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3. Cat & Dog > oncology 4 > Flashcards

oncology 4 Flashcards

1
Q

first line diagnostic for lymphoma? what info do we want from pathologist, at a basic level?

A

FNA
- neoplastic vs not neoplastic?
- malignant vs benign?

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2
Q

lymphoma diagnostic options

A
  • cytology ± flow cytometry
  • ± Histology ± Immunohistochemistry (IHC)
  • ±Polymerase chain reaction (PCR) of antigen
    receptor rearrangements of lymphocytes (PARR)
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3
Q

relevance of clonal proliferation to lymphoma diagnosis with PCR

A

Cancer (usually) arises from a single cell, one which has developed a growth advantage &
that has lost normal controls on proliferation
- can examine cells with PCR of antigen receptor rearrangements (PARR) of lympohocytes
- single or few bands indicate clonal expansion in malignancies
- multiple bands in normal tissue

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4
Q

how common in lymphoma in dogs? what breeds and age group especially?

A
  • 7‐24% canine neoplasia
  • 13-24/100,000
    > boxers, basset, Rottweiler, Golden Retriever, Bernese mountain dog, cocker spaniel, st. bernard, Scottish, Airedale, bulldog
  • middle-aged to older
    > 6-9 years
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5
Q

how common is lymphoma / lymphosarcoma in cats? what is the nature of 1/3 of the tumors? whats breeds and ages?

A

– highest incidence of LSA
- 1/3 of tumors are hematopoietic
- 200/100,000
> siamese
- bimodal age dist.
> 2 years (often FeLV +vs)
> 10-12 years

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6
Q

purpose and use of staging tumours

A
  1. Defines the extent of disease
  2. Aids in planning treatment
  3. Allows more accurate prognostication
  4. Assists in evaluation of therapy
  5. Allows communication between clinicians
  6. Nomenclature: ‘TNM’ System
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7
Q

staging for LSA - what do the stages mean?

A

I - single LN
II - regional LN
III - generalized LN
IV - liver +/- spleen
V - bone marrow
()
a - without systemic signs
b - with systemic signs

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8
Q

what does lymphoma staging require

A
  • CBC
  • biochem profile
    > (paraneoplastic hypercalcemia)
  • Urinalysis
  • FeLV / FIV status
  • ± thoracic radiographs
  • ± abdominal ultrasound
  • ± bone marrow
  • ± CSF tap
  • ±CT/MRI/bonescan
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9
Q

anatomic types of lymphoma

A
  • multicentric
  • mediastinal
  • alimentary (GI)
    > solitary, multifocal, or diffuse
  • extranodal
    > renal, cutaneous, neural, ocular, etc.
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10
Q

canine anatomic types of lymphoma by how common they are:

A
  • multicentric: 80-85%
  • alimentary (GI): ~7%
  • skin: 6%
  • mediastinal: ~3%
  • extranodal: <3%
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11
Q

canine anatomic types of lymphoma by how common they are:

A
  • multicentric: 20-30% (FeLV > 30-80% +ve)
  • alimentary (GI): 30-70% (FeLV > 30% +ve)
  • mediastinal: 10-20% (FeLV > 90% +ve)
  • extranodal:
    > nose: 5-10% (FeLV > -ve)
    > renal: ~5% (FeLV > 25% +ve)
    > CNS: 1-3% (FeLV > ??)
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12
Q

clinical signs of lymphoma vary with what?

A

form (location) of LSA

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13
Q

canine phenotypic types of lymphoma? which is most common? how do we diagnose?

A
  • B cell: 75-80%
    > CD79a
  • T cell
    > CD3
  • null (neither B nor T)
  • determined by flow cytometry or IHC
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14
Q

in T cell lymphomas, expression of what is correlated with longer survival and PFI?

A
  • MHC II expression
    > MHC II negative has short survival
    > CD4+/MHCII- = shortest survival and PFI
    > CD4-, CD8-, MHCII- = next shortest survival
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15
Q

what histologic grade do most canine lymphomas have?

A

80% high grade (vs low or intermediate)

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16
Q

what histologic grade do feline lymphomas have?

A
  • low : 8.6%
  • intermediate: 35.1%
  • high: 55.2%
17
Q

canine lymphoma prognostic factors

A
  • WHO clinical stage: V < I/II
  • WHO clinical sibstage: b < a
  • immunophenotype: T < B
  • hypercalcemia: negative
  • prolonged steroid pretreatment: negative
  • anatomic form:
    > leukemia, mediastinal, cutaneous, alimentary < multicentric
18
Q

feline lymphoma prognostic factors

A
  • complete remission (CR): positive
  • feline leukemia status: negative
  • WHO clinical stage: early
  • WHO clinical substage: b < a
  • anatomic form:
    > mediastinal worse
    > nasal best
19
Q

indications for chemotherapy for lymphoma

A
  1. Systemic neoplasia
  2. metastatic neoplasia
  3. cytoreduction
  4. nonresectable neoplasia
20
Q

contraindications for chemotherapy for lymphoma treatment

A

– severe multiple organ dysfunction
– substitute for surgery

21
Q

purpose of combination chemotherapy

A
  • protocols often consist of combinations of
    drugs with different effects on tumour cells &
    different toxicities on the host
  • manipulate growth kinetics of cells
  • additive therapeutics with subadditive toxicities
  • biologic synergistic effect
  • delay of resistance
    ()
  • more effective than single agent
  • action on more than one cell stage simultaneously (greater fractional cell kill)
22
Q

problems with chemotherapy

A

– tumour resistance*
– toxicity
– lack of efficacy
- cost

23
Q

chemotherapy classifications based on mode of action

A
  • alkylating agents
  • plant alkaloids
  • antimetabolites
  • antitumour antibiotics
  • hormones
  • miscellaneous agents
  • enzymes
24
Q

dosing of chemotherapy drugs is based on?

A
  • most chemotherapeutic drugs are dosed based on body surface area (m^2)
    > correlates with metabolic rate (better than body weight)
25
Q

Cornerstone of medical oncology practice

A

MAXIMUM TOLERATED DOSE “MTD” CHEMOTHERAPY

26
Q

MAXIMUM TOLERATED DOSE “MTD” CHEMOTHERAPY
> how important? does it work? issues? how does it work?

A
  • Cornerstone of medical oncology practice
    > highly effective for some tumors
    > significant resistance in established metastasis
  • Target is the rapidly dividing cell
    > log relationship between dose and cancer cell kill
  • Mandatory break period
27
Q

common options for lymphoma chemotherapy protocols

A
  • single agent
    > prednisone
    > doxorubicin
    > lomustine
  • multidrug
    > CHOP (L-CHOP)
    > COP (COAP)
28
Q

what is the COP chemotherapy protocol?

A
  • Cyclophosphamide
  • Oncovin (Vincristine)
  • Prednisone
29
Q

prognosis of canines receiving lymphoma chemotherapy? vs untreated?

A
  • 70 - 90% complete remission
  • 12 - 16 months median survival
  • 20-30% survival at 2 years
    ()
  • untreated: 1-2 month median survival
30
Q

prognosis of felines receiving lymphoma chemotherapy? vs untreated?

A
  • 60% complete remission
  • 6-7 month median survival
  • 20% survival > 1 year
  • small cell GI > 2 years
    ()
  • untreated: 1-2 month median survival
31
Q

Tanovea in a drug for lymphoma treatment that work via what mechanism? contraindications?

A

‐converted intracellularly to its active metabolite PMEGpp, acts at the level of the cellular DNA polymerases
* contraindicated in dogs with pulmonary
fibrosis, chronic bronchitis & West Highland white terriers
– associated with life‐threatening or fatal pulmonary fibrosis

32
Q

Vedinexor is a lymphoma medication that works via what mechanism?

A
  • Oral medication given twice/ week
  • prevents tumour suppressing proteins from leaving the nucleus of cells, resulting in disruption of cancer cell survival and eventual cancer cell death
33
Q

is immunotherapy good for trewating lymphoma

A
  • use in humans for non-hodgkinn’s, but not animals at this point

3. Cat & Dog (33 decks)

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