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SAM 2 > Oncology > Flashcards

Oncology Flashcards

1
Q

what causes cancer?

A

it is mulifactorial

  • genetic mutations in DNA that result in defective regulatory circuits of a cell
  • lifestyle and environment: diet, exposure, viruses, age
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2
Q

what is the mechanism of cancer? (steps)

A
  • initiation: induce DNA damage
  • promotion: reversible tissue and cellular changes
  • progression: irreversibly convert an initiated cell into a cell exhibiting malignancy
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3
Q

what are the 6 hallmarks of a cancer cell?

A
  1. evading apoptosis
  2. self-sufficiency in growth signals
  3. insensitivity to anti-growth signals
  4. tissue invasion and metastasis
  5. limitless replicative potential
  6. sustained angiogenesis
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4
Q

what are the three cell types cancer comes from ?

A

round, mesenchymal and epithelial cells

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5
Q

what are the differentials for a round cell cytopathology ?

A

Please Help Me Learn This

  • plasmacytoma
  • histiocytoma
  • melanoma
  • lymphoma
  • tvt
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6
Q

what are the differentials for a mesenchymal cell cytopathology ?

A

sarcomas

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7
Q

what are the differentials for an epithelial cell cytopathology ?

A

carcinomas

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8
Q

what type of cell will be spindle shaped on cytology?

A

mesenchymal cells

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9
Q

what type of cell has very good exfoliation on cytology ?

A

round cells

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10
Q

what type of cell is round and arranged in sheets on cytology?

A

epithelial cells

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11
Q

what characteristics of malignancy do we look for?

A
  • homogenous vs. heterogeneous
  • monomorphic vs. pleomorphic
  • cellular/cytoplasmic criteria like anisocytosis or hyperchromasia
  • nuclear criteria ** - anisokaryosis, multiple nucleoli, increased mitosis
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12
Q

what is an advantage and disadvantage of cytopathology?

A

highly specific but low sensitivity

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13
Q

what is the exception to remember with needle tract implantation?

A

urogenital neoplasms

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14
Q

what do we associate multiple similar nodules on splenic ultrasound with?

A

significantly associated with malignancy

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15
Q

what method do we use when performing cytology of spleen?

A

non-aspirate technique due to less blood contamination

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16
Q

true or false.

ultrasound guided cytology of GI tumors is not specific.

A

false. highly specific almost 100%

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17
Q

when performing a cytology of bone tumor if we get a positive ALP stain, what is the interpretation?

A

100% sensitive for OSA

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18
Q

true or false.

we can determine a grade of a tumor based on cytology.

A

false, need a block of tissue to determine

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19
Q

does staging or grading determine if tumor is localized or has spread?

A

staging

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20
Q

does staging or grading determine the aggressiveness of tumor ?

A

grading, grade 1-3

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21
Q

what are some classic staging tests?

A
  • CBC/CHEM (min. database)
  • regional lymph node cytology
  • THREE view thoracic met check
  • abdominal ultrasound
  • CRT or MRI
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22
Q

what is locoregional lymph node sampling based on?

A

sentinel node

- first lymph node in the drainage of nodes to drain tumor

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23
Q

true or false.

the sentinel lymph node is always the draining lymph node

A

false

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24
Q

true or false.

if the lymph nodes are normal sized we can assume they are not metastatic.

A

FALSE, never assume this

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25
Q

how many views of thoracic radiographs should we take when staging?

A

ALWAYS THREE

- can miss 12-15%of mets if you only do a 2 view study

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26
Q

what is the minimum threshold size required to reliably detect nodules on rads

A

7-9 mm

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27
Q

if we have a facial tumor do we need to perform an abdominal ultrasound?

A

yes, the liver is the most common receptacle for blood borne metastasis so need to confirm there are no mets

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28
Q

true or false.

paraneoplastic syndromes are often the first sign of malignancy but aren’t hallmarks of malignancies.

A

false. often the first sign of malignancy and can be a hallmark of malignancy

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29
Q

what are some examples of a classic paraneoplastic syndrome ?

A
  • anal sac adenocarcinoma - hypercalcemia
  • thymoma/myasthenia gravis - neurologic
  • intestinal leiomyosarcoma - hypoglycemia
30
Q

what are the 2 goals of conventional chemotherapy?

A
  1. enhance or maintain quality of life and family bond

2. stabilize, diminish or eliminate neoplastic process

31
Q

what types of cells does chemotherapy drugs target?

A

all rapidly dividing cells

- tumor cells but also GI, bone marrow and hair

32
Q

what does fractionation of dosing do?

A

allows recovery of normal tissue between treatment intervals

33
Q

why do we use a neoadjuvant ?

A

used prior to treatment for things like attempting to shrink the tumor

34
Q

when determining dose of chemo drugs what do we base dose on?

A

dosage is based on toxicity rather than efficacy, we determine the maximum tolerated dose

35
Q

what is the maximum tolerated dose?

A

a dose that produces an “acceptable” level of toxicity

36
Q

what accounts for a large amount of mistakes with chemotherapy dosing ?

A

dose calculation errors!

- have 2 people do calculation

37
Q

what are the drugs that have an increased risk due to the MDR 1 gene?

A

vincristine, vinblastine, paclitaxel and doxorubicin

38
Q

what PPE should we use with chemo drugs?

A

gloves, gowns, face masks

39
Q

what is something we should inform owners of when they have a pet undergoing chemo treatments ?

A
  • to wear gloves when cleaning up after pet for the first 48 hours after drug administration
  • never crush or split pills
40
Q

what are the most common adverse events with cytotoxic chemotherapy?

A

BAG!

  • Bone marrow suppression (most common)
  • Alopecia (non-shedding breeds only)
  • Gastrointestinal
41
Q

true or false.
in order to give chemo, the neutrophil count needs to be 3,000 or higher and platelet count needs to be 100,000 or higher.

A

true

42
Q

how do we monitor patient after we give the chemo drugs?

A

recheck CBC at the NADIR which is usually 5-10 days

usually recheck CBC at 7 days post chemo and compare with CBC results from before chemotherapy was given

43
Q

what is the NADIR?

A

the expected low point of bone marrow insult

44
Q

if the neutrophil count at nadir is below 1,500 or the platelet count is below 60,000, what do we do?

A

reduce the subsequent doses by 20-25%

45
Q

what happens when we reduce the dose 20%?

A

the efficacy of the therapy is reduced 50%

46
Q

how do we try to control the side effects of myelosuppression in chemo patients?

A
  • use prophylactic antibiotics to avoid systemic infections (want 4 quadrant coverage)
  • avoid sources of infection like park, groomers, raw diets, etc.
  • keep in ICU in severe cases
47
Q

what chemotherapy drugs are cell-cycle specific?

A

antimitotics and antimetabolites

48
Q

what chemotherapy drugs are cell-cycle non-specific?

A

alkylating agents and antibiotics

49
Q

what is the mechanism of action of antimitotics?

A

immobilize the mitotic spindle which is necessary for cell division

50
Q

what should we do if vincristine (antimitotic) extravasates ?

A

warm it up! need to disperse and dilute

51
Q

what chemotherapy drug can result in a neuropathy?

A

vincristine

52
Q

what is the mechanism of action of alkylating agents?

A

changes the structure of DNA and interferes with transcription, replication and repair machinery

53
Q

what chemo drug is associated with sterile hemorrhagic cystitis ?

A

cyclophosphamide

54
Q

what chemo drug is liver toxic and what should we give in conjunction with it?

A
  • lomustine or CCNU

- give with denamarin because it is hepatoprotective

55
Q

what chemo drug is related to dose-related cardiotoxicity ? what should we do to prevent it?

A
  • doxorubicin

- prescreen boxers/dobermans with an echo

56
Q

what chemo drug is also called “red death”?

A

doxorubicin

57
Q

what chemo drug is also called “blue thunder”?

A

mitoxantrone

58
Q

what chemo drug can cause tinnitus ?

A

doxorubicin

59
Q

if doxorubicin extravasates, what should we do?

A

DON’T disperse!

use ice to localize and neutralize

60
Q

what chemo drug is cardiac sparing?

A

mitoxantrone

61
Q

what is the mechanism of action of antimetabolites ?

A

effects the S phase

62
Q

what is the mechanism of action of platinum agents ?

A

covalent binding to DNA strands and forms interstrand cross links

63
Q

can we give cisplatin to cats?

A

NOOOO - splats cats!

64
Q

why does cisplatin splat cats?

A

fatal pulmonary edema

65
Q

can we give L-asparaginase IV?

A

no, causes a hypersensitivity reaction

66
Q

true or false.

cisplatin causes nephrotoxicity.

A

true

67
Q

can you give carboplatin to cats?

A

yes this one is okay, DONT give cisplatin

68
Q

what is metronomic chemotherapy?

A

revolves around the concept of eliminating break period by giving low dose continuous chemotherapy

69
Q

what are pros and cons of metronomic chemotherapy?

A

pro - lower toxicity

con - not cytotoxic

70
Q

what are the MOAs of metronomic chemotherapy ?

A
  • antiangiogenesis
  • immunomodulation
  • direct targeting

SAM 2 (9 decks)

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