticular 4mo
Hemophagocytic 1-2mo, no effective tx
Using pred –> worse px
2019 VCNA Mullin
Thalidomide has been shown to be beneficial in treatment of what type of cancer?
What first line drug is typically used? MST with this?
HSA
Doxorubicin 5-8mo
2019 VCNA Mullin
True or False: Studies support that Yunnan Baiyao is beneficial for HSA patients.
False
2019 VCNA Mullin
True or False: Dermal carries a favorable prognosis and wide surgical excision is generally curative.
True
2019 VCNA Mullin
Answer the following regarding skeletal muscle metastases (SMM) in dogs with HSA.
–Prevalance?
–Sex predilection?
–Usually one or multiple mets?
–% lameness in SMM vs non-SMM dogs?
25%
Male
All had multiple mets
60% SMM lame, none of the non-SMM dogs were lame
JVIM 2019 Carloni
True or False: HSA dogs treated with carboplatin have worse survival than with doxorubicin.
False – was comparable
JVIM 2021 Faulhaber
A study in HSA dogs treated with carboplatin evaluated monocyte count as a potential prognostic indicator. What did they find?
Incr monocytes post splenectomy –> worse px
JVIM 2021 Faulhaber
MST for feline mammary neoplasia overall? MST if it has metastasized?
1.5yrs overall
If mets –> 6-8 weeks depending on the chemo protocol
CS at diagnosis –> worse px (2 weeks)
JFMS 2021 Petrucci
JSAP 2023 Price
8yr FI lab with multiple mammary masses. Is she more likely to have benign tumors or malignant tumors?
Overall odds are in favor of benign. More than one mass does not incr prevalence of malignancy.
JAVMA 2019 Litterine-Kaufman
What is the local recurrence rate of dermal MCT in dogs treated with adjunctive chemo? SQ MCT?
7%, 0%
JVIM 2021 Mason
2yr FS Sphinx cat with chronic, raised red spots on the front half of her body, esp head/neck and axillas. She is itchy on exam.
–Her age, signalment, and CS should put what cancer on your ddx list?
–What form would this be? What are the two other presenations?
–One other predisposed breed?
–How does this disease typically respond to tx?
Maculopapular cutaneous mastocytosis
–Monomorphic (this cat): small lesions, crusts, moderate pruritus
–Polymorphic: bigger lesions, wheals, moderate pruritus
–Chronic pigmented: pigmentation, lichenification, severe pruritus
Devon rex
Variable
JFMS 2019 Ngo
What are four basic features of MCT histopath that would be consistent with high grade disease?
What are two IHC markers of prognostic value?
High grade has lots of:
–Mitotic figures
–Multinucleated cells
–Bizarre nuclei
–Variation in nuclear diameter
Worse px if incr markers of cell growth:
–Kit expression and c-Kit mutation
–AgNOR x Ki67 index
VCNA 2019 Kiupel
For dogs with MCT treated with vinblastine, does concurrent radiation increase, decrease, or not change the risk of neutropenia?
No change
JSAP 2019 Stiborova
True or False: Oral malignant melanoma and oral SCC have unpredictable LN metastases (site and side relative to the tumor). Thus, proactive removal of both mandibular and medial retropharyngeal nodes should be part of the tx plan.
True
JAVMA 2019 Grimes
Stereotactic body radiation therapy (SBRT) delivers a high dose of radiation to a small target.
In a small study of cats with advanced facial SCC, what was the relative safety and efficacy?
Safe – acute and late effects were common but mild and easy to medically manage
Effective – all cats had complete response.
JFMS 2021 Swan
What is the gold standard treatment for oral SCC or oral fibrosarcoma?
Which tumor type carries a better px?
If gold standard tx is insufficient, would either tumor type benefit from a follow up therapy?
Gold standard = aggressive sx to achieve clean margins
SCC better px (MST not reached) vs fibrosarcoma (MST 1.5yrs)
If dirty margins, SCC benefits from radiation (MST without 6mo vs with 5.5yrs) but fibrosarcoma does not (with 10mo, without 2yrs)
JAVMA 2018 Riggs
What is photodynamic therapy?
What is it used to treat?
What two characteristics would make a tumor a poor candidate for this treatment?
Noninvasive tx for feline SCC using a photosensitizer, light, and endogenous molecular oxygen to kill cancer cells.
84% of cats respond, mean PFI 3yrs, OST 3.3yrs.
Contraindicated if large or invasive tumor
JFMS 2018 Flickinger
In cats with SCC treated by radiation, how does fractionated vs single dose affect response rate and survival time?
Three prognostic factors?
No difference
Worse px:
–Larger/more advanced tumor (esp if nasal planum tumor extended to upper lip)
–Comorbidities
–Partial or incomplete response to tx
–Male
JFMS 2019 Berlato
JFMS 2019 Lino
Which two markers are found in >95% of feline injection site sarcomas?
c-KIT
COX-2
Desmin
DOG1
E-cadherin
FeLV viral particle
S-100 protein
Vimentin
Vimentin, S-100 protein
JFMS 2019 Carneiro
In cats with injection site sarcoma treated with surgery, which cats would benefit from definitive radiation vs palliative?
First time sx –> definitive (median PFI 4yrs)
Multiple sx –> palliative is fine, no additional benefit from definitive (median PFI 1.5yrs)
JFMS 2019 rossi
What percentage of STS grade 3 vs grades 1 and 2 have pulmonary mets?
STS grade 3: 38%
STS grade 1, 2: 6%
JAVMA 2021 Jan
Regarding giant cell pleomorphic sarcoma (aka malignant fibrous histiocytoma) in cats:
Do these tend to be large (>2cm) or small (<2cm) at the time of diagnosis?
Three cell types on cytology and histopath?
Which of the following IHC markers are useful?
–Desmin
–DOG1
–E-cadherin
–Iba-1
–S-100
–Vimentin
Large
Cyto: spindle cells, small round cells, multinucleated giant cells on dense eosinophilic stroma
All bx in the study were positive for Iba-1 (confirms histiocyte origin) and vimentin (spindle cells), neg for S-100. Variable Desmin – not helpful.
**Note – very similar findings to a tumor type in people
JFMS 2021 de Cecco
in dogs with osteosarcoma tx with amputation, does prompt initiation of chemo post op affect DFI and/or MST?
Chemo within 5d of sx –> SHORTER DFI and MST. So give it a week!
JAVMA 2021 Marconat
True or False: Carboplatin SQ is better tolerated than IV and achieves a longer MST in dogs with OSA.
False. Well tolerated but no difference in MST, recc use carbo IV.
JAVMA 2019 Santamaria
You are seeing an OSA patient for a routine visit. You detect a new skin mass on physical exam. It doesn’t bother the dog.
Do you monitor or recommend testing? Why?
If the latter, what test do you do for the mass?
Test it – if cutaneous or SQ met, add’l mets are likely already present or soon to follow and px is poor (sx+chemo 3mo, chemo 2mo, no tx 1.5 weeks).
Can usually dx via FNA/cyto. ALP staining may be helpful.
JVIM 2019 Parachini-Winter
Flourodeoxyglucose is a glucose analogue taken up by active cells. This can be measured via PET/CT scan to identify tumors and mets. How does SUVmax (max standard uptake value) inform prognosis for OSA dogs?
Higher SUVmax –> shorter survival
JVIM 2019 Griffin
True or False: Amiloride (K+ sparing diuretic) is synergistic with doxorubicin in tx of canine OSA.
True
JVIM 2019 Poon
Regarding PTH carcinoma treated with sx:
–How long til resolution of hypercalcemia?
–Frequency of hypocalcemia? How many required rehospitalization for it? How many were euth’d for refractory hypocalcemia?
–Any predictors for PTH carcinoma vs adenoma, or post op hypocalcemia?
–How many had mets post op? How did clean vs dirty margins affect this risk?
–75% normal iCa within 2d, most of the rest within a week
–24% mild hypocalcemia, 6% severe –> rehospitalize, 3% refractory –> euth
–PTH carcinomas tended to be slightly larger but lots of overlap. No predictors for post op hypoCa (incl preop iCa).
–Mets 1% (1 dog). At least 50% of dogs had dirty margins. So, cancer on paper but behaviorally benign.
JAVMA 2021 Erickson
Regarding canine thyroid tumors:
–What proportion of palpable thyroid masses are malignant?
–Overall complication rate? One risk factor?
–Most common periop complication?
–At least two post op complications?
–% that died prior to discharge?
–MST?
–Any benefit in surgery for dogs with mets?
90%
20%, higher risk if fixed (and thus more invasive) tumor. Periop - hemorrhage. Post op - asp pneumonia (most common), lar-par, Horner’s, hypothyroidism.
2%
MST 2.5yrs
Mets are rare and dog may still benefit from sx
JAVMA 2018 Reagan
JVIM 2023 Enache
In dogs with confirmed gliomas, which of the following affect survival time:
Tumor type
Tumor grade
Tumor size
Tumor location
Definitive vs palliative tx
How does this compare with other studies that include several different tumor types (presumed based on imaging, no bx) treated with radiation?
Glioma: Only definitive vs palliative tx affected MST (3mo vs 1mo). Overall, px is poor.
Other more general studies have conflicting results. Depending on the study, tumor size and/or location, type may be prognostic. Overall MST with radiation ~1-2yrs.
JVIM 2021 Jose-Lopez
JVIM 2021 Carter
JVIM 2018 Schwarz
For dogs with brain tumors treated with cytoreductive surgery:
–% died within the first 30d?
–% with non-fatal complications and most common?
–One preop risk factor for both?
13% (half of these prior to discharge)
19% – esp seizures
Abnormal preop neuro exam
JAVMA 2018 Kohler
What is stereotactic brain biopsy?
High, moderate, or low agreement with tumor type compared with standard bx?
Grade in gliomas? If there was disagreement, did it tend to over or underestimate grade?
Noninvasive brain tumor bx method involving core needle bx guided by CT or MRI
Near perfect agreement with tumor type
80% agreement with glioma grade; underestimate grade
JVIM 2019 Kani
In a study of cats with inoperable brain tumors (mostly meningiomas, pituitary macroadenomas):
–Proportion that responded to radiation?
–MST?
–Did they tend to die due to their brain tumor or other cause?
95%
MST 1.4yrs
Other cause
JFMS 2019 Korner
When sinonasal tumors in dogs recur after radiation, does it tend to be:
Within the originally radiated tumor
At the margin of the originally radiated tumor
New location
What does this indicate about the reason for recurrence?
Within the original tumor which got an adequate dose of radiation. Means there is a subpopulation of cancer cells within the tumor that is resistant to radiation.
JVIM 2021 Poirier
True or False: Cats with intranasal carcinoma have greater benefit from definitive > palliative radiation. If tumor recurs, repeating radiation extends survival.
True for both
MST definitive radiation 1.5yrs vs palliative 7mo
JVIM 2021 Yoshikawa
What is the basic difference between stereotactic vs fractionated radiation?
Does one or the other offer better survival and/or fewer side effects when used to treat canine nasal tumors?
Stereotactic: radiation tightly targeted to tumor cells, to spare normal tissue of radiation
Fractionated: many small doses of radiation to decrease side effects to healthy tissue
Both have similar survival for nasal tumors, stereotactic has fewer acute side effects
JAVMA 2019 Mayer
What are two characteristics on CT that would increase suspicion for chondrosarcoma over other nasal tumors?
72% have calcification. Most of these are “popcorn”, some ring and arc.
JSAP 2019 Jania
True or False: Radiation is not an option for feline GI large cell LSA.
False. Radiation + lomustine had similar outcome to CHOP. MST 3.3mo.
JVIM 2021 Gieger
Which two IHC markers are helpful in diagnosing GIST? Which marker has implications for treatment target?
c-KIT
COX-2
Desmin
DOG1
FeLV viral particle
S-100 protein
Vimentin
c-Kit, DOG1
Kit expression – tx with TK inhibitor (tocerinib)
JVIM 2019 Berger
What two factors (one systemic workup, one biopsy) influence prognosis in dogs with GIST?
What is MST with sx + tocerinib?
Worse px if mets and high mitotic index
MST 1.3yrs (range 2mo-4yrs)
JVIM 2019 Berger
In dogs with small intestinal adenocarcinoma treated with surgery, what is MST? Which of the following impacted survival?
Age
LN mets
Chemo
NSAIDs
MST 1.5yrs
Age – <8yrs –> longer survival
JAVMA 2019 Smith
Drug-eluting bead transarterial chemoembolization is a novel treatment for nonresectable hepatic carcinoma in dogs.
In a small study of N=16 dogs, what was most common: improved, stable, or worse following tx?
Frequency of major complications? What were two major complications?
In dogs that tolerated the procedure, what was one prognostic indicator for survival?
Stable»_space; partial response»_space;> progressive disease
11% major complications – hepatic abscess/sepsis, cholecystitis. One dog died.
JVIM 2021 Rogatko
True or False: AUS and CT are accurate in determining divisional origin of liver tumors.
True, though CT is a bit more accurate (84% vs 74%)
**Note: Liver is divided into three divisions (left, central, right)
JSAP 2018 Lamb
JSAP 2019 Cheney
What is microwave ablation? What are at least three benefits over radiofrequency ablation, and at least two drawbacks?
In a small case series (N=3 dogs with retroperitoneal tumors), how many had tumor recurrence?
MWA: cooks the tumor
Benefits over RFA:
–No need for grounding pad
–Can achieve larger ablation zone
–Higher temp
–Better tumor penetration
–Faster
Drawbacks:
–Can only use for small (<4cm) masses
–Need to see your target (imaging, scope, palpation, sx)
–Expensive equipment
–Technically challenging
None had tumor recurrence even years out
JAVMA 021 Culp
What is the most common renal tumor in dogs?
Most common CS?
One very reliable prognostic indicator?
Renal carcinoma
Hematuria
Mitotix index (high –> MST 6mo, low –> MST >3yrs)
VCNA 2019 Urologic oncology
What tumor type occurs due to mutation of the folliculin gene? What dog breed is predisposed?
Renal cystadenocarcinoma
GSDs: bilateral multifocal renal tumors, nodular dermatofibrosis, uterine leiomyomas
VCNA 2019 Urologic oncology
In general, how are primary renal tumors treated?
What is one special consideration for renal LSA?
Sx + chemo
Renal LSA: use chemo that can penetrate CNS (tends to spread there)
VCNA 2019 Urologic oncology
What factors increase risk of TCC in dogs in the following categories?
Sex
Neuter status
Breed
BCS
What are two prognostic factors?
Fat FS dogs
Breeds:
–Scottie
–Westie
–Sheltie
–Sheepdog
–Beagle
Worse px if prostatic involvement or mod/severe CS
VCNA 2019 Urologic oncology
JVIM 2021 Clerc-Renaud
For dogs with TCC, is response to treatment better when vinblastine and piroxicam are given together or one after the other? Two possible explanations?
Best to give vinblastine then piroxicam
Possible delay in resistance mechanisms
Vinblastine may sensitize tumor to piroxicam
VCNA 2019 Urologic oncology
What is one major complication following radiation of LUT carcinomas in dogs?
Permanent urinary incontinence 30%, develops at mean 2mo post radiation
JVIM 2021 Cler-Renaud
Regarding prostatic artery embolization for prostatic neoplasia in dogs:
–What determines if embolization should be uni- or bilateral?
–How common are major and minor complications?
–In general, what is the response clinically and grossly?
All should ideally be bilateral
Uncommon minor complications, none major in this study (though nontarget embolization is a potential risk – bladder, urethra, etc).
All dogs (N=20) had improvement or resolution of signs, smaller prostate with less blood flow.
JVIM 2021 Culp
True or False: Household insecticide use is associated with TCC.
True
JVIM 2021 Culp
True or False: Ureteral balloon dilation relieves obstruction from TCC in most dogs, and can be repeated with similar benefit each time.
False. Good for the first time but has diminishing returns.
JAVMA 2019 Kim
Which two markers are associated with development of mets in AGASACA?
c-KIT
COX-2
Desmin
DOG1
E-cadherin
Ki-67
S-100 protein
Vimentin
E-cadherin, Ki-67 (markers of cellular growth and pleomorphism)
JAVMA 2018 Skorupski
In a small study of N=15 dogs with stage 3 (advanced regional nodal mets) and stage 4 (distant mets) AGASACA, what was the effect of treatment with tocerinib compared with previous studies in dogs with advanced disease?
Longer MST (~1yr) than previous studies and most had signs of “clinical benefit”, but none had complete or partial response (not sure how this differs from clinical benefit…)
JAVMA 2019 Elliot
AGASACA is rare in cats.
What is the most common clinical sign?
MST?
What are two negative prognostic indicators? (both related to bx)
Perineal ulceration or discharge
Worse px if dirty margins, high nuclear pleomorphism
MST 8.5mo
JAVMA 2019 Amsellem
What is the sens/spec of FNA/cytology for distinguishing perianal adenoma vs carcinoma?
Sens 90, spec 85
JSAP 2019 Sabattini
LSA in cats:
Which anatomical site is NOT associated with high serum amyloid A?
Nasal
JFMS 2022 Schiavo
What are two advantages of pegylated Elspar over native Elspar?
In cats with large cell LSA treated with pegElspar + COP, what were two prognostic indicators?
Less immunogenic, longer T1/2
MUCH better px:
–Complete response after first inj (MST >5.5yr vs partial responders 4mo)
–Gastric vs intestinal LSA (MST 2.4yrs vs 3.5mo)
JFMS 2022 Krupa
What is the most common laryngeal/tracheal neoplasm in cats?
Which portion of the trachea is most commonly affected? (cranial, middle, carina, variable)
Which tumor type carries the best px?
Is surgical resection of laryngeal masses a viable option?
LSA
Cranial
LSA (MST 7mo vs other tumor types 3 weeks)
Yes, but be prepared for short term resp distress post op (2/3) +/- need for temp trach (1/3)
JFMS 2022 Moser
JFMS 2023 Kanemoto
What is LN cytology good for?
A) Diagnosis of LSA
B) Grading LSA
C) Classifying LSA (T cell, B cell etc)
A only
JVIM 2022 Martini
Name three environmental risk factors for LSA in boxers.
Live close to:
Nuclear power plant
Chemical supplier
Crematorium
JVIM 2020 Craun
How does amount of Ki67 expression (flow cytometry) affect prognosis for small cell B cell LSA in dogs treated with CHOP?
Low Ki67 –> better px (MST 1.5yrs) vs high Ki67 (MST 8mo)
JVIM 2020 Rout
Canine LSA rescue therapy with Tanovea and Elspar:
–What is the generic name for Tanovea?
–Overall response rate?
–Median PFS for partial vs complete responders?
–AEs?
Rabacfosadine
Two thirds
2mo vs 5mo
AEs were usually mild
JVIM 2020 Cawley
What two medications target antiapoptotic B cell lymphoma 2 proteins (BCL2) in vitro?
Which cell types tend to be more sensitive to it? (B/T cell, nodal/circulating)
How does qualitative and quantitative measurement of BCL2 protein in the target population predict sensitivity?
Venetoclax, Navitoclax
Sensitive: all T cells
Resistant: circulating normal B cells, neoplastic nodal B cells
Need BCL2 to be sensitive (qualitative) but quant did not predict degree of sensitivity
JVIM 2023 Jegatheeson
How do absolute neut count and neut:lymph ratio at the time of diagnosis affect prognosis in dogs with multicentric LSA tx with CHOP?
Worse px with absolute neutrophilia (PFS 2mo vs 6mo), but Neut:lymph ratio didn’t matter
JAVMA 2020 Veluvolu
4yr FS mini dauchshund with new diagnosis of GI large cell LSA.
–Likely B or T cell?
–Px compared to non-mini dachshunds?
**Note - mini dachshunds have a bimodal age distribution for GI LSA (<4yrs and >10yrs)
B cell (most other breeds get T cell)
Better – MST 4yrs vs 2mo
**Other note – this study was in Japan, dunno if is similar in US dachshunds
JVIM 2022 Rimpo
6yr MI English bulldog with lymphocytosis and hyperglobulinemia. He is clinically well.
What do you expect to find on:
–The rest of his CBC/Chem?
–Blood smear lymph morphology?
–Flow cytometry? PARR? Protein electrophoresis?
–PE, AUS?
What cancer does this behave like?
Might have:
–Anemia
–Hyperglobulinemia (70% are polyclonal, usually IgA and IgM)
–Enlarged LNs, enlarged +/- mass spleen/liver
Lymphs
–Blood smear: small
–Flow: B cell, CD21+; low expression MHC II and CD25
–PARR: polyclonal
Unclear if this is cancer. Behaves like CLL.
JVIM 2020 Rout
Which is the only histiocytic disease with macrophage origin? What are the other two origins?
Hemophagocytic histiocytic sarcoma
Langerahns - pulmonary langerhans cell histiocytosis (cats)
Lang or dendtritic - cutaneous histiocytosis (dogs)
All others are dendritic
VCNA 2023 Moore
How does treatment differ for:
Cutaneous histiocytosis
Systemic histiocytosis
Histiocytic sarcoma - local (top 4 affected sites?)
Histiocytic sarcoma - disseminated
Cutaneous and systemic histiocytosis: immunosupp (pred, cyclosporine, leflunomide, etc) but will work better for skin > systemic
Histiocytic sarcoma
–Local (lung, joint > spleen, skin, others): sx +/- radiation, fair ox if spleen, good if lung, joint, skin
**Note - splenic involvement does not necessarily mean disseminated!
–Disseminated: can try lomustine or doxo, poor px
VCNA 2023 Moore
JVIM 2020 Latifi
JAVMA 2022 Doka
Which feline histiocytic disease is associated with smoking?
Px?
Pulmonary langerhans cell histiocytosis
Poor – eventually succumb to restrictive lung disease
VCNA 2023 Moore
JFMS 2020 Argenta
What serum test (other than globulins) can be used to monitor dogs under tx for multiple myeloma? How does this impact px?
M-protein
>90% reduction better px than <50% reduction (MST 1.7yrs vs 9.5mo)
Increase in M-protein predicts clinical relapse
JVIM 2020 Moore
True or False: Bence Jones proteinuria is best performed using a 24hr urine collection.
True
VCNA 2023 Moore
Pulmonary carcinoma in dogs tx with surgery:
–In general, what is stage based on?
–MST based on stage (1-4)?
–Four px indicators? (Tumor size, concurrent intrathoracic findings, histopath)
–How does adjuvant chemo affect survival time?
Stage is based on primary nodule size, presence of pulmonary mets, and invasion of other intrathoracic structures.
MST by stage:
1: 1.8yrs
2, 3: ~1yr
4: 9mo
Worse px with:
Tumor >5cm
Pleural effusion
Distant or LN mets
High mitotic count
JAVMA 2022 McPhetridge
Chemo doesn’t change MST over sx alone
Serum microRNA 19b and 18a may be good noninvasive biomarkers for what cancer?
Mammary
19b - diagnosis
18a - prognosis
JVIM 2020 Fish
Which is true about treatment of cutaneous mast cell tumors in dogs?
A) Wider margins (3cm vs 2cm) achieve better local tumor control in grade I and grade II MCTs
B) Local lymphadenectomy improves outcome in high grade MCT, even if not grossly abnormal
C) Dogs treated with a single injection of tigilanol tiglate have a high complete response rate.
D) Most dogs who have a complete initial response to a single inj of tigilanol will relapse within 4mo.
B
In summary:
–Low grade MCT –> smaller sx margins
–High grade MCT –> take the local LN
–75% of dogs respond to a single inj of tigilanol. Only a few relapse, usually within 4mo.
JAVMA 2020 Chu
JSAP 2022 Chalfon
JVIM 2020 Jones
Oral melanoma in dogs:
–Tumors <___ mm almost never have lymphatic invasion
– Tumors >___ mm almost always have lymphatic invasion
6.5mm
24.5mm (so, ~1 inch)
JAVMA 2020 Carroll
Feline inj site sarcoma treated with sx then radiation OR iridium-192 interstitial implant:
Compare DFS, MST, and recurrence rate
All about the same for both treatment modalities
DFS 1.7yrs, MST 3.4yrs, recurrence rate 55%
JFMS 2020 Bloch
8yr MN boxer with an incompletely excised high grade STS.
–Do you refer to medical oncologist, radiation oncologist, or either?
–How important is it that they follow the treatment schedule?
Radiation – chemo doesn’t help
Stick to the schedule!! Delays in radiation –> prolonged radiation course –> worse px
JAVMA 2020 Crownshaw
Canine OSA:
–Briefly, how is combo therapy with autologous cancer cell vaccine, activated cellular therapy, and IL-2 done?
–MST longer, shorter, or similar to current treatment protocols?
Limb amp –> use tumor to make vaccine
Vaccinate dog –> harvest lymphocytes –> amplify population in vitro
Give lymphs back to dog along with IL-2 (immune stimulation)
Better or comparable depending on the study (this protocol MST 1yr)
JVIM 2020 Flesner
Feline appendicular OSA tx with limb amp +/- chemo:
–Proportion that met? Usually local or distant?
–Which primary tumor location had the highest likelihood for mets?
–MST? How did tumor location affect this?
About half, most were distant
Humerus
1.5yrs - tumor location did not affect this
JAVMA 2022 Nakano
True or False: Single photon emission CT has much higher sensitivity for mets of thyroid carcinoma in dogs compared with CXR.
True – SPECT found mets in 15/39 dogs vs CXR 3 dogs
JVIM 2020 Berg
Which is/are helpful in staging insulinoma and predicting presence of metastasis?
A) Insulin level
B) 18F-fluorodeoxyglucose PET-CT
C) Both
D) Neither
D) Neither
JSAP 2022 Walczak
JVIM 2023 Petrelli
What size cutoff has 100% specificity (albeit low sensitivity) for malignant adrenal tumors?
> 2cm
VCNA 2022 Hayes
Adrenal tumors:
CT is excellent for detecting invasion into which vessels?
A) CVC
B) Renal vein
C) Phrenocoabdominal vein
D) None of the above
A) CVC
Moderate to good for the others
JVIM 2022 Pey
13yr MN DLH with an intraventricular brain tumor, which is rare. Based on a small study, what two treatments do you recommend? MST with this?
Radiation + ventriculoperitoneal shunt
MST 3yr (vs 5mo if RT only)
JVIM 2023 Beckmann
Exact MSTs for feline nasal LSA are variable, but rank the following in general order from longest to shortest MST.
Chemo
RT
RT+chemo
MST for nasal carcinoma?
Three negative px indicators on CT?
LSA: RT ~ RT+Chemo (so, adding chemo doesn’t really help) MST 1-2.5yrs > chemo MST 3mo-1yr
Carcinoma ~1yr
Worse px with cribriform lysis, brain involvement (LSA and carcinoma), facial deformation (carcinoma)
JVIM 2022 Reczynska
JFMS 2020 Guiliano
PFS and MST for dogs with non-LSA nasal tumors treated with stereotactic radiation?
8mo, 1.5yrs
JAVMA 2022 Nolan
In dogs undergoing splenectomy for a splenic mass, when should you also grab a liver biopsy?
A) Presented with hemoabdomen
B) Grossly abnormal liver
C) Always
A and B
If grossly normal liver and no hemoab, hepatic neoplasia is rare
JSAP 2020 Clarke
Which is true regarding doxorubicin IV vs drug-eluting bead transarterial chemoembolization to treat canine nonresectable HCC?
A) Equal efficacy but beads had fewer side effects
B) Equal efficacy and frequency of side effects, but type of side effects were different
C) IV was more effective and safer
D) Beads were more effective and safer
E) Equal efficacy and type/quality of side effects
D
JVIM 2022 Samuel
True or False: Chemoembolization for renal carcinoma should only be considered in dogs with local, nonresectable disease.
False. Tiny N = 2 case series but both had pulmonary mets, survival 7mo and 1.4yrs.
JSAP 2022 Kimata
Cats with TCC:
–Frequency of LUT issues prior to TCC diagnosis?
–Location of TCC?
–Relative frequency of seeding with FNA?
–MST with and without partial cystectomy?
–80% (UTI > FIC > urolithiasis)
–Most commonly trigone but much more variable than in dogs
–Rare but it happens
–MST without partial cystectomy 6mo, with 10mo
**Note - use NSAIDs too!
JVIM 2020 Griffin
True or False: Dogs with prostatic carcinoma are prone to infection and prostate FNA has the highest sensitivity to detect this.
False – infxn is uncommon and cysto is just as sensitive as prostate FNA
JSAP 2022 Skorupski
In dogs with AGASACA treated in part with tocerinib:
–Proportion that benefit? Are most of them CR, PR, or stable disease?
–One neg px indicator (on bloodwork) and one pos (relating to tx)?
70% benefit, most stable disease, none complete responders
Worse px: hypercalcemia
Better px: response to tocerinib
JVIM 2020 Heaton
12yr FS lab with cytologically confirmed AGASACA. You are staging prior to surgery. Abdominal imaging shows normal LNs.
–Is lack of LN mets at diagnosis common or uncommon?
–Does this influence likelihood of pulmonary mets?
Uncommon – 70% have LN mets at time of diagnosis. Pulmonary mets WITHOUT LN mets is rare.
JSAP 2022 Sutton
8yr MN DMH with R sided nasal signs and exophthalmos OD. Skull CT confirms a nasal tumor with extension to the retrobulbar space. What is the most likely tumor type?
2/3 of nasal tumors with retrobulbar extension are LSA
JFMS 2022 Jones
Which is NOT associated with improved survival in dogs with tonsillar carcinoma?
A) Lack of CS at diagnosis
B) No mets
C) Surgery
D) RT
E) Chemo
F) NSAIDs
D) RT
Overall survival time 4mo, if no mets 1yr
JVIM 2023 Treggiari
7yr FS boxer with nontraumatic hemoabdomen. There is a liver mass on A-FAST, but no splenic mass. How likely is HSA?
Very unlikely – hemoab + HSA almost always has a splenic mass. Would suspect HCC.
JAVMA 2021 Cudney
LN FNA/cyto is highly sensitive for mets of which neoplasms:
Sarcoma
Carcinoma
Melanoma
MCT
Other round cell tumors
Carcinoma, other round cell tumors
VCNA 2019 Liptak
Relative sens/spec of BRAF+BRAF Plus for detection of TCC?
Sens 95/spec 99
VCNA 2019 Wiley
4yr MI mixed breed with generalized lymphadenopathy and fever. LN FNA/cyto was suspicious but not confirmatory for LSA, so you want to submit PARR. What infection could give a false positive of clonality?
Ehrlichia
VCNA 2019 Wiley
Is liquid biopsy for cancer detection prone to false negatives or false positives?
False neg (sens 61, spec 97) – can trust positives
JAVMA 2023 O’Kell
JVIM 2023 Flory
True or False: Dogs with carcinoma have high thrombopoietin, and degree is not affected by whether or not they have thrombocytosis.
True
JVIM 2022 Cheney
Dogs who are more susceptible to doxorubicin cardiotoxicity are also at incr risk for what other heart condition?
MST after developing CS of doxo cardiotox?
True or False: Decreasing the infusion rate decreases risk of cardiotox.
DCM – and doxo cardiotox is DCM phenotype
1mo
False
JVIM 2019 Hallman
True or False: Cats are more likely to experience AKI on doxorubicin monotherapy than CHOP.
True
JVIM 2020 Kopecny
What are the top three complications of doxo overdose?
How does this compare with top two AEs of normally dosed doxo?
Neutropenia (almost all – and weirdly unresponsive to colony stim factor) > thrombocytopenia > anemia
Neutropenia > inapp/diarrhea
JVIM 2022 Lawson
JVIM 2022 Matsuyama
What is the main adverse effect of toceranib?
GI
JVIM 2019 Kovac
List at least 4 tumor types that benefit from electrochemotherapy.
Perianal gland
Feline head/neck carcinomas (ex: SCC)
Sarcomas
Melanoma
MCT
VCNA 2019 Sugnini
What is unique about the blood supply in liver tumor vs normal liver that makes them a good candidate for embolization?
Liver tumor - most of blood supply is arterial
Normal liver - most is portal
VCNA 2019 Culp
