Oncology Flashcards
what is CR?
complete response
disappearance of all measurable disease
what is PR?
partial response
reduction in volume of all disease, no new lesions
what is SD?
stable disease
what is PD?
progressive disease
prednisone can have anti-tumor effects on which cancers?
lymphoma
multiple myeloma
mast cell tumor
prednisone can help control clinical signs in which cancers?
insulinoma
CNS tumor
paraneoplastic hypercalcemia
indications for radiation therapy?
- adjuvant
- neoadjuvant
- primary therapy
- palliation
what are some complications of biopsies?
hematoma
surgical site infection
exophytic tumor growth
limitations of FNA cytology on tumor
no info on structure, grade and if benign or malignant
limitations of needle-core on tumor
size of tumor that is amenable
may penetrate naive tissue/plane
risk of procedure (bleeding, air)
when should you do an excisional biopsy?
curative intent resection
high suspicion is benign
palliation
when should you absolutely not do an excisional biopsy
injection site sarcoma
do you cut parallel or perpendicular to tension lines?
parallel
what are these
1. aseptic technique
2. gentle tissue handling
3. hemostasis
4. preserve blood supply
5. eliminate dead space
6. accurate tissue apposition
7. min tension
halsted principles
what type of approach?
narrow, high risk for leaving microscopic disease
marginal
what type of approach?
2 cm outwards to account for active zone or microsatellites
wide
what type of approach?
tumor removal and significant amount of normal tissue around it (e.g. entire muscle)
radical
definition:
palliative vs curative/definitive vs cytoreduction
surgical intent
definition:
how much tissue is taken (marginal, wide, radical)
surgical dose
definition:
tissue plane of dissection, “cutting edge”, which is continuous with what remains in wound bed
surgical margin
are active or passive drains preferred?
active (closed)
what should never be done with reconstruction?
releasing incisions
what cases with seromas are high risk?
LN/ventral neck
high motion areas
inguinal
pre-op radiation therapy
what are the major determinants of metastasis?
- histotype (highly metastatic)
- histologic grade
- primary tumor size
examples of highly metastatic tumors
HSA
OSA
malignant melanoma
AGASACA
examples of tumors whose high grades have high chances of mets?
mast cell tumor
soft tissue sarcoma
what is the Ewing Mechanistic Theory?
First site to which cancer metastasizes is the closest one in which there are small blood vessels (first capillary bed)
what is the Paget seed and soil theory?
Cells are dispersed randomly but only grow in organs which provide the correct factors necessary for growth of that particular tumor
what is the rate limiting step in metastasis?
survival and proliferation in new microenvironment
why do tumors develop its own blood supply?
bc they should not be able to grow beyond 1 mm unless they have their own blood supply
how do tumors develop their own blood supply - differ between the classical and vasculogenesis theory?
classical theory: ingrowth of endothelial cells from existing vessels
vasculogenesis theory: endothelial precursors
treatments that might target tumor blood vessels
- block angiogenic growth factors w/ Avastin or Palladia
- give angiogenesis inhibitors - angiostatin, endostatin
- target cytotoxic drugs to growing endothelial cells
- metronomic chemotherapy (small amounts more frequently)
what do you call cancer-associated alterations in bodily structure and/or function that are not directly related to the physical effects of the primary or metastatic tumor
paraneoplastic syndromes
hypercalcemia of malignancy
MOA
PTHrp
hypercalcemia of malignancy
associated tumor types in dogs
AGASACA
lymphoma
multiple myeloma
hypercalcemia of malignancy
associated tumor types in cats
lymphoma
SCC
hypercalcemia of malignancy
treatment
treat underling tumor!
IV or SQ fluids
furosemide
bisphosphonates (pamidronate, zoledronate)
prednisone (must have definitive diagnosis before starting)
hypertrophic osteopathy (HO)
MOA
poorly understood
vagal n stimulation from thorax or humoral mechanism through increased VEGF, growth hormone and PDGF
hypertrophic osteopathy (HO)
associated tumor types
primary lung tumors
osteosarcoma mets to lungs
hypertrophic osteopathy (HO)
treatment
remove underlying tumor!
if secondary to mets from OSA - palliative pain management (oral analgesics), bisphosphonates (pamidronate, zoledronate), talk about euthanasia
how does radiation therapy kill cells?
ionizing radiation at or near DNA, can be direct or indirect
mostly mitotic cell death
some apoptotic death
stereotactic body radiation therapy
type of fractions?
what is required?
hypofractionated
requires CT, immobilization and target localization (OBI or contour)
how does stereotactic body radiation therapy spare normal tissues?
by avoidance
what is IMRT?
intensity modulated radiation therapy
what does IMRT do?
fractionation?
what does it require?
non-uniform dose delievery
fractionated or hypofractionated
requires on board imaging
when do acute radiation effects occur? which systems are involved?
within 3 months
skin, GI, hematopoietic
when do early delayed radiation effects occur? which systems are involved?
2 weeks - 4 months
neurologic tissues
when do late radiation effects occur? which systems are involved?
3 months - year
lung, kidney, heart, bone, liver
should you use skin care products (aquaphor, lidocaine jelly, A/D) for the acute treatment of the skin from radiation effects?
no - controversial
treatment for pneumonitis due to radiation
glucocorticoids
rest
O2
toceranib can be a problem with which type of radiation
GI radiation
concurrent use of what chemotherapeutics is not recommended
dacarbazine
lomustine
doxorubicin
cisplatin
gemcitabine
paclitaxel
toceranib
why can concurrent antioxidants interfere with radiation cell killing
antioxidants prevent ROS
but ROS cause indirect killing of cancer cells
Pentoxifylline and vitamin E can be given to help what chronic conditions to treat what
skin
CNS
bone
lungs
radiation fibrosis
