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Small Animal Medicine (GP cert) > Oncology AI > Flashcards

Oncology AI Flashcards

1
Q

What is the main disadvantage of incisional biopsies?

A

They provide visual access but harvest smaller samples than other methods.

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2
Q

When is excisional biopsy indicated?

A

For lymph nodes, some intestinal masses, and most mammary tumors.

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3
Q

What are some features of malignancy used to establish malignancy grade?

A

Degree of differentiation, mitotic index, degree of cellular or nuclear polymorphism, amount of necrosis, invasiveness, stromal reaction, nucleolar size and number, overall cellularity, lymphoid response

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4
Q

How can the presumed clinical behavior of a tumor be assessed when there is no validated grading scheme?

A

On the basis of well, moderately, or poorly differentiated

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5
Q

What are grading schemes often used for?

A

To give a prognosis and decide treatment intensity

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6
Q

What is the role of histologic grade?

A

It is complementary to the TNM clinical stage

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7
Q

What is the mechanism of action of toceranib against MCTs?

A

Antiangiogenic nature, results of VEGFR and PDGFR blockage

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8
Q

Is tumour grade associated with response rate to toceranib?

A

No

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9
Q

Is duration of response longer for grade II or grade III MCT treated with toceranib?

A

Grade II

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10
Q

What are potential mechanisms for resistance to toceranib?

A

Development of new mutations in c-kit, significant overexpression of KIT, activation of other signaling pathways

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11
Q

What was the response rate in the randomized trial of masitinib for dogs with inoperable MCTs?

A

15% for treatment group, 16% for placebo group

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12
Q

Was there a significant difference in time to disease progression between masitinib and placebo group?

A

Yes, masitinib group had a significantly improved time to disease progression

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13
Q

Did c-Kit mutation presence affect the time to disease progression in the masitinib group?

A

No

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14
Q

What are the survival rates at 12 and 24 months for dogs treated with masitinib?

A

Higher survival rate at 12 and 24 months

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15
Q

What is the treatment response rate of masitinib in non-resectable and metastatic MCT?

A

50%

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16
Q

What is the most significant prognostic factor for survival in dogs treated with masitinib?

A

Response to masitinib

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17
Q

What are the adverse reactions associated with masitinib treatment?

A

Diarrhoea, anorexia, vomiting, lethargy, lameness, weight loss, blood in stool

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18
Q

What are the laboratory abnormalities associated with masitinib treatment?

A

Neutropenia, hypoalbuminaemia, thrombocytopenia, increased ALT, decreased hematocrit, increased creatinine, hyperbilirubinemia, urinary tract infection

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19
Q

Is there evidence of TKIs effectiveness against feline MCTs?

A

No published studies on the activity of masitinib against feline MCTs

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20
Q

What was the response rate of feline MCTs positive for c-kit mutation treated with imatinib?

A

Complete response: 2/9, Partial response: 6/9

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21
Q

What is a possible alternative chemotherapy regime for feline MCTs?

A

Toceranib and prednisolone

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22
Q

What is the dosage of toceranib for cats?

A

2.75mg/kg three times per week

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23
Q

What was the clinical benefit seen in cats treated with toceranib?

A

86% for cutaneous cases, 76% for gastrointestinal cases

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24
Q

What is the median duration of treatment for cats experiencing clinical benefit with toceranib?

A

36 weeks for cutaneous cases, 23 weeks for gastrointestinal cases

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25
Q

What is the most significant prognostic factor for survival in cats treated with toceranib?

A

Response to toceranib

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26
Q

Why should tablets or capsules of cyclophosphamide never be broken or opened?

A

Breaking or opening the tablets or capsules may lead to an inappropriate dose and exposure to cytotoxic drugs.

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27
Q

What precaution should be taken by veterinary surgeons or pet owners when administering cytotoxic drugs?

A

They must wear gloves when administering these drugs.

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28
Q

What is the recommended administration route for chemotherapy drugs in dogs and cats with malignant pleural or abdominal effusions?

A

Intracavitary administration, with the implantation of permanent thoracic or pleural catheters.

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29
Q

Which chemotherapy drugs have been successful in reducing malignant effusion in dogs?

A

Cisplatin, carboplatin, mitoxantrone, and fluorouracil.

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30
Q

What factors should be considered in monitoring and managing the adverse effects of chemotherapy?

A

Dose-related toxicity, organ system failure, genetic defects, and tissue-specific effects.

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31
Q

What is the common term for the toxic effects of chemotherapy on the bone marrow?

A

Myelosuppression.

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32
Q

What is the limiting factor of myelosuppression in pets undergoing cytotoxic therapy?

A

Neutropenia.

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33
Q

When does the nadir of neutrophils typically occur after the administration of chemotherapy?

A

Around 8 days post-administration, varying from 5 to 10 days depending on the drug.

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34
Q

What is the recommended interval for administering most chemotherapy drugs in veterinary oncology?

A

At least every one to two weeks, except for lomustine and carboplatin.

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35
Q

What should be performed when the neutrophil nadir is expected?

A

A full complete blood count, including platelet count.

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36
Q

When should the dose of a chemotherapy drug be reduced?

A

If nadirs below 1000 neutrophils per microliter are detected.

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37
Q

How much should the dose of a chemotherapy drug be reduced if the neutrophil count falls below 1000/μl?

A

By 15 - 20% for the next administration.

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38
Q

What is the general approach when the neutrophil count is below 2000/μl?

A

Delay chemotherapy treatment by 3 days to one week and consider other factors for treatment decision-making.

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39
Q

When should chemotherapy not be administered, regardless of the neutrophil count?

A

If the patient is clinically unwell (anorexia, diarrhea, vomiting) or has a fever.

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40
Q

What is the high-risk complication associated with neutrophil counts below 500/μl?

A

Sepsis.

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41
Q

What breakthrough was achieved in the treatment of canine melanoma?

A

A breakthrough was achieved with a DNA vaccine encoding the human tyrosinase.

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42
Q

What is the name of the DNA vaccine used for treating oral melanoma in dogs?

A

The DNA vaccine is commercialized under the name of Oncept.

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43
Q

Which regulatory authority has licensed Oncept for veterinary use?

A

Oncept is the only veterinary therapeutic tumour vaccine licensed by the US FDA.

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44
Q

How was the clinical efficacy of Oncept evaluated in a study?

A

The clinical efficacy of Oncept was evaluated in a pilot study with 9 dogs.

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45
Q

What was the administration method used for the DNA vaccine?

A

The DNA vaccine was administered i/m in a needle-free manner without electroporation.

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46
Q

What was the advantage of the administration method used for the DNA vaccine?

A

Unlike electroporation, no general anaesthesia was required for the administration of the DNA vaccine.

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47
Q

What was the frequency of administration for the DNA vaccine in early trials?

A

The DNA vaccine was administered four times weekly in early trials.

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48
Q

How was the frequency of administration for the DNA vaccine changed in recent trials?

A

In recent trials, the DNA vaccine was administered four biweekly injections followed by boosts every 6 months.

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49
Q

What type of response was observed in some patients after vaccination?

A

An antibody response against human tyrosinase was observed in some patients.

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50
Q

What correlation was observed between the antibody response and the clinical response?

A

A correlation between the antibody response and the clinical response was observed in the initial pilot study.

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51
Q

What is tyrosinase and why was the antibody response unexpected?

A

Tyrosinase is an intracellular protein, and it was unexpected to see a response from antibodies.

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52
Q

How were the survival times of vaccinated dogs compared to a control group?

A

A statistical survival analysis compared the survival times of vaccinated dogs to a historical control group.

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53
Q

What was the median survival time for vaccinated dogs in the study?

A

The median survival time was not reached for vaccinated dogs.

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54
Q

What percentage of vaccinated dogs were expected to live beyond 464 days?

A

75% of vaccinated dogs were expected to live beyond 464 days.

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55
Q

What is a weakness of the study comparing survival times to a control group?

A

The study used survival data from an article published in 1999, which may not be comparable to the present.

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56
Q

What additional study design is recommended to prove the clinical efficacy of Oncept?

A

A randomized, placebo-controlled study should be performed to prove the clinical efficacy of Oncept.

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57
Q

What did a recent study find in terms of survival time for vaccinated and non-vaccinated dogs?

A

No difference in survival time could be found between vaccinated and not vaccinated dogs.

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58
Q

How many dogs were included in the study with canine oral melanoma?

A

The study included 151 dogs with canine oral melanoma.

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59
Q

What is the recommended approach for cases of oral melanoma in terms of local control?

A

Complete removal of primary tumor and removal of metastatic lymph nodes is recommended for local control.

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60
Q

What are the four major categories of tumour antigens?

A

Differentiation antigens, cancer/testis antigens, mutational antigens, ubiquitous antigens

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61
Q

What are differentiation antigens?

A

Antigens overexpressed in a given type of cancer and often expressed in normal tissue.

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62
Q

What are examples of differentiation antigens?

A

Prostate-specific antigen and tyrosinase.

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63
Q

What are cancer/testis antigens?

A

Antigens expressed in germ-line tissue and different types of cancers.

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64
Q

Why are cancer/testis antigens considered tumour specific?

A

Germ-line tissue lacks MHC expression, hence tolerance and autoimmunity are not major issues.

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65
Q

What are mutational antigens?

A

Antigens resulting from mutations and are strictly tumour specific.

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66
Q

What are the limitations of mutational antigens?

A

They are patient-specific or restricted to certain patients.

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67
Q

How can unknown mutational antigens be included in tumour vaccines?

A

By using whole, autologous tumour cell vaccines.

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68
Q

What are ubiquitous antigens?

A

Antigens expressed in many normal tissues and overexpressed in tumours.

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69
Q

What is the rationale behind the effectiveness of ubiquitous antigens without causing autoimmunity?

A

Overexpression in tumour cells can reach the threshold for T-cell recognition, breaking immune tolerance.

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70
Q

What is an example of a ubiquitous antigen?

A

Her2/neu

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71
Q

What are the three classes of antigens based on their origin?

A

Autologous, allogeneic, and xenogeneic antigens.

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72
Q

What are autologous antigens?

A

Antigens isolated from the patient’s own tumour cells, representing personalized therapy.

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73
Q

How can autologous antigens be included in tumour vaccines?

A

By using tumour cell vaccines, dendritic cell vaccines, peptide vaccines, or DC tumour fusion vaccines.

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74
Q

What are allogeneic antigens?

A

Antigens from the same species as the patient, but from a different individual.

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75
Q

What are xenogeneic antigens?

A

Antigens derived from another species than the patient, breaking immune tolerance to self-antigens.

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76
Q

When does surgical resection become possible after neoadjuvant chemotherapy?

A

Surgical resection becomes possible after a few cycles of chemotherapy.

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77
Q

Should chemotherapy be used as a substitute for surgery or radiotherapy?

A

No, chemotherapy should not be used as a substitute for surgery or radiotherapy.

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78
Q

When can chemotherapy be used following surgery with incomplete margins?

A

Chemotherapy can be used following surgery with incomplete margins, usually for neoplasms not very responsive to chemotherapy and/or with low mitotic index.

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79
Q

Why should chemotherapy not be used in patients with severe organ dysfunction?

A

Chemotherapy should not be used in patients with severe organ dysfunction due to the increased risk of systemic toxicity.

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80
Q

What are the considerations for choice, combination, and dose calculation of cytotoxic drugs?

A

Drugs must have proven efficacy, different mechanisms of action, and no overlapping toxicities.

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81
Q

Why are combinations of drugs usually more effective than single agents?

A

Combinations of drugs have proven to be more effective than single agents, except for doxorubicin/carboplatin in osteosarcoma.

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82
Q

What is dose intensity?

A

Dose intensity is the amount of drug administered per unit time.

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83
Q

How can dose intensity be increased?

A

Dose intensity can be increased by increasing the dosage or shortening the time interval between drug administrations.

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84
Q

What is the aim of dosing myelosuppressive drugs?

A

The aim is to deliver doses that produce a neutrophil nadir of between 1.0 and 1.5 x 109/L.

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85
Q

What is the formula for calculating the body surface area (BSA) for dogs and cats?

A

For dogs: S=10.1 x weight (kg)0.66 / 104, For cats: S=10 x weight (kg)0.66 / 104

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86
Q

Why is dosage based on BSA imperfect for small dogs and cats?

A

Dosage based on BSA for many drugs is imperfect because small dogs and cats should be dosed at a lower rate than larger dogs.

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87
Q

What should be done for patients with fever or gastrointestinal symptoms?

A

Hospitalization and administration of intravenous fluids and antibiotics.

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88
Q

What should be done for patients who are not febrile?

A

Careful monitoring and administration of broad-spectrum antibiotics.

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89
Q

What treatment is usually sufficient for neutrophil counts from 500-1200/μl if the patient does not present clinical signs?

A

Administering broad-spectrum oral antibiotics orally for several days and monitoring until the next blood count.

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90
Q

How long does the neutrophil nadir rarely last for in most cases?

A

48-72 hours.

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91
Q

What is considered a normal neutrophil count below in certain breeds, especially sighthounds?

A

3000/μl.

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92
Q

What factors should be considered when deciding whether or not to treat?

A

Number of neutrophils, type of neoplasm, and clinical stage of the disease.

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93
Q

What is the potential adverse effect with the greatest impact on the quality of life of pets treated with chemotherapy?

A

Gastrointestinal (GI) toxicity.

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94
Q

How can gastrointestinal toxicity be managed?

A

Through prevention and a good preventive plan.

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95
Q

What factors should be assessed to determine the patient’s risk of GI toxicity?

A

Prevalence of GI toxicity associated with the drug, breed of the patient, individual sensitivity, and whether the neoplasm being treated affects the gastrointestinal tract.

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96
Q

What should be prescribed when a drug with a high prevalence of GI toxicity is administered for the first time?

A

Symptomatic treatment (antiemetics or antidiarrhea agents).

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97
Q

What are the common clinical signs of gastrointestinal toxicity?

A

Lack of appetite, anorexia, nausea, vomiting, diarrhoea, abdominal pain, and constipation.

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98
Q

What can cytotoxic drugs cause in the gastric and intestinal epithelium?

A

Gastrointestinal toxicity due to high cell turnover, leading to vomiting and mucoid or haemorrhagic diarrhea.

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99
Q

What should be considered for unacceptable toxicity?

A

Reductions in the dose or changes to the chemotherapy protocol.

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100
Q

What can contribute to the severity of gastrointestinal toxicity?

A

Lack of symptomatic or preventive therapy.

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101
Q

What can some drugs induce?

A

Nausea and vomiting.

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102
Q

What is the proposed dose range of TKIs in dogs and cats?

A

10-15 mg/kg

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103
Q

How are TKIs mostly eliminated in dogs and cats?

A

Through feces (92%) with a small portion excreted in urine (7%)

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104
Q

Where can concentration of toceranib be detected in dogs after a single oral dose?

A

Bile, liver, lymph nodes, adrenals, colon, bone marrow, kidneys, lungs, spleen, pancreas, and skin

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105
Q

What are the most common adverse effects of TKIs in dogs and cats?

A

Gastrointestinal (GI) disorders

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106
Q

What are the second most common adverse effects of TKIs in dogs and cats?

A

Hematologic disorders (neutropenia and thrombocytopenia)

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107
Q

What are the third most common adverse effects of TKIs in dogs and cats?

A

Musculoskeletal disorders (muscle pain and lameness)

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108
Q

What is a confounding factor when reporting adverse effects in dogs with mast cell tumors?

A

The prevalence of GI signs in patients with this disease secondary to histamine release

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109
Q

What is the prevalence of grade III and IV adverse effects in dogs with non-mast cell neoplasia treated with toceranib?

A

Lower than in dogs with mast cell tumors

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110
Q

What are some less frequently described adverse effects of TKIs in dogs and cats?

A

Liver toxicity, vasculitis, edema, hypertension, hypopigmentation, alopecia, pancreatitis, pulmonary thromboembolism, nephrotic syndrome, hemolytic anemia, etc.

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111
Q

What adverse effects were observed in cats administered masitinib?

A

Proteinuria, neutropenia, gastrointestinal toxicity, and increases in creatinine

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112
Q

Why is early recognition of adverse effects important when using TKIs?

A

Due to the possible occurrence of a cumulative effect

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113
Q

How long can it take for the resolution of adverse effects after TKI discontinuation?

A

Weeks in some cases

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114
Q

What is the suggested monitoring plan for early detection of adverse effects?

A

Not mentioned in the given text

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115
Q

What is the known potential toxicity with the use of this drug in dogs?

A

10% of dogs had evidence of this side effect at some point during treatment.

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116
Q

Which drugs have been shown to be relatively safe in dogs with advanced tumors when used in a metronomic fashion?

A

Lomustine and chlorambucil.

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117
Q

Why did a significant number of dogs have to withdraw from receiving lomustine?

A

Due to toxicosis (GI, hepatic and renal).

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118
Q

Are there veterinary studies that examine the usefulness of these drugs to reduce angiogenesis, number of CEPs or Tregs?

A

No, there are currently no veterinary studies that examine the usefulness of these drugs.

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119
Q

Are there objective measures of outcomes and efficacy for metronomic therapy?

A

No, there are no objective measures of outcomes and efficacy.

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120
Q

What does sustained stable disease manifest as with metronomic chemotherapy?

A

Sustained stable disease may be the only manifestation of objective results with metronomic chemotherapy.

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121
Q

How long does it typically take for actual tumor shrinkage to occur with continuous therapy?

A

Actual tumor shrinkage, if it occurs, may manifest only after 1 to 2 months of continuous therapy, or more.

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122
Q

When may the benefits of metronomic dosing be maximized?

A

The benefits of metronomic dosing may be maximized at the lowest tumor burden, i.e., as adjuvant therapy.

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123
Q

What were the initial dosing recommendations for cyclophosphamide in metronomic therapy?

A

Cyclophosphamide 15 mg/m2 daily (reduced to EOD in face of toxicity).

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124
Q

What is the recommended dosing of piroxicam in metronomic therapy?

A

Piroxicam 0.3mg/kg daily (or NSAID of choice).

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125
Q

What are the potential side effects of long-term metronomic chemotherapy?

A

Up to 30% prevalence of sterile hemorrhagic cystitis, therefore concurrent use of frusemide at 0.5mg/kg is recommended.

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126
Q

Can anti-angiogenic therapies and metronomic scheduling replace traditional cytotoxic schedules?

A

No, on their own, anti-angiogenic therapies and metronomic scheduling may not replace traditional cytotoxic schedules.

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127
Q

What do current research focus on in terms of metronomic chemotherapy?

A

Understanding its effects on angiogenesis, immunology, tumour microenvironment, cell specificity, and drug-resistance mechanisms.

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128
Q

Are metronomic chemotherapy protocols currently considered the standard of care?

A

No, they are still considered investigational and not the current standard of care.

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129
Q

Who should input be sought from when considering the approach?

A

All involved parties, including radiation and surgical oncologists.

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130
Q

What treatment is often used for tumors at high risk of metastasis?

A

Hypofractionated radiation and chemotherapy.

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131
Q

Name three tumors that may be treated with full-dose chemotherapy and radiation therapy.

A

Appendicular osteosarcoma, tonsillar squamous cell carcinoma (SCC), and oral melanoma.

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132
Q

What is the primary purpose of giving chemotherapy in conjunction with radiation therapy?

A

Systemic effect on presumed microscopic metastatic disease.

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133
Q

How does chemotherapy impact local tumor control?

A

It may impact local tumor control, but it is primarily given for its systemic effect.

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134
Q

What are potential complications of full-dose chemotherapy?

A

Bone marrow suppression and sepsis.

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135
Q

How can carboplatin concurrently given with radiation impact myelosuppression?

A

It can result in marked myelosuppression, including profound neutropenia.

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136
Q

What factors can influence the response of tumors to radiation therapy?

A

Species, histology, tumor location, histopathological grade, stage of disease, age of patient.

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137
Q

What response can be expected for SCC on the nasal planum of a cat?

A

Typically an excellent response.

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138
Q

How does the response of oral SCC in cats differ from that in dogs?

A

Oral SCC in cats is notoriously radio-resistant, while dogs may achieve long-term local control with radiation alone.

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139
Q

What characteristic is associated with the papillary variant of SCC in young dogs?

A

Local aggression and extensive osteolysis.

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140
Q

What are acute radiation side effects primarily caused by?

A

Rapidly proliferating cells in tissues.

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141
Q

How long do acute radiation side effects typically take to resolve?

A

Within 3 to 6 weeks.

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142
Q

Name one treatment option for skin reactions during radiation therapy.

A

Topical aloe vera based lotions or silver sulfadiazine cream.

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143
Q

Where do late radiation side effects primarily occur?

A

In tissues where cells do not undergo mitosis, such as nerves and bone.

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144
Q

What causes late radiation side effects?

A

Changes in connective tissues, stroma, and vasculature.

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145
Q

What can cause diarrhoea after chemotherapy administration?

A

Direct stimulation of the chemoreceptor trigger zone.

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146
Q

When does diarrhoea tend to occur after administration of chemotherapy?

A

3 to 5 days.

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147
Q

Which drugs can be used for symptomatic management of chemotherapy-induced diarrhoea?

A

Sulphasalazine, metronidazole, and loperamide.

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148
Q

What are some other causes of diarrhoea?

A

Dietary indiscretion and parasites.

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149
Q

What can vincristine cause in cats?

A

Ileus paralyticus.

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150
Q

What clinical signs are associated with vincristine-induced ileus paralyticus?

A

Lack of appetite, abdominal pain, and constipation.

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151
Q

What is the recommended treatment for vincristine-induced ileus paralyticus?

A

Reduce vincristine dose, replace with vinblastine, or discontinue treatment.

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152
Q

What is the most common clinical sign of gastrointestinal toxicity in cats?

A

Anorexia.

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153
Q

What can high dose cyclophosphamide administration lead to in cats?

A

Development of nausea.

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154
Q

What gastric protectants can be used for nausea or vomiting secondary to gastroenteritis?

A

Antacids, proton pump inhibitors (omeprazole), or H2 blockers (ranitidine or famotidine).

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155
Q

What is the purpose of sucralfate in gastrointestinal therapy?

A

To help the healing of the GI mucosa and prevent further damage.

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156
Q

What is a possible side effect of doxorubicin in dogs?

A

Cardiotoxicity and mast cell degranulation.

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157
Q

What is the cumulative dose that can lead to chronic doxorubicin-induced dilated cardiomyopathy?

A

> 180 mg/m2.

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158
Q

What is a possible side effect of doxorubicin in cats?

A

Nephrotoxicity.

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159
Q

What can cause sterile haemorrhagic cystitis in dogs?

A

Cyclophosphamide.

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160
Q

What is the metabolite of cyclophosphamide that is irritant to the bladder lining?

A

Acrolein.

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161
Q

What is the efficacy of toceranib and masitinib in malignancies other than MCTs?

A

Information is scarce.

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162
Q

What are the types of neoplasms in which toceranib has been used as a treatment?

A

Canine solid neoplasias.

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163
Q

What is the expected benefit of toceranib treatment for dogs with solid neoplasms?

A

Good quality of life and partial response or stabilization of the disease.

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164
Q

What are the clinical benefits observed in dogs treated with toceranib?

A

Clinical benefit was observed in 74% of dogs with AGASACA, OSAs, thyroid carcinomas, head and neck carcinomas, and nasal carcinomas.

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165
Q

What other treatments did the dogs in the study receive along with toceranib?

A

NSAIDs or metronomic cyclophosphamide or both.

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166
Q

What was the median dose of toceranib for dogs experiencing clinical benefit?

A

2.8 mg/kg.

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167
Q

What was the duration of treatment for most dogs experiencing clinical benefit?

A

Four months or longer.

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168
Q

What safety study involved the combination of toceranib and piroxicam?

A

A study to document the safety of the combination.

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169
Q

What neoplasm showed a complete response with toceranib in a case report?

A

Canine lymphangiosarcoma.

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170
Q

What neoplasm showed a temporal complete remission with masitinib in a case report, but subsequently relapsed?

A

Canine neurofibrosarcoma.

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171
Q

What technique was used in a case report for primary tumor cell culture from a primary osteosarcoma in a dog?

A

Establishment of a primary tumor cell culture.

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172
Q

What is the relationship between the dose per fraction and the probability of late effects?

A

The higher the dose per fraction, the higher the probability of late effects.

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173
Q

Which animals are more likely to experience late effects after palliative radiation therapy?

A

Animals treated with a larger dose per fraction in palliative radiation therapy.

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174
Q

What are some possible treatments for late effects?

A

Surgery to remove cataracts, surgical debridement for bone necrosis, and bougienage or resection for strictures of hollow viscera.

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175
Q

Why are palliative/hypofractionated protocols not recommended for patients expected to live long?

A

Increased potential for late side effects is one of the reasons.

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176
Q

What is stereotactic radiosurgery?

A

The use of multiple, non-coplanar beams of radiation to deliver a single, high-radiation dose precisely to the target.

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177
Q

In which cases has helical tomotherapy been used?

A

Helical tomotherapy has been used in the treatment of brain tumors and canine appendicular osteosarcoma.

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178
Q

What is tomotherapy?

A

It is intensity-modulated radiation therapy that uses CT imaging for planning, delivery, and verification of treatment.

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179
Q

What is the role of surgery in the management of cancer?

A

Diagnosis (biopsy), resection for cure, palliation, and debulking.

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180
Q

What is the purpose of tumour biopsy?

A

To allow a diagnosis, prognosis, staging, and decision-making about therapeutic options.

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181
Q

When is biopsy performed for staging purposes?

A

Biopsy of primary lesions and potential metastases may be performed for staging purposes.

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182
Q

What type of gloves should veterinary surgeons and staff wear for chemotherapy?

A

Thick latex gloves specifically for chemotherapy or two pairs of latex gloves.

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183
Q

What is more important for the glove used in chemotherapy?

A

Thickness is more important than the material.

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184
Q

What additional protective clothing should personnel wear for chemotherapy?

A

Disposable impermeable gowns.

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185
Q

What precautions are recommended when closed systems are not used in chemotherapy?

A

Eye protection and particle-filtering masks.

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186
Q

What should be done to reduce environmental contamination in chemotherapy?

A

Purge the infusion equipment before adding drugs to the saline solution.

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187
Q

How should potentially contaminating material be disposed of in chemotherapy?

A

Place in bags or bins for bio-hazardous material.

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188
Q

Who can arrange for the disposal of material contaminated with cytotoxic drugs in chemotherapy?

A

Human hospital or approved companies.

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189
Q

Can the materials used in the preparation and administration of chemotherapy be reused?

A

No, they cannot be reused.

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190
Q

What precautions should be taken when handling waste from patients who received chemotherapy?

A

Disposable gown and gloves should be worn by personnel while cleaning excreta.

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191
Q

Who should not prepare or administer chemotherapy drugs or handle hospitalized patients?

A

Pregnant women.

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192
Q

Where should tablets be prepared and transferred for chemotherapy patients?

A

To an area with little movement of personnel and animals.

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193
Q

What is the advantage of tumour vaccination in cancer therapy?

A

Practically no or minor adverse effects and potential protection from relapses.

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194
Q

Why is research on tumour vaccination in pets also of interest for human medicine?

A

Successful vaccines in pets can often be translated to human medicine.

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195
Q

What are two therapeutic tumour vaccines that have gained approval?

A

Provenge for prostate cancer in men and Oncept for melanoma in dogs.

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196
Q

What is a weakness of tumour vaccination?

A

It takes a long time to develop an effective immune response which may be too late for aggressive tumours.

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197
Q

What is a concern with tumour vaccines?

A

Autoimmunity is a theoretical concern with tumour-associated vaccines.

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198
Q

What is the purpose of a break period in chemotherapy?

A

To allow normal tissues to recover before the next dose.

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199
Q

How long can a break period be in chemotherapy?

A

It can be as lengthy as 2-4 weeks depending on the chemotherapy agent.

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200
Q

Which chemotherapy agents are used for osteosarcoma?

A

Carboplatin

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201
Q

Which chemotherapy agents are used for haemangiosarcoma?

A

Doxorubicin or epirubicin

202
Q

What is the term for continuous low-dose chemotherapy?

A

Metronomic chemotherapy

203
Q

What are the advantages of metronomic chemotherapy?

A

Low-cost, high-convenience, and acceptable side effect profiles

204
Q

What is the main assumption regarding the mechanism of metronomic chemotherapy?

A

Cytotoxic effect of the drugs on tumour cells

205
Q

What is the goal of conventional chemotherapy regarding drug dose?

A

Raise the dose to the maximum tolerated level

206
Q

What is angiogenesis?

A

The process of blood vessel growth within a tumour

207
Q

Why do traditional chemotherapeutics have common side effect profiles?

A

They cause damage to rapidly dividing cell populations, including normal tissues

208
Q

What is the problem with standard chemotherapy from an antiangiogenic perspective?

A

Regrowth and replacement of damaged tumour vasculature during the break period

209
Q

What are the potential effects of chemotherapy on tumour blood vessels?

A

Direct cytotoxic effect and tipping the balance of angiogenic growth factors and inhibitors

210
Q

What may be required for the expansion of tumour blood vessels?

A

Recruitment of bone marrow-derived endothelial progenitor cells

211
Q

What is the term for the relative sparing of normal cells during chemotherapy?

A

Endothelial cell selectivity

212
Q

What is spared during endothelial cell selectivity?

A

Normally susceptible cells

213
Q

What is the recommended administration strategy for a high dose of medication?

A

Dividing the dose over 2 days or giving furosemide on the same day.

214
Q

How long does it take for resolution of SHC?

A

Several weeks.

215
Q

What should be ruled out and discontinued when treating SHC?

A

Infection and the drug.

216
Q

What are some possible treatments for SHC?

A

Analgesia, oxybutinin, and intravesical DMSO.

217
Q

What are the potential side effects of vincristine in cats?

A

Ileus paralyticus, constipation, abdominal pain, and anorexia.

218
Q

What are the recommended treatments for vincristine side effects in cats?

A

Metoclopramide and ranitidine.

219
Q

What are the rare side effects of vincristine?

A

Peripheral neuropathies and skin sloughs if injected perivascularly.

220
Q

What percentage of dogs treated with lomustine may develop hepatotoxicity?

A

7%.

221
Q

What is the recommended action for monitoring ALT when using lomustine?

A

Monitor ALT prior to dosing.

222
Q

What treatment can be considered to protect the liver when using lomustine?

A

SAMe.

223
Q

What are the potential side effects of cisplatin?

A

Nephrotoxicity and vomiting via the Chemoreceptor Trigger Zone.

224
Q

Can cisplatin be used in cats?

A

No, it can cause fatal pulmonary edema in cats and should not be used.

225
Q

What should be monitored prior to dosing with carboplatin?

A

Renal function (USG).

226
Q

What are the potential side effects of receptor tyrosine kinase inhibitors?

A

Gastrointestinal effects, myelosuppression, proteinuria, muscle cramping, and hypertension.

227
Q

What are some specific toxicities that cats may experience with certain drugs?

A

Cisplatin causes fatal pulmonary edema, and 5-fluoruracil causes extreme neurotoxicity.

228
Q

Which dog breeds may have increased sensitivity to vinca alkaloids and doxorubicin?

A

Herding breeds, such as collies, Shetland Sheepdogs, Australian Shepherds, and long-haired whippets.

229
Q

Why do some herding breeds have increased sensitivity to certain drugs?

A

Due to a mutation in the MDR1 gene, leading to impaired excretion.

230
Q

What guidelines should be followed for handling cytotoxic chemotherapy drugs?

A

Cytotoxic drugs should be prepared and administered in closed systems or in a human hospital/pharmacy.

231
Q

What are the potential side effects of exposure to cytotoxic drugs for personnel?

A

Headache, nausea, liver disease, and reproductive disorders.

232
Q

What precautions should be taken to limit personnel’s exposure to cytotoxic drugs?

A

Personnel should wear suitable protective clothing and follow safe handling practices.

233
Q

What equipment is recommended for reconstituting cytotoxic drugs?

A

A class II vertical laminar flow cabinet or closed systems for chemotherapy administrations.

234
Q

Did the addition of systemic therapy with chemotherapy or vaccine improve survival time?

A

No, it did not improve survival time.

235
Q

What is the cost of the 4 doses of vaccine?

A

The cost is no less than 2,500-3,500£.

236
Q

How many patients were used in the study with digital melanoma?

A

58 patients were used in the study.

237
Q

What was the MST (median survival time) for patients in the study with digital melanoma?

A

The MST was 476 days.

238
Q

What was the MST (median survival time) for the historical control group in the literature?

A

The MST was 365 days.

239
Q

What did the authors consider as an important explanation for the lower efficacy of the vaccine?

A

The authors indicated a long interval between diagnosis and start of the vaccination as an important explanation.

240
Q

What is implicated in the aetiology of canine MCTs?

A

The stem cell factor receptor, KIT, is implicated in the aetiology of canine MCTs.

241
Q

What is KIT?

A

KIT is a surface growth factor receptor encoded by the proto-oncogene c-kit.

242
Q

What activities are initiated by activated KIT?

A

Activated KIT initiates a signaling cascade that culminates in a wide array of biological activities including proliferation, migration, maturation, and survival of mast cells.

243
Q

Is KIT expressed in both normal and neoplastic canine MCs?

A

Yes, KIT is expressed in both normal and neoplastic canine MCs.

244
Q

What percentage of canine MCTs are affected by c-kit mutations?

A

About 15% to 40% of canine MCTs are affected by c-kit mutations.

245
Q

Are mutations of c-kit identified in more than 60% of canine MCTs?

A

No, mutations of c-kit are not identified in more than 60% of canine MCTs.

246
Q

What are tyrosine kinase inhibitors?

A

Tyrosine kinase inhibitors are drugs that can have anti-cancer activity and prevent the formation of blood vessels important for tumor growth.

247
Q

Which two veterinary TKIs are available for use in canine mast cell tumors?

A

Toceranib phosphate (Palladia®) and masitinib (Masivet®) are available for use in canine mast cell tumors.

248
Q

What other effects does toceranib have besides blocking KIT?

A

Toceranib also has effect over VEGFR, PDGFR, CSF-1, Flt-3, and probably Ret.

249
Q

What effect has toceranib been demonstrated to have on T-regulatory cells in dogs?

A

Toceranib has been demonstrated to decrease the number and percentage of T-regulatory cells in peripheral blood of dogs with cancer.

250
Q

What is the action of Toceranib on KIT in mast cell tumours?

A

Toceranib blocks KIT in inoperable mast cell tumours of grade II or III.

251
Q

What is the antitumor activity of Toceranib based on?

A

Toceranib has a greater spectrum of RTKs it can block, including VEGFR and PDGFR, which results in important anti-angiogenic activity.

252
Q

What is the dosage of Toceranib for dogs?

A

The dosage is 3.25 mg/kg every other day, but it can be reduced if adverse effects are observed.

253
Q

How long does the concentration of Toceranib remain sustained in plasma?

A

The concentration remains sustained for more than 48 hours.

254
Q

What is the clinical benefit of Toceranib at different dosages?

A

At 2mg/kg, the clinical benefit is 68%, while at 3.25 mg/kg, it is 60%.

255
Q

What is the recommended administration regimen for Toceranib?

A

A common regimen is three days per week (e.g. Monday, Wednesday, Friday) and it can be combined with other drugs like NSAIDs or metronomic cyclophosphamide.

256
Q

What is the dosage of Masitinib in dogs?

A

The recommended dosage is 12.5mg/kg daily.

257
Q

What is the selectivity of Masitinib for specific RTKs?

A

Masitinib is designed to block KIT, PDGF, Lyn, Lck, and Fyn, providing selectivity in its action.

258
Q

What potential benefit does Masitinib have in diseases other than MCT?

A

Masitinib may be beneficial in feline asthma or canine atopic dermatitis, and potentially in other neoplasms through its antiangiogenic and anti-inflammatory actions.

259
Q

What is the dosage of Masitinib in cats?

A

There is no specific dosage described for cats, but an alternative regime of 2.75 mg/kg three days per week is used anecdotally.

260
Q

What are the components of the baseline monitoring plan?

A

History, physical examination, CBC, serum biochemistry, urinalysis, and blood pressure.

261
Q

When should the 2 weeks post start monitoring be performed?

A

Two weeks after the start of treatment.

262
Q

What adverse effects are the 2 weeks post start monitoring aimed at detecting?

A

Gastrointestinal adverse effects and hematologic toxicity.

263
Q

What conditions might predispose pets to development of toxicity with TKIs use?

A

Pets with cancer, especially those with mast cell tumors, which can cause GI ulceration and intestinal bleeding.

264
Q

What is the recommended approach to minimize risk of GI toxicity in pets with altered GI mucosa?

A

Pre-treatment with symptomatic therapy for a few days before starting TKI therapy.

265
Q

What is the recommended strategy if adverse GI effects appear during treatment?

A

Symptomatic therapy if effects are mild to moderate, and a ‘holiday period’ off TKIs if effects are moderate to severe.

266
Q

Which medications are recommended for dogs with risk or evidence of GI bleeding?

A

Antacids such as H2 blockers or proton pump inhibitors, and sucralfate.

267
Q

Which medications can be beneficial in patients with GI ulceration from mast cell degranulation?

A

Antihistaminics like diphenhydramine or chlorpheniramine.

268
Q

What medications can be used for appetite loss, nausea, or vomiting?

A

Ondansetron or maropitant.

269
Q

What is the recommended management approach for diarrhea in pets receiving toceranib?

A

The use of metronidazole or loperamide, with possible drug holiday and dose decrease.

270
Q

What is the potential risk of concurrent use of NSAIDs with toceranib?

A

Exacerbation of GI toxicity.

271
Q

How should NSAIDs be administered when using toceranib?

A

On alternate days when TKI is not given, with prophylactic GI protection.

272
Q

Which combination of drugs did not show increased toxicity when used with toceranib?

A

Toceranib and piroxicam.

273
Q

What is the effect of combination cyclophosphamide (metronomic dosage) with toceranib on GI toxicity?

A

It does not seem to increase GI toxicity or myelosuppression.

274
Q

What is the mitotic index?

A

The percentage of cells in mitosis in a tissue.

275
Q

What is the relationship between the mitotic index and the sensitivity of tissues to chemotherapy?

A

Tissues with a high mitotic index are more sensitive to chemotherapy.

276
Q

Describe the growth pattern of tumors.

A

Tumor growth is Gompertzian, with initial rapid growth followed by a plateau phase.

277
Q

When are cells most susceptible to chemotherapy?

A

Cells are most susceptible to chemotherapy when they are in the process of division.

278
Q

What is the significance of the fraction of resting cells in the tumor population?

A

The fraction of resting cells (Go) in the tumor population determines the outcome of chemotherapy.

279
Q

Which tissues are known to have a high mitotic index?

A

The epithelium of intestinal villi and bone marrow have a high mitotic index.

280
Q

What is the effect of chemotherapy on cells?

A

Chemotherapy kills a percentage of cells rather than a constant number.

281
Q

What type of tumors are more sensitive to chemotherapy?

A

Tumors with a high growth rate and high mitotic index are more sensitive to chemotherapy.

282
Q

When is chemotherapy indicated as the primary therapy?

A

Chemotherapy is indicated as primary therapy for animals with systemic or metastatic neoplasms.

283
Q

When is chemotherapy indicated as adjuvant therapy?

A

Chemotherapy is indicated as adjuvant therapy following surgery in tumors with high rates of metastasis.

284
Q

What is a shape constant?

A

A shape constant is a constant derived from studies with small sample sizes.

285
Q

Is the shape constant constant for different breeds of dogs?

A

No, the shape constant is not constant for different breeds of dogs.

286
Q

Do studies show that the constant varies in cats?

A

Yes, studies have shown that the constant varies in cats.

287
Q

What is the best practical solution for a veterinarian until further guidelines are available?

A

The best practical solution is to use a BSA conversion table and become familiar with drugs that require lower dosages for small pets.

288
Q

What is the recommended dosage of doxorubicin for dogs weighing less than 15 kilos and cats?

A

The recommended dosage is 1 mg/kg instead of the standard dosage.

289
Q

Why is chemotherapy less effective for large bulky solid tumors?

A

Chemotherapy is less effective for large tumors due to poor blood supply and lower delivery of drugs to cancer cells at cytotoxic levels.

290
Q

What types of tumors are exceptions to the rule of chemotherapy effectiveness for large tumors?

A

Haemangiosarcomas, canine transmissible venereal tumor, lymphoma, mast cell tumors, multiple myeloma, malignant histiocytosis, and leukemias.

291
Q

What factors affect the success of anti-cancer drug therapy?

A

Tumor type, penetration of drug into the tumor, and development of drug resistance.

292
Q

What are some mechanisms of drug resistance in tumors?

A

Decreased drug uptake, increased removal of drug from cells, decreased drug activation, increased drug inactivation, increased or altered drug targets, alternative cell-signalling pathways, and increased DNA repair.

293
Q

What is multi-drug resistance and how does it occur?

A

Multi-drug resistance is when tumor cells become cross-resistant to unrelated compounds. It occurs due to increased expression of the MDR1 gene and P-glycoprotein (Pgp) expression.

294
Q

What is the recommended approach if resistance occurs during chemotherapy?

A

Switch to drugs that the tumor has not been exposed to before, preferably combinations of drugs with different mechanisms of action (rescue therapy).

295
Q

When is adjuvant chemotherapy used?

A

Adjuvant chemotherapy is used following resection of a primary tumor with a significant risk of recurrence or metastasis.

296
Q

When is the effectiveness of adjuvant chemotherapy greatest?

A

The effectiveness is greatest at the earliest stages of tumor growth.

297
Q

What are some examples of drugs that inhibit proliferation and migration of endothelial cells?

A

Cyclophosphamide, methotrexate, vinblastine, paclitaxel

298
Q

What is the balance that must be tipped in favor of angiogenic stimulation?

A

Balance between pro-angiogenic and antiangiogenic factors

299
Q

What is one strategy for targeted antiangiogenic therapy?

A

Increasing levels of endogenous angiogenic inhibitors

300
Q

What are Circulating Endothelial Progenitor Cells (CEPs) derived from?

A

Bone marrow

301
Q

What happens to CEP levels when traditional chemotherapy is administered?

A

They fall markedly and abruptly

302
Q

What type of immune cells are present in the tumor microenvironment?

A

B and T cells

303
Q

What type of lymphocytes are involved in autoimmune disease prevention and tolerance?

A

Regulatory T-cells (Tregs)

304
Q

What were the results of the human clinical trial using daily low-dose cyclophosphamide and methotrexate in women with advanced breast cancer?

A

Around a third of women responded or had disease stabilization

305
Q

What protocol was used to treat canine splenic haemangiosarcoma?

A

Daily cyclophosphamide, oral etoposide, and piroxicam

306
Q

What was the outcome of the adjuvant study using metronomic cyclophosphamide and piroxicam treatment for incompletely resected soft tissue sarcomas?

A

Significant prolongation of the disease-free interval

307
Q

What is a potential concern regarding the use of cyclophosphamide?

A

Possibility of sterile hemorrhagic cystitis

308
Q

What are the indications for biopsy?

A

A cytologic diagnosis has not been reached; Treatment or prognosis would be altered by knowing the tumour type; Owner’s willingness to treat would be altered by knowledge of tumour type and prognosis.

309
Q

What are the guidelines for tumor biopsy?

A

Biopsy site within likely surgical field; Minimal risk of local dissemination of tumor; Fresh instruments for multiple biopsies; Longitudinal incisions on limbs and tail; Avoid tissue difficult to resect or needed for surgical closure.

310
Q

How can a diagnosis be improved during a biopsy?

A

Taking a large biopsy; Taking several samples from a single mass.

311
Q

What are the steps for proper fixation of the tissue specimen?

A

Use 10% neutral buffered formalin; Use 1-part tissue to 10 parts of fixative; Less than 1cm thick tissue for penetration; Deep incisions for large masses.

312
Q

What information can be gained from a biopsy?

A

Identification of benign vs malignant tumor; Determination of tumor grade; Assessment of margins (if excisional biopsy); Evaluation of potential metastasis sites.

313
Q

What is surgery with curative intent?

A

The use of surgery as the sole method of treatment for an outright cure in a single procedure.

314
Q

What are the advantages of surgery with curative intent?

A

Immediate cure; Not carcinogenic; No local toxic effects; Better for large masses.

315
Q

What are the disadvantages of surgery with curative intent?

A

Local cure only; Change in cosmetics; Change in function; Not immunosuppressive.

316
Q

What are the principles of surgical excision?

A

Establish diagnosis by biopsy; Perform early in the course of disease; First surgery has best chance of success; Adequate margins in three dimensions; Don’t compromise margins for closure; Remove incisional biopsy tracts with tumor.

317
Q

Who is the module developer for Small Animal Medicine Distance Learning Module 10?

A

Dr Ana Lara

318
Q

What are the learning objectives of this module?

A

Develop an understanding of radiotherapy, surgical oncology, chemotherapy, and other medical therapy options.

319
Q

What is the role of radiation therapy in treating cancer in companion animals?

A

It is an important component of a multimodality approach in controlling and potentially curing cancer.

320
Q

What are the potential acute and late side effects of radiation therapy?

A

The notes don’t mention specific side effects.

321
Q

What advances are being made in clinical veterinary radiation oncology?

A

Use of daily radiation therapy protocols, higher total doses of radiation, and computed tomography (CT) for imaging and treatment planning.

322
Q

What types of radiation sources are used in external beam radiation therapy?

A

X-rays, gamma rays, and electrons.

323
Q

What is the difference between orthovoltage and megavoltage radiation therapy equipment?

A

Orthovoltage is used on a limited basis while megavoltage delivers higher energy radiation.

324
Q

What is teletherapy and how is it commonly used in the UK?

A

Teletherapy is radiation applied from a distance to the patient, similar to a massive x-ray machine, and it is the most common method used in the UK.

325
Q

What is a linear accelerator and how does it treat tumours?

A

A linear accelerator uses X-rays or electron beams to treat both deep and superficial tumours.

326
Q

What is the maximum photon energy range of a linear accelerator?

A

The photon energy can range from 4 to 25 MV.

327
Q

What is the ‘skin-sparing’ effect in megavoltage radiotherapy units?

A

The maximum radiation dose is not deposited at the skin surface but at a depth of 0.5 cm below the skin.

328
Q

What is the purpose of using a tissue-equivalent material over a surgical incision during radiation treatment?

A

To allow the radiation dose to build up and maximize deposition at the skin surface.

329
Q

How are photons used in radiation treatment?

A

Photons are used to treat deeper-seated tumors or when more depth is required.

330
Q

What are the two sets of jaws used for in a linear accelerator?

A

Collimating the photon beam and field shaping to form square or rectangular fields.

331
Q

How is field modification achieved in radiation treatment?

A

Lead blocks or multileaf collimators (MLC) are used to create the desired field shape.

332
Q

What is the typical source-to-skin distance in radiation treatment?

A

100 cm.

333
Q

What is a cone used for in electron beam therapy?

A

A cone is attached to the head of the machine to collimate the electron beam.

334
Q

Why are electron beams particularly useful for treating lesions over critical normal tissues?

A

Electron beams have a rapid dose fall-off in tissues, allowing safe delivery of radiation to tumors overlying critical structures.

335
Q

How does ionizing radiation cause biological damage?

A

X-rays and gamma rays produce fast-moving charged particles that cause chemical and biological damage when absorbed in tissue.

336
Q

What is the most critical target for radiation damage?

A

Deoxyribonucleic acid (DNA) is the most critical target for radiation damage.

337
Q

What is the term used when cells die after irradiation when they attempt to divide at the next or a later mitosis?

A

Mitotic death or mitotic catastrophe.

338
Q

Why do some solid tumors take a long time to shrink with radiotherapy?

A

Cells typically die after irradiation when they attempt to divide at the next or a later mitosis.

339
Q

How do some cells die as a result of radiation therapy?

A

Some cells die by apoptosis (programmed cell death).

340
Q

Why are lymphocytes particularly sensitive to radiation?

A

Lymphocytes undergo apoptosis quickly and are therefore exquisitely radiosensitive.

341
Q

What is the role of oxygen in radiation therapy?

A

Oxygen is important because free radicals, which cause DNA damage, are primarily formed in the presence of oxygen.

342
Q

What is the most effective targeted therapy for the dog’s tumour?

A

An Src (non RTK tyrosine kinase) inhibitor

343
Q

What is the clinical response in dogs with epitheliotropic cutaneous lymphoma treated with masitinib?

A

Documented clinical responses

344
Q

What is the treatment option for dogs with chronic monocytic leukemia?

A

Tyrosine kinase inhibitors

345
Q

What is the response rate of cats with FISS treated with toceranib?

A

No clinical response

346
Q

What was the clinical benefit in feline patients with solid neoplasias treated with toceranib or masitinib?

A

Clinical benefit of 70%

347
Q

What was the medium time to progression for cats with stable disease?

A

123 days

348
Q

What was the medium survival time of cats with squamous cell carcinoma treated with toceranib?

A

96 days

349
Q

What side effects are associated with tyrosine kinase inhibitors?

A

Anorexia, GI upsets, haematological dyscrasias, and renal disease

350
Q

What is metronomic chemotherapy?

A

Chemotherapy administered on a continuous basis

351
Q

What is the goal of traditional chemotherapy?

A

To administer as much drug as can be tolerated

352
Q

What factors make metronomic chemotherapy protocols attractive to the veterinary world?

A

Low cost, oral administration, and low toxicity

353
Q

What is the efficacy of metronomic chemotherapy?

A

Continuous drug exposure to susceptible cancer cells, anti-angiogenesis, and alterations in the immune response

354
Q

What is the result of the reaction between a free radical and oxygen?

A

The production of an organic peroxide that is a non-restorable form of the target material.

355
Q

In the absence of oxygen, what can potentially happen to ionized target molecules?

A

They can repair themselves and recover the ability to function normally.

356
Q

Why are hypoxic cells more resistant to the effects of radiation?

A

Because they have the ability to potentially repair themselves and recover in the absence of oxygen.

357
Q

How does fractionation of radiation therapy work?

A

The total radiation dose is divided and delivered as smaller doses known as fractions.

358
Q

Why is it considered better to give small fractions daily for curative-intent therapy?

A

It allows less time between fractions for tumor cells to repair DNA damage and repopulate.

359
Q

What happens to hypoxic cells during the course of radiotherapy?

A

Some of the initially resistant hypoxic cells become re-oxygenated, allowing greater radiation kill.

360
Q

Why is giving more frequent treatments beneficial in radiation therapy?

A

It prevents the repair of damage and repopulation of tumor cells between fractions.

361
Q

What are some factors that can affect the sensitivity of cells to radiotherapy?

A

The presence of oxygen, cell cycle phase, and redistribution of tumor cells.

362
Q

What are some initial evaluations involved in radiation therapy?

A

Haematology, biochemical profile, urinalysis, and thoracic radiography.

363
Q

How are regional and distant metastases evaluated in radiation therapy?

A

Through regional lymph node aspiration, thoracic radiographs, and abdominal ultrasonography.

364
Q

Why is it important to perform aspiration cytology or biopsy of a regional lymph node?

A

To evaluate the expected biological behavior of the primary tumor, not just detectable lymphadenopathy.

365
Q

What are the commonly used imaging tools for tumor imaging and localization?

A

Radiography and CT, but other tools include ultrasonography, nuclear scintigraphy, and MRI.

366
Q

Which imaging tool is considered a critical component in radiation treatment planning?

A

Computed tomography (CT).

367
Q

What are the possible complications of implanting permanent catheters for vascular access?

A

Stress in the hospital or having an aggressive nature

368
Q

How long can permanent catheters for vascular access remain in the patient?

A

Up to 3 years

369
Q

What are the functions of permanent vascular access catheters?

A

Taking blood samples and administering intravenous cytotoxic drugs

370
Q

What is the recommended treatment for extravasation of vesicant chemotherapy drug?

A

Symptomatic treatment with anti-inflammatories, local antibiotics, bandages, and surgical debridement if necessary

371
Q

What should be done if extravasation of a strictly intravenous chemotherapy drug occurs?

A

Stop the infusion immediately

372
Q

What should be used to check the effective venous access after extravasation?

A

A certain volume of saline solution

373
Q

What should be done if the catheter is outside the vein or a certain extravascular volume has been administered?

A

Do not remove the catheter and try to aspirate if possible

374
Q

What is the recommended procedure for treating extravasation of vincristine/vinblastine?

A

Infiltrate the area with hyaluronidase, apply warm compresses, and apply anti-inflammatory ointment

375
Q

What is the recommended procedure for treating extravasation of doxorubicin/epirubicin/actinomycin/mitoxantrone?

A

Apply cold compresses, administer dexrazoxane IV, apply DMSO topically, and apply anti-inflammatory ointment

376
Q

What is a helpful solution for oral administration of chemotherapy drugs in small dogs or cats?

A

Reformulating drugs in capsules with fewer milligrams

377
Q

What is the purpose of three-dimensional treatment planning?

A

To deliver maximum dose to the tumor while minimizing dose to normal structures.

378
Q

What are the differences between definitive and palliative therapy?

A

Definitive therapy aims for long-term control, while palliative therapy focuses on pain relief and improving quality of life.

379
Q

What side effects are more commonly seen with a full course of radiation therapy?

A

Acute side effects that temporarily decrease the quality of life for 3 to 6 weeks.

380
Q

What types of tumors are often treated with radiation therapy alone?

A

Nasal tumors, brain tumors, and pituitary macroadenomas and macroadenocarcinomas.

381
Q

What are the goals of palliative radiation therapy?

A

Alleviate pain, decrease obstructive masses, and alleviate debilitating signs of cancer.

382
Q

What are the potential benefits of hypofractionated radiation therapy?

A

Less acute side effects and good long-term outcomes for certain neoplasias.

383
Q

What is the difference between preoperative and postoperative radiation therapy?

A

Preoperative aims to kill microscopic extensions, postoperative treats residual microscopic disease.

384
Q

Why are haemoclips used in radiation treatment field establishment?

A

They facilitate delineation of the region containing residual microscopic disease.

385
Q

What complications can arise with preoperative radiation therapy?

A

Potential wound-healing problems.

386
Q

When should adjuvant chemotherapy be used?

A

After local disease control for types of cancer with high prevalence of metastasis.

387
Q

Name two types of cancer in dogs that may require adjuvant chemotherapy.

A

Osteosarcoma and hemangiosarcoma.

388
Q

For neoplasia with low prevalence of metastasis, is adjuvant therapy indicated?

A

No, adjuvant therapy is not indicated.

389
Q

What is the objective of neoadjuvant chemotherapy?

A

To reduce the size of the primary tumor and the side effects of other treatment.

390
Q

What factors should be considered when choosing a chemotherapy regimen?

A

Patient-related factors, owner-related factors, and disease-related factors.

391
Q

Give an example of a patient-related factor that influences treatment choice.

A

Presence of systemic diseases.

392
Q

What should be discussed with the owner when choosing a chemotherapy protocol?

A

Willingness to treat, tolerance of adverse effects, availability, and cost of treatment.

393
Q

What is the main objective of chemotherapy?

A

To cure the disease.

394
Q

What is the objective of treatment when a cure is unlikely?

A

To maintain a good quality of life and achieve remission or stable disease.

395
Q

How does early diagnosis affect prognosis and survival time?

A

Early diagnosis generally carries a better prognosis and longer survival time.

396
Q

What are cytotoxic drugs and how do they work?

A

Cytotoxic drugs have anti-cancer activity and work through different mechanisms.

397
Q

Name two alkylating agents used in chemotherapy.

A

Cyclophosphamide and Melphalan.

398
Q

When do anti-metabolites act in the cell cycle?

A

They act in the S-phase of the cell cycle.

399
Q

How do anti-tumor antibiotics inhibit DNA and RNA synthesis?

A

They use multiple mechanisms, including DNA breakage and inhibition of enzymes.

400
Q

Which phase of the cell cycle do vinca alkaloids act in?

A

They act in the M phase of the cell cycle.

401
Q

What do platinum-based drugs interfere with?

A

They interfere with DNA replication and RNA synthesis.

402
Q

What does hydroxycarbamide inhibit?

A

Ribonucleoside diphosphate reductase.

403
Q

What is the purpose of cytoreductive surgery?

A

Cytoreductive surgery is performed when complete excision is not possible to retain essential structures.

404
Q

When is excision with narrow margins indicated?

A

Excision with narrow margins is indicated when complete excision is not possible but recurrence rate is low.

405
Q

What is the conservative approach after cytoreductive surgery?

A

The conservative approach is a ‘watch and see’ approach or radiation therapy based on owner preference.

406
Q

What is the aim of palliative surgery?

A

The aim of palliative surgery is to improve the patient’s quality of life, not necessarily the length of life.

407
Q

When is palliative surgery considered?

A

Palliative surgery is considered when complete excision or in the presence of metastasis is not possible.

408
Q

Give an example of surgical palliation.

A

Removal of large ulcerating tumors causing systemic illness or amputation of bone tumors causing lameness with distant metastasis.

409
Q

What does chemotherapy mean?

A

Chemotherapy is medical treatment using chemical substances, commonly associated with cytotoxic drugs for cancer treatment.

410
Q

What percentage of dogs and cats are estimated to get cancer?

A

Approximately 25% of dogs and cats will suffer from cancer during their lifetime.

411
Q

What is the main objective of chemotherapy treatment in pets with cancer?

A

The main objective is to treat the disease while maintaining or improving the quality of life.

412
Q

Why is good communication with pet owners important during chemotherapy treatment?

A

Good communication ensures owners understand the prognosis, treatment aim, and possible adverse effects.

413
Q

What are the four phases in the cell cycle?

A

The phases are G1, S, G2, and M, which include DNA synthesis and mitosis.

414
Q

What types of tumors are suitable for margin indications?

A

Benign tumors with local infiltration capacity, malignant tumors with limited infiltration potential

415
Q

What types of tumors are contraindicated for margin indications?

A

Malignant tumors with moderate to high potential for local infiltration

416
Q

What is the purpose of radical local excision?

A

To remove the tumor along with margins extending into adjacent undisturbed fascial planes

417
Q

When is radical local excision suitable?

A

For tumors with circumferential zones of compressed tissue due to rapid radial expansion

418
Q

What is compartmental excision?

A

Removal of the tumor within an intact anatomic compartment surrounded by undisturbed fascial planes

419
Q

For which tumors is muscle group excision suitable?

A

Small tumors involving muscle bellies without breached fascial planes

420
Q

What is the purpose of amputation?

A

To remove the tumor along with the entire limb

421
Q

When is amputation indicated?

A

For large tumors where compartmental or muscle group excision is not practical

422
Q

What should be done to the resected tissue for histological examination?

A

It should always be submitted for histological examination

423
Q

What does histological evaluation of resected tissues determine?

A

Histological type, grade, lymph node status, margins, and invasion

424
Q

What is cytoreductive surgery?

A

Planned incomplete removal of a tumor to improve the efficacy of other therapies

425
Q

When is cytoreductive surgery considered a failed excision?

A

When it follows a planned surgical excision for cure

426
Q

How can complications such as haematoma, seroma, or wound infection be avoided?

A

Complications can be avoided by using gentle surgical technique, ensuring meticulous haemostasis, closing dead space, using surgical drains, and rational peri-operative antibiosis.

427
Q

Why is it important to ligate the vascular supply to the tumour and its venous and lymphatic drainage?

A

It is important to ligate the vascular supply to prevent exfoliation or dissemination of cells and metastasis via haematogenous or lymphatic routes.

428
Q

Which type of tumour is more likely to metastasize to regional lymph nodes: epithelial tumours or mesenchymal tumours?

A

Epithelial tumours are more likely to metastasize to regional lymph nodes.

429
Q

When should the removal of regional lymph nodes draining the primary tumour be considered?

A

The removal of regional lymph nodes should be considered if there is a diagnosed malignant neoplasia or if the lymph node is known to be metastatic.

430
Q

What impact does the removal of affected metastatic lymph nodes have on the outcome of neoplasms like anal gland adenocarcinomas, malignant melanomas, and mast cell tumours?

A

The removal of affected metastatic lymph nodes has a positive impact on the outcome of these neoplasms.

431
Q

When should lymph nodes be removed if they are positive for tumour?

A

Lymph nodes should be removed if they are positive for tumour and not fixed to the surrounding tissues.

432
Q

What factors should be considered when selecting the margins of excision for surgical removal of tumours?

A

The selection of appropriate margins depends on the established pattern of behaviour for that histological type and the grade of the tumour.

433
Q

What are the common reasons for failure of definitive tumor excision?

A

Failure to plan the surgery and failure to stick to the plan.

434
Q

Why is closure of the defect more difficult in cases where surgery has been performed previously?

A

There is less normal tissue.

435
Q

What are the practical considerations for oncologic surgery?

A

Effect on cosmetics and function, pre-operative patient preparation, dissection technique, reduction of tumor cell contamination, avoidance of wound complications.

436
Q

What should be explained to the client pre-operatively regarding the effect of surgery?

A

The effect on the animal’s cosmetic appearance and the function of the body part.

437
Q

What are the risk factors associated with an increased likelihood of wound infection in tumor-bearing patients?

A

Old age, poor nutritional status, obesity, hypoxemia, presence of remote sites of infection, poor blood supply to the surgical site, presence of systemic illness, and concurrent use of other medication.

438
Q

What technique should be used to make the incision in the skin and hollow viscera?

A

A scalpel.

439
Q

Why should blood vessels be isolated and ligated or cauterized prior to transection?

A

To prevent bleeding.

440
Q

How should tissues be placed during dissection to facilitate the identification of fascial planes and tumor margins?

A

Under moderate tension.

441
Q

What should be used to manipulate the tumor during surgery?

A

Only normal tissue, such as thumb forceps or stay sutures.

442
Q

Why should gloves, instruments, and drapes be changed after excision?

A

To avoid adherence of tumor cells.

443
Q

How does Bleomycin act?

A

Bleomycin causes single- and double-stranded DNA breaks, leading to inhibition of DNA and RNA synthesis.

444
Q

What is the main toxic side effect of Bleomycin?

A

Bleomycin can cause pulmonary fibrosis.

445
Q

What are the normal tissues in the body susceptible to cytotoxic drugs?

A

Bone marrow and gastrointestinal tract (GIT) are susceptible to toxicity from cytotoxic drugs.

446
Q

What is the mechanism of action of L-Asparaginase?

A

L-Asparaginase depletes L-Asparagine, leading to inability of neoplastic lymphoid cells to synthesize protein and their death.

447
Q

Which types of cells are targeted by corticosteroids?

A

Corticosteroids induce apoptosis in lymphoid cells and other round cells with steroid receptors.

448
Q

What are the mechanisms of action of NSAIDs in cancer treatment?

A

NSAIDs inhibit COX-2, promote apoptosis, inhibit angiogenesis, and have anti-inflammatory and analgesic effects.

449
Q

How should intravenous chemotherapy drugs be administered?

A

Intravenous administration should use small-gauge catheters or butterfly catheters and ensure correct positioning and fixation.

450
Q

Which drugs are exceptions to intravenous administration and can be administered subcutaneously?

A

L-asparaginase, cytosine arabinoside, gemcitabine, and bleomycin can be administered subcutaneously.

451
Q

What are the recommended practices for blood sample collection in chemotherapy patients?

A

Blood samples should be taken from the jugular vein to prevent damage to peripheral veins needed for administering chemotherapy.

452
Q

Why is it important to alternate veins for administration of chemotherapy drugs?

A

Alternating veins allows for recovery from phlebitis caused by previous treatments.

453
Q

What is computer-assisted radiation treatment planning based on?

A

CT scan

454
Q

What does a CT scan help determine in radiation treatment planning?

A

Extent of disease

455
Q

How does histopathology of the tumor help determine the usefulness of radiation therapy?

A

Tumor grading and expected prognosis

456
Q

What are good candidates for radiation therapy?

A

Animals with radiosensitive tumors and localized disease

457
Q

What are the potential treatment options for animals with distant metastases or radioresistant tumors?

A

Palliative radiotherapy or a combination of radiotherapy and cytoreductive surgery

458
Q

What is the purpose of post-treatment evaluations after radiation therapy?

A

Evaluate tumor response and side effects in normal tissues

459
Q

What is the unit of dose in radiation therapy?

A

Gray (Gy)

460
Q

What is the standard radiation protocol for a full course of definitive radiation therapy?

A

2.25 to 3.2 Gy/fraction, 16 to 25 treatments, 48 to 63 Gy total dose

461
Q

What does a palliative radiation protocol usually entail?

A

Larger dose per fraction and lower total dose, such as 8-9 Gy/fraction, 4 consecutive weeks, 32-36 Gy total dose

462
Q

What can affect radiation protocols in terms of tumor type, stage, and site?

A

Variation from one facility to another

463
Q

What is required for radiation therapy?

A

Anaesthesia

464
Q

What types of treatments can be done with manual treatment planning?

A

Single treatment fields or bilateral, parallel-opposed fields

465
Q

Which tumors typically require CT-based, computer-generated treatment planning?

A

Large head and neck tumors, caudal oral tumors, brain tumors, and abdominal/pelvic masses

466
Q

What do three-dimensional radiation treatment planning systems provide?

A

Information on radiation dose to both tumor and normal tissues

467
Q

How often can Cytarabine be added during treatment?

A

Cytarabine can be added every 3 weeks.

468
Q

What maintenance protocol follows the COP protocol?

A

LP or LPV is the maintenance protocol that follows the COP protocol.

469
Q

What is the initial dosage of L-asparaginase for complicated presentations?

A

The initial dosage of L-asparaginase for complicated presentations is 400 IU/kg SC.

470
Q

What medication is given 24 hours after L-asparaginase in complicated presentations?

A

Vincristine is given 24 hours after L-asparaginase in complicated presentations.

471
Q

How often is Vincristine administered in Week 1 of the Wisconsin-Madison protocol?

A

Vincristine is administered once during Week 1 of the Wisconsin-Madison protocol.

472
Q

What is the dosage of L-Asparaginase in Week 1 of the Wisconsin-Madison protocol?

A

The dosage of L-Asparaginase is 400 IU/kg IM or SC in Week 1 of the Wisconsin-Madison protocol.

473
Q

How often is Prednisolone administered in Week 1 of the Wisconsin-Madison protocol?

A

Prednisolone is administered every 24 hours in Week 1 of the Wisconsin-Madison protocol.

474
Q

What medication is given in Week 2 of the Wisconsin-Madison protocol?

A

Cyclophosphamide is given in Week 2 of the Wisconsin-Madison protocol.

475
Q

What is the dosage of Prednisolone in Week 2 of the Wisconsin-Madison protocol?

A

The dosage of Prednisolone is 1.5 mg/kg PO every 24 hours in Week 2 of the Wisconsin-Madison protocol.

476
Q

How often is Vincristine administered in Week 3 of the Wisconsin-Madison protocol?

A

Vincristine is administered once during Week 3 of the Wisconsin-Madison protocol.

477
Q

What is the dosage of Prednisolone in Week 3 of the Wisconsin-Madison protocol?

A

The dosage of Prednisolone is 1 mg/kg PO every 24 hours in Week 3 of the Wisconsin-Madison protocol.

478
Q

What medication is given in Week 4 of the Wisconsin-Madison protocol?

A

Doxorubicin is given in Week 4 of the Wisconsin-Madison protocol.

479
Q

What is the dosage of Prednisolone in Week 4 of the Wisconsin-Madison protocol?

A

The dosage of Prednisolone is 0.5 mg/kg PO every 24 hours in Week 4 of the Wisconsin-Madison protocol.

480
Q

How often is Vincristine administered in Week 6 of the Wisconsin-Madison protocol?

A

Vincristine is administered once during Week 6 of the Wisconsin-Madison protocol.

481
Q

What medication is given in Week 7 of the Wisconsin-Madison protocol?

A

Cyclophosphamide is given in Week 7 of the Wisconsin-Madison protocol.

482
Q

How often is Vincristine administered in Week 8 of the Wisconsin-Madison protocol?

A

Vincristine is administered once during Week 8 of the Wisconsin-Madison protocol.

483
Q

What medication is given in Week 9 of the Wisconsin-Madison protocol?

A

Doxorubicin is given in Week 9 of the Wisconsin-Madison protocol.

484
Q

How often is Vincristine administered in Week 11 of the Wisconsin-Madison protocol?

A

Vincristine is administered once during Week 11 of the Wisconsin-Madison protocol.

485
Q

What medication is given in Week 13 of the Wisconsin-Madison protocol?

A

Cyclophosphamide is given in Week 13 of the Wisconsin-Madison protocol.

486
Q

How often is Vincristine administered in Week 15 of the Wisconsin-Madison protocol?

A

Vincristine is administered once during Week 15 of the Wisconsin-Madison protocol.

487
Q

What medication is given in Week 17 of the Wisconsin-Madison protocol?

A

Doxorubicin is given in Week 17 of the Wisconsin-Madison protocol.

488
Q

How often is Vincristine administered in Week 19 of the Wisconsin-Madison protocol?

A

Vincristine is administered once during Week 19 of the Wisconsin-Madison protocol.

489
Q

What medication is given in Week 21 of the Wisconsin-Madison protocol?

A

Cyclophosphamide is given in Week 21 of the Wisconsin-Madison protocol.

490
Q

How often is Vincristine administered in Week 23 of the Wisconsin-Madison protocol?

A

Vincristine is administered once during Week 23 of the Wisconsin-Madison protocol.

491
Q

What medication is given in Week 25 of the Wisconsin-Madison protocol?

A

Doxorubicin is given in Week 25 of the Wisconsin-Madison protocol.

492
Q

What is the recommended dose range for Vincristine?

A

The recommended dose range for Vincristine is 0.5-0.7 mg/m2.

493
Q

What dose of Vincristine is typically used for feline protocols?

A

For feline protocols, the lower end of the dose, 0.5 mg/m2, is typically used.

494
Q

What medication can be substituted for vincristine in cases of GI toxicity?

A

Vinblastine can be substituted for vincristine at a dosage of 1.8 mg/m2 IV.

495
Q

What medications are included in the LPV maintenance protocol?

A

The LPV maintenance protocol includes Vincristine, Chlorambucil, and Prednisolone.

496
Q

How often is Vincristine administered in the LPV maintenance protocol?

A

Vincristine is administered every 2 weeks in the LPV maintenance protocol.

497
Q

What is the dosage of Chlorambucil in the LPV maintenance protocol?

A

The dosage of Chlorambucil is 20 mg/m2 PO every 2 weeks in the LPV maintenance protocol.

498
Q

How often is Prednisolone administered in the LPV maintenance protocol?

A

Prednisolone is administered every 48 hours in the LPV maintenance protocol.

499
Q

When is the LP maintenance protocol used?

A

The LP maintenance protocol is used for intermediate/high grade LSA, low grade alimentary LSA, chronic lymphocytic leukaemia, and feline multiple myeloma.

500
Q

What medications are included in the LP maintenance protocol?

A

The LP maintenance protocol includes Chlorambucil and Prednisolone.

Small Animal Medicine (GP cert) (22 decks)

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