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PCP > Oncology > Flashcards

Oncology Flashcards

1
Q

Introduction

Breed associated tumours in dogs
a) Flat-coated retrievers and Bernese Mountain
b) German shepherd and Golden retrievers
c) Boxers, pugs, golden retrievers
d) Giant breeds

A

a) Disseminated histiocytic sarcomas
b) Haemangiosarcoma
c) Mast cell tumour
d) Osteosarcoma of appendicular skeleton

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2
Q

Introduction

Features of neoplasia (4)

A
  • Uncontrolled cell proliferation
  • Impaired cellular differentiation
  • Chromosomal instability, mutations, altered gene expression
  • Invasion and metastasis
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3
Q

Introduction

Cytological features of malignancy
a) Cell number
b) Cytoplasmic features
c) Nuclear features

A

a) Numerous cells
b)
- Large/giant cells (anisocytosis)
- Poorly differentiated
- High nuclear : cytoplasmic ratio

c)
- Large nuclear size
- Multiple prominent nucleoli
- Hyperchromatic

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4
Q

Introduction

Histological features of malignancy
a) Tumour architecture
b) Other features

A

a)
- Densely cellular mass
- Lack of structural organisation
- Cytological features

b)
- Invasion of cells into adjacent tissues
- Tumour necrosis
- Evidence of vascular or lymphatic invasion by tumour cells

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5
Q

Introduction

Common sites of metastasis (2)

A
  • Drainage lymph nodes
  • Viscera (lungs, kidney, liver, spleen)
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6
Q

Clincal approach to cancer

Histology biopsy techniques (5)

A
  • Needle - eg Tru cut
  • Skin Punch
  • Grab biopsy
  • Incisional biopsy
  • Excisional biopsy
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7
Q

Clinical approach to cancer

Cytology techniques (3)

A
  • Impression smears
  • Fine needle aspiration
  • Cytospins of body fluids / effusions
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8
Q

Clinical approach to cancer

Cytology vs Histology (advantages and disadvantages)

A

Cytology
- Quick
- Cheap
- Gives valuable info on cell type and malignancy
- Cannot grade tumours

Histology
- Should provide definite diagnosis
- Histological features provide Grade
- Takes time to process tissue
- Biopsy procedure and processing costs

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9
Q

Clinical approach to cancer

Primary tumours
a) physical signs of local invasion (3)
b) Other diagnostic techniques to be considered to aid evaluation (4)

A

a)
- diffuse, indistinct boundaries between normal tissue and tumour
- fixation of tumour mass in one or more planes
- thickening of adjacent tissues

b)
- radiography: tumours near bone, especially oral cavity and nasal chambers, contrast used for body cavities
- ultrasound: soft tissues and abdominal organs
- endoscopy: hollow organs
- CT/MRI: tumours otherwise inaccessible (brain)

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10
Q

Cancer complications

Direct effect of tumours on haematopoesis

A
  • neoplastic invasion of bone marrow (myelophthisis) in lymphoproliferative and myeloproliferative conditions
  • reduction in normal cell numbers (non-regenerative anaemia, thrombocytopenia, neutropenia)
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11
Q

Cancer complications

a) Indirect effect on haematopoesis
b) How tumours can cause blood loss

A

a)
- oestrogen producing tumours
- myelofibrosis (non-regenerative anemia, thrombocytopenia, neutropenia)

b)
- haemorrhage from tumour
- gastroduodenal ulceration due to hyperhistaminaemia or hypergastinaemia
- secondary to bleeding disorder

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12
Q

Cancer complications

Paraneoplastic syndromes
a) Topic vs ectopic
b) Examples of topic paraneoplastic syndromes (5)
c) Examples of ectopic paraneoplastic syndromes (3)

A

a)
- Topic: resulting from functional tumour of endocrine origin
- Ectopic: non-endocrine tumours

b)
- Hyperadrenocorticism (cushings)
- Hyperthyroidism
- Primary hyperparathyroidism
- Hypoglycaemia
- Hypergastrinaemia

c)
- Hypercalcaemia
- Hypoglycaemia
- Hyperhistaminaemia

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13
Q

Cancer complications

Hypercalcaemia
a) Common malignancies causing (2)
b) Effects (4)
c) How to manage hypercalcaemia

A

a)
- Lymphoid tumours
- Anal gland adenocarcinoma

b)
- Renal effects: renal failure
- Gastrointestinal effects: anorexia, vomiting
- Neuromuscular effects: lethargy, weakness
- Cardiovascular effects: bradycardia, arrhythmias

c)
- restore circulating volume (IV fluids)
- reduce plasma calcium concentration
- identify and treat cause

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14
Q

Cancer complications

Mast cell tumours
a) Commonly affected species
b) What is it associated with and local effects of this (5)
c) Systemic effects of (b)
d) Treatment

A

a) Dogs (occasionall cats and horses)
b) Hyperhistaminaemia
- oedema
- erythema
- pruritis
- bleeding tendency
- delayed wound healing

c)
- anaphylaxis
- gastroduodenal ulceration

d) H2 antagonists

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15
Q

Chemotherapy

a) Types of tumour that have high chemosensitivity (3)
b) Types of tumour that have low chemosensitivity (3)
c) Define growth fraction

A

a)
- lymphoma
- myeloma
- some forms of leukaemia

b)
- slow growing sarcomas
- carcinomas
- melanoma

c) Determines whether chemotherapy will be effective. Drugs are only active against dividing cells, so the most proliferative cancers will respond

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16
Q

Chemotherapy

a) Induction therapy
b) Maintenance therapy
c) Rescue therapy

A

a)
- reduce tumour burden to a minimal level below limits of detection (remission)
- involves intensive course of treatment over a defined time period

b)
- when clinical remission achieved by induction treatment, a less intensive treatment can be adopted to maintain remission

c)
- establish further remission of the tumour, usually with a more aggressive therapy with agents that the tumour hasn’t been exposed to

17
Q

Chemotherapy

Myelosuppression
a) Exceptions of cytotoxic drugs that aren’t myelosuppressive (2)
b) Clinically significant effects of myelosuppression (2)

A

a)
- vincristine
- L-asparaginase

b)
- neutropenia: significant risk of overwhelming infection/sepsis
- thrombocytopenia

18
Q

Chemotherapy

Common complications of chemotherapy (4)

A
  • myelosuppression
  • anorexia, vomiting, GI toxicity (provide anti-emetics, antacids, appetite stimulants)
  • hypersensitivity/anaphylaxis (L-asparaginase, doxorubicin)
  • phlebitis and tissue necrosis (at injection site)
19
Q

Chemotherapy

Specific drug associated toxicity
Cyclophosphamide

A
  • Alkylating agent
  • Associated with haemorrhagic cystitis
  • metabolites are excreted in the urine, which irritates bladder mucosa
  • To prevent: administer early in the morning, ensure good fluid intake, encourage regular bladder emptying
20
Q

Chemotherapy

Specific drug asociated toxicity
Doxorubicin

A
  • Anti-tumour antibiotic
  • Associated with cardiotoxicity (acute or chronic changes)
  • Acute: tachycardia and arrhythmia on administration/immediately after
  • Chronic: due to cumulative, dose-related damage to myocardium
  • Drug should be infused over at least 15 minutes
  • All patients should have thoracic radiographs, ECG and ultrasound assesment prior to treatment
21
Q

Chemotherapy

Specific drug associated toxicity
Cisplatin (carboplatin)

A
  • Associated with nephrotoxicity
  • Platimum compounds accumulate in renal tubular epithelial cells, leading to proximal tubular necrosis
  • Must be administered with fluid diuresis and monitor renal parameters
22
Q

Chemotherapy

Breed predisposition to toxicity

A
  • MDR-1 gene mutation can lead to an increased risk of toxicity
  • Encodes P-gp drug transport protein, and when mutation is present, substrates are not excreted, leading to increased drug exposure and toxicity
  • Involved vinca alkaloids, doxorubicin, actinomycin D and taxanes
  • Common in herding breeds, german shepherds and mixed breed dogs
23
Q

Radiotherapy

What determines radiosensitivity of living cells (3)

A
  • Growth fraction: dividing cells more sensitive (eg bone marrow, GI epithelium, tumours with high turnover)
  • Cell cycle: cells in M phase are most radiosensitve, cells in S phase or G0 are more radioresistant
  • Oxygenation: tumour cells in low oxygen tension (hypoxic cells) are less sensitive
24
Q

Radiotherapy

Application of radiation
a) Teletherapy
b) Brachytherapy
c) Advantages/disadvantages of each

A

a) Radiation applied as an external beam of X-rays, γ-rays or electrons directed to the tumour

b) Radioactive substances that emit γ or β rays are applied to the tumour surface, implanted in the tumour, or administered systemically

c)
- Teletherapy: safe for operator, but expensive and multiple treatments needed
- Brachytherapy: single treatment and better localisation, but does result in a radioactive patient

25
Q

Radiotherapy

Methods of external beam therapy (teletherapy) (3)

A
  • Linear accelerators: deep penetrating radiation that spares superficial tissues
  • Orthovoltage units: lower energy, softer radiation that is preferentially absorbed by bone, used for superficial tumours
  • Cobalt units: have radioactive source (but been replaced by linear accelerators)
26
Q

Radiotherapy

Radiation-induced changes
a) Acute reactions
b) Late toxicity

A

a)
- death of actively dividing cell populations
- range from mild reddening/erythema of skin or mucosa, to severe exfoliative effects or necrosis
- usually resolve spontaneously
- localised hair loss common

b)
- less predictable, often progressive and irreversible
- occurs in slowly proliferating tissues
- skin: fibrosis induced resulting in thickened, rubbery texture and very slow healing
- bone: osteonecrosis possible
- nervous tissue

27
Q

Radiotherapy

Photodynamic therapy (PDT)
a) Outline how it works
b) Photosensitiser agents
c) What tumours is it used for

A

a)
- photosensitiser agent accumulates preferentially in tumour cells
- when exposed to light of a specific wavelength (according to agent used) oxygen free radicals produced to kill tumour cells

b)
- porphyrins
- 5-ALA cream (absorbed through damaged keratin)

c)
- squamous cell carcinoma of head and neck (eg cat SCC)
- non-invasive lesions
- potential for use in other non-resectable, superficial tumours or tumours in hollow organs

28
Q

Cancer surgery

Types of biopsy
a) Tru-cut
b) Incisional
c) Excisional

A

a)
- Quick to perform, generally small sample
- Subcutaneous masses, ultrasound-guided biopsy or abdominal/thoracic masses

b)
- Use scalpel or Keyes biopsy punch
- Soft tissue sarcomas, oral tumours, ulcerated/necrotic tumours

c)
- Perform if treatment not affected by tumour type (very small skin, lung, splenic, mammary masses)

29
Q

Cancer surgery

Four main categories of oncological surgery

A
  • Intracapsular: debulking tumour
  • Marginal excision: No surrounding tissue margin, use for benign tumours or if there are local anatomical constraints or if adjunctive treatment is planned
  • Wide local excision: Significant margin of surrounding tissue, use for tumours with limited infiltration
  • Radical excision: removal of tumour and entire tissue compartment that extends into adjacent fascial planes (eg limb amputation, chest wall excision)

PCP (8 decks)

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