Oncology Flashcards

1
Q

How can you define cancer for your client?

A

Disease where a group of abnormal cells grow uncontrollably be disregarding the normal rules of cell division

Normal cells = subject to signals that dictate whether the cell should divide, differentiate into another cell or die

Cancer cells develop a degree of autonomy from these signals

  • > equals uncontrolled growth and proliferation
  • > if malignant eventually metastasis and death
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2
Q

What causes cancer?

A

DNA mutations -defect in regulatory circuits of a cell
—> disruption of normal cell proliferation and behaviour

LIFESTYE AND ENVIRONMENT
Diet - high fat, low fiber diets linked to bowel, pancreatic, breast, and prostate cancers

Exposure - carcinogens, mutagens (UV, cigarette smoke, and alcohol)

Viruses -HepB, FeLV, FIV

Age- alterations in the immune system (accumulation of random genetic mutations or lifetime carcinogen exposure; hormonal alterations or exposure

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3
Q

What is the mechanism of cancer development?

A

Initiation (rapid): carcinogens induce DNA damage but not enough to induce neoplastic transformation

Promotion: original carcinogens or normal growth promoters cause reversible tissue and cellular changes

Progression (slow): processing agents are able to irreversibly convert an initiated cell into a cell exhibiting malignancy

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4
Q

What are the 6 hallmarks of cancer?

A
Self-sufficiency in growth signals 
Insensitivity to anti-growth signals 
Tissue invasion and metastasis 
Limitless replicative potential 
Sustained angiogenesis 
Evading apoptosis
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5
Q

A dog comes in with a mass on its limb, suspecting cancer, what is the first thing you should do?

A

Comprehensive history

  • rapid vs slow growth
  • tease out extent of involvement
  • co-morbidities

Signalment assessment
-breed specific neoplasms

Complete PE

DIAGNOSTIC CYTOLOGY —> establish a tissue diagnosis

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6
Q

When doing a cytopatholgoy, all (most) cancer comes from what three distinct cell types?

A

Round cell
Mesenchymal cell
Epithelial cell

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7
Q

Best to worst, when doing cytopathology, which cell type has the best yield(exfoliation)?

A

Round > epithelial > mesenchymal

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8
Q

What is the cell type?

Individualized round cells arranged in a monolayer

A

Round cells

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9
Q

What is the cell type?

Spindle-shaped, stellate or oval shaped cells arranged individually or in non-cohesive aggregates

A

Mesenchymal

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10
Q

What type of cells?

Round, cuboidal, columnar, or polygonal cells arranged in cohesive sheets or clusters

A

Epithelial

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11
Q

Round, cuboidal, columnar, or polygonal cells arranged in cohesive sheets or clusters

DDX?

A

Carconoma

Eg squamous cell, adenocarcinoma, undifferentiated

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12
Q

Spindle-shaped, stellate or oval shaped cells arranged individually or in non-cohesive aggregates

DDX?

A

Sarcoma

Eg osteo, chondro, fibro, hemangiosarcoma

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13
Q

Individualized round cells arranged in a monolayer

DDX?

A
Lymphoma 
Mast cells 
Plasmacytoma 
Histiocytoma 
TVT 

Melanoma (sometimes)

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14
Q

What are characteristics of malignancy?

A

Homogenous (cancer cell) vs heterogenous (inflamm)

Monomorphic (single lineage with uniform appearance) vs pleomorphic (malignant)

Cellular/cytoplasmic criteria - anisocytoisis (var in size), hyperchromasia, variable N:C ratio

Nuclear criteria - anisokaryosis (var in size), multiple nucleoli, increased mitosis

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15
Q

What are the advantages to cytopathology?

A
Non-invasive, low risk 
Low cost 
Rapid turnover of results 
Ability to evaluate morphological appearance of individual cells 
Highly specific
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16
Q

What are the disadvantages of cytopathology?

A

Low sensitivity (false -)
Poor sample quality
Small sample size
Inability to evaluate tissue architecture

17
Q

In what cases can cytopathology not give you a diagnosis?

A

Oral and splenic tumors —> bleed a lot, may not get a good tissue spample

Feline mammary gland tumors -> may inflammatory cells (carcinomas generally have a lot of inflammation)

Mesenchymal tumors dont exfoliate well —> not always found with cytology

18
Q

T/F: there is a high rate of needle tract implantation of neoplasms

A

False

Very low incidence
**except in urogenital neoplasms

19
Q

What is the clinical techniques used for FNA?

A
Needle off (coring) 
—> mass is grasped and stabilized in non-dominant hand between thumb and index finger

—> needle is advanced through the mass and is redirected several times to dislodge cells

—>coring diminishes blood contamination of the specimen in vascular tissues

Needle on (suction)

20
Q

What type of tumor is Alkaline Phosphate staining used??

A

Osteosarcoma

ALP is required for bone mineralization
Marker of osterobastic lineage

21
Q

What is the difference between staging and grading ?

A

Staging = is the tumor localized/spread OR is there any evidence of advanced stage disease

Grading= establishes aggressiveness of tumor

22
Q

T/F: cytology is used for grading tumors

A

False

Requires biopsy

23
Q

What are tests used for staging a tumor?

A
MDB (CBC/chem/T4/UA/FeL/FIV) 
Regional LN cytology 
Three-view thoracic metastasis check (ie radiographs) 
Abdominal ultrasound (+/- FNA)
Cross sectional imaging (CT/MRI)
24
Q

When doing lymphnode cytology to stage cancer, you should be sampling the _______ node

A

Sentinel node -> not always the anatomic drainage pathway

25
T/F: distant metastasis should not be present if the sentinel lymph node does not have evidence fo tumor
True
26
How can a sentinel lymph node be found?
Peri-tumors injection of technectium-99 in the region of the right elbow showing an accumulation in the right periscapular and 2 axillary lymph nodes —> X-rays 24hrs later
27
How many views do you take when doing thoracic radiographs for met check?
3!
28
What is the most specific method of determining metastasis?
CT
29
What is the most common receptacle of blood-borne metastasis?
Liver —> abdominal ultrasound
30
What is paraneoplasic syndrome?
Tumor associated alterations in bodily structure or function —> secondary to small molecules (cytokines/hormones/peptides) secreted by tumor which mimic native substances causing effects Often are the first sign of malignancy and can be a HALLMARK of certain malignancies
31
What neoplasms are associated with hypercalcemia?
Anal sac adenocarcinoma Lymphosarcoma Multiple myeloma Mammary tumor
32
What type of tumor causes a paraneoplasic syndrome manifesting as neurological problems like myasthenia gravis?
Thymoma
33
What tumor PNS results in a nodular dermatofibrosis?
Cutaneous
34
What tumors can have a PNS that results in a hypoglycemia?
Intestinal leiomyosarcoma Insulinoma lymphosarcoma
35
What tumor PNS results in hypertrophic osteopathy?
Primary lung tumors Esophageal tumor Metastatic tumor