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Small animal medicine II > Oncology > Flashcards

Oncology Flashcards

1
Q

T/F: With oncology, it is always better to wait and see

A

False

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2
Q

What is the difference between staging and grading a tumor?

A

Grade is the histopathological scoring by the pathologist.

Staging is determined by the clinician with tests that rank the extent of the body affected

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3
Q

How do you stage lymph nodes and why?

A

Sample both normal and enlarged, since normal may have mets and enlarged may just be reactive.

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4
Q

What direction do the lymph nodes drain?

A

Towards the heart

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5
Q

What are some tests to run to determine the staging of a cancer?

A

Diagnostic imaging: CT, rads, MRI, nuclear scintigraphy

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6
Q

What are the advantages of cytology for neoplasm?

A

Least invasive, inexpensive, safe, and quick

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7
Q

What are the disadvantages of cytology for neoplasm?

A

Cannot grade it histologically, false positives/negatives

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8
Q

What are the indications of using a non-aspiration technique for cytology?

A

Your first attempt, fewer lysed cells, less blood.

For lymph nodes, round cell tumors, highly vascularized tumors

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9
Q

What are the indications of using an aspiration technique for cytology?

A

Second attempts if non-aspiration doesn’t yield good results, hard/firm lesions, very small lesions where you cannot redirection the needle

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10
Q

What do you monitor when performing an FNA?

A

the needle hub to make sure the sample doesn’t fill and dilute with blood

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11
Q

What is the goal when applying the cytology sample onto the slide?

A

A monolayer of cells onto the slide

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12
Q

What are some biopsy techniques?

A

Needle core, punch, jamshidi bone, incisional, excisional

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13
Q

What are the indications for an incisional biopsy?

A

When the type of treatment, the extent of resection is determined by the type of tumor

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14
Q

What are some potential issues with excisional biopsy?

A

The blade can seed the tumor to other areas, and the owner may think you fixed the issue and may not want further treatment

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15
Q

What are some features that determine the grading scheme of tumors?

A

Cellular differentiation, degree of necrosis, invasion, and stromal tissue reaction, and the mitotic index

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16
Q

What does a clinician need to provide for the pathologist when submitting a sample for a tumor?

A

History and anatomical location, submission of all tissue removed and fixated, inking the tissue, request for 2nd opinions

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17
Q

What are some properties of epithelial tumors?

A

Adenoma/Carcinoma

Exfoliate easily, cellular

Sheets, clusters, acinar

Round, cuboidal, polyhedral

Vacuolated

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18
Q

What are some properties of mesenchymal tumors?

A

Sarcomas

Exfoliate poorly

Individual

spindle, stellate, round

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19
Q

What are some properties of round cell neoplasia?

A

Exfoliate easily, highly cellular

Individual

Round/oval

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20
Q

What are the three cellular criteria of malignancy?

A

Anisocytosis, macrocytosis, pleomorphism

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21
Q

What cancer treatment is useful to control local recurrence or progression of certain tumors?

A

Radiation

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22
Q

What cancer treatment is used to suppress cancer cells for some time, but has low cure rates?

A

Chemotherapy

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23
Q

What cancer treatment is used to cure more cancer than the other treatments?

A

Surgery

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24
Q

If a cure is not possible, what other reasons would you want to treat a cancer patient?

A

Pain control, supportive care (palliative)

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25
Q

What types of cancer are highly responsive to chemotherapy?

A

Hematopoietic (lymphoma, leukemia, myeloma)

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26
Q

Why is it “imperative” to establish a diagnosis with cancer?

A

To determine the appropriate therapy

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27
Q

When would you perform chemotherapy?

A

As an adjuvant therapy, palliate metastatic cancer, to downstage a tumor before definitive therapy, to sensitize tissue for radiation

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28
Q

What is the Goldie Coldman Hypothesis?

A

Tumors are clinically detectable after 30 doublings (1 billion tumor cells, 1 gram/cm3)

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29
Q

What is expected, in terms of treatment, if a tumor has reached 1 million cells?

A

Chemotherapy will probably not work

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30
Q

What does the Gompertezian growth show?

A

That tumor growth rate is not constant, and that is grows exponentially at early stages

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31
Q

When is chemotherapy most effective when looking at the Goldie Coldman hypothesis and Gompertezian growth chart?

A

Early when cancer is quickly proliferating

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32
Q

T/F: It is better to use one single form of chemotherapy to avoid summation of symptoms

A

False. Combination chemotherapy exert effort through different mechanisms, maximizing the killing of cancer cells, and decreases chance of resistance

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33
Q

What is BAG toxicity?

A

Bone marrow, alopecia, GI side effects

34
Q

What can you do if the patient is responding really poorly to chemotherapy?

A

Remove the specific drug, reduce the specific drug, stop chemotherapy all together

35
Q

Which chemotherapies are a high risk for dogs with the MDR1 gene mutation?

A

Vincristine, vinblastine, doxorubicin, mitoxantrone

36
Q

What are the three areas of safety concern with chemotherapy?

A

The staff, the patient, and the owners

37
Q

What is the most dangerous way the staff can be affected by the chemotherapy drug?

A

Aerosolization

38
Q

T/F: You cannot split/open chemotherapy tablets and capsules

A

True

39
Q

What type of syringe (not needle) do you want to use when dealing with chemo drugs?

A

Luer locks

40
Q

How are most chemotherapy drugs eliminated from the body?

A

Urine or feces

41
Q

What are some examples of alkylating agents for chemotherapy?

A

Cyclophosphamides, Chlorambucil, Melphalan, CCNU, Ifosfamide

42
Q

What are the toxic effects of alkylating chemotherapy agents?

A

BAG

43
Q

What are some examples of antimetabolic chemotherapies?

A

Cytosine arabinoside, 5-fluorouracil, methotrexate, gemcitabine

44
Q

How does alkylating chemotherapies work?

A

Alkylate DNA bases, induces apoptosis

45
Q

How do antimetabolites work?

A

Interrupt DNA synthesis by mimicking nucleoside analogs

46
Q

What are some examples of antitumor antibiotics?

A

Doxorubicin, Mitoxantrone, Epirubicin

47
Q

What is the mechanism of antitumor antibiotics?

A

Inhibits topoisomerase II leading to production of free radicals, killing tumor cells

48
Q

What are some toxic side effects of Antitumor antibiotics?

A

BAG

49
Q

What are the toxic effects of doxorubicin specifically?

A

Irreversible cardiotoxicity in dogs, nephortoxicity in cats, tissue damage if outside the vein, colitis

50
Q

What are some examples of spindle toxin: vinca alkaloid toxins?

A

Periwinkle, vincristine, vinblastine

51
Q

What is the mechanism of spindle toxins?

A

Binds to the tubulin to interfere with mitosis

52
Q

What are some examples of Platinum dugs?

A

Cisplatin, Carboplatin

53
Q

What is the mechanism of platinum drugs?

A

Binds to DNA causing cross links

54
Q

What can platinum toxicity do to cats?

A

Fatal idiosyncratic pulmonary edema

55
Q

What do NSAIDs do to aid in cancer treatment?

A

Chemoprevention, over-expression of cyclo-oxygenase II, mostly unknown mechanism

56
Q

What are the common NSAIDs used for cancer treatment in dogs?

A

Carprofen, prioxicam

57
Q

What are examples of passive immunotherapy?

A

Anti-tumor antibodies, activated lymphocytes, cytokines

58
Q

What are examples of active immunotherapy?

A

Tumor vaccines, gene therapy

59
Q

How does canine melanoma vaccine work?

A

It leads to production of DNA that codes for non-canine tyrosinase, leading to a strong immune response and acting against the melanoma

60
Q

What drug is currently being studied to target genetic mutations?

A

Gleevec (Imatinib mesylate-Gleevec)

61
Q

What cancer drug is a tyrosine kinase inhibitor and used to treat mast cell tumors but also other head and neck tumors?

A

Palladia (toceranib)

62
Q

What cancer treatment is anti-angiogenic and antimetastatic?

A

Low Dose Continuous Chemotherapy (cyclophosphamide).

Suppresses T cells leading to blood vessel inhibition

63
Q

What are the three radiation margins with RT?

A 
GTV = gross tumor volume
CTV = clinical target volume
PTV = planning target volume
64
Q

What is the main target of photons and electrons from radiation therapy?

A

DNA, but also get cell membranes

65
Q

T/F: Radiation therapy targets only cancer cells

A

False. Cancer and normal

66
Q

What are the 4 R’s of radiation therapy?

A

Repair, repopulation, redistribution, reoxygenation, radiosensitive

67
Q

Which of the 4 R’s is considered good for tumor cells

A

Redistribution, reoxygenation, radiosensitive

68
Q

What of the 4 R’s is desired among normal cells?

A

Repair, repopulation

69
Q

T/F: the larger the tumor, the higher the dose of radiation needed

A

True

70
Q

T/F: Acute radiation toxicity is generally irreversible

A

False.

71
Q

What is acute radiation toxicity dependent on?

A

Dose, dose rate, and dose per fraction. TOTAL DOSE

72
Q

What is late radiation toxicity dependent on?

A

VERY dependent on dose per fraction. FRACTION SIZE

73
Q

T/F: Late radiation toxicity is usually progressive and irreparable

A

True

74
Q

What is the protocol for definitive RT?

A

Large # of fractions with low doses. Long term control with expected acute side effects, but limited late toxicity

75
Q

What is the protocol for palliative RT?

A

Fewer # of fractions but higher doses. Few acute side effects but higher risk of late toxicity

76
Q

What is the difference between SRS and SRT?

A

SRS is radiosurgery with usually only 1 treatment, SRT is radiotherapy with several.

77
Q

What is used for systemic radiation therapy?

A

Iodine-131

Samarium-153

78
Q

What is another term for strontium therapy?

A

Plesiotherapy

79
Q

What are the indications for strontium therapy?

A

Small, superficial tumors

Feline MCT, dermal SCC
Canine limb SCC, melanoma

80
Q

What are external beam radiation and strontium therapy primary used for?

A

Local or locoregional disease

81
Q

With cancer, what is cryotherapy used for?

A

Superficial lesions ONLY
ex: MCT
(<1.5 cm)

82
Q

What is the proposed mechanism of electrochemotherapy?

A

Opens channels in cells to allow drug to enter them.

Small animal medicine II (8 decks)

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