Oncology Flashcards
Rate of fluids for tx of hypercalcaemia
Saline 3x maintenance
Tumours causing paraneoplastic hypoglycaemia
Insulinoma
Smooth muscle tumours
Hepatocellular carcinoma
Lymphoma
Treatment of hypoglycaemia when tumour is not resectable
Iv glucose in emergencies (risk if increase in insulin and rebound hypoglycaemia with insulinoma)
Prednisolone
Diazoxide
Glucagon
Paraneoplastic production of ACTH by what tumours
Hepatic carcinomas
Abdominal neuroendocrine tumour
Primary lung tumours
Prognosis of patients with bone marrow suppression and pancytopaenia secondary to hyperoestrogenism
Poor - bone marrow takes months to recover
Broad spectrum abs required for pancytopaenia
What causes hypertrophic oesteopathy
Primary intrathoracic masses
Space occupying lesions in abdomen or thorax
What causes paraneoplastic glomerulonephritis
Immune complex formed by tumours
Tumours causing peripheral neuropathy
Lymphoma Multiple myeloma sarcomas Carcinomas Insulinoma
What causes paraneoplastic myasthenia gravis
Thymona
But has been reported with other tumours
Treatment of myasthenia gravis
Anticholinesterase agents like Pyridostigmine bromide
Immunosuppression is controversial given risk of aspiration pneumonia
What tumour causes modular dermatofibrosis
Renal cystadenocarcinoma
Uterine leiomyomas
Paraneoplastic causes of erythrocytosis
Excess EPO production by renal tumour or secondary increased renal EPO production due to tissue hypoxia as a result of tumour compression
Clinical signs of erythrocytosis/polycythaemia
Hypertension, hyperviscosity, seizures, ataxia, disorientation
Thymidine kinase
Can be used for monitoring tx of lymphoma but needs to be measured before tx
Becomes high again 3 weeks before coming out of remission
Real time PCR for monitoring lymphoma
Measures amount of DNA in blood - lower at start better prognosis
Alkylators
Chlorambucil
Cyclophosphamide
Lomustine
Melphalan
Anti-tumour antibiotics
Anthracyclines
Doxorubicin
Epirubicin
Actinomycin-D
Mitoxantrone
Vinca alkaloids
Vincristine and vinblastine
Cell cycle specific - inhibit Microtubules thus preventing motorists spindle
Platinating agents
Carboplatin
Inhibits protein synthesis and cell death
Anti-metabolites
Cytosine arabinoside
Methotrexate
L-asparaginase
Malignant lymphocytes are dependant upon asparagine which l-asparaginase destroys leading to cell death
Much less effective in cats and asparagine is replaced much more quickly
Chemotherapy agents which penetrate the CNS
Prednisolone L-asparaginase Cytosine arabinoside CCNU Methotrexate
Radiotherapy side effects
Dermatitis and moist desquamation
Mucositis/colitis/anusitis
Dry eye
Long term: Dry eye Alopecia and leucotrichia Skin fibrosis and poor wound healing Small increase in rate of de novo tumours Degenerative brain lesions
Breeds with a mutation making them susceptible to side effects of anthracyclines and vinca alkaloids
Sheltie Westie Rough collie Border collie Australian shepherd Long haired whippet
Consider dose reduction of which chemo drugs with liver dz
Anthracyclines
Vinca alkaloids
Cyclophosphamide
Consider dose reduction of which chemo drugs with renal dz
Carboplatin
Methotrexate
Cyclophosphamide
side effects of masitinib and toceranib
PLN, hypertension
Haemolytic anaemia
GI side effects
Hepatotoxicity
Drug holidays, reduction in doses
For hepatotoxicity - denamarin and drug holiday
Pancreatitis following toceranib
When to treat as septic when on chemotherapy
If sick neutrophil count < 1x10^9/L
Chemo drugs causing extravasation injury
Vinca alkaloids
Anthracyclines
Cisplatin
Tx of extravasation injury
Consider immediate debridement for anthracycline extravasation
Local infiltration of Hyaluronidase
IV administration of dexrazoxane within three hours and again at 24 and 48
Doxorubicin and epirubicin specific toxicity
Acute arrhythmias - give slowly and monitor ECG
Cumulative cardiotoxicity leading to DCM and heart failure - if heart problems use an alternative drug, pre-treatment echo and at high doses can consider dexrazoxane (protects heart against anthracycline toxicity)
Renal toxicity - particularly cats. Cumulative. Monitor urea/crea/USG and give fluids before and after tx in cats
Lomustine specific toxicity
Hepatic toxicity - delayed and cumulative - monitor liver enzymes particularly ALT and bile acids. If alt is climbing stop this
Do not treat for longer than 6 months and consider SAMe
Highly myelosuppressive
Renal toxicity - give fluids before and after tx in cats
Vincristine specific side effects
Neurotoxicity - peripheral neuropathy and hindlimb weakness that resolves when tx is stopped
Chemotherapy for mast cell tumours
Vinblastine and prednisolone - 8 cycle protocol over 12 weeks
Lomustine
Tyrosine kinase inhibitors
Chemotherapy for osteosarcoma and MST
Carboplatin following amputation
MST surgery alone 4 months
Surgery plus chemo - 11 months
Chemotherapy for haemangiosarcoma and MSTs
Doxorubicin I/V every three weeks x five
MST 2 months surgery alone and 6 months w tx
Metronomic chemotherapy
MST for MCTs with vinblastine and prednisolone
All - 570 days
Grade III - 330 days
Visceral mast cell tumours MST
Bone marrow MST
90 days
Bone marrow 45 days - poor response to tx
What pre-cancerous changes can be seen in cats prior to development of SCCs?
Actinic keratosis
MST of nasal/pinnal SCC after surgery?
20 months
Treatment of feline mast cell tumours
If compact surgery with narrow margins
If diffuse surgery with larger margins
Splenectomy if spleen involved
Preds can be used but not that effective
Vinblastine not to be used as assoc with severe neutropaenia in cats
Treatment of feline squamous cell carcinoma
Surgery
Radiotherapy (strontium 90 plesiotherapy or sxternal bean radiatiotherapy
Photodynamic therapy
Cryotherapy
How to tell if pleural effusion is idiopathic or secondary to haemangiosarcoma
High troponin with haemangiosarcoma (>0.25ng/ml)
If >2.45ng/ml cardiac involvement is likely in a dog with haemangiosarcoma elsewhere
Echo if between 0.07 and 0.25
Why does detection of c-kit mutation help with mast cell tumours
Diagnosis
Determining relatedness between mast cell tumours (because the in tandem duplications May be different)
Prognosis (only found in grade I and II MCTs so if a round cell with an ambiguous origin is identified can search for c-kit)
Treatment monitoring
Could do PCR on tissue aspirates/blood to see if malignant mast cells are present (only need a small amount of dna) could guide treatment - more vs less aggressive
Diagnosis of CML and ALL with PCR and monitoring
Detection of bcr-abl fusion gene
Can monitor response to tx - ratio of bcr-abl to regular bcr
MST of feline injection site sarcoma
Nodulectomy v radical excision
Non-specialist v specialist
79 days v 325-419days
66 v 274days
Most common site of metastasis of FISS
Lungs
Then regional LNs
Then abdomen - liver/spleen
Advantages and disadvantages of pre-surgery neoadjuvant radiotherapy in tx of FISS
Cells not hypoxic so easier targets
Smaller radiation field
Improves surgical margins by reducing tumour size
More wound complications post-surgery
Not as good against macroscopic dz as it is against microscopic dz
Advantages and disadvantages of post-surgery neoadjuvant radiotherapy in tx of FISS
Radiotherapy more effective against microscopic dz
Increased size of radiation field
More hypoxic cells
Risk of tumour cell repopulation
Chemotherapy that can be used with FISS
Doxorubicin Carboplatin Mitoxantrone Cyclophosphamide Vincristine
Only an option in cats with non-resectable disease where radiotherapy is not available
Other adjunctive tx for FISS
Oncept-IL2 injections alongside surgery and radiotherapy
TKIs masitinib and toceranib (inhibit PDGF AND PDFR) / in vivtro activity shown
Difference between injection site sarcomas and other feline sarcomas
In s/c tissues thought could be in muscular
Spread along fascial planes
Usually fibrosarcomas
More aggressive behaviour - marked cellular and nuclear pleomorphism, necrosis and high mitotic index
Rim of inflammatory cells
Higher metastic rate
Most high grade (60%)
May see vaccine adjuvant Material within cells in his top ATG
Which types of feline lymphoma are commonly FeLV positive
Mediastinal in young cats and spinal in young cats
Aim of immunohistochemistry in lymphoma
To determine phenotype and differentiate between cell types eg mast cells, undifferentiated carcinomas/sarcomas etc
Treatment low grade intestinal lymphoma in cats
Primary and rescue
Chloambucil and pred
Rescue (if relapse or no response within 3-4 doses): cyclophosphamide single agent
Lomustine single agent
COP protocol
Prognosis low grade
Alimentary LSA feline
Good to excellent 18-24
Months MST
(4.1 months without complete remission)
Intermediate/high grade alimentary lymphoma in feline
Treatment
Cop / CHOP
RESCUE:
single agent doxorubicin is not effective in cats
L-asparaginase, lomustine, pred - 38% response
Mitoxantrone single agent
MOPP (mechloretamine, vincristine, procarbazine, pred)
TKIs in the future?
Prognosis intermediate / high grade feline alimentary lymphoma
Median response 4-9 months longer if good initial response
Chemotherapy for oral SCC with likelihood of mets (eg tonsilar)
And oral malignant melanoma
Piroxicam with cisplatin or carboplatin
Mitoxantrone with RT
Melanoma:
Carboplatin and intralesional cisplatin
Melphalan
Immunotherapy!
Most common site of metastasis for canine oral malignant melanoma
Lungs
