Oncology Flashcards

1
Q

Cytology indication

A

Lesion palpable external/ seen on image
Organomegaly
Cavitary effusion
Cancer staging
Pyrexia of unknown origin

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2
Q

Cyto expectations

A

Inflammation/ neoplasia
Benign/ malignant
Can’t do-
Hyperplasia/ adenoma

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3
Q

Cyto adv/ dis

A

Advantages -
non invasive
inexpensive equipment
done in house
rapid results
Dis -
May not be definitively diagnostic
Need sample to be of diagnostic quality

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4
Q

Slide evaluations

A

Macroscopic- label and smeared correctly
Micro
-10x scan whole slide, find most representative area
- higher magnification to ID cells and morphology

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5
Q

Sample quality problems

A

Thickness
Insufficient staining time
Inadequate drying
-Nuclei don’t pop- more staining needed
-bubbles- aspiration pressure, repeat with needle only technique
-cells balled up- slow drying

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6
Q

Inflammation or neoplasia

A

Inflammation
-inflammatory cells, microbes, fibroblasts
Neoplasia
-monomorphic atypical cells
-abnormal cells for site of collection
Neoplasms can become inflamed
-SCC, mammary, mast cell

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7
Q

Inflammation types

A

Neutrophilic
-imm-mediate, pathogens
Histio/macrophage
- FB, fungus, Mycobacterium
Eosinophilic
-hypersensitivity, parasites, cancer
Lympo/lymphoplasmacytic
- antigenic stimulation, Chr inflammation

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8
Q

Benign tumour cyto

A

Uniform
Delineated
Low mitotic count
Low nuclear: cytoplasmic ratio

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9
Q

Malignant neoplasia cyto

A

Pleomorphism
Anisokaryosis: Atypical nuclear: cytoplasmic ration
High and varied mitotic count
Clumped chromatin
Multinucleation

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10
Q

Epithelial neoplasms

A

Tight clumped cells
Distinct cytoplasmic borders

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11
Q

Sebaceous adenoma

A

Raised cauliflower alopecic lesions
Foamy cytoplasm

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12
Q

Perianal gland tumour

A

Entire males
Sheets of hepatocyte like cells
Large oval cells

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13
Q

Squamous cell carcinoma

A

Proliferative and ulcerative lesions
Limbs, pinnae, faces
Polygonal cells, pleomorphic
Highly malignant and invasive

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14
Q

Mammary carcinoma

A

Background blood, basophilic
Variable cellular arrangement
Pleomorphic

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15
Q

Mesenchymal tumours

A

Poor delineation
Soft tissue sarcoma
-fibro, lipo, leiomyo, rhabdmyo, perivascular
=

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16
Q

Lipoma

A

Benign
Can’t distinguish from normal subcut adipose tissue on cytology

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17
Q

Osteosarcoma

A

Round/ spindle cells
Basophilic cytoplasm
Eccentrically placed nucleus and prominent nucleoli
Osteoclasts - large multinucleated cells may be present

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18
Q

Round cell tumours

A

Cells exfoliate individually
Round cells with distinct borders
Ex
- transmissible veneral, mast cell, lymphoma, plasmacytoma

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19
Q

Histiocytoma

A

Dome shaped, alopecia
Younger dogs, regresses after few weeks
Small lymphocytes common

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20
Q

Plasmacytoma

A

Cutaneous plasmacytoma is benign
Deep blue cytoplasm
Round eccentric nuclei

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21
Q

Lymphoma

A

Round
High nuclear: cytoplasm ration
Large lymphocytes
Monomorphic population

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22
Q

Mast cell tumour

A

Breed related - boxer/ pug
Vary in granularity
less granular -> more aggressive
Eosinophils often seen aswell

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23
Q

(Neuro) endocrine tumour

A

Exfoliate into loose sheets
Naked nuclei in lakes of cytoplasm
Highly cellular samples
Ex-
-thyroid, phaeochromocytoma

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24
Q

Thyroid carcinoma

A

Blood in background
Clusters cells with scattered naked nuclei
Extracellular pink colloid often seen

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25
Phaeochromocytoma
Chromaffin cells in adrenal medulla CS from catecholamine release Naked nuclei in basophilic cytoplasm lake
26
Melanoma
Raised dark hairless mass Malignant - variable pigmentation, inflammed Pleomorphic
27
Forms of radiotherapy
Various protocols for visits (weekly/ daily) Brachytheraypy -Direct aplication -implantation -Systemic administration Teletherapy -External beam
28
High energy electromagnetic radiation
Analgesic and carcinogenic Compton theory -high frequency photons scattering following an interaction with a charged particle Damage is caused by H2O ionisation (around DNA) -free radicals produced harm DNA Rapid repaired unless O2 fixation Cell death -apoptosis, cell cycle arrest, mitotic catastrophe
29
Radio beam
Shaped with jaw Margins Multiple beams increase tumour dose whilst sparing surrounding tissue E-: direct ionisation, loses energy rapidly through tissue (superficial tumours)
30
RT response
Repair of sublethal cell damage -repair capacity for tumour and self similar Repopulation -rapidly dividing tissue Redistribution ReO2 -may occur after therapy
31
Fractionation
2 separate RT doses < 1 combined RT dose -cell repair damage between doses and repopulate Fractionation reduces self tissue toxicity Limitations -GA, cost, compliance (hospitalisation and frequent visits)
32
RT tumours
Smaller are more sensitive Most sensitive -lymphoma, transmissible venereal, acanthomatous ameloblastoma Mid -Oral SCC (dog) -brain Poor -fibrosarcoma -osteosarcoma -feline oral SCC Tumour response varies (type and sit)
33
RT side effects
Acute and late Tissue in irradiated area will be affected Damage apparent following division of cells (days rapid, year slow division) Ac -skin, MM -resolve within few weeks Late -ischaemic necrosis (bone and brain) -alopecia Carcinogenic (years, avoid in young patients)
34
Chemotherapy use
1°- sole Tx for sensitive tumours Adjuvant - post Sx for metastic Dz Neoadjuvant- Tx pre Sx to shrink, easier resection Concurrent with RT - increase sensitivity to RT
35
Tumour cell heterogenity
Cancer is the result of genetic instability Tumours produce subclones with more mutations Resistant clones can form
36
Chemo success factors
Tumour cell heterogeneity Inherent tumour sensitivity Drug dosage Tumour supply Tx interval
37
Factors affecting chemo response
Administration Distribution Metabolism Excretion
38
Polychemotherapy
Sequential - several drugs at different times Combo - several given simultaneously Avoid topical/ intratumoural Env. contamination risk High dose chemo has narrow therapeutic range
39
Chemo tox
Immediate -Anaphylaxis, arrhythmia, emesis Acute tumour lysis syndrome -large burden/ rapid tumour destruction Rapidly dividing cells most affected Bone marrow Alopecia (uncommon in smallies) GI -enterocyte damage, mucosal barrier compromised, maropitant 7-10d post Tx -Haematopoietic cell damage (low neutrophil count) -pyrexic/ afebrile neutropenic
40
Drug associated complications
Doxorubicin - Canine cardiotoxicity Cyclophosphamide - sterile haemorrhagic cystitis Lomustine - hepatoxicity Cisplatin - nephrotoxic Vincristine - peripheral neuropathy Extravasation - perivascular irritants - doxorubicin, vincristone 0raise and rawn back vein
41
Metronomic chemo
Continuous low dose chemo (less dose, more doses) Palliative/ following MTD chemo Targets angiogenesis Stim immune response Cyclophosphamides w/ piroxicam
42
TKI
Tyrosine Kinase Inhibitors Inhibit activation of cancer signalling pathways (specific neos) -affect angiogenesis, toxicity, need monitoring Mastinib oral for Mast Cell Tumour Adv- D+. anorexia, bone marrow suppression
43
Lymphoma clinical presentations (dogs)
Mid to old aged CS dependent on tumour sites Multicentric 80% Mediastinal and GI 5% each
44
Canine multicentric lymphoma
Generalised peripheral lymphadenopathy CS- enlarged LN, D+, V+, anorexia, lethargy
45
Cranial mediastinal canine lymphoma
Solitary or part of multicentric form Tachy & dyspnoea Hyper Ca signs (PUPD, V+, tremors) Altered cardiac PMI
46
Canine alimentary lymphoma
CS- V+, D+, pan hypoproteinaemia, abdominal masses Aggressive form
47
Cutaneous lymphoma
Epitheliotropic - T cell Non epitheliotropic - B cell, multi lesions Raised erythematous plaques Poor chemo response
48
Paraneoplastic syndrome
HyperCa IMHA Monoclonal gammopathies Neuropathies Cachexia
49
Lymphoma Dx
Cytological or histological Ancillary tests - PARR (clonality and phenotypes) Histo classes -Grade; low-intermediate-high - Immunophenotype; B cell, T cell, null Staging - bloods, biopsy
50
Lymphoma Tx
No Tx -Asymptomatic - MST 5 wks -CS present -> PTS Prednisolone -MST up to 2m -chemo resistance Multidrug chemo best -MST dependent on drugs and protocol -prolong survival time
51
Lymphoma chemo protocol
COP (high dose) -haematology pre Tx 70% response rate Median survival time 7m Drugs- -Prednisolone -Vincristine -Cyclophosphamide Discontinuous CHOP 90& response rate Median survival time 1yr Drugs -Prednisolone -Vincristine -Cyclophosphamide -Doxorubicin L-asparaginase if CNS lymphoma (penetrates BBB)
52
Lymphoma rescue protocols
DMAC Dexamethosone Melphalan Actinomycin-D Citarabine MST 2m , 3.5m if CR
53
Feline leukaemia aetiology
Pre FeLV -mediastinal/ multicentric Post FeLV -GI in geriatrics FeLV -oncogenesis through immune suppression -B cell lymphoma
54
Multicentric feline lymphoma
Regional lymphadenopathy Mid aged CS -painless enlarged nodes -anorexia, malaise,
55
Mediastinal feline lymphoma
Younger siamese CS- Dyspnoea, dysphagia CE- palpable reduction in Cr thorax compressibility
56
Alimentary feline lymphoma
Older cats with insidious weight loss
57
Feline lymphoma Dx
FNA Flow cytometry Biopsy (node) PARR - PCR Antigen Receptor Rearrangements (+/-) Staging, Grade, Type Different stages to dogs
58
Feline lymphoma prognostic indicators
+ve -CR -small extra nodal Dz -ve -No CR -FeLV +
59
Feline lymphoma Tx
None (4wks) Corticosteroids Multi drug chemo (COP best) -Vincristine -Cyclophosphamide -Prednisolone
60
Feline chemo side effects
Myelosuppressive agents (check haem each dose) Whisker loss GI
61
Leukaemia
Rare Class -Acute/ Chronic, Lymphoid/ Myeloid Acute forms rapidly fatal - palliative -MST w/ chemo 120d Chr MST w/ Preds 2yrs (CL leukaemia)
62
Leukaemia Dx
Haematology Flow cytometry of peripheral blood Bone marrow biopsy
63
Multiple myeloma
Sys neoplastic proliferation of plasma C -> overproduction of Abs Dx -haematology, biochem, urine Monoclonal gammopathy Osteolytic bone lesions (X ray) Bence-Jones proteinuria Tx -Support -Preds -Chemo
64
Paraneoplastic syndrome or Systemic effects
Paraneo -consequence of cancer but not due to neoplasm location Sys -consequence of neoplasm location
65
Neo GI effects
Cancer cachexia -anaerobic respiration due to tumoral hypoxia -altered metabolism due to cytokines and inflammation -poor appetite -Tx- maintain calorie intake Gastroduodenal ulceration -bleeding -> anaemia -melena Protein losing enteropathy (lymphoma) -diffuse lesions allow protein loss
66
Mechanisms of haematological effects
Loss Less production Destruction Cytoses Monoclonal gammopathies Coagulation disorders
67
Blood loss anaemia
Acute -no haematemesis/ melena then likely splenic -TP drops pre PCV Chr -CS- lethargy/ pallor -Poorly regenerative - microcytic hypochromic anaemia (Fe deficiency)
68
Reduced protein cytopaenia
Anaemia of Chr inlammation -disorder Fe storage -short RBC life span Myelophthisis -stem cell crowded out by neoplasm -non-regenerative normochromic -Dx bone marrow aspirate Hyperoestrogenism -sertoli cell tumour -neutrophilia > pancytopenia (cause of bone marrow hypoplasia
69
Destruction cytopaenia
Paraneoplastic immune mediated anaemia (thromboaemia) -exclude lymphoproliferative Dz Microangiopathic anaemia -Sys effect -RBC fragmentation > anaemia
70
Monoclonal gammopathies
Excess production of a single Ig by tumour cell High blood globulins Blood hyper viscosity -renal failure, neuro, coagulopathy Dx -electrophoresis of serum and urine (Bence-Jones proteins) Tx- -plasmapheresis sera and urine, tumour directed Tx
71
Coagulation
Altered coagulation -altered platelet function and infarcts Disseminated IV coagulation -altered consumptive coagulation -multi organ failure possible -schistocytes, high APTT -carcinomas
72
Endocrine
HyperCa -PNS -elevated PTH -assess tCa and iCa Hypoglycaemia -PNS with insulinoma Ectopic ACTH syndrome -lung tumours -+ve hyperadrenocorticism test but no sign of adrenal -hyperadrenocorticism Hyperaestrogenism
73
Neurological
Sys effect of neuro mass lesion PNS -myaesthenia gravis -peripheral neuropathy
74
Myasthenia gravis
2°immune mediated Dz CS -weakness, exercise intolerance, dysphagia Dx -+ACHr Ab and tumour (thymoma, osteo, lymphoma) Tx -Tx tumour, immune suppression
75
Peripheral neuropathy
Demyelination Myelin globulation Axonal degeneration Varied tumour relations Apparent lesions uncommon Tx- Tx tumour
76
Cutaneous PNS
Alopecia Malassezzia ass. dermatitis Pancreatic ass. panniculitis Superficial necrolytic dermatitis Pemphigus multiforme Nodular dermatofibrosis Feline thymoma ass. exfoliative dermatitis
77
Feline paraneoplastic alopecia
Alopecia -acute, non pruritic -hair easily epilated -initially ventral abdomen Glistening skin -alopecic skin inelastic and thin -smooth and shiny Footpad -concentric scale, painful fissures Malassezzia dermatitis -brown greasy accumulations
78
Pancreatic panniculitis
Inflammation and hydrolysis of adipose tissue Pancreatic carcinoma and adenocarcinoma
79
Superficial necrolytic dermatitis
Hepatic Dz Pancreatic neo Associated amino acid deficiency Distinctive histo and US Footpad hyperkeratosis -erythema, fissures Crusting dermatitis -alopecia, pressure point crusts
80
Paraneoplastic pemphigus
Autoimmune induced ulceration of mucosa junctions Lymphoma, thymoma, splenic sarcoma Cutaneous markers -oral and mucocutaneous ulceration -rapidly rupturing vesicles -oral ulceration
81
Feline Thymoma-Associated Exfoliative Dermatitis
Generalised exfoliative dermatitis in old cats Ass. thymoma Exfoliative dermatitis -diffuse erythema and skin exfoliation Kerato-sebaceous accumulations Crusting and ulcerations
82
Hypertrophic osteodystrophy
Palisading periosteal proliferation along long bone shafts Pulmonary tumours CS- shifting lameness Dx- long bone x-ray Tx- remove inciting cause
83
Oral tumours
Malignant melanoma SCC Fibrosarcoma Dx- biopsy Staging -1° often locally invasive, imaging required (CT/ MRI) Thoracic Xray for metastases Tx- Sx best if possible (mandiblectomy) -Adjuvant RT (SCC)
84
Melanoma
Small old dogs Locally invasive and metastatic Dx- melanin containing mesenchymal cells Sx - ass. lots recurrence RT also viable Chemo not indicated
85
Oral SCC
Low metastatic rate Tx- Sx +/- RT (+ = 3yr MST) Tonsillar SCC -high metastatic rate Tx- Sx +/- RT
86
Fibrosarcoma
Large breeds middle aged Invasive Mod metastatic risk Tx- Sx +/- RT
87
Epulides
Non metastatic lesions from gingiva Acanthomatous ameloblastoma
88
Canine oral osteosarcoma
Not as metastatic as appendicular form of OSA Tx- Sx Maxilla OSA - death from recurrence Mandibular OSA - death from metastases
89
Feline oral SCC
RF- canned food, smoke Oral discomfort and anorexia Locally invasive Low metastatic risk Tx- Sx, feeding tube often indicated
90
Feline fibrosarcoma
Mid to old age Locally invasive Tx- Sx
91
Mammary tumours
RF- reduced if neutered pre 3rd cycle -obesity, age, breed (Small dogs and Siamese) Normally multiple masses Dx- FNA, excisional biopsy Staging Tx- mastectomy (single/ regional) Ovariohysterectomy 1/2 recurrence rate (time of mastectomy)
92
Canine inflammatory carcinoma
Tumours extremely painful Mistaken for mastitis, all glands normally affected Palliative Tx
93
Feline mammary tumours
Similar RF to canids Normally malignant Ddx- fibroepithelial hyperplasia (all enlarged) Tx- chain mastectomy
94
Sarcomas
Malignant mesenchymal (connective/structural tissue) cancer Locally invasive High metastatic risk (haematogenous route) -osteo, haemangio, histiocytic Stage- how has it got (Dz burden) Grade- histo features (activity, vascularity, invasiveness) Dx- FNA, Biopsy Imaging- CT> Xray Sx- 3cm lateral + 1 fascial plane Excision margin assessed- cardinal method (spheroid mass), bread loafing Adjuvant RT, metronomic chemo
95
Feline injection site sarcoma
Malignant fibroblasts Inflammed (lymphocytes) Firm cutaneous mass Dx- incisional biopsy, advanced imaging Tx- Sx (incomplete resection adjuvant RT)
96
Bone tumours
Most skeletal tumours = osteosarcoma (norm. axial skeleton) 95% metastised pre Dx Mid to old large breeds CS- lameness (1 leg) -swelling, radiographic changes Tx- Sx (amputation), RT Reducing pain- bone stabilisation Sx (high failure risk) Chemo prolongs survival (carboplatin) Prognostic factors- location, metastasis, total alkaline phosphatase
97
Hemangiosarcoma
Blood vessel wall tumour Spleen, right auricular appendage, liver Highly invasive and metastatic CS - from bleeding -shock, haemoabdomen, pericardial effusion Pth- anaemia, schistocytosis Dx- histology, imaging Sx- splenectomy (ventricular arrhythmia risk) Survival time poor if gross metastases pre splenectomy (chemo help anthracycline) RT works for non visceral sites (muscle)
98
Histiocytic sarcoma
Highly metastatic Histiocytes (antigen presenting cells) Affects various tissues St bernards Tx - Multimodal therapy best -Sx + RT + anthracycline (chemo) 4-5m MST if gross metastases present If not 500d
99
Mast cell tumour
Most common skin tumour Present - cutaneous mass (variable appearance) -intracytoplasmic granules (histamine) -local erythema, haemorrhage (Darier's sign) Dx- FNA Staging- bloods, urinanalysis, FNA LN, Abd US Patnaik grading system - histological grade (prognostic factor (I-III grades) Tx- often multimodal -Sx (I,II curative often), RT adjunctively, Chemo (III/ metastases) -prednisolone, vinblastine
100
Transitional cell carcinoma
Urinary bladder tumour (bladder trigone) Often metastases to iliac LN RF- schnauzer CS- low URI tract signs Dx- histopathological (FNA cause seeding) Stagin- bloods, urine, Abd US, thoracic radiograph Tx- brachytherapy, chemo
101
Quality of life
1° concerns for vet and owner -most owners value quantity of quality Difficult definition Satisfaction -physical; appetite, mobility, pain, behaviour, lethargy, grooming -emotional; attitude, depression, happiness -social; owner and animal relationship -interaction with env. Health related
102
Assess QOL
Subjective- indirect information Species specific Individual specific Questionnaire - multiple items, different domains, vary scales
103
Pain management
Prevalence of cancer pain Consequence of pain -worse QOL, altered physiological function Classifications -mal/ adaptive -nociceptive/ neuropathic -Ac/ Chr Recognition -Physical response -measurable parameters -activity, gait -attitude
104
Pain Tx
NSAIDs (contraindicated - corticosteroids, GI/ kidney problems) Prostaglandin receptor antagonists (grapiprant -dogs w/ OA Paracetemol- dogs (okay w/ corticosteroids) Tramadol- opioidergic- weak µ agonist Gabapentin- neuropathic pain Buprenorphine
105
Pain relief, symptom relief
Amputation -Sx excision of ulcerated/ painful mass Stenting -Urethra, trachea Cystotomy tubes -urethral obstruction (TCC) -not long term
106
Why does cancer cause anorexia and cachexia
Anorexia -oral +/- Abd pain -chemo and cytokine release (IL6) Cachexia -cytokine release (IL6) -extensive lipidolysis and proteolysis -pre diabetes -more common cats vs dogs Help -well balanced palatable diet -CKD - low protein -DM - slow release carbs Assess BCS regularly, diet changes slow, small frequent meals, warm up (cats) Meds, assisted feeding technique
107
5 step hospice and palliative care
1 Evaluate caregivers needs and goals -emotional, financial, physical 2 Education on Dz and delivery of care -Dx, Tx 3 Develop personalised plans 4 Application of palliative care techniques 5 Emotional support
108
Euthanasia
Make sure you have enough time Administrative aspects discuss pre PTS Talk owner through procedure Check catheter Consider sedation pre pentobarbital
109
Equine neoplasms
90% are skin tumours Sarcoid SCC Papilloma Melanoma MCT RF- age -Breed lipizzaner (melanoma), Shire (ocular SCC)
110
Equine neo signs
Depends on type and functionality (hrm secreting) Size- GCT small no sign, mid colic, large ruptured ovarian artery Location Number Duration
111
Equine paraneoplastic syndromes
mucocutaneous and skin syndromes -pemphigus, pruritus Neurological syndromes Haematological syndromes -anaemia, polycytaemia Endocrine and metabolic -cachexia, marie's Dz
112
Equine lymphoma
Most common haematopoietic neo Lymphatic origin Multicentric, alimentary, mediastinal, cutaneous
113
Multicentric equine lymphoma
4-12yrs CS- weight loss, ventral oedema, recurrent fever Dx- cyto/ biopsy Tx- Sx removal
114
Alimentary lymphoma EQ
Most common intestinal neoplasia >12yrs CS- malabsorption, colic Dx- cytology (peritoneal fluid), biopsy Tx- Sx excision Typically poor prognosis
115
Mediastinal lymphoma EQ
Most common thoracic neoplasia Horses of all ages CS- weight loss, depression, ventral and limb oedema Dx- cytology Tx- palliative
116
EQ haemangiosarcoma
Mid to old aged Dx- cytology, biopsy Tx - palliative
117
EQ alimentary neoplasia
Ameloblastoma - odontogenic epithelium Ossifying fibroma - young rostral mandible SCC- most common oral neo Melanoma- lip/ parotid region Gastric SCC Intestinal lymphoma Intestinal adenocarcinoma Lipoma Hepatic adenocarcinoma
118
EQ respiratory neoplasms
URT -SCC -atheroma -nasal polyp -ethmoidal haematoma -guttural pouch melanoma LRT -Pulmonary granular cell tumour -Haemangiosarcoma -Lymphoma Haematopoietic -Lymphoma -Plasma cell myeloma -Leukaemia
119
EQ endocrine and CNS neoplasms
Pituitary - PPID Thyroid - adenoma/ adenocarcinoma Adrenal -phaeochromocytoma CNS -Astrocytoma/ meningioma -Lymphoma -Melanoma Peripheral nerves -Neuroma -Schwannoma
120
EQ ocular neoplasms
Orbit -Sarcoid -SCC -Melanoma -MCT -Lymphoma Globe -Melanoma -Ameloblastoma -Astrocytoma -Proliferative optic neuropathy
121
Other EQ tumours
Repro Male - SCC, melanoma. sarcoid, testicular (rare) Female - SCC, GCT, mammary (rare) Kidney- carcinoma Bladder- carcinoma Muscle- rhabdomyoma/ sarcoma, haemangiosarcoma Bone- osteoma/ sarcoma
122