Oncology 2 AI Flashcards
How often can Cytarabine be added during treatment?
Cytarabine can be added every 3 weeks.
What maintenance protocol follows the COP protocol?
LP or LPV is the maintenance protocol that follows the COP protocol.
What is the initial dosage of L-asparaginase for complicated presentations?
The initial dosage of L-asparaginase for complicated presentations is 400 IU/kg SC.
What medication is given 24 hours after L-asparaginase in complicated presentations?
Vincristine is given 24 hours after L-asparaginase in complicated presentations.
How often is Vincristine administered in Week 1 of the Wisconsin-Madison protocol?
Vincristine is administered once during Week 1 of the Wisconsin-Madison protocol.
What is the dosage of L-Asparaginase in Week 1 of the Wisconsin-Madison protocol?
The dosage of L-Asparaginase is 400 IU/kg IM or SC in Week 1 of the Wisconsin-Madison protocol.
How often is Prednisolone administered in Week 1 of the Wisconsin-Madison protocol?
Prednisolone is administered every 24 hours in Week 1 of the Wisconsin-Madison protocol.
What medication is given in Week 2 of the Wisconsin-Madison protocol?
Cyclophosphamide is given in Week 2 of the Wisconsin-Madison protocol.
What is the dosage of Prednisolone in Week 2 of the Wisconsin-Madison protocol?
The dosage of Prednisolone is 1.5 mg/kg PO every 24 hours in Week 2 of the Wisconsin-Madison protocol.
How often is Vincristine administered in Week 3 of the Wisconsin-Madison protocol?
Vincristine is administered once during Week 3 of the Wisconsin-Madison protocol.
What is the dosage of Prednisolone in Week 3 of the Wisconsin-Madison protocol?
The dosage of Prednisolone is 1 mg/kg PO every 24 hours in Week 3 of the Wisconsin-Madison protocol.
What medication is given in Week 4 of the Wisconsin-Madison protocol?
Doxorubicin is given in Week 4 of the Wisconsin-Madison protocol.
What is the dosage of Prednisolone in Week 4 of the Wisconsin-Madison protocol?
The dosage of Prednisolone is 0.5 mg/kg PO every 24 hours in Week 4 of the Wisconsin-Madison protocol.
How often is Vincristine administered in Week 6 of the Wisconsin-Madison protocol?
Vincristine is administered once during Week 6 of the Wisconsin-Madison protocol.
What medication is given in Week 7 of the Wisconsin-Madison protocol?
Cyclophosphamide is given in Week 7 of the Wisconsin-Madison protocol.
How often is Vincristine administered in Week 8 of the Wisconsin-Madison protocol?
Vincristine is administered once during Week 8 of the Wisconsin-Madison protocol.
What medication is given in Week 9 of the Wisconsin-Madison protocol?
Doxorubicin is given in Week 9 of the Wisconsin-Madison protocol.
How often is Vincristine administered in Week 11 of the Wisconsin-Madison protocol?
Vincristine is administered once during Week 11 of the Wisconsin-Madison protocol.
What medication is given in Week 13 of the Wisconsin-Madison protocol?
Cyclophosphamide is given in Week 13 of the Wisconsin-Madison protocol.
How often is Vincristine administered in Week 15 of the Wisconsin-Madison protocol?
Vincristine is administered once during Week 15 of the Wisconsin-Madison protocol.
What medication is given in Week 17 of the Wisconsin-Madison protocol?
Doxorubicin is given in Week 17 of the Wisconsin-Madison protocol.
How often is Vincristine administered in Week 19 of the Wisconsin-Madison protocol?
Vincristine is administered once during Week 19 of the Wisconsin-Madison protocol.
What medication is given in Week 21 of the Wisconsin-Madison protocol?
Cyclophosphamide is given in Week 21 of the Wisconsin-Madison protocol.
How often is Vincristine administered in Week 23 of the Wisconsin-Madison protocol?
Vincristine is administered once during Week 23 of the Wisconsin-Madison protocol.
What medication is given in Week 25 of the Wisconsin-Madison protocol?
Doxorubicin is given in Week 25 of the Wisconsin-Madison protocol.
What is the recommended dose range for Vincristine?
The recommended dose range for Vincristine is 0.5-0.7 mg/m2.
What dose of Vincristine is typically used for feline protocols?
For feline protocols, the lower end of the dose, 0.5 mg/m2, is typically used.
What medication can be substituted for vincristine in cases of GI toxicity?
Vinblastine can be substituted for vincristine at a dosage of 1.8 mg/m2 IV.
What medications are included in the LPV maintenance protocol?
The LPV maintenance protocol includes Vincristine, Chlorambucil, and Prednisolone.
How often is Vincristine administered in the LPV maintenance protocol?
Vincristine is administered every 2 weeks in the LPV maintenance protocol.
What is the dosage of Chlorambucil in the LPV maintenance protocol?
The dosage of Chlorambucil is 20 mg/m2 PO every 2 weeks in the LPV maintenance protocol.
How often is Prednisolone administered in the LPV maintenance protocol?
Prednisolone is administered every 48 hours in the LPV maintenance protocol.
When is the LP maintenance protocol used?
The LP maintenance protocol is used for intermediate/high grade LSA, low grade alimentary LSA, chronic lymphocytic leukaemia, and feline multiple myeloma.
What medications are included in the LP maintenance protocol?
The LP maintenance protocol includes Chlorambucil and Prednisolone.
What medications are used for rescue protocols for high-grade lymphoma?
Lomustine, Prednisolone, and L-asparaginase can be used for rescue protocols for high-grade lymphoma.
What is the initial dosage of Lomustine for rescue of high grade LSA?
The initial dosage of Lomustine is 40-50 mg/m2 PO or 1.5 mg/kg for rescue of high grade LSA.
What medication can be added if desired effect is not reached with Lomustine?
If desired effect is not reached after 1-2 doses of Lomustine, dose escalation can be done within the range.
What is the recommended dosage of Actinomycin D in the DMAC rescue protocol?
The recommended dosage of Actinomycin D is 0.5 mg/m2 IV in the DMAC rescue protocol.
What is the dosage of Cytarabine in the DMAC rescue protocol?
The dosage of Cytarabine is 250 mg/m2 IV infusion over 4-6 hours in the DMAC rescue protocol.
When can Chlorambucil be added in the DMAC rescue protocol?
Chlorambucil can be added on Day 10 or Day 15 in a 3-week cycle of the DMAC rescue protocol.
What is the dosage of Chlorambucil in the DMAC rescue protocol?
The dosage of Chlorambucil is 20 mg/m2 PO in the DMAC rescue protocol.
What is the dosage of Dexamethasone in the DMAC rescue protocol?
The dosage of Dexamethasone is 1 mg/kg PO or SC once weekly in the DMAC rescue protocol.
What is the length of treatment in the DMAC rescue protocol?
The length of treatment in the DMAC rescue protocol is until relapse, with a minimum of 5 cycles if complete remission is achieved.
What medication is given first in the MiCC rescue protocol?
Mitoxantrone is given first in the MiCC rescue protocol.
What is the dosage of Mitoxantrone in the MiCC rescue protocol?
The dosage of Mitoxantrone is 4-4.5 mg/m2 IV in the MiCC rescue protocol.
What is the dosage of Cytarabine in the MiCC rescue protocol?
The dosage of Cytarabine is 250 mg/m2 IV infusion over 4-6 hours in the MiCC rescue protocol.
When can Cytarabine be added in the MiCC rescue protocol?
Cytarabine can be added on Day 8 or Day 15 in the MiCC rescue protocol.
What is AgNor?
AgNor is silver staining of nucleolar organising regions.
What is the significance of increased AgNor counts?
Increased AgNor counts are associated with increased risk of local recurrence, distant metastasis, and MCT-related death.
How is the Ag67 index assessed?
The Ag67 index is assessed by multiplying AgNor count with Ki-67 value using the grid area technique.
What is the cut-off value for the Ag67 index indicative of a poorer prognosis?
A cut-off value of >54 is indicative of poorer prognosis.
What is the KIT gene?
The KIT gene is a tyrosine kinase receptor for the haematopoietic growth factor stem cell factor (SCF).
What percentage of canine MCT have mutations in the KIT gene?
Around 20-40% of canine MCT have mutations in the KIT gene.
Describe the mutations in the KIT gene in canine MCT.
Mutations in the KIT gene in canine MCT are usually tandem duplications in exon 11, with activating mutations in exons 8 and 9 also reported.
What is the prognosis for canine MCT possessing KIT gene mutations?
Canine MCT possessing KIT gene mutations have a poorer prognosis than those with normal KIT.
What are receptor tyrosine kinase inhibitors (RTKIs) designed to do?
RTKIs are designed to inhibit signaling through the KIT receptor.
What tests can be performed to identify KIT gene mutations?
PCR test for exon 8, 9, and 11 mutations and full KIT gene sequencing are available.
What is the association between abnormal subcellular localization of KIT and prognosis?
Abnormal subcellular localization of KIT, as assessed by immunohistochemistry, is associated with a poorer prognosis.
What is the sensitivity of MCT to radiation treatment?
MCT is sensitive to radiation treatment.
In what situations can radiation treatment be used as the primary treatment modality?
Radiation treatment can be used as the primary treatment in sites where surgery is not possible.
What are the control rates when radiation is used as the sole therapy for bulky MCT?
One year control rates are around 50%.
How is radiation used in the adjuvant setting?
Radiation is used in the adjuvant setting following incomplete resection of a primary mass when the disease is localized.
What should be included in the field of irradiation to prevent recurrence?
The field of irradiation should include at least 3 cm around the surgical scar as a minimum.
What are the preferred radiation protocols for MCT?
Hyperfractionated or definitive radiation protocols are preferred.
What are the acute adverse effects of radiation treatment?
Acute adverse effects include erythema of the skin, moist desquamation, and hair loss.
What can be used to alleviate acute adverse effects of radiation treatment?
Analgesics, topical steroid cream, and antibiotics may be required to alleviate the acute adverse effects.
When do the adverse effects of radiation treatment usually occur?
The adverse effects usually occur towards the end of the treatment course and settle down within 2-4 weeks of completing radiation treatment.
What are the late adverse effects of radiation treatment?
Late adverse effects may include skin fibrosis and the skin remaining alopecic or growing back white.
What are the two types of radiation protocols used for MCT?
Hyperfractionated (definitive) and coarsely fractionated (hypofractionated / palliative) protocols are used.
What are the control rates for incompletely excised low to intermediate grade MCT treated with hyperfractionated radiation protocols?
Two-year control rates of 85-90% can be achieved.
What is the efficacy of coarsely fractionated radiation protocols?
Limited information exists about the efficacy of coarsely fractionated radiation protocols.
What is the characteristic skin response to radiation treatment?
The skin may remain alopecic, or sometimes the hair grows back white.
What are the serious late effects of radiation treatment?
Serious late effects are not mentioned in the course notes.
What is the recommended dosage of cimetidine for a large-sized dog?
4-5.5 mg/kg PO or IV q 6-8 hours.
Which drug is a proton pump inhibitor used to inhibit acid secretion?
Omeprazole.
What are some ancillary drugs used for cases with active evidence of gastrointestinal ulceration?
Sucralfate and occasionally misoprostol.
When should ancillary drugs be used?
When systemic signs of illness are present, the tumour is likely to be incised or extensively manipulated at surgery, or when treatment is undertaken where gross disease will remain and tumour degranulation is likely to occur in situ.
How can canine mast cell tumours be cured?
With well-planned surgery with wide margins.
When is radiation therapy useful for canine mast cell tumours?
For localised disease and most commonly in the adjuvant setting for microscopic residual disease.
When is systemic drug therapy generally reserved for?
High grade or metastatic tumours, or for those tumours where surgery and radiation treatment is not possible.
What are possible treatment options for canine MCT?
Conventional cytotoxic chemotherapy and RTKIs.
When may ancillary therapy be required for MCT?
To treat the systemic effects of MCT.
What are some suggested sources for further reading on mast cell tumours?
Book chapters: Mast cell tumour, London, CA. In Kirk’s Current Veterinary Therapy XIV 2009 pp373-377, Mast cell tumors, Thamm, D. and Vail, D. In Withrow and McEwen’s Small Animal Clinical Oncology (2013) pp335-346, Mast cell tumors, McCaw, D. In Cancer Management in Small Animal Practice (2010) Henry C and Higginbotham, ML., Saunders Elsevier pp317-325. Selected Papers: Cooper, M, Tsai, X and Bennett, P. Combination CCNU and vinblastine chemotherapy for canine mast cell tumours: 57 cases. Veterinary and Comparative oncology (2009), 7, 196- 206, Hahn et al. Masitinib is safe and effective for the treatment of canine mast cell tumours. Journal of Veterinary Internal Medicine (2008), 22 1301-1309, London, CA et al. Multi-center placebo controlled, double-blind, randomised study of oral toceranib phosphate (SU11654), a receptor tyrosine kinase inhibitor, for the treatment of dogs with recurrent (either loal or distant) mast cell tumor following surgical excision. Clinical cancer research 2009, 15, 3856-3865, Maglennon et al. Association of Ki-67 index with prognosis for intermediate grade canine cutaneous mast cell tumours Veterinary and Comparative Oncology (2008) 6: 268-274) Rassnick, KM, Bailey, DB, Russel DS et al A phase II study to evaluate the toxicity and efficacy of alternating CCNU and high-dose vinblastine and prednisolone (CVP) for treatment of dogs with high-grade, metastatic or nonresectable mast cell tumours Veterinary and Comparative oncology (2010), 8, 138-152 Romansik, EM, Reilly, CM, Kass, PH, Moore, PF and London CA Mitotic index is predictive for survival for canine cutaneous mast cell tumours Veterinary Pathology (2007), 44, 335- 341 Taylor, F, Gear, R, Hoather, T and Dobson J. Chlorambucil and prednisolone for the dogs with inoperable mast cell tumours: 21 cases Journal of Small Animal Practice (2009) 50, 284- 289.
What is the most common primary bone neoplasia in dogs?
Osteosarcoma (OSA).
What is the recommended treatment for hepatoprotective agents if ALT reaches >5x the top of normal range?
Treatment should be stopped.
What adverse effect is rarely reported with lomustine?
Nephrotoxicity
How often can the drugs be alternated in the adjuvant setting with no gross disease?
Every 2 weeks
What combination of drugs have shown promising results for canine MCT in a study by Cooper et al 2009?
Vinblastine and lomustine
How many dogs with MCT were treated in the study by Cooper et al 2009?
56
What is the grade distribution of the 37 dogs with gross disease in the Cooper et al 2009 study?
46% grade III and 32% high risk grade II
What was the overall progression free survival for responding animals in the Cooper et al 2009 study?
52 weeks
What was the median progression free survival time for twenty dogs with microscopic disease in the Cooper et al 2009 study?
35 weeks
What drugs were used in the adjuvant setting for high risk MCT in the study by Rassnsick et al. (2010)?
Vinblastine and lomustine
What was the overall median progression free survival time in the study by Rassnsick et al. (2010)?
489 days
What was the progression free survival time for dogs with grade III tumors in the study by Rassnsick et al. (2010)?
190 days
What is the chlorambucil and prednisolone protocol for canine MCT (Taylor et al 2009)?
Chlorambucil 5mg/m2 every other day, Prednisolone 40 mg/m2 for 14 days and then at 20 mg/m2 thereafter
How often is CBC recommended with the chlorambucil and prednisolone protocol (Taylor et al 2009)?
Q 4-6 weeks
Which two receptor tyrosine kinase inhibitors have been licensed to treat canine MCT?
Masitinib (Masivet®, AB Science) and toceranib (Palladia®, Zoetis)
What are the current license agreements for masitinib (Masivet®)?
For the treatment of dogs with non-resectable mast cell tumours (grade 2 or 3) with a confirmed mutated c-kit tyrosine kinase receptor
What is the recommended dosage for masitinib (Masivet®)?
12.5 mg/kg daily PO
What are the current license agreements for toceranib (Palladia®)?
Treatment of non-resectable Patnaik grade II (intermediate grade) or grade III (high grade), recurrent cutaneous mast cell tumours
What is the recommended starting dose for toceranib (Palladia®)?
2.75 mg/kg every other day
Which type of MCT do receptor tyrosine kinase inhibitors (RTKIs) work best in?
MCT that possess mutated KIT and aberrant, constitutively activated KIT receptors
What was the overall response rate in toceranib-treated dogs in the initial clinical trial?
37.20%
What was the overall response rate in toceranib-treated responders when including all treated dogs?
42.80%
What is the relationship between measuring total calcium and serum albumin?
Measuring total calcium needs to be done in relationship to serum albumin.
What is responsible for hypercalcaemia in patients with primary hyperparathyroidism?
Excess production of parathyroid hormone is responsible for hypercalcaemia in primary hyperparathyroidism.
How can the excess production of parathyroid hormone in primary hyperparathyroidism be confirmed?
Checking the level of parathyroid hormone in circulation can confirm the excess production.
What are the common mechanisms of paraneoplastic hypercalcaemia?
Focal bone destruction and humoral paraneoplastic syndrome are common mechanisms.
How does focal bone destruction contribute to paraneoplastic hypercalcaemia?
Tumour cells infiltrating bone secrete paracrine factors that increase bone resorption.
What is the most common factor involved in humoral hypercalcaemia of malignancy?
Parathormone-related peptide (PTHrP) is the most common factor.
What is the multifactorial pathogenesis of humoral hypercalcaemia?
PTHrP can act on target cells in bone, kidney, and intestines, leading to hypercalcaemia.
What are the effects of PTHrP on bone, kidney, and intestines?
PTHrP stimulates bone resorption, increases renal tubular calcium resorption, and converts inactive vitamin D to active vitamin D.
What is the associated malignancy with humoral hypercalcaemia?
Carcinomas and sarcomas are associated with humoral hypercalcaemia.
How can hypercalcaemia be treated as a medical emergency?
Identify the underlying cause and consider fluid therapy, prednisolone, bisphosphonates, and calcitonin.
How does fluid therapy help in treating hypercalcaemia?
Fluids expand the intravascular volume and can be used in conjunction with furosemide to enhance calcium excretion.
What is the role of prednisolone in reducing hypercalcaemia?
Prednisolone is effective against hypercalcaemia caused by lymphoid tumours but not solid tumours.
How do bisphosphonates treat hypercalcaemia?
Bisphosphonates inhibit bone resorption and are effective against hypercalcaemia with skeletal metastases.
What is the action of calcitonin in treating hypercalcaemia?
Calcitonin inhibits osteoclast-mediated bone resorption and promotes urinary calcium excretion.
When is calcitonin used in treating hypercalcaemia?
Calcitonin is used only in the acute setting due to tachyphylaxis within a few days.
When is tumour lysis syndrome (TLS) commonly seen in veterinary medicine?
TLS is rarely seen, but when encountered, it is usually in patients with acute leukaemia or late-stage lymphoma.
What is recommended for pain management in patients undergoing surgery?
A multimodal analgesic plan, including a combination of NSAIDs and opioids.
Which analgesic medications are recommended for temporary pain relief in patients undergoing surgery?
NSAIDs and opioids, such as tramadol or a fentanyl transdermal patch.
What type of analgesics can be administered to patients in the hospital with high levels of pain?
Intravenous opioids can be administered.
What types of loco-regional anesthesia techniques can be considered for patients with high levels of pain?
Epidural catheter or plexus block.
What is recommended for pain management when the client declines surgery?
Pain management must be the clinician’s goal.
What can be used as a fast and effective method to control pain in patients with bone destruction?
Hypo fractionated or palliative radiation therapy.
What is the recommended total dose of radiation therapy for pain control in osteosarcoma?
A total dose of 32Gy (one 8Gy weekly session for 4 weeks) combined with oral analgesics is recommended.
Which medications can be administered in combination with bisphosphonates to increase bone density?
NSAIDs, opioids, gabapentin, and/or amantadine.
What is the most commonly used bisphosphonate in veterinary medicine?
Pamidronate.
How should alendronate be administered in dogs?
10 mg/dog once daily in the mornings, 30 minutes before any meal.
What is the recommended dosage of pamidronate in dogs?
Between 1.0 and 2.0 mg/kg, given as an intravenous infusion, once a month.
What treatment modality is considered the most effective for the management of osteolytic bone pain in dogs?
Hypo fractionated or palliative radiation therapy (RT) protocols.
How many fractions of radiation therapy are commonly used for the management of bone cancer pain?
2 to 4 weekly fractions of 8-9 Gy.
What is the reported median time of disease control with radiation therapy?
53 to 130 days.
What accumulative dosages of radiation therapy have shown to increase progression free intervals?
57 Gy obtained with hyper fractionated radiation protocols, or 70Gy with intraoperative extracorporeal radiation.
What adverse effects are associated with bisphosphonates?
Uncommon, with only gastrointestinal adverse effects being described.
What is the most common subtype of feline lymphoma?
The most common subtype of feline lymphoma is low grade lymphoma.
What percentage of feline lymphomas are low grade lymphomas?
Low grade lymphoma accounts for 10-13% of all feline lymphomas.
What is the percentage of low grade lymphoma in the alimentary form?
In the alimentary form, low grade lymphoma can range from 37-75% depending on the study.
How can low grade lymphoma be diagnosed?
Low grade lymphoma requires a biopsy for diagnosis, while other forms can be diagnosed by cytology.
What is the least common subtype of AL?
The LGLL form is the least common subtype of AL, comprising 6-7% of cases.
What staining technique is required to visualize azurophilic granules in LGLL?
Special staining is often required to visualize the azurophilic granules with granzyme A in LGLL.
What is the association between LSA immunophenotype and location within the GI tract?
There is a strong association between LSA immunophenotype and location within the GI tract.
Which type of lymphoma predominates in the stomach and large intestine?
B cell lymphoma predominates in the stomach and large intestine.
Where are T cell lymphomas most common?
T cell lymphomas are most common in the small intestine.
What is the suggested origin of T cell lymphomas?
T cell lymphomas arise from the diffused mucosa associated lymphoid tissue (MALT) of the small intestine.
What are the common phenotypic markers of neoplastic LGLs and intraepithelial lymphocytes in cats?
Neoplastic LGLs and intraepithelial lymphocytes in cats are CD3+, CD8αα+, CD103+.
What is the suggested risk factor for T cell AL lymphoma?
Chronic intestinal inflammation is a suggested risk factor for T cell AL lymphoma.
What are the common clinical presentations of LGAL?
Weight loss, vomiting, diarrhea, anorexia, lethargy, and polydipsia are common clinical presentations of LGAL.
What are the common findings on non-invasive tests for gastrointestinal diseases?
Lymphoplasmacytic enteritis (LPE) is a major differential diagnosis for LGAL.
What are the possible treatments for metastatic disease in bones?
Radiotherapy, bisphosphonates, and medical pain therapy
What are the radiographic features of aggressive bone lesions?
Bone lysis pattern, cortical destruction, solid pattern, extensive and ill-defined periosteal reaction
What are the radiographic features of non-aggressive bone lesions?
Mottled or geographic bone lysis pattern, continuous and smooth borders, well-defined periosteal reaction, and a discontinuous pattern
What is the flow chart for the diagnosis, treatment, and prognosis of canine appendicular osteosarcoma?
Bone lesions with radiographic appearance of primary bone neoplasia, clinical signs, history, and location consistent with osteosarcoma (OSA), presumptive diagnosis of OSA± bone biopsy, staging (thoracic radiographs or Computed Tomography), presence or absence of metastases, curative or palliative treatment options, and amputation and chemotherapy with or without biphosphonates
What are the analgesic drugs and dosages for pain palliation in dogs with OSA?
NSAIDs: Robenacoxib (1-2 mg/kg PO q 24h), Carprofen (4 mg/kg PO q 24h or 2mg/Kg PO q 12h), Meloxicam (0.1 mg/kg PO q 24 h), Piroxicam (0.3 mg/kg PO q 48 h), Deracoxib (1-2 mg/kg PO q24 h), Aspirin (10 mg/kg PO q 12h); Opioids: Morphine (0.2–0.5 mg/kg IV q 4h), Methadone (0.2-0.5 mg/kg IV q 4h), Fentanyl (1-5microgr/Kg/h (CRI)); Tramadol (2-4mg/kg PO q 8-12h); Amitriptyline (1-2 mg/kg PO q 12 h); Gabapentin (2-10 mg/kg q 12 h); Amantadine (3-5 mg/kg q 24 h)
What are the outcomes with common chemotherapeutic protocols for canine appendicular OSA?
Carboplatin: Median survival time of 137-256 days, progression-free interval of 277-307 days, 36-37% 1-year survival rate, 19-22% 2-year survival rate; Doxorubicin: Median survival time of 366 days, 35% 1-year survival rate, 9% 2-year survival rate; Doxorubicin & Carboplatin: Median survival time of 227 days, 48% 1-year survival rate, 18% 2-year survival rate
What neoplasms are commonly associated with hypercalcaemia of malignancy in dogs?
Canine lymphoma (often T-cell lymphoma), multiple myeloma, anal sac adenocarcinoma, and squamous cell carcinoma
What are the symptoms associated with hypercalcaemia in patients?
Polyuria/polydipsia, nausea/vomiting, constipation, and disorientation
What is the most common cause of elevated calcium levels?
Laboratory error
What is the definition of low grade lymphomas?
Low grade lymphomas are those with cells that resemble normal lymphoid cells and have a low proliferation rate.
What is the definition of high grade lymphomas?
High grade lymphomas comprise populations of immature cells with clear malignant features and high mitotic index.
How can canine lymphoma be classified according to the World Health Organisation (WHO)?
Canine lymphoma can be classified based on assessment of morphological features of malignant cells and their tissue distribution in hematopoietic organs.
How can the grade and immunophenotype of lymphoma be obtained?
The grade can be obtained through morphologic WHO classification, and the immunophenotype can be obtained with immunohistochemistry or flow cytometry.
What is a common method for diagnosing lymphoma?
Diagnosis often relies on a cytologic specimen as it is cheaper and provides quick results.
What information can be obtained with a cyto-morphologic interpretation and immunophenotype?
Important prognostic information can be obtained, including the type of lymphoma and likely outcomes of treatment.
What are the methods used for obtaining immunophenotype in lymphoma diagnosis?
Immunohistochemistry on biopsy samples, immunocytochemistry on cytologic specimens, or flow cytometry using fine needle aspirates can be used.
What does flow cytometry provide in lymphoma diagnosis?
Flow cytometry provides immunophenotype information and a comprehensive panel of lymphoid surface receptors present in the neoplastic population.
What is PARR in lymphoma diagnosis?
PARR (PCR for antigen receptor rearrangement) can inform about B versus T-cell type, but its accuracy is approximately 70%.
How does the biological behavior of B-cell and T-cell lymphomas differ?
B-cell and T-cell lymphomas with low or high grade have different biological behavior and prognosis.
What is the classification and prognosis of high grade T-cell LSAs?
High grade T-cell LSAs are often classified as peripheral T cell lymphomas (PTCL) and have an aggressive clinical course with median survival times of 159 days.
What is the prognosis of low-grade multicentric T-cell LSAs?
Low-grade multicentric T-cell LSAs, such as T-zone LSA, have an indolent behavior and a fair prognosis with median survival times of 637 days.
What is the most common morphological type of multicentric LSA?
The most common morphological type of multicentric LSA is diffuse large B-cell LSA (DLBCL).
What is the prognosis for dogs with DLBCL treated with CHOP?
The reported median remission times for dogs with DLBCL treated with CHOP are 254 days.
What type of drugs are used peri-operatively for mast cell tumors?
Anti-histamine drugs (e.g. chlorpheniramine)
What are the signs of degranulation in mast cell tumors?
Oedema, erythema, bruising
How should multiple mast cell tumors be treated?
Each tumor should be treated individually with wide excision
What should be assessed for each mast cell tumor?
Margins, grade, and MI (mitotic index)
What is the prognosis for multiple cutaneous tumors compared to a single tumor?
Prognosis is usually not worse
When is drug therapy indicated for mast cell tumors?
In cases with very large numbers of tumors or cases with metastatic disease
What should be removed to achieve good local control of metastatic lymph nodes?
Metastatic lymph nodes
What treatment may be sufficient for grade II tumors with low MI and LN spread but no evidence of metastasis elsewhere?
Good local control
What information should be extracted from the MCT pathology report?
Histological grade, surgical margins, mitotic index
How can MCT be graded?
According to the Patnaik system (grade I: well-differentiated, grade II: intermediate differentiation, grade III: poorly differentiated)
What should be considered for grade II tumors with a high mitotic index?
Systemic therapy
What is the risk of recurrence or metastasis for most completely excised grade I and grade II tumors?
Low (<10% for grade I, <20% for grade II)
What should be done for grade I or grade II tumors with low mitotic index and incomplete surgical margins?
Revision surgery with histopathological review
What should be considered when further surgery or radiation therapy is not possible or declined?
Systemic drug treatment
What is the risk of recurrence and metastasis for high grade MCT with complete margins?
Moderate risk of recurrence, high risk of metastasis
What is indicated for high grade MCT with incomplete margins?
Additional local therapy and systemic therapy
Do all incompletely resected MCTs recur?
Not all, but they frequently do
What should be done when recurrent MCTs occur?
Review the situation and pursue further treatment straight away
What can mast cell tumors secrete that affects mast cells?
Chemotactic factors for normal mast cells
What is the recommended dosage of Cyclophosphamide for a 3-week cycle?
200-250 mg/m² PO.
What is the recommended dosage of Cyclophosphamide for rescuing low-grade (intestinal) lymphoma?
200-250 mg/m² PO q 2 weeks.
What is the recommended dosage of Prednisolone for rescuing low-grade (intestinal) lymphoma?
20 mg/m² PO every 48 hours.
What is the most common type of skin tumor seen in dogs?
Mast cell tumors.
What percentage of skin tumors do mast cell tumors represent in dogs?
13-20%.
What can mast cell tumor cases frequently pose for vets in practice?
A challenge.
What is important to have in order to create an appropriate treatment plan for canine mast cell tumors?
A sensible diagnostic plan.
What are the different treatment options discussed for canine mast cell tumors?
Surgery, radiation treatment, and drug treatment (chemotherapy and receptor tyrosine kinase inhibitors).
What will be included in the lecture regarding canine mast cell tumor treatment?
Information on using the pathology report to guide treatment decisions.
What are the learning outcomes of the lecture on canine mast cell tumors?
To possess a logical approach to diagnosing, staging, and treating canine mast cell tumors.
What is the first step in diagnosing mast cell tumors in dogs?
Palpating and assessing masses for size, texture, and degree of invasion.
What can mast cell tumors feel like when they occur in subcutaneous tissues?
Like a lipoma.
In what percentage of dogs can multiple mast cell tumors be present?
Around 9%.
What is recommended for any lumps and bumps on dogs?
Fine needle aspirates.
What does cytology typically reveal in mast cell tumor cases?
Large, round cells with a central nucleus and basophilic cytoplasmic granules.
What can be used as a special stain to highlight mast cell granules?
Toluidine blue.
When should the drainage lymph node be aspirated in mast cell tumor cases?
Whenever possible to rule out early metastasis.
Is staging necessary for every mast cell tumor case?
No, it may be unnecessary for the majority of cases.
What factors can be helpful in determining whether further staging is needed in mast cell tumor cases?
Histological grade, rapid growth or tumor ulceration, and clinical stage.
Which grade of mast cell tumors are more likely to behave aggressively and metastasize?
Grade III tumors and grade II tumors with a high mitotic index.
What does lymph node metastasis indicate in mast cell tumor cases?
The need for screening for more metastases.
What chemotherapy drug is commonly used for high-grade lymphomas in dogs?
Doxorubicin
What are the characteristics of high-grade lymphomas in dogs?
High mitotic index, rapid progression, frequently B-cell phenotype
How do high-grade lymphomas in dogs respond to chemotherapy?
They respond rapidly and go into remission in a short period of time
Why is it recommended to use chemotherapy protocols with several drugs for high-grade lymphomas in dogs?
To prevent the development of resistance due to the high potential for mutations
What are the characteristics of low-grade lymphomas in dogs?
Low mitotic index, less common (5-29%), commonly of T-cell origin
How do low-grade lymphomas in dogs respond to chemotherapy?
They do not respond rapidly regardless of aggressive protocols, and remission can take several weeks or may never be completely achieved
What is the most common form of presentation for canine lymphoma?
Multicentric form with peripheral lymphadenopathy
What is the clinical stage of lymphoma associated with in dogs?
The prognosis of the disease
What are the clinical signs seen in dogs with substage b of multicentric lymphoma?
Lethargy, anorexia, vomiting, weight loss, etc.
What are the common sites of lymphoma spread in dogs with multicentric lymphoma?
Lungs (30%) and abdominal organs (50%, normally spleen and/or liver)
What type of lymphoma has poor survival times with CHOP-type chemotherapy protocols including doxorubicin in dogs?
Alimentary lymphoma
Why is the management of treatment in dogs with alimentary lymphoma often difficult?
Gastrointestinal symptoms caused by the disease and chemotherapy overlap, with digestive tracts already damaged
How does the prognosis change if lymphoma is confined to the large bowel in dogs?
Excellent with chemotherapy, median remission periods of 1318 days and MSTs of 1845 days
What chemotherapy protocols are commonly used for gastrointestinal lymphoma in dogs?
COP or CHOP, with no difference in efficacy
What therapy has been shown to have good response rates and median survivals for low-grade diffuse gastrointestinal lymphoma in dogs?
Oral therapy with alkylating agents like chlorambucil, cyclophosphamide, or lomustine
What is the presentation of cutaneous epitheliotropic LSA in dogs?
Diffuse skin involvement with peripheral lymphadenopathy
What chemotherapy treatment has longer-lasting responses in dogs with cutaneous epitheliotropic LSA?
Single agent oral lomustine and prednisolone
What is the response rate of dogs with activating mutations in the KIT gene to toceranib?
60%
What is the most common adverse effect of drugs used to treat mast cell tumors?
Gastro-intestinal problems
What are the common gastro-intestinal problems associated with the use of drugs for mast cell tumors?
Diarrhoea, vomiting, inappetence
What type of adverse effect can occur with RTKIs?
Myelosuppression
What are some symptoms of myelosuppression?
Neutropenia, thrombocytopenia, anaemia
What type of adverse effect has been reported with toceranib?
Muscle cramping
What effects can histamine have on the stomach?
Stimulating acid production, hyperacidity, gastritis, gastric ulceration
What can be used to ameliorate the effects of histamine?
H1 blockers
What are some examples of H1 blockers?
Diphenhydramine, chlorphenamine
What preliminary reports suggest the activity of masitinib against?
T-cell lymphoma, anal sac adenocarcinoma, melanoma, metastatic osteosarcoma, haemangiosarcoma
When should an RTKI be used for mast cell tumors?
Unknown, further research needed
Can RTKIs be combined with conventional chemotherapy drugs for MCT?
Preliminary data suggests possibility
For how long can masitinib be safely used in dogs with MCT?
Preliminary data suggests up to 2 years
What are some potential unanswered questions about RTKIs?
Use in post-operative setting, role in high-risk MCT, duration, other tumor types
What should be monitored during RTKI treatment?
Complete blood counts, serum biochemistry, urinalysis
What is the median survival time with hypo fractionated protocols?
122-313 days
What is the median survival time with hyper fractionated or intraoperative protocols?
209-598 days
What is the general effect of radiation therapy on local disease?
Shorter progression free intervals
What is the general effect of radiation therapy on bone pain?
Limited management
What is the recommended surgical treatment for OSA?
Amputation or limb-sparing surgery
What is the goal of surgical treatment?
Complete excision of the primary tumor and achieving local control
Why is cosmetic result considered important in forequarter amputation?
Avoiding scapular muscle atrophy
What is the preferred technique for pelvic limb amputation and why?
Coxofemoral disarticulation, because it achieves wide or radical surgical margins
What surgical technique is preferred for tumours in the proximal femur?
Limb amputation with block acetabulectomy or hemipelvectomy
How long does it typically take for dogs to adapt following limb amputation?
4 weeks
What are some complications associated with limb amputation?
Intraoperative air emboli, inadvertent penetration of the thoracic cavity, infection, phantom limb syndrome, intraoperative hemorrhage and postoperative seroma
What are some complications associated with limb-sparing surgery?
Infection, implant failure, local recurrence
When is limb sparing surgery indicated?
When there is a concomitant neurological or orthopaedic condition, previous amputation of another limb, or when owners decline amputation
What criteria should limb sparing surgery candidates fulfill?
Well defined tumor with minimal extension into adjacent soft tissues, no evidence of pathologic fracture, and bone involvement less than 50% of its length
What are some challenges of postoperative care for limb-sparing surgery patients?
High risk of complications, cost of the procedure, and postoperative management
What is the median progression free interval (PFI) reported in a study with 119 cases of I/HGAL?
57 days
What is the median survival time (MST) reported in a study with 119 cases of I/HGAL?
97 days
What is the PFI and MST for cats with complete remission (CR) in the study with 119 cases of I/HGAL?
PFI of 205 days and MST of 318 days
What is the PFI in cats with AL treated with a COP protocol?
50 days
What is the PFI in cats with AL achieving complete remission (CR) treated with a COP protocol?
210 days
Does surgical resection of an intestinal mass prior to chemotherapy improve survival time in COP-treated cats?
No
What is the response rate and median duration of remission associated with rescue protocols (e.g., CCNU, MOPP) in cats with AL?
50% response rate and 1.5–2 months median duration of remission
What is the overall response rate to COP or CHOP type protocols in cats with LGLL?
30%
What is the median survival time (MST) in cats with LGLL treated with a combination of prednisolone and either chlorambucil, cyclophosphamide, or lomustine?
137 days
Which type of chemotherapy is currently favored over IV chemotherapy for cats with poor responses to COP or CHOP type protocols?
Alkylating agents
What was the overall MST and MST post-radiation therapy in cats with AL (6 LGAL, 4 I/HGAL, 1 LGLL) treated with whole-abdomen radiation?
Overall MST of 355 days and MST post-radiation therapy of 214 days
What were the recommended treatments for cats presenting acutely with AL?
IV fluid therapy, blood products if needed, antimicrobials, antiemetics, and treatment for GI ulceration if suspected
What are the potential appetite stimulants that might be helpful for cats with poor appetite?
Mirtazapine or cyproheptadine
What are the possible dietary modifications for cats with concurrent LPE or dietary intolerance?
Gluten-free with a novel protein or hydrolyzed diet, with a single-source and highly digestible carbohydrate component
Which supplements should be considered for cats with folate and cobalamin deficiency?
Folate and cobalamin supplements
What are some treatment options for locally confined tumours?
Radiation therapy to the local site or surgical resection.
What is the potential duration of progression-free survival for cats with intranasal lymphoma treated with radiation and chemotherapy?
945 days.
What is the percentage of cats that had local recurrence after treatment for intranasal lymphoma?
23%.
What is the negative prognostic factor found in cats with intranasal lymphoma?
Involvement of the cribriform plate.
What is the most important part of the therapy for LSA in cats?
Systemic therapy.
What is the median duration of remission for cats with high grade or large cell LSA treated with chemotherapy?
7-9 months.
What percentage of cats with high grade or large cell LSA can be expected to live beyond one year?
20-30%.
How do FeLV positive cats respond to the myelosuppressive side effects of chemotherapy for LSA?
They tend to be more sensitive.
What is the recommended therapy for true mediastinal lymphoma?
Combination chemotherapy with COP therapy.
What is the reported median survival time for cats with true mediastinal lymphoma treated with COP?
373 days.
What are the better outcomes in response to treatment for renal lymphoma?
Solitary kidney involvement.
What is the association of spinal lymphoma with renal primary disease?
Spinal lymphoma has been noted to occur in cats with renal lymphoma.
What is the recommended initial chemotherapy for renal lymphoma in cats with poor renal function?
Prednisone or dexamethasone, l-asparginase, and vincristine.
What drugs should be added to chemotherapy for renal lymphoma when renal function is improved?
Cyclophosphamide and doxorubicin.
What is one of the longest survival durations observed in feline lymphoma?
Up to 4 years from diagnosis.
What are some common clinical signs of spinal lymphoma in cats?
Posterior paresis and severe pain.
What is the recommended treatment for spinal lymphoma in cats?
Chemotherapy with focal radiation therapy.
When is surgical decompression helpful in treating spinal lymphoma?
When cats are diagnosed with focal lesions.
What factors must be taken into account to determine the best treatment option for canine lymphoma?
Grade, immunophenotype, clinical presentation, economic factors, owners’ beliefs, and patient’s quality of life.
What is the most potent single agent drug used in the treatment of canine lymphoma?
Doxorubicin
What are the response rates and mean survival times achievable with doxorubicin as a single agent?
Response rates of 50-75% with mean survival times of 6-8 months.
What is the remission rate and duration achieved with prednisone as a single agent?
Remission in around 50% of patients with remission times of 1-3 months.
Name some other drugs with proven efficacy as single agents in the treatment of canine lymphoma.
Cyclophosphamide, L-asparaginase, epirubicin, mitoxantrone, actinomycin D, and lomustine.
Which induction protocol is used as the treatment of choice for high grade B-cell canine lymphoma?
Madison-Wisconsin protocol induction.
Which induction protocol is used as the treatment of choice for high grade T-cell lymphoma?
LOPP protocol.
Which induction protocol is recommended when budget or other factors are a limitation?
COP followed by oral maintenance.
How are low-grade T-cell lymphomas often managed?
Monitored without treatment or treated with oral protocols with corticosteroids and chlorambucil.
What is the COP/COAP protocol combination used in?
Cyclophosphamide, vincristine, and prednisone with or without cytosine arabinoside.
What are the mean remission time and adverse effects associated with the COAP protocol?
Mean remission time of 6 months; adverse effects include mild leucopenia, alopecia, mild gastrointestinal symptoms, and sterile haemorrhagic cystitis.
Describe the Madison-Wisconsin protocol induction.
Sequential rotation of vincristine, L-asparaginase, prednisone, cyclophosphamide, and doxorubicin with a length of 19 or 25 weeks, with no maintenance phase.
What are the longer remission times achieved with the Madison-Wisconsin protocol?
80% of patients going into remission, with mean remission times of 10-12 months; 25% of dogs surviving for over 2 years.
What are some potential adverse effects associated with the Madison-Wisconsin protocol?
Adverse effects observed in 60% of treated dogs.
What are the considerations when choosing chemotherapy protocols for canine lymphoma treatment?
Immunophenotype, grade, clinical presentation, economic factors, personal situation of family members, presence of children or pregnant women, time commitment, transport, owners’ beliefs, and patient’s quality of life.
What are some differentials for primary appendicular bone tumors in dogs?
Chondrosarcoma, fibrosarcoma, hemangiosarcoma, histiocytic sarcoma, and multilobular osteosarcoma.
What are some malignant bone lesions sometimes affecting the skeleton in dogs?
Metastatic lesions and systemic neoplasias like multiple myeloma, lymphoma, or disseminated malignant histiocytosis.
Which dog breeds are reported to be at an increased risk of osteosarcoma (OSA) development?
Dobermans, German Shepherds, Golden Retrievers, Great Danes, Greyhounds, Irish Setters, Rottweilers, and the Saint Bernard.
What is the evidence of breed-associated heritability in OSA?
Scottish Deerhounds, retired racing Greyhounds, Saint Bernard’s, and Irish Wolfhounds show limited genetic diversity due to selective breeding, contributing to OSA heritability.
What is the age at presentation for OSA in dogs?
Bimodal with a small peak at 18 to 24 months of age and a larger one at 7 to 9 years of age.
What physical factors may be associated with canine OSA?
There is a theory that OSA could be associated with multiple minor trauma in the physeal region and subsequent chronic cellular damage.
What is the most common site for metastasis in dogs with OSA?
Lungs, bone, and soft tissue.
What are some history and clinical signs of OSA in dogs?
Localized limb swelling, lameness, swelling or mass in areas of sparse soft tissue coverage.
What bones are commonly affected by OSA in dogs?
Metaphyseal regions of distal radius and proximal humerus.
What percentage of dogs with OSA die secondarily to metastatic disease?
Almost 80%.
What are the different types of lymphocytes involved in LGL lymphomas in cats?
Natural killer cells and subset of cytotoxic T lymphocytes
What is the dichotomous behavior of LGL lymphomas in cats?
Some lesions are indolent and slow to progress, while others are rapidly progressive and fatal
What is the median survival time reported for rapidly progressive LGL lymphomas in cats?
57 days
How is the definitive diagnosis of lymphoma in cats made?
Through histologic or cytologic examination
What laboratory abnormalities are seen in cats with LSA?
Variable abnormalities depending on disease stage, anatomic site, and FeLV status
How is the FeLV status determined in cats?
Through ELISA testing or immunofluorescence testing of blood or serum
What is the significance of bone marrow aspiration or biopsy in evaluating cats with LSA?
Useful in staging and evaluating marrow infiltration with malignant cells
What percentage of cats with LSA are reported to have marrow infiltration?
Approximately 50%
What additional complications may arise in cats with FeLV infection and LSA?
Myelosuppression, anemia, granulocytopenia, thrombocytopenia, or immune mediated disease
What is the role of staging in clinical oncology?
To define the extent of tumor in a patient and guide therapeutic decision-making
How is lymphoma staged in cats?
Through CBC, serum chemistry panel, urinalysis, radiographs, and bone marrow evaluation
What imaging modalities are used for lymphoma in specific regions like the intestine or kidneys?
Abdominal ultrasound for intestine and renal lymphoma, CT imaging for nasal LSA
What is the goal of therapy in LSA?
Palliation of symptoms, inducing remission, and improving the quality of life
Is cure possible in LSA in cats?
In some cases, especially in localized or low-grade disease
How does the choice of therapy depend on the presentation of the lymphoma?
It depends on the region of involvement
What type of therapy is used for cats with Stage I lymphoma?
Local therapy
What is the agreement rate between cytology and histopathology in cases of neoplasia?
92%
What is the specificity of ultrasound-guided FNA in diagnosing osteosarcoma lesions?
100%
What is the sensitivity of ultrasound-guided FNA in diagnosing osteosarcoma lesions?
97%
When is biopsy indicated in the diagnosis of OSA?
In atypical cases and/or when the lesion is not in a common location
What should be performed to confirm the diagnosis of OSA if surgery is performed?
Histopathologic evaluation of the specimen
What are the advantages of using a Michele trephine for bone biopsy?
Larger sample and 93% diagnostic accuracy
What are the disadvantages of using a Michele trephine for bone biopsy?
Increased likelihood of post-biopsy fracture
What is the less invasive alternative for bone biopsy?
Jamshidi needle
What accuracy is achieved in determining tumor versus non-tumor with a Jamshidi needle?
92%
What is the risk of bone biopsy?
Exacerbating lameness and increasing risk of pathologic fracture
Why should multiple samples be obtained during bone biopsy using a Jamshidi needle?
Smaller sample size and risk of fracture with this device
What should be avoided when taking samples of soft tissue lesions during biopsy?
The center of the lesion where necrotic tissue is frequently found
What should be done to detect evidence of metastasis and concomitant conditions in a patient with suspected or confirmed osteosarcoma?
Perform a complete physical examination
What is the most common site of metastasis in osteosarcoma?
Lungs
Which diagnostic tool provides higher sensitivity for detecting pulmonary nodules in osteosarcoma?
CT
What is the most effective diagnostic tool for assessing metastatic bone lesions?
Nuclear scintigraphy
What can be used as an adjunctive diagnostic modality when nuclear scintigraphy is not available?
CT
What factors can affect the chosen treatment options and survival times in patients with OSA?
Patient status, stage, and owner’s motivation
What is an essential component of the management plan for dogs with OSA?
An effective analgesic plan
What should be included in the analgesic plan for dogs with OSA?
Frequent pain assessment and evaluation of quality of life
What factors are associated with a poor outcome in osteosarcoma?
Increased tumour size, higher tumour grade, mitotic index, humeral surface location
Does age affect the risk of developing metastasis in osteosarcoma?
No, age is not associated with an increased risk of developing metastasis
What is the median survival time (MST) for dogs with stage III osteosarcoma?
76 days (range: 0-1586 days)
Among dogs with metastasis, which location has longer survival times?
Bone metastases have longer survival times compared to lung or lung and other soft tissue metastases
What treatment leads to a longer survival time for dogs with stage III osteosarcoma?
Palliative treatment with radiation therapy (RT) and chemotherapy
What is the impact of elevated alkaline phosphatase (ALP) on prognosis?
Elevations in ALP are associated with a poor prognosis
What are the diagnostic techniques for presumptive diagnosis of osteosarcoma?
Location, imaging characteristics, patient’s risk factors, and cytology
What are the typical radiographic findings of appendicular osteosarcoma?
Monostotic lesions, lytic pattern of destruction, irregular margins, periosteal reaction
What are the advantages of cytology in diagnosing osteosarcoma?
Minor cost, faster technique, less invasiveness, quick results compared to biopsy
How often does bone FNA and cytology agree with incisional and excisional biopsies?
71% of the time
What treatment options can achieve disease control for dogs with solitary lesions?
Surgery or radiotherapy.
What is the median survival time for dogs with localised oral mucocutaneous LSA treated with radiation therapy?
770 days.
In which organs is primary lymphoma more rarely seen?
Kidneys, central nervous system (CNS), nasal cavity.
What drugs should be included in the treatment protocol for dogs with multicentric lymphoma with spread to the CNS or ocular involvement?
Steroids, cytosine arabinoside, lomustine.
What clinical features are frequently found in dogs with renal lymphoma?
Unilateral or bilateral renomegaly, moderate to marked azotaemia, erythrocytosis.
What is the documented response to COP or CHOP protocols for dogs with renal lymphoma?
Variable, with most cases having short survival times.
Where can splenic marginal zone lymphomas arise primarily?
Spleen.
What diagnostic methods are required to confirm the diagnosis of splenic marginal zone lymphomas?
Histopathology and immunophenotyping.
What is the median survival time for dogs with splenic marginal zone lymphomas after splenectomy?
383 days.
When is systemic treatment not needed in dogs with splenic marginal zone lymphomas?
After surgery.
What tests are recommended for clinical staging of canine lymphoma?
Full blood count, serum biochemistry, urinalysis, abdominal ultrasound, thoracic radiographs.
What percentage of dogs with multicentric lymphoma will present with bone marrow infiltration?
About a third.
When should bone marrow aspiration be performed in dogs with cytopenias?
When there is a peripheral blood cytopenia at the time of diagnosis.
What factors should be considered in determining the clinical stage of lymphoma?
Limiting factors, such as expenses and impact on management.
What is the prognosis for dogs with generalised lymphadenopathy, good clinical status, and normal hematological and blood chemistry results?
Similar prognosis.
What gastrointestinal signs are associated with diffuse lymphoma of the digestive system?
Worse prognosis.
What treatment should be provided before starting therapy for lymphoma in patients with gastrointestinal signs?
Treatment aimed at palliating and preventing further gastrointestinal signs.
Why might prophylactic antibiotics be beneficial in lymphoma patients with gastrointestinal signs?
To prevent bacterial translocation due to disrupted mucosal intestinal barrier.
Why are patients with focal high-grade lymphoma at risk of intestinal or gastric perforation when starting chemotherapy?
Due to the large number of masses in the intestine or stomach.
What should be considered before starting chemotherapy in patients with intestinal or gastric lymphoma masses?
Prophylactic treatment to prevent perforation and damage to the mucosal barrier.
What is the recommended dosage of carboplatin for treatment?
300 mg/m2 IV q21 days for 5-6 treatments.
What percentage of patients experience gastrointestinal toxicity with carboplatin?
Less than 20% of patients.
How is carboplatin excreted?
Carboplatin is excreted by the kidney.
What should be monitored 10-14 days after administration of carboplatin?
The nadir for neutrophils should be monitored.
What should be performed before each treatment of carboplatin?
A complete blood count should be performed.
What is the recommended dosage of doxorubicin for treatment?
30 mg/m2 IV q 14 days for 5-6 treatments.
What is the main adverse effect reported with doxorubicin treatment?
Gastrointestinal toxicity, with a prevalence of 40-60%.
What should be monitored 1 week after treatment with doxorubicin?
The nadir of neutrophils should be monitored.
What is the maximum total dosage of doxorubicin before cumulative cardiotoxicity becomes clinically relevant?
180mg/m2 (equivalent to 6 doses of doxorubicin at 30mg/m2).
What is the recommended administration method for doxorubicin to minimize vascular damage in the case of extravasation?
Rigorously intravenous with a constant rate infusion over 25 minutes.
What combination of chemotherapy agents has shown similar outcomes but higher toxicity?
Simultaneous administration of carboplatin and doxorubicin.
What are two drugs attempted for the medical treatment of pulmonary metastatic disease?
Carboplatin and doxorubicin.
What drugs have been evaluated in a small number of cases as oral medical therapy for pulmonary metastatic disease?
A COX-2 inhibitor combined with the tyrosine kinase inhibitor toceranib.
What is the median progression free survival for the oral medical therapy with a COX-2 inhibitor combined with toceranib?
36 days.
What is the median overall survival for the oral medical therapy with a COX-2 inhibitor combined with toceranib?
90 days.
What is the most common type of canine cancer diagnosed by general veterinary practitioners?
Lymphoma
What is lymphoma?
An uncontrolled clonal proliferation of lymphoreticular cells originating from lymphoid tissues.
Where does lymphoma normally originate in the body?
Lymph nodes, spleen, and bone marrow.
What is the incidence of lymphoma in dogs?
24 cases/100,000 dogs/year.
Which breeds have a higher risk of developing lymphoma?
Boxers, Alsatians, Rottweilers, Scottish Terriers, and Golden Retrievers.
Do cats have a retroviral aetiology for lymphoma?
No, a retroviral aetiology has not been demonstrated in dogs.
What are the different lineages of canine lymphoma?
B-, T-, or NK-cell lymphoma.
How can we determine the lineage of canine lymphoma?
Using immunophenotyping techniques in cytology, tissue, or cell suspensions.
Why is cytological diagnosis of lymphoma alone not sufficient?
The biology of the disease is very variable and does not provide enough information about behavior and treatment.
What are the different grades of canine lymphoma?
Low, high, and intermediate.
What are the most commonly used limb-sparing surgery techniques?
Cortical allograft, pasteurized autograft, and endoprosthesis.
What are the steps involved in planned limb-sparing surgical procedures?
Distal radius resection, arthrodesis of the carpal joint, and excision of the distal radius.
What is the recommended margin for excising the distal radius in limb-sparing surgery?
A minimum margin of 3 cm from the proximal extent of the tumor.
What should be done if the tumor extends into the ulna during limb-sparing surgery?
The ulna should also be excised with a bone saw proximal to the level of the tumor.
What is the purpose of taking a bone marrow sample during limb-sparing surgery?
To assess the margin end and/or proximal margins of the sectioned piece.
What are the disadvantages of using cortical allograft in limb-sparing surgery?
High infection rate (~50%), risk of implant failure, and the need for a bone bank or frozen allograft.
What is an alternative to using cortical allograft in limb-sparing surgery?
Endoprosthesis, which involves the application of a limb-sparing plate with a stainless steel endoprosthesis.
What are the advantages of using endoprosthesis in limb-sparing surgery?
Availability of the implant and increased simplicity of surgery without the need for a prepared allograft.
What is the role of chemotherapy in canine appendicular osteosarcoma treatment?
Adjuvant treatment to delay progression or development of metastatic disease.
Which chemotherapy drugs are commonly used for canine appendicular osteosarcoma?
Cisplatin, carboplatin, and doxorubicin.
Why is cisplatin not recommended for chemotherapy in canine appendicular osteosarcoma?
Potential nephrotoxicity and high prevalence of emesis.
What are the median survival times post amputation followed by adjuvant chemotherapy?
Between 104 and 413 days, with one-year survival rates of 34-50%.
Which chemotherapy drug has a higher 2-year survival rate for canine appendicular osteosarcoma?
Carboplatin (17%) compared to doxorubicin (10%).
Why should fast-acting drugs such as L-asparaginase be avoided in patients with focal lymphoma in the gastrointestinal tract?
Tumour cells will be rapidly eliminated.
What should be done if a dog presents with signs of liver dysfunction?
Perform an abdominal ultrasound and fine needle aspiration of the liver.
What potential impact can compromised liver function have on the efficacy of chemotherapy drugs used to treat lymphoma?
Reduction in activation or more likely adverse effects due to a reduction in hepatic metabolism.
What type of chemotherapy drugs should be avoided in patients with hepatic dysfunction?
Alkylating agents such as cyclophosphamide or lomustine.
What is the recommended treatment for severely neutropenic patients with lymphoma?
Start with non-immunosuppressive drugs such as L-asparaginase.
Which breeds are more prone to mutations in the MDR gene?
Collies, Shelties, Australian Shepherds, etc.
What is the clinical state called when there is no macroscopic evidence of disease in any organs or blood?
Remission.
What is the median survival time for dogs with high grade multicentric lymphoma untreated?
4 to 8 weeks.
What is the treatment of choice for high grade multicentric lymphoma in dogs?
Chemotherapy.
What percentage of dogs with multicentric lymphoma does chemotherapy induce remission in?
60-90%.
What is the median survival time for dogs with high grade multicentric lymphoma after chemotherapy?
6 to 14 months.
What drugs are included in the LOPP protocol for canine lymphoma?
Vincristine, lomustine, prednisolone, procarbazine
Why is the starting dose of lomustine usually 50-60mg/m2?
Lomustine is quite immunosuppressive
What is the recommended substitution for procarbazine in the LOPP protocol?
Cyclophosphamide
What is the remission rate after a first relapse of lymphoma?
Around 70%
What protocol can be used for reinduction if the original induction protocol fails?
DMAC (dexamethasone, actinomycin D, cytosine arabinoside, melphalan)
What is a commonly used rescue protocol for reinduction of canine lymphoma?
DMAC (dexamethasone, actinomycin D, cytosine arabinoside, melphalan)
What is the remission rate of DMAC in reinduction of canine lymphoma?
Up to 74%
What are some alternative treatments to chemotherapy for lymphoma?
Bone marrow transplantation, radiotherapy, immunotherapies
What is the most common indication for radiotherapy in the treatment of canine lymphoma?
Localized lymphoma in a particular anatomical site
When is radiotherapy used in emergency situations for lymphoma?
When lymphoma is confined to a single anatomical site and associated with severe clinical symptoms
What is the most common rescue protocol for reinduction of canine lymphoma?
MOPP (merchlorethamine, procarbazine, vincristine, prednisone)
What are some references for further reading on chemotherapy protocols for canine lymphoma?
Alvarez FJ, et al. 2006; Beaver LM, et al. 2010; Brodsky EM, et al. 2009; Hosoya K, et al. 2007; Mealey KL, et al. 2008; Modiano JF, et al. 2020
What is the most common biochemical abnormality in LGAL?
Hypoalbuminaemia
What is the common finding in abdominal ultrasonography for I/HGAL?
Transmural intestinal thickening with disruption of wall layering, hypomotility, and lymphadenomegaly
What is the common finding in abdominal ultrasonography for LGAL?
Normal or increased wall thickness with preserved wall layer
What is the common finding in abdominal ultrasonography for LGLL?
Similar features to I/HGAL
What is the main method for diagnosing LGAL?
Ultrasound-guided FNA cytology
What can be helpful for diagnosing LGAL if combined with diagnostic techniques like PARR?
Cytology of enlarged mesenteric lymph LNs
What can be obtained by sampling the spleen and liver if infiltration is suspected?
Diagnosis of LGAL
What are the characteristics of LGLs on cytology?
Large mononuclear cells with moderate amounts of deeply basophilic cytoplasm containing multiple blue or purple granules
What may be required for histological demonstration of disruption of normal intestine in LGAL?
Intestinal biopsy
What is the current recommendation for endoscopic investigation of enteropathies in cats?
Sampling both the duodenum and ileum
What should be sampled during laparotomy to diagnose LGAL?
Duodenum descendens, mid-jejunum, and ileum
What are the histological features of LGAL?
The histological features of LGAL include the relative absence of mixed lymphoid and granulocytic cells and the replacement with monomorphic sheets of neoplastic lymphoid cells in the lamina propria.
What patterns in the villous or crypt epithelium are highly specific for LGAL?
Nests or plaques in the villous or crypt epithelium are highly specific for LGAL.
What is the purpose of clonality testing in distinguishing LGAL from LPE?
Clonality testing helps distinguish between LGAL and LPE by determining the clonality of T cell populations in lymphocytic intestinal infiltrates.
What is the prognostic significance of bicavitary disease location in LGAL?
Bicavitary disease location is a negative prognostic factor for LGLL.
What chemotherapy protocols have shown good response in LGAL?
Oral alkylating agents and prednisolone have achieved complete remission in 70% of cases of LGAL.
What is the response rate to therapy in LGAL?
70% of cases of LGAL achieve complete remission with therapy.
What is the median remission length reported in LGAL?
Median remission lengths reported in LGAL are 26 and 29 months.
How is LGAL re-induced remission achieved?
Re-induced remission in LGAL is achieved using cyclophosphamide.
What is the treatment approach for I/HGAL?
Traditionally, I/HGAL has been treated with intravenous chemotherapy.
What are some rare complications of canine mast cell tumors?
Bone necrosis, second tumor in the radiation field
How often should patients with low grade mast cell tumors be reassessed after surgery?
After one month, then every 3 months until 18 months, then every 6 months
When is systemic drug therapy indicated for canine mast cell tumors?
High grade mast cell tumors, metastatic disease, non-resectable tumors, incompletely resected tumors, large numbers of tumors, tumors at unfavorable locations
What are some examples of conventional chemotherapy protocols for canine mast cell tumors?
Vinblastine/prednisolone, vinblastine/lomustine/prednisolone
What are the median response rates for different chemotherapy agents in canine mast cell tumors?
Prednisone: 4% complete response, 16% partial response; Vincristine: 0% complete response, 7% partial response; Lomustine: 6% complete response, 38% partial response
What is the recommended dosage of vinblastine in the vinblastine/prednisolone chemotherapy protocol for canine mast cell tumors?
2 mg/m2 IV weekly for 4 weeks then every 2 weeks
What is the recommended dosage of lomustine in the vinblastine/lomustine/prednisolone chemotherapy protocol for canine mast cell tumors?
50-70 mg/m2
What monitoring should be done after administering lomustine in the vinblastine/lomustine/prednisolone chemotherapy protocol?
Check CBC approximately 7 days after each drug to assess for myelosuppression, and ALT before each dose of lomustine to check for hepatotoxicity
What supplement is recommended for patients receiving lomustine?
SAMe
What is the prevalence of lymphoma in cats?
Around 20-25 cases per 100,000 cats at risk per year.
What is the incidence rate of lymphoma in cats compared to humans?
Similar to the rate seen in humans.
What percentage of cats with lymphoma were FeLV positive before the advent of vaccines?
50-70%
What percentage of lymphoma cats are FeLV positive in the 1990s?
8-14%
What is the relationship between feline immunodeficiency virus and lymphoma in cats?
FIV-infected cats have a greater relative risk of developing lymphoma.
What is the average age at onset of lymphoma in cats?
5-6 years
What are the criteria used to classify lymphoma in cats?
Histologic type, anatomic location, cytologic appearance, and immunologic type of lymphocyte affected.
What are the anatomic locations of lymphoma in cats?
Alimentary, anterior mediastinal, multicentric, leukemic, and miscellaneous types.
Which immunophenotype of lymphomas is more common in cats with large cell alimentary LSA?
B cell lymphomas
What is notable about large granular lymphocyte (LGL) lymphoma in cats?
Presence of pink granules
What is the cause of TLS?
Rapid cell death leading to the release of potassium, phosphate, uric acid, and other purine metabolites.
Which metabolic abnormalities result from TLS?
Hyperkalaemia, hyperphosphataemia, secondary hypocalcaemia, and hyperuricaemia.
Why do dogs not become hyperuricaemic?
Dogs have differences in purine metabolism, except for Dalmatians and English Bulldogs due to a lack of the enzyme uricase.
What is the significance of increased lactic dehydrogenase (LDH) in TLS?
Increased LDH is observed in TLS.
How do patients with TLS present clinically?
Patients present with signs of acute renal failure and metabolic acidosis.
What is the single most important treatment for TLS?
Aggressive hydration with 0.9% NaCl.
When should insulin/dextrose therapy be considered for TLS treatment?
Insulin/dextrose therapy should be implemented if potassium is extremely high (>8) in addition to aggressive fluid therapy.
What is essential for patient recovery in TLS?
Good supportive care and continual assessment are important for patient recovery.
What are some locations where mast cell tumors can occur?
Oral, mucocutaneous junction, nail bed, and preputial/scrotal tumors
In which cases is further staging preferred prior to resection?
Cases showing distant metastasis, recurrent tumors, systemic signs, or sites not amenable to wide excision
What does complete staging for canine MCT involve?
FNA of drainage lymph nodes, abdominal ultrasound, FNA of enlarged lymph nodes/liver/spleen, and thoracic radiographs
Why can interpreting cytology of ultrasonographically normal liver and spleen be challenging?
They can contain occasional normal mast cells, making results difficult to interpret
When is incisional biopsy indicated in the staging process?
In some individual cases, as part of the staging process
What is the treatment of choice for most MCT?
Surgery
What are the recommended surgical margins for MCT?
2-3 cm of normal-appearing tissue, 360 degrees around the tumor, and at least one fascial plane deep to the tumor
