Oncology and Gastroenterology Flashcards
Steps in the diagnostic work up of the cancer patient
- History
- Physical Exam
- Medical Imaging
- FNA and Cytology
- Biopsy
- Histopathology
Clinical Stage
Physical extent of the tumor
- Size of the primary tumor
- anatomical location of metastases
- Tumor size
- Nodal Metastasis
- Distant Metastasis
Histiological grade
Histiological scoring by pathologist
Stage
Extent of body affected, determined by clinician with diagnostic tests
What do you use a CT scan for with Oncology?
pulmonary metastases
Bony invasion
radiation treatment planning
What do you use MRI for with Oncology?
Neurological diagnosis
Surgical planning
What do you use nuclear scintigraphy for with oncology?
bony metastases
When would you perform a non-aspiration sampling technique for Oncology?
Lymph nodes
round cell tumors
highly vascular tumors
When would you perform an aspiration sampling technique for oncology?
Hard/firm lesions
very small lesions where multiple passes are impossible
second attempt
What would you perform a new methylene blue stain on?
mast cell tumors
lipomas
Biopsy
removal of a small piece of tissue for laboratory examination
Incisional biopsy
biopsy of a selected portion of a lesion
Excisional biopsy
removal of a mass primarily for diagnostic purposes
When would you perform an incisional biopsy?
when the therapy is determined by tumor type
when extent of resection is determined by tumor type
when planning is needed because tumor is in a difficult area to reconstruct
when tumor type and predicted behavior would affect the decision to treat
What are the indications for Chemotherapy?
Patients with measurable tumor known to be sensitive to chemo
Adjunct therapy to suppress occult micro-metastasis after local therapy
Palliative non-resectable or metastatic cancer
to downstage/reduce a chemosensitive tumor before definitive therapy
to sensitize tissues to radiation
Growth fraction
proportion of cells that are proliferating/active in the cell cycle
Cell loss factor
sloughing, necrosis , and apoptosis
Goldie Coldman Hypothesis
once the tumor has reached one million cells, it is likely that chemo resistant cells have developed due to mutations
When is chemotherapy most effective?
during the rapid growth of the tumor
What have we learned from the Goldie Coldman Hypothesis?
Chemo should be initiated early in the course of disease
a protocol containing multiple agents is ideal
What are the “BAG” of adverse effects of Chemo?
B - Bone Marrow toxicity
A - Alopecia
G - Gastrointestinal effects
At what point would we administer prophylactic antibiotics with chemo?
less than 1,000 WBC/uL
What chemo causes the most vomiting?
Cisplatin
What are the anti-emetics used to combat the vomiting associated with chemotherapy?
Meropitant
Metaclopramide
Ondanzetron
What are the GI effects seen with Chemotherapy?
Vomiting and Diarrhea
In what breed should you avoid Doxorubicin and why?
Dobermans with cardiomyopathy
In what species and age should you avoid Doxorubicin?
Geriatric cat with CRF
What phase of the cell cycle is refractory to chemo?
G0
What chemo drugs target Interphase and Protein and RNA synthesis?
L-Asparaginase
What chemo drugs target DNA synthesis?
Antimetabolites
Doxorubicin????
What chemo drugs target Protein and RNA Synthesis and Mitotic spindle formation?
Vinca Alkaloids
Taxanes
What chemo drugs target mitosis and segregation of DNA into daughter cells?
Vinca Alkaloids
Taxanes
What chemo drugs are cell cycle independent?
Alkylating agents: Cyclophosphamide
Platinum agents: cisplatin
Doxorubicin
What are the chemo drugs in the Alkylating agents category?
Cyclophosphamide Chlorambucil Melphalan CCNU Ifosfamide
What is the mechanism of action for Alkylating agents?
Alkylate DNA bases
crosslinks
induce apoptosis
What is the toxicity associated with Cyclophosphamide?
Sterile hemorrhagic cystitis
What causes Sterile hemorrhagic cystitis?
Acrolein
How do you prevent Sterile hemorrhagic cystitis?
Give the medication in the AM and allow the animal to urinate often
What is the toxicity associated with CCNU?
Hepatotoxicity
What are the chemo drugs in the Antitumor Antibiotics category?
Doxorubicin
Mitoxantrone
Epirubicin
What is the mechanism of action for Antitumor Antibiotics?
Intercalation into DNA
Inhibition of topoisomerase II
Production of free radicals
Cell membrane damage
What do you use Mitoxantrone to treat?
Mast Cell tumors
What is the toxicity associated with Doxorubicin in dogs?
Cardiotoxic irreversibly after 6 doses
What is the toxicity associated with Doxorubicin in cats?
Nephrotoxic
What are the chemo drugs in the Spindle Toxins category?
Vinca Alkaloids: VIncristine and Vinblastine
Taxanes: Paclitaxel and Docetaxel
What is the mechanism of action for Spindle Toxins?
Cell cycle specific M-phase
bind tubulin/interfere with Mitotic spindle formation or microtubule disassembly
What are the toxicities associated with Vincristine?
Myelosuppressive
GI
Peripheral neuropathy
tissue irritation
What is the reaction associated with Taxanes?
high rate of allergic reactions
What is the mechanism of action for Platinum drugs?
Platinum binds to DNA causing crosslinks
What are the chemo drugs in the Platinum category?
Cisplatin
Carboplatin
What is the toxicity associated with Cisplatin and cats?
Fatal idiosyncratic pulmonary edema in cats
Cisplat = “Cats go splat”
What are the toxicities associated with Platinum Chemo drugs?
Vomiting
Nephrotoxicity
Fatal idiosyncratic pulmonary edema in cats
What are the reasons for chemotherapy failure?
Pharmacologic
Kinetic issues
Cellular resistance
MDR/ABCB1
What is the mutation associated with toxicity with chemotherapy?
MDR-1
What do you treat TCC with?
Piroxicam (NSAID)
What tumors can be treated with NSAIDs?
Carcinomas: Bladder Prostate Oral cavity Nasal Mammary gland tumors
What is the mechanism of action for Toceranib?
Tyrosine kinase inhibitor
Radiation Dose
Amount of radiation absorbed by the patient
ERBT
(external beam ration therapy) Radiation delivered from outside the body using a machine to aim high energy x or gamma rays at the tumors
Fraction
individual administration of dose radiation
What are the 5 Rs of radiation therapy?
Repair Repopulation Redistribution Reoxygenation Radiosensitive
SRS
Stereotactic radiosurgery
SRT
Stereotactic radiation therapy
When would you use Cryotherapy?
superficial lesions only
less than 1-1.5 cm
What is the premise for the use of Electrochemotherapy?
electrical impulse can open channels in cells that chemotherapy has the potential to enter into those cells
Definition of Lymphoma
malignant tumor of lymphoid tissue
How do yo diagnose Lymphoma?
FNA/Cytology
LN Tissue Biopsy
Where does Lymphoma metastasize to?
LNs
Liver
Bone marrow
What syndrome is associated with Lymphoma?
Paraneoplastic syndrome
What are the Chemotherapy drugs with activity against Lymphoma?
Prednisone/Dex Doxorubicin Vincristine Cyclophosphamide L-Asparaginase CCNU
What is the single strongest agent against Lymphoma?
Doxorubicin
What are the clinical signs associated with Lymphoma?
Generalized painless lymphadenopathy weight loss anorexia lethargy secondary to paraneoplastic syndrome Anemia
What is the multi agent protocol for High grade Lymphoma?
CHOP
What is the remission duration associated with Doxorubicin used in the treatment of High grade Lymphoma?
6-7 months
What is the remission duration associated with the CHOP protocol used in the treatment of High grade Lymphoma?
9-12 months
Which has a better prognosis B cell Lymphoma or T cell Lymphoma?
B cell
“B is better”
What should you consider in the treatment of localized lymphoma?
Surgery or radiation
How often should you recheck for lymphoma?
every 1-2 months
aspirate small nodes
What treatment would you consider for Low Grade Lymphoma?
Prednisone
Chlorambucil
What is the MST for low grade Lymphoma?
1.5 years +
How do you diagnose lymphoma in a feline?
MDB FNA/cytology Radiographs Endoscopy Surgical Exploratory BIOPSY: GIT, Liver, Spleen, and nodes
Where is the most common anatomic location for Feline Lymphoma?
GI tract
What are the clinical signs for GI lymphoma in a feline?
inappetance
vomiting
weight loss
diarrhea
How do you treat Lymphocytic Lymphoma in Felines?
Prednisone
Chlorambucil
What is the MST for Lymphocytic Lymphoma in Felines?
2 years
What is the treatment for GI/Multicentric Lymphoblastic Lymphoma in Felines?
CHOP protocol
What is the MST for GI/Multicentric Lymphoblastic Lymphoma in Felines?
2.5 years +
What is the treatment for Colonic Lymphoma in Felines?
Surgical biopsy/mass removal
Chemo
What is the MST for colonic Lymphoma in felines?
3-4 months
What are the clinical signs for Mediastinal/Thymic Lymphoma in Felines?
Dyspnea
dull lung sounds
How do you diagnose Mediastinal/Thymic Lymphoma in Felines?
Radiographs
U/S guided FNA
How do you treat Mediastinal/Thymic Lymphoma in Felines?
CHOP Protocol
Surgery or Radiation for localized lesion
What is the Remission time for Mediastinal/Thymic Lymphoma in Felines?
6 months
What are the clinical signs for Lymphoid Leukemia?
Vague eight loss Vomiting Diarrhea lethargy lymphadenopathy splenomegaly Thrombocytopenia Anemia neutropenia
How do you diagnose Lymphoid Leukemia?
MDB
Flow cytometry
How do you treat Acute Lymphoblastic Leukemia?
Prednisone
CHOP
What is the MST for Acute Lymphoblastic Leukemia?
5 months
What are the clinical signs for Chronic Lymphocytic Leukemia?
Anorexia
Weight loss
lethargy
How do you diagnose Chronic Lymphocytic Leukemia?
Bone marrow aspirate
Flow Cytometry
What is the treatment for Chronic Lymphocytic Leukemia?
Chlorambucil + prednisone if there are clinical signs
What is the MST Chronic Lymphocytic Leukemia?
1-3 years
What are the clinical signs for Multiple Myeloma?
lethargy inappetance lameness CNS signs bleeding
How do you diagnose Multiple Myeloma?
MDB MONOCLONAL GAMMOPATHY! Radiographs Ultrasound FNA of liver and spleen Electrophoresis Bone Marrow Aspirate
What are the four requirements for Multiple Myeloma?
- Plasma cell infiltrate in bone marrow or other organs (spleen or liver)
- Monoclonal gammopathy in serum
- Monoclonal gammopathy in urine
- Osteolytic bone lesions
What is the treatment for Multiple Myeloma?
Melphalon - oral
Prednisone
Cyclophosphamide and Chlorambucil are effective
What is the MST for Multiple Myeloma in a dog?
18 months
What is the MST for Multiple Myeloma in a cat?
8 months +
What are the neoplastic Histiocystic diseases?
Histiocytic Sarcoma Malignant Histiocystosis
What are the non neoplastic Histiocystic diseases?
Cutaneous Histiocytosis
Systemic Histiocytosis
What is the treatment for Histiocytoma?
Self-limiting: resolve in weeks
Where do you often find Histocytic Sarcoma?
Skin/SQ
Spleen
Lung
What staging should you perform if you suspect Histocytic Sarcoma?
Regional LN aspirate
Thoracic radiographs
Abdominal ultrasound
Bone marrow aspirate
What is the treatment for Histocytic Sarcoma without metastases?
Surgery
radiation
What is the prognosis for Histocytic Sarcoma without metastases?
1 year +
What chemotherapy can you use with Histocytic Sarcoma?
CCNU/Doxorubicin
Prednisone
What are the clinical signs for Polycythemia Vera?
Lethargy
Anorexia
seizures/ataxia
How do you diagnose Polycythemia Vera?
MDB: erythrocytosis
Ultrasound
Radiographs
What is the treatment for Polycythemia Vera?
Phlebotomy - 20ml/kg
Chemo: Hydroxyurea, Busulfan or other alkylating agents
What the prognosis for Polycythemia Vera?
1-3 years
What is the most common skin tumor in dogs?
Mast cell Tumors
What are the clinical signs of Mast cell Tumors?
pruritic asymptomatic GI signs: anorexia, vomiting Hives Wheezing Hypotension Anaphylactoid rxns
How do you diagnose Mast cell Tumors?
FNA/Cytology Staging: LN aspirate Abdominal Ultrasound: Liver and Spleen aspirates Thoracic radiographs Bone Marrow aspirate
What is the treatment for Mast cell Tumors?
Surgery - DO NOT USE MORPHINE!
Radiation therapy
if non-resectable: CCNU, Vinblastine, toceranib, and Prednisone
Symptomatic therapy
What is the MST for high grade Mast cell Tumors?
6-12 months
What is the most common form of Feline Mast cell Tumors?
Mastocystic
Where is the most common place for cutaneous Mast cell Tumors in cats?
Head and neck
Pinnae and base of ear
How do you diagnose cutaneous Mast cell Tumors in cats?
FNA/cytology
What is the treatment for cutaneous Mast cell Tumors in cats?
Surgery for localized lesions
if not resectable: CCNU, vinblastine, toceranib, and prednisone
What is the treatment for Diffuse miliary cutaneous Mast cell Tumors in cats?
CCNU Vinblastine Prednisone Toceranib Symptomatic therapy
What is the treatment for splenic Mast cell Tumors in cats?
Surgery + chemo
What is the MST for splenic Mast cell Tumors in cats?
12-19 months
What is the treatment of choice for intestinal Mast cell Tumors in cats?
Chemo
Feline Vaccine Associated Sarcoma
Tumor development 1 month to 10 years post vaccination
How do you diagnose Feline Vaccine Associated Sarcoma?
FNA/Cytology
Tissue biopsy
Where do Feline Vaccine Associated Sarcoma metastasize to?
Lungs
Skin
LNs
What staging is recommended for Feline Vaccine Associated Sarcoma?
CT scan
Thoracic radiographs
What is the treatment for Feline Vaccine Associated Sarcoma?
Surgery
NO MARGINAL RESECTION
What is the most common primary bone tumor in dogs?
Osteosarcoma
What tumors can spread to the bone?
Anal sac
Mammary
TCC
Where does Osteosarcoma metastasize to?
Lungs
Bones
Where is Osteosarcoma located?
“Towards the knee and away from the elbow”
Mandible and maxilla
What are the contributing factors to Osteosarcoma?
Multiple minor trauma with weight bearing
Metallic implants
Chronic osteomyelitis
Fractures with no internal stabilization
Exposure to ionizing radiation
Bone infarcts
What staging would you want to perform with Osteosarcoma?
Thoracic and Appendicular Radiographs
FNA
Bone Scintigraphy
What are the clinical signs associated with Osteosarcoma?
Lameness
swelling
PAIN
pathologic fractures
What has a better prognosis for Osteosarcoma?
Location: Mandible
What has the worst prognosis with Osteosarcoma?
Scapular Osteosarcoma
What is the treatment for Osteosarcoma?
Surgery: Amputation or Limb Sparing Radiation Therapy Chemo: Carboplatin, Doxorubicin, Cisplatin Pain Meds Bisphosphonates
What is the mechanism of action for Bisphosphonates?
reduce bone turnover
What is the most common malignant tumor in the dog?
Melanoma
What is the most common benign tumor in dogs?
Ameloblastoma
What is the most common malignant tumor in cats?
Squamous cell carcinoma
What is the most common thyroid cancer in the dog?
Thyroid carcinoma
What is the most common thyroid cancer in the cat?
Thyroid Adenoma
What are the clinical signs of Oral cancer?
Ptyalism Odor Changes in chewing Decreased appetite Oral bleeding
How do you diagnose Oral cancer?
FNA
Incisional biopsy
CT SCAN!
Where does Melanoma metastasize to?
Lungs
Liver
Submandibular LNs
What staging tests are performed on Melanoma?
CT SCAN!
Thoracic radiographs
Abdominal ultrasound
LN aspirate
What is the treatment for Melanoma?
Surgery
Radiation
Chemo: Carboplatin
What is the MST for melanoma?
7-17 months
What is the treatment for Fibrosarcoma?
Surgery + radiation
What is the MST for Fibrosarcoma?
18-26 months
What is the treatment for Canine Squamous cell carcinoma?
Surgery
Radiation
What is the MST for Canine Squamous cell carcinoma?
26-36 months
What is the treatment for Feline Squamous cell carcinoma?
Surgery
Radiation
Where does Feline Squamous cell carcinoma metastasize to?
LNs
What is the MST for Feline Squamous cell carcinoma?
14 months
What is the treatment for Feline Fibrosarcoma?
Surgical excision
Radiation
What is the most common benign tumor of the oral cavity?
Ameloblastoma (Epulis)
What is the treatment for Ameloblastoma?
Surgical resection
Radiation
What is the MST for Ameloblastoma?
5 years +
What are the clinical signs of Nasal cancer?
Nasal discharge
Sneezing
Epistaxis
Facial swelling and distortion
What are sites of Metastasis for Nasal Cancer?
Lungs
LNs
What are the staging tests performed for Nasal cancer?
Thoracic radiographs
FNA of LNs
What is the treatment for Nasal cancer?
Radiation!
Chemo: CHOP or Carboplatin is palliative
NSAIDs
What are the clinical signs of Thyroid cancer in dogs?
Dysphagia
Dysphonia
Horner’s syndrome
Hyperthyroidism
How do you diagnose Thyroid cancer in a dog?
Ultrasound/CT scan
FNA/cytology
NO INCISIONAL BIOPSY!
What staging tests do you perform on thyroid cancer in dogs?
Thoracic radiographs/ CT or MRI!!!! Scintigraphy FNA/Cytology of LNs Ultrasound abdomen MDB + T4
Where does Thyroid cancer metastasize to in dogs?
Lungs
LNs
Bones
Abdomen
What is the treatment for Canine Thyroid Tumor?
Surgery
If non resectable: Radiation
What is the MST for canine Thyroid Tumors?
2-3 years
What is the treatment for Feline Thyroid Tumors?
Surgery
Methimazole
What is the most common tumor of the Bladder?
Transitional cell carcinoma
What is the most common tumor of the urethra?
Transitional cell carcinoma
What are the clinical signs for canine transitional cell carcinoma?
Hematuria
Dysuria
Stranguria
Pollakiuria
How do you diagnose canine TCC?
MDB Urinalysis + culture Abdominal imaging Radiographs Ultrasound bladder Cystoscopy
Why do you not perform FNA on canine TCC?
tumor seeding
How do you stage canine TCC?
Abdominal ultrasound/CT
Where does canine TCC metastasize to?
LN
Lungs
What is the treatment for canine TCC?
Surgery for apically located TCC
Cystectomy
Adjuvant Chemo: Piroxicam and Mitoxantrone
Where does Prostatic cancer metastasize to?
Lungs
LNs
Bone
What diagnostic tests should be perform for Prostatic cancer?
FNA
Abdominal radiographs
Ultrasound
Chest radiographs or CT - Lung and bone mets
What is the treatment for canine Prostatic cancer?
Piroxicam (NSAIDs)
Radiation therapy
Urethral stents
What is the MST for canine prostatic cancer?
1-7 months with NSAIDs and Radiation
Radiation + chemo = 14-18months
What mammary glands are most commonly affected with cancer in dogs?
Caudal (4,5)
What diagnostic tests should be performed for Mammary gland tumors?
Thoracic and abdominal imaging
Where do Mammary gland tumors metastasize to?
Lungs
Liver
Bone
What is the treatment for Canine Mammary tumors?
Lumpectomy Mammectomy Mastectomy OHE recommended Chemo: Carboplatin + NSAIDs
What factors are NOT prognostic for Canine Mammary tumors?
Number of tumors Glands involved Type of surgery Age breed weight
Where do Feline Mammary gland tumors metastasize to?
LNs Lungs Pleura Liver Kidneys Adrenals
What are the diagnostic and staging tests for feline Mammary gland tumors?
Thoracic and abdominal imaging
CT
What is the treatment for Feline Mammary gland tumors?
Complete mastectomy
OHE
Chemo: Carboplatin and Piroxicam, Doxorubicin
What is the MST for Feline Mammary gland tumors?
8 months - 3 years
What is the most common Primary Pulmonary Mass in cats?
Adenocarcinoma
Where do pulmonary pulmonary masses in dogs metastasize to?
Lung
LN
Bone
Nervous system
Where do primary pulmonary masses in cats metastasize to?
Digits
What are the diagnostic tests for Primary pulmonary masses?
Thoracic Radiographs
FNA/US
Cytology
CT scan
What is the treatment for primary pulmonary masses?
Surgery for solitary lung tumors
What is the MST for canine primary pulmonary masses?
13 months
What is the prognosis for primary pulmonary tumors in cats?
115 days
What is the treatment of choice for Metastatic pulmonary neoplasia?
Chemotherapy
What are the diagnostic tests for Thymoma?
Thoracic radiographs
US FNA
Cytology
Flow cytometry
What is the treatment for Thymoma?
Surgery
What is the MST for thymoma in dogs?
2.5months - 2years+
What is the MST for thymoma in cats?
5 years
What is the most common cardiac tumor in cats?
Lymphoma
What is the treatment for Hemangiosarcoma in dogs?
Surgery: Pericardiectomy + resection
Chemo: Doxorubicin
What is the MST for Hemangiosarcoma in dogs?
1 month - 6 months
What is the diagnostic approach for Hemangiosarcoma of the heart?
MDB ECG Echocardiogram US guided FNA Cardiac troponin I
What cancers metastasize to the liver?
Lymphoma
mast cell
histiocytic sarcoma
Are malignant tumors of the liver more common in dogs or cats?
dogs
What are the diagnostic tests for Hepatobiliary neoplasia?
MDB
Abdominal imaging
Abdominal ultrasound - FNA
CT scan
What is the treatment for Hepatobiliary tumors?
surgery
What is the prognosis for Hepatocellular carcinoma in cats?
Guarded to poor
What are the diagnostic tests for GI c cancer?
MDB Abdominal radiographs contrast radiography Abdominal ultrasound Thoracic imaging for mets
What is the most common SI tumor in dogs?
Lymphoma
What is the treatment for Lymphoma in the SI of the dog?
Chemo
What is the treatment for Carcinoma and Leiomyoma/Leimyosarcoma in the Si of dogs?
Surgery
What is the most common SI tumor in cats?
Lymphoma
What is the treatment for Lymphoma in the SI of the cats?
Chemo
What is the treatment for Carcinoma and Leiomyoma/Leimyosarcoma in the Si of cats?
Surgery
What are the most common tumors of the spleen in dogs?
Sarcomas
What are the most common tumors of the spleen in cats?
Spleen
How do you diagnose Splenic Hemangiosarcoma?
Abdominal Radiographs Abdominal ultrasound Thoracic radiographs Thoracic/Cardiac ultrasound Abdominocentesis FNA/Cytology
Where does Splenic Hemangiosarcoma metastasize to?
Liver
Lungs
What is the treatment for Splenic Hemangiosarcoma?
Stabilize!
Surgery
What is the MST for Splenic Hemangiosarcoma with surgery?
1.5-3 months
What is the MST for Splenic Hemangiosarcoma with surgery and chemo?
68 days - 200 days
What is the protocol for chemotherapy with Splenic Hemangiosarcoma?
Doxorubicin + (Cyclophosphamide or Deracoxib)
Toceranib
Where does Anal Sac Adenocarcinoma metastasize to?
LNs
Lungs
What staging tests do you perform with Anal Sac Adenocarcinoma?
Thoracic and Abdominal Radiographs
What is the treatment of choice for Anal Sac Adenocarcinoma?
Surgery
Radiation
Chemo: Carboplatin or toceranib
What is the MST for Anal Sac Adenocarcinoma?
1-1.5 years