Oncology Exam I Flashcards
What is the disease where abnormal cells grow uncontrollably by disregarding normal rules of cell division?
CANCER
How are cancer cells different from normal cells in terms of growth?
Cancer cells develop a degree of autonomy from cell division signals allowing for uncontrolled growth & proliferation
What are the three phases of cancer mechanism?
Initiation
Promotion
Progression
What is the initiation phase of cancer?
Rapid phase
Carcinogens induce DNA damage but not enough to induce neoplastic transformation
What is the promotion phase of cancer?
Original carcinogens or normal growth promoters/hormones cause reversible tissue & cellular changes
What is the progression phase of cancer?
Slow phase
Progressing agents irreversibly convert an initiated cell into a cell exhibiting malignancy
What are the 6 hallmarks of cancer cells?
- Self-sufficiency in growth signals
- Insensitivity to anti-growth signals
- Tissue invasion & metastasis
- Limitless replicative potential
- Sustained angiogenesis
- Evading apoptosis
When should you not perform diagnostic cytopathology for cancer dx?
Urogenital neoplasms
What are the three types of cell lines cancer comes from?
Round cells, mesenchymal cells and epithelial cells
What are the micro characteristics of round cell tumors?
Individualized round cells arranged in monolayer
What are the micro characteristics of mesenchymal tumors?
Spindle shaped arranged individually or in non-cohesive aggregates
What are the micro characteristics of epithelial tumors?
Round, cuboidal or columnar cells arranged in sheets or clusters
What are the DDx of round cell tumors
Lymphoma Mast cell tumor Plasmacytoma Histiocytoma TVT "Please Help Me Learn This"
What are the DDx of mesenchymal tumors?
Sarcomas (osteo, chondro, firbo, hemangio)
What are the DDx of epithelial tumors?
Carcinomas (squamous cell, adeno, undifferentiated)
Anisocytosis
Variation in cytoplasmic size
Anisokaryosis
Variation in nuclear size
What are the characteristics of malignancy?
Heterogenous, pleomorphic, hyperchromasia of cytoplasm, anisokaryosis
T/F: Cytopahtology is highly specific and low sensitivity
TRUE
Multiple similar splenic nodules is associated with what?
Malignancy
When bone cytology is positive- it is 100% sensitive for what?
OSA
What is the difference of staging vs. grading?
Staging: based on TNM system (tumor, node, metastasis system. NON-INVASIVE testing series required (MDB, LN sampling). promotes prognostication & appropriate planning
Grading: requires block of tissue (biopsy) and allows definitive prognostication & might alter therapeutic recommendations
LN sampling should be based on what?
The sentinel LN
T/F: LN that is normal size= non-metastatic
FALSE- just because it is normal size doesn’t mean that there is no metastasis
What is the minimum views needed to be taken on rads?
3
What is the most common location of blood borne metastasis?
Liver
What is the first sign of malignancy?
Paraneoplastic syndromes- tumor associated alterations in bodily structure or function distant from tumor
What are the ddx for hypercalcemia?
Anal sac ACA, LSA, multiple myeloma, mammary tumor
What is the ddx for hypoglycemia?
Intestinal leiomyosarcoma, insulinoma LSA
What is the ddx for hypertrophic osteopathy?
Primary lung tumors, esophageal tumors and metastatic tumors
What are the classic paraneoplastic syndromes?
Hypercalcemia Hypoglycemia Neurologic Cutaneous Bone
What cells does chemotherapy target?
ALL rapidly dividing cells (even normal cells like GI, BM and hair follicles)
Fractionation
allows recovery of normal tissue between treatment intervals
What is a neoadjuvant?
Treatment used prior to definitive treatment in attempt to shrink tumor
T/F: Animals respond poorly to chemotherapy if sick
TRUE
What is dosing of chemotherapy based on?
Toxicity rather than efficacy-highest possible dose that will kill cancer but not the patient
T/F: Patient BW is used to predict physiologic function of patient in regards to chemotherapy?
FALSE- body surface area
What is the leading cause of chemotherapy mistakes?
Dose calculation
What gene codes for production of Pgp pumps acting to remove drugs from individual cells?
ABCB-1 gene (MDR-1 gene)
What is recommended to be present in practices that perform chemotherapy treatments?
Biological safety cabinet and closed system drug transfer device
What does BAG stand for in “BAG of side effects”
Common side effects of chemotherapy=BAG
B- bone marrow suppression-myelosuppression
A-alopecia: non-shedding breeds only
G- GI: crypt cells destroyed leading to vomiting and diarrhea
At what level of neutrophils and platelet counts can you safely administer chemotherapy?
Neutrophils > 3000
PLT > 100,000
Why can you not rely on chemo patients having fevers anytime they are sick?
Often times chemo patients won’t present with fever becuase they are not producing IL-1 and TNF because of the decreased WBC
What are two chemo drugs that are commonly seen causing GI toxicity?
Cisplatin and doxorubicin
What are the cell-cycle specific vs. cell-cycle nonspecific chemotherapy drugs?
Cell-cycle specific: antimitotics and antimetabolites
Cell-cycle nonspecific: alkylating agents and antibiotics
How do antimitotic chemo drugs work?
Disrupt/immobilize mitotic spindle which plays a critical role in cell function/division
What are examples of antimitotic chemo drugs?
vinca alkaloids and taxanes
What is the chemo drug that can be seen causing skin necrosis if administered outside of vein?
Vincristine
Can use hyaluronidase to separate tissue planes and aids in improving absorption of extravasated drug into circulation
What is the MOA of alkylating agent chemotherapy drugs?
bind DNA strands, insert alkyl group & change DNA structure to interfere w/ transcription, replication & repair machinery
What are some alkylating chemotherapy agents?
Chlorambucil, cyclophosphamide, lomustine, melphalan, dacarbazine, ifosamide
What are the two common antibiotic chemotherapy agents?
Doxorubicin and mitoxantrone
What are two platinum chemotherapy agents?
L-asparaginase and cisplatin
What is the first FDA approved lymphoma tx for dogs?
Tanovea CA1
What cell cycle do antimetabolite chemotherapy drugs work on?
S-phase- DNA synthesis
What is metronomic chemotherapy?
Requires a break period to allow recovery of cells
Greater chance of recurrence with this method
What is critical for tumor expansion?
Blood vessels (angiogenesis)
What upregulates endogenous angiogenesis inhibitor?
Thrombospondin-1
How does antiangiogenesis (metronomic chemotherapy) work?
Blockade of COX and circulating endothelial progenitor cells
what are the three MOA of metronomic chemotherapy drugs?
Antiangiogenesis
Immunomodulation
Direct targeting
T/F: regulatory T-cells are increased by MC
FALSE- T-regs are decreased
WHat is a common alkylating agent used int MC protocols?
Cyclophosphamide
What is a uinque adverse effect of cyclophosphamide?
Sterile hemorrhagic cystitis
How can SHC be avoided with cyclophosphamide therapy?
Give free access to water and encourage frequent urination
When are tyrosine kinase inhibitors used?
Patnaik grade II or III, recurrent cutaneous mast cell tumors
How does tyrosine kinase inhibitor work?
Inhibits the growth factor signal to keep cells from dividing
What type of cancer are tumor vaccines labeled for?
Stage II/III oral melanoma
What is the name of the listeria-based antigen delivery system tumor vaccine?
Pipeline
What is the presenting complaint for nasal planum tumors?
Older light pigmented cats with history of erythema progressing to ulcers
What are the ddx for nasal planum tumors in dogs and cats
Dogs: SCC, MCT and Sarcoma
Cat: SCC, LSA, eosinophilic granuloma, mast cell tumor
T/F: Cytology is effective for nasal planum tumors?
FALSE
What should be used for the workup/staging test?
Wedge/punch biopsy for tissue dx
What are the tx options for nasal planum tumor patients?
LIMIT UV EXPOSURE
superficial lesions use cryoablation or photodynamic therapy/hyperthermia, RT, electrochemotherapy
What is the presenting complaint for ear canal tumor patients?
Recurrent signs of infection w/ visible mass in ear
What breeds are associated with ear canal tumors?
Cocker spaniels, poodles and GSD
What are the DDx for ear canal tumors?
Ceruminous gland adenocarcinoma
Cats= malignant > benign
Dogs= 50/50 M:B
What test is used for staging?
Shave/pinch biopsy
What is the tx for ear canal tumors?
TECA-BO .
Total ear canal ablation and bulla osteotomy
What are negative prognostic factors of ear canal tumors?
extension beyond ear canal (beyond soft tissue- in the middle ear doesn’t mean poor prognosis)
neuro signs at dx
What are the presenting complaints of canine sinonasal tumors?
Older, large breed dolichocephalic breeds
Exposure to kerosene heaters
History of epistaxis, sneezing or facial deformity (advanced)
What are the ddx for canine sinonasal tumors?
Carcinomas (ACA, Scc)= dogs
Sarcoma (fibro, osteo, chondro) = dogs
LSA= cats
What radiographic evidence supports sinonasal tumors?
Ipsilateral turbinate loss, bone invasion, sinus infiltration
What are tx options for canine sinonasal tumors?
NSAIDs
Chemo- Palladia
Hemorrhage control
RT
What is pallitation?
percutaneous arterial embolization tx of intractable epistaxis in dogs
Carotid artery ligation
What is the presenting complaint for salivary tumors?
Older spaniels and siamese
More aggressive in cats
What salivary glands are commonly affected in salivary tumors?
Mandibular or parotid
What is the ddx of salivary tumors?
Carcinomas
What are the presenting complaints of a dog with a thyroid tumor?
Older goldens, beagles, boxers and huskies
Invasive= coughing, dysphagia, dyspnea, horner’s syndrome
Functional: signs of hyperthyroidism
What are the presenting complaints of a cat with a thyroid tumor?
Older
HYPERTHYROIDISM
Siamese/Himalayan= DECREASED risk
What are the ddx for thyroid tumors?
Dogs= carcinomas (90:10 M:B) Cats= adenomas (10:90- M:B)
What size thyroid tumor is a negative prognostic factor?
Volume: >20 cm
Diameter: > 5 cm
T/F: Bilateral thyroid carcinoma has greater risk for developing metastatic dz?
TRUE
T/F: Non-medullary thyroid carcinomas may be more likely to develop metastatic disease?
TRUE
