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Small Animal Medicine > Oncology > Flashcards

Oncology Flashcards

1
Q

What is cancer/neoplasia?

A

Caused by: Genetic predisposition and viral.
Enviro, abiotic, nutirional, zenobiotic factors

Most cause:
- Inflammation, Damage to DNA, reactive oxygen species

  • A cluster of molecular disturbances causing abnormal growth regulation
  • Cells no longer respond to growth & differentiation stimulation & act like embryonic cells
  • Cancer cells can hijack cellular support mechanisms and evade inflammation/immune defences
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2
Q

What are the different types of cancer?

A

Cell types:
- Epithelial
- Mesenchymal
- Round

Cancer types:
- Carcinoma: Malignant, arise from cell lining/glandular structures
e.g. Squamous cell carcinoma, adeno(gland)-carcnimoa (Intestinal adenocarcinoma)
- Sarcoma: Malignant, arise from connective tissue
e.g. Haemangiosarcoma, oesteosarcoma

‘oma’ without carcin/sarc is a benign tumour
EXCEPT melanoma, lymphoma

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3
Q

What are the differences in benign vs malignant?

A

Benign:
- Growth rate: Slow, may cease
- Growth manner: Expansive, well defined and encapsulated
- Effects on adjacent tissue: Often minimal, may cause pressure necrosis and anatomical deformity
- Metastasis: Not present
- Effect on host: Minimal and life threatening if in vital organ

Malignant:
- Growth rate: Rapid, rarely ceases
- Growth manner: Invasive, poorly defined, scattered
- Effects on adj. tissues: Serious, destruction of adj. normal tissues via ulceration
Metastasis: via lymphatic, haematogenous routes, transcoleomic spread
- Effects on host: Life threatening destruction and metastatic dissemination to vital organs

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4
Q

What are the clinical signs of cancer?

A
  1. Local: Anatomical perturbations i.e. lameness, dyspnoea, seizures, GIT obstruction
  2. Systemic:
    - General: Wt loss, pain, malaise, inflammation
    - Paraneoplastic: Hypercalcaemia, gastric ulcers, hyperviscosity, anaemia, polycythaemia, coagulopathy
    - Presentation: a visible mass or sick dog/cat
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5
Q

What is the diagnostic approach to cancer?

A

Findings of interest with cytology:
- Tissue origin
- Cell type
- Malignancy markers
- Biological aggression markers
- Cellular atypia
- Predominate cytological picture (Inflam vs neoplasia)

*BIOPSY and fine needle aspirate

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6
Q

Describe fine needle aspiration as a tissue sampling technique

A
  • Poke/stab vs suck/aspiration
  • Cells are spread (squash or slide)

Adv: Quick, cheap, fairly sensitive
Dis: Lymph nodes difficult

Definitive diagnosis: MCT (mast cell tumour), LSA (lymphosarcoma), melanoma
Sensitivity: 66%for cytology

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7
Q

Methods of Biopsy?

A
  • Trucut biopsy (Tissue core)
    –> Don’t recommend
    Indication: Small samples
    Dis: Easy to sample non-representative area, cannot grade lesion, sensitivity equal to FNA
  • Incisional: piece without removing
    Indication: Diagnose before planning approach or removal
    Adv: Improves outcome, histological grade prior to surgery, poor prognosis leads to euthanasia (save costs)
    Dis: No histo grade, no indication of metastatic potential, may seed tumour into adjacent areas
  • Excisional:
    Indication: Low finances or lipomas, small skin tags, readily excisable and benign
    Adv: Diagnostic + curative, cheaper, accurate grading, assess margins
    Dis: May compromise long term prognosis, may cost money in a hopeless prognosis

Pre-op: Full physical (lymph node, lymph, co-morbidities), check thoracic radiographs and abdominal ultrasounds, explain risk and sign waiver
Post-op: Send for HP, considered malpractice if not

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8
Q

What is cancer grading and staging?

A

Grading: Histological appearance, categorised from 1-4 or low-mod-high.
Associated with biological aggression and likelihood of metastasis

Role:
- Aggression: How much tissue to remove, where it can spread to
- Prognosis: Likelihood of metastasis, recurrence, median survival time, median disease-free interval
- Treatment: If post-op chemo/radiation is required or more extensive surgery

Staging:
Refers to: Tumour (T), Node (N), and Metastasis (M)
Classed according to mass nature and extension beyond mass limits

Role:
- Local vs Systemic
- Prognosis according to stage
- Req. of multimodal approaches, LN excision or chemo/radiation

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9
Q

Describe the staging system?

A
  • Primary Tumour (T):
    0 – Primary neoplasia not evident
    1 - <1cm, mobile
    2 – 1-3cm diameter, not deeply attached
    3 – 3-5cm diameter, partially fixed
    4 – 5cm diameter, invading deeper structures
  • Regional Lymph Node (N):
    0 – Palpably normal size & consistency
    1 – Enlarged, firm, ipsilateral
    2 – Fixed to surrounding tissues
    3 – Involvement of LN beyond 1st region
  • Distant Metastasis (M):
    0 – No evidence of Mx
    1 – Single visceral Mx
    2 – Multiple visceral Mx
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10
Q

What are paraneoplastic syndromes?

A

Disruption to the physiology and homeostasis that occurs systemically or distant to the tumour
Not directly related to the mass effect of the tumour

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11
Q

Describe how hypercalcaemia can be a sign of paraneoplastic syndrome

A

Role of Ca:
- Bone formation
- Muscle contraction
- SA node firing and contraction
- Glycogen metabolism
- Nerve function
- Blood clotting
Normal Range: 1.1-1.5 mM/L (ionised)

Regulation of Ca:
- Excess Ca: Thyroid glands release calintonin –> Ca falls
- Low CA: Parathyroid lands release release of PTH –> Ca rises.

Differentials for hypercalcaemia:
- Lymphoma, lymphoid leukemia, myeloma, bone metastases, anal gland adenocarcinoma

Clinical signs:
- PU/PD, renal failure, muscle weakness, coma/seizures, bradycardia, hypertension, GI signs (anorexia, vomiting, constipation)

Pathophysiology:
- Humoral: Tumours secrete PTH related peptide
e.g. Multiple myeloma, lymphoma, anal gland adenocarcinoma
- Cell Mediated: Unlikely to have marked hypercalcaemia, caused by bone metastases and oesteoclastic activity.

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12
Q

Describe how hypoglycaemia can be a sign of paraneoplastic syndrome

A

Tumours: Large hepatic tumours (Hepatoma, hepatocellular carcinoma, islet cell tumours,
Insulinoma, saliavry adenocarcinoma, leukaemia, non-islet solid tumours

  • Leukaemia: Consume blood lucose
  • Non islet solid tumours: Produce insulin like growth factors.
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13
Q

Describe how hypergammaglobulinaemia can be a sign of paraneoplastic syndrome

A

Tumours: Multiple myeloma, B cell lymphoma
Produces: Monoclonal gammopathy - IgG, IgA, IgM & light chains via replication
CS: Hyper-viscosity –> Bleeding, retinopathy, seizures, renal disease, heart disease
Treatment: Identify and treat underlying cause e.g. melphalan and prednisolone if multiple myeloma
AND phelbotomy and crystalloid fluids

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14
Q

Describe how erythrocytosis can be a sign of paraneoplastic syndrome

A

Renal tumours or several other tumours (Mesothelioma)
Pathogenesis: Increased erythropoietin
CS: Hyperviscosity

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15
Q

How does paraneoplastic syndrome cause cachezia/fever

A

CS: Anorexia, wt loss, impaired immunity –> Cannot be fully corrected via diet
Pathogenesis:
- Cytokines mediate effect
- Some tumours use carbs for growth
Diagnose: Alterations in carbs, fats and protein metabolism which are detectable before clinical cachexia

Treatment: Doxorubicin, arginine supplementation –> Supress tumour dose

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16
Q

Differences in chemotherapy from animals to humans?

A
  • Dogs and acts do not get sick as it is palliative instead of curative, doses of chemo are lower.
    Quality of life should be good if used correctly
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17
Q

What are the main therapeutic modalities for cancer

A

Surgery
Drugs i.e. chemotherapy
Radiation

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18
Q

What are the types of chemo?

A
  • Systemic
  • Intralesional/Intracavitary
  • Neoadjuvant (before surgery)
  • Adjuvant (During or post surgery)
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19
Q

What are the goals of chemo?

A
  • Induce complete remission
  • Delay development of drug resistance
  • Minimise morbidity with treatment and disease
  • Induce second remission following relapse if owner requests (‘rescue)
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20
Q

What are the principles of chemotherapy?

A
  • Use single agent drugs
  • Combine drugs with different MOAs
  • Use drugs with different toxicities
  • Use intermittent treatment schedules
  • Treat big when the tumour is small

Pre-requisities: Achieve definitive diagnosis, explain to owner, understand drugs, handling

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21
Q

What are chemotherapy kill kinetics?

A

Fractional Kill: Lowered by logs. Clinical detection limit is power to 9, below is remission.
E.g. 4 logs: will reduce 10^12 to 10^8

Fast dividing cells: When tumour is small and rapidly growing

Resting tumours or terminally differentiated: Are not dividing and resistant to treatment

Normal tissues: Active dividing cells or short cycles are prone to destruction.

Phases: Induction + intensification, maintenance, rescue

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22
Q

Describe how to dose antineoplastic drugs

A

By body surface area but influenced by breed variations, basal metabolic rate, toxicity

Main Drugs: CHOP C
- Cyclophosphamide
- Hydroxydaunorubicin AKA Doxorubicin
- Oncovin AKA vincristine
- Prednisolone
- Cytosine

  • Contraindicated in Cats: Cisplatin, 5-Fluorouracil
23
Q

Safety considerations of antineoplastic drugs?

A
  • Vet: Carcinogenic, teratogenic, corneal ulcers, nasal irritation, skin necrosis & pruritis
  • Owner: Urine/faeces excretion. Should use gloves if handling poo, ask if pregnant
  • Drugs: Keep separated from others, label, never break tablets, check dose & route
  • Disposal: In purple, cytotoxic waste bin or incinerated or sharps container with symbol, bag
  • Patient: Restrain, place IV catheter as distal as possible, 5-10mL flush prior to removal, record when veins are used and only draw blood from jugulars.
24
Q

What is metronomic chemotherapy?

A

Indication: Incompletely resected soft tissue sarcomas where radiation or resection is impossible, adjuvant following conventional chemo or if clients decline normal chemo

Method: Continuous trickle of low dose chemo drugs e.g. cyclophosphamide, piroxicam

MOA: Anti-angiogenic, anti-t lymphocyte regulation and direct anti tumour effects

Adv: Increases disease-free time, safer,

Dis: Higher hemorrhagic cystitis

25
Q

What are alkylating agents as drugs for chemotherapy?

A

MOA: Bind to and disrupt DNA synthesis
DIS: Myelosuppressive,
Cross-resistance: No

Includes:
- Cyclophosphamide: IV or Oral. GI signs, hemorrhagic cystitis
- Chloroambucil: Oral. Replacement for cyclophosphamide.
-

26
Q

What are anti-tumour antibiotics?

A

Dis: Myelosuppression, perivascular sloughing if given IV, cardiomyopathy/renal failure

Cross-resistance: Mitotic inhibitors

Include: Doxorubicin, best single drug, good shelf life but expensive, CMO (Dogs), Renal failure (Cats)

27
Q

What are mitotic inhibitor drugs?

A

MOA: Inhibit spindle formation in mitosis

Cross-Resistance: Antitumour Ab

Dis: Severe vesicant, myelosuppression, perivascular sloughing (given IV)

Include:
- Vinblastine: Good for mast cell tumour, good shelf life
- Vincristine: Good shelf life, neuropathy, constipation

28
Q

What are the platinum drugs for chemo?

A

MOA: Cross link DNA to disrupt synthesis
Cross-resistance: No

Includes:
- Cisplatin
- Carboplatin: 2nd gen, given IV, IP, IT (intra-tumour). Indicated in osteosarcoma, multiple myeloma, carcinoma

29
Q

Other drugs for chemo?

A

Prednisolone
MOA: Many
Admin: Oral
DIS: PU/PD, polyphagia, panting. Protects against haemorrhagic cystitis

L-Asparginase
MOA: Destroys asparagine which is needed by lymphoma cells to survive
Admin: SC, IM
Dis: Anaphylaxis, increases toxicity of vincristine, short shelf life.

Cystosine Arabinoside
MOA: Anti-metabolite, interferes w DNA synthesis
Admin: SC, IV, IP, IT
Dis: Myelosuppressive
Adv: Penetrates blood-brain barrier well

30
Q

Describe the toxicity of antineoplastic drus

A
  • Tissues with high proportion of resting/terminally differentiated cells are relatively resistant to chemo
  • Normal tissues with high proportion of actively dividing cells, or short cell cycle time, are susceptible to destruction (GI crypts, bone marrow)

Monitor:
- Renal temperature: Check regularly if ill, >40 degree
CBC: Check depending on chemo protocol e.g. doxorubicin done 10-14 days after treatment

31
Q

What is myelosuppression?

A
  • Bone marrow progenitor cells have high proportion of dividing cells
    Potent Drugs: Doxorubicine, cyclophosphamide, cystosine arabinoside, carboplatin, vinblastine

CS: Peripheral blood cytopenias, granulocytopenia –> Thrombocytopenia –> anaemia (Rare)

Importance: Granulocytopenia Is dose-limiting with the nadir (lowest cell count) at 7-10d post-drug, rebound <1-2d

Diagnose: CBC to assess absolute neutrophil count
- N < 3000: Continue treatment
- N 1000-3000: Delay schedule for 3-7 days until >3000 unless a routine nadir check –> Continue
- N < 1000:
–> No symptoms: Prophlyactic Ab, monitor at home, reduce future doses by 25%, recheck
–> Febrile, lethargic, GI symptoms: emergency, hospitalise and treat for sepsis w IV fluids, Ab, support

32
Q

Describe gastrointestinal toxicity from chemo

A

CS:
- At admin to 1-2 days post treatment: Nausea and vomitting via vomitting centre trigger or chemoreceptor trigger zoner
- Years later: Nausea and vomiting due to GI mucosal damage around myelosuppressive nadir
- Gastroenteritis: Seen if sufficient mucosal cells die and slough off
- Constpiation: Occasional with vincristine

Drugs: Doxorubicin, cyclophosphamide, methotrexate (Dogs), high dose vincristine

33
Q

Features of Soft tissue Sarcoma?

A

Locally invasive and may look benign
Usually on skin/subcut in older dogs/cats
Metastasise in 20% of cases (Haematogenously). (Lung –> Liver –> Spleen).
Lymph node involvement is unusual
Poor response to chemo and radiation in bulky tumours.
Recurrence: usually due to inadequate surgical resection

Causes: Radiation, trauma, foreign body, implants,
Vaccines/injections in cats

Arise from connective tissue:
- Fibrosarcoma
- Nerve Sheath tumour
- Myosarcoma
- Neurofibrosarcoma
- Malignant fibrous histiocytoma
- Liposarcoma
- Rhabdomyosarcoma

34
Q

How to diagnose soft tissue sarcoma?

A

Diagnose:
- FNA: Poor exfoliation, often negative
- Biopsy: Incision, avoid compromising margin
- CT, Rads, US: Staging
- Bloods: Co-morbidities

Staging:
1. No LN or metastasis involvement (Grade 1-2)
2. Superficial (Not fascia), no lymph node/metastasis (G3)
3. Deep tumour, no LN or Mx (Grade 3)
4. LN involvement or Mx

Treatment:
- Wide margin resection OR refer is unable:
- Low Grade: Narrow resection and monitor
- High Grade: Amputation/Staging surgery

Prognosis: Grade predicts metastasis/progress.
Margins predict resection
Poor response to chemo/radiation

Mistakes:
1. Assuming benign based on negative FNA
2. Inadequate resection of known Soft tissue sarcoma
- Excisional biopsies of lumps: First surgery is likely the best attempt and should avoid until defintiive diagnosis.

35
Q

Overview of Feline Associated Soft tissue sarcoma?

A

Caused: Vaccinations: Modified live rabies or FeLV
Type: FSA common
Onset: 2m to 4 years post-injection
Treatment: Refer especially in hard location: Require wide resection + amputation + radiation to lower recurrence

Prognosis: Grade is predictive, rarely metastasis and size is not important

Prevent: Vaccinate as distal on limb as possible or tails to allow resection, vax only if required, explain risks.

36
Q

Describe canine lymphoma

A

Cause: Unknown
Hosts: Middle to old dogs
Presentation: Stage 3-4
CS: Rarely inappetent, weight loss, lethargy, PU/PD if hypercalcaemia + anaemia, septic, bleeding

  • Stage 1: Single LN involvement
  • Stage 2: Multiple LN in one region
  • Stage 3: General lymphandenopathy
  • Stage 4: Liver +- Spleen involved
  • Stage 5: BM, blood, non-lymphoid involved
  • Substage a: W/o CS of illness
  • Substage b: W/ CS of illness

Forms:
- Multicentric: 80-85%
- Alimentary ~7%: Non-specific GIT Sx, Dx +- Palpably thick bowel loops, Dx – US/Barium study
- Cutaneous: ~6%
- Mediastinal 3%: Dyspnoea, muffled/displaced heart/lung sounds +- PU/PD (50%), CrVC dz
- Misc: CNS, bone, heart, nasal cavity, eye

37
Q

How to diagnose lymphoma?

A
  • Physical exam: Incl. rectal, retina
  • Cytology/Histopath: LN, effusion, liver, spleen, kidney, bone marrow → be gentle, diff-quick
    immediately for cytoplasm
  • Routine labs (blood, urine)
  • Imaging (Ab US, Chest rads, CT)

Prognosis:

38
Q

Feline lymphoma?

A

Cause: Unknown, FeLV or FIP
25 years ago: Mediastinal form, 3-6 year old FeLV positive cats
Now: GIT, 9-10 year old FeLV negative cats

Immunophenotypes: Previously T Cell, currently B Cell

Prognosis: best in FeLV negative substage A (doxrubicin) and 50-70% CR with CHOP.

39
Q

Describe Canine Haemangiosarcoma

A

Origin: Blood vessel endothelial cells

Location: Mostly spleen, right auricle and liver
Metastases: 70% at diagnosis
Hosts: 9 years. German shepherds

Malignancy: 2/3 large dog splenic masses are <50% in small breeds.

CS: Sudden collapse (due to bleeding), weak, pale, muffled heart, dyspnoea, arrhythmia, fluid in abdomen

40
Q

How to diagnose/treat canine haemangiosarcoma?

A

Diagnosis:
- Haematology: : Schistocytes, acanthocytes

  • Radiograph: Pericardial effusion

US: Splenomegaly, heart, liver, free fluid, Ddx – nodular hyperplasia or haematoma

  • Biopsy: FNA cannot confirm, do splenectomy at same time
  • Factor 8 Related Antigen Stain: Highly specific for endothelial cells but not used currently

Treatment:
- Splenectomy and chemotherapy (high metastases)
–> Not likely to be curative
Cutaneous removal: Not curative

Prognosis:
Surgery: median survival time 60d
- Sx & Doxorubicin: 170-260d
- Cats: Survive 12m

41
Q

How to treat Mast Cell Tumour?

A

Incidence: most common cutaneous malignancy (20%)

Origin: Bone marrow –> mature in connective tissue

Differentiation: Promoted by c-kit ligand (Stem cell factor)
Metastases: Spleen, liver, LN, BM and lungs

Location: Cutaneous and visceral
- 45%: Trunk and perineum
- 35%: Legs
- 10%: Head and Neck
- 10%: Multifocal

Hosts: Middle-aged dogs esp. boxers, boston terriers, goldens and pugs

CS: Vomitting, Melaena, Ab discomfort, gastric ulceration, Darier’s Sx (Bruising after tumour manipulation!)

42
Q

Diagnosis of Mast Cell Tumour?

A

Diagnosis:
- FNA, histopathology, Eosinophilia, CS reflect systemic extent, Giemsa for agranular smears

Staging:
Abdominal US, thoracic rads, FNA draining LN +- Spleen, Liver & BM FNA, peripheral LN

  1. One Intradermal tumour, not completely excised, LN not involved
  2. One Intradermal tumour, No LN involvement
  3. One Intradermal tumour, LN involvement
  4. Multiple Intradermal tumours, infiltrative, with or w/o LN involvement
  5. Any with distant Mx or recurrence with Mx
    Substage a: No CS Substage b: CS of illness

Important: Can appear as other conditions, i.e., SCC, skin infx, papilloma, may be agranular

Treatment:
Surgical excision
Radiation as sole treatment
- Chemotherappy not effective as sole treatment
Wide margin excision (Preferred) w/ Vinblastine + Prednisolone

Supportive treatment: H1 blockers (Chloramphenamine) or omeprazole > H2 blockers
For GI ulcers, poor evidence for efficacy

Prognosis: Using mitotic index (Grade) and Histopathology markers
- Good: Confined to skin w/ no Mx
- Better: Older age, Boxer, Pug
- Poor: Clinically ill, Shar-pei’s
- Very Poor: Nail bed, footpad, inguinal, preputial, perineal

43
Q

What is Stelfonta?

A

From fontainea: Stimulates protein kinase C to create necrosis and cell death. Max 5mL

  • Indication: Cutaneous <10cm3 anywhere or SC below elbow/hock IF no LN involvement
  • Adv: Lower cost, no anaesthesia, easier skill
  • Dis: 75% remission rate 1st dose, 87% 2nd (Good but not awesome for a ‘definitive tx’), wound formation
44
Q

Mast Cell Tumour in cats?

A

Incidence: 2nd most common cutaneous tumour

Host: Males > Females, Siamese (Grade 1-2)

Type: Single cutaneous, usually benign, primary spleen MC

Tx: Surgery is curative!!

45
Q

Overview of Squamous cell carcinoma?

A

PF: Sun damage, white/pink skin Pathogenesis: Actinic damage, ROS induced damage

Canine:
Location: Tonsillar (Young dogs), Nose

Treatment: Wide surgical excision, radiation (incomplete margins), pre-neoplastic 5FU intralesional chemo (Suspect)

Prognosis: Not very chemo responsive, depends on location

Feline:
Location: Ear tips, nose

Treatment: Surgical excision, imiquimod cream for small lesions

46
Q

Describe Anal Gland Anal Sac Adenocarcinoma

A

Incidence: 20% of peri-anal tumours
Hosts: Cocker spaniel, middle-older aged, 30% incidental

Metastases: 40-80% to regional LN

Complication: 30% Hypercalcaemia

Diagnosis: Rectal, FNA, Ab US

Ddx: Perianal tumour, non-neoplastic gland dz (Impact, abscess), other skin tumours (MCT)

Tx: Surgery Anal sphincter removal + LN Removal +- Chemo (Carboplatin), radiation

Px: 2yr mean survival time

47
Q

What is hepatoid periadenoma?

A

Morph: Cytologically resemble hepatocytes
Location: Skin of the external anal sphincter
Host: Intact males
Dx: FNA
Tx: Surgical resection + Castration

48
Q

What is Melanoma?

A

Groups:

  1. Skin: Malignant, often considered less aggressive, bad on the nail bed, not bad on trunk
  2. Mouth: Malignant, Aggressive

Dx: FNA, Biopsy , CT (Chest & Ab) Mx: LN and Lungs

TX: Surgery + Chemo (Doxorubicin) or Melanoma DNA Transdermal vaccine (Unknown efficacy)

49
Q

What are bone tumours?

A

Osteosarcoma (OSA)
Chondorsarcoma (CSA)
Haemangiosarcoma (HAS)
Multiple myeloma (affects bone)

Location: ANY bone
CS: Lameness, Swelling, pathological fracture

Differential diagnosis: Arthritis (multifocal), Trauma (Resolves), Septic arthritis (Swelling of joints, wound), Fungal disease, muscular injury.

50
Q

What is the approach to lameness?

A
  • Full Clinical Exam: LN, lumps, abdomen, petechiae
  • Orthopaedic exam: Isolate pain, evaluate other limbs
  • Neuro Exam: Only if indicated
  • Lameness in 1 Limb: Consider Ddx, Rads if swelling, NSAIDS 5d if injury → rads

Diagnosis:
- Bone Radiographs: 30% bone loss before lysis seen, aggressive bone lesion, osteolysis, periosteal reaction, soft tissue swelling → mainly at metaphyseal regions

  • Chest Radiographs: Mx check, will usually be seen at time of Dx
  • ALP: Prognostic indicator

Approach to Finding a Lesion:
- Establish Owner Expectations: Quality of Life vs long-term survival, amputation, chemo

  • Availability of Radiation in Location - Ddx: Osteomyelitis (FNA, bloods)
  • Make Definitive Dx:
    o Biopsy (Painful +- Fx) OR Jamshidi 14G impression smear cytology
    Prior: Chest Rads, Organ function, ALP +- Ab US
51
Q

Treatment for bone tumours?

A

Goals: Palliative, extend survival

  • Surgery: Amputation
    Role: To remove pain source, palliative
    Resistance: concerns of Mobility, arthritis, fat patients, attitudes to disability

Limb Sparing
Adv: Oesteosarcoma doesn’t move joints, can keep leg, 3D printing of limb implants
Dis: High rate of infection (need to give Chemo), high complication rate, long hospitalisation
Indication: Not recommended but always mention, large dogs, severe arthritis

  • Radiation
  • Chemo:
    Drugs: Carboplatin (+-Doxorubicin, gemcitabine), doxorubicin, cisplatin Timing: Start prior to or after amputation, OR when stitches are removed
    Dis: Poor wound healing (Myelosuppression)
    Cistoplastin: In cats
  • Pain Tx: Multimodal
    – NSAID, Opiod, Gabapentin, Paracetamol + pamidronate (Inhibit osteoclasts) BUT NONE ARE EFFECTIVE

Px: Guarded to poor, OSA die in most cases
- Sx & Chemo: 30-40% survive 1yr
- Amputation + Chemo: 8-12m MST
- Amputation: 3-4m MST - Mx: Lung Mx common, chemo slows rate
- Cats: Lower incidence of OSA, lower Mx rate, long MST ~24-44m

52
Q

Other anorectal tumours?

A

Colorectal Adenocarcinoma
Incidence: Uncommon

Ddx:
- Rectal polyp
- Leiomyosarcoma
- Fibrosarcoma
- Dyschezia: Anal, Anal gland & Colonic dz
- Tenesmus: Colitis/Colon dz, PH, Bladder pathology, Intrapelvic neoplasia, anal gland dz
- Haematochezia: Colitis, Inflam, FB, Anal gland dz, Bleeding disorders

Dx: Rectal examination, imaging (Hard to see), Colonoscopy/Biopsy

Tx: Surgery (Rectal pull-through or pelvic approach) +- Chemotherapy, radiation

Mammary Adenocarcinoma
Association: Speying – 0.5% before first heat, 8% 2nd, 26% 3rd → Increasing w/ duration of intact
Hosts: Poodles, English Setters, GSD, Siamese – Males rare (Usually benign exc. Male cats malignant)

Morph: Single or multiple (50:50), firm +- ulcerated
Canine: 60% Benign, 50% malignant Rx/Mx,
Px factors: Poor differentiation, sarcoma, inflam, grade

Feline: 80% Malignant,
Px indicators – Tumour size and grade.
Complete resection = longer survival
Dx: FNA/Bx, Lung rads, cytology of LN, thorax rads (Mx)
Ddx: Mastitis, abscessation
Tx: Surgery (Except Inflam types w/ distant Mx, Remove entire gland) + OHE +- Chemo (Cats)

53
Q

Urogenital tumours?

A

Transitional Cell Carcinoma

Hosts: Older females, Scottish terriers (21x) > WHWT, Shetland Sheepdog, Beagle
RF: Neutered, Cyclophosphamide, obesity, older flea products
Location: Trigone!
CS: Stranguria, pollakiuria, haematuria Ddx: Cystitis, Urolithiasis, inflam polyp
Dx: US, Traumatic catheterisation, Cystoscopy, TCC Bladder Ag (Not-reliable), UA/general +- CT
AVOID: FNA – causes seeding, cystocentesis
Tx: Chemo (Mitoxantrone, Carboplatin, Gemcitabine), piroxicam/Metacam (COX2), urethral stent

Kidney Tumours
Incidence: Rare
Type: Carcinoma, lymphoma (Cats), HSA (Dogs)
CS: Non-specific, haematuria
Dx: FNA, Bx, Ab US, CT, MRI > Thorax rads
Tx: Nephrectomy (Unilateral CA), Chemo (Lymphoma)

Prostatic Tumours
Type: CA
Host: Neutered 10yo dog, incl. Scottish terrier, Shetland sheepdogs
Mx: HIGH Dx:
- Radiograph: Mineralisation, mineralised lumbar vertebrae, lung Mx
- US: Mineralisation, enlarged irregularly shaped
- Prostatic Wash - Traumatic Catheterisation - US Guided FNA

Tumour of Vulva/Vagina
Types: TVT, MCT, SCC (Vulva), Leiomyoma (MC Vaginal)
Ddx: Leiomyoma resembles vaginal hyperplasia or prolapse (Large pink smooth, pedunculated
Tx: Surgery is curative

Multiple Myeloma
Location: BM
Complication: Hyperviscosity dz (Increased IgA, TP 120, Alb 30, Glob 90) CS: Anaemia, Low WCC, pain around lesions in bone
Dx: Monoclonal gammopathy, CBC/BC, UA (Bence Jones Proteins), BM aspirate, X-ray (Bone lesion)

Extra-medullary Plasmacystoma (EMP)
Morph: Solitary benign-looking on skin Type: Benign
Complication: May produce monoclonal gammopathy (Rare) → should remove

Small Animal Medicine (14 decks)

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