Oncology Exam I Flashcards by Caitlyn Crawford

What is the disease where abnormal cells grow uncontrollably by disregarding normal rules of cell division?

CANCER

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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

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What are the three phases of cancer mechanism?

Initiation
Promotion
Progression

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What is the initiation phase of cancer?

Rapid phase

Carcinogens induce DNA damage but not enough to induce neoplastic transformation

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What is the promotion phase of cancer?

Original carcinogens or normal growth promoters/hormones cause reversible tissue & cellular changes

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What is the progression phase of cancer?

Slow phase

Progressing agents irreversibly convert an initiated cell into a cell exhibiting malignancy

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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

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When should you not perform diagnostic cytopathology for cancer dx?

Urogenital neoplasms

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What are the three types of cell lines cancer comes from?

Round cells, mesenchymal cells and epithelial cells

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What are the micro characteristics of round cell tumors?

Individualized round cells arranged in monolayer

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What are the micro characteristics of mesenchymal tumors?

Spindle shaped arranged individually or in non-cohesive aggregates

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What are the micro characteristics of epithelial tumors?

Round, cuboidal or columnar cells arranged in sheets or clusters

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What are the DDx of round cell tumors

Lymphoma
Mast cell tumor
Plasmacytoma
Histiocytoma
TVT
"Please Help Me Learn This"

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What are the DDx of mesenchymal tumors?

Sarcomas (osteo, chondro, firbo, hemangio)

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What are the DDx of epithelial tumors?

Carcinomas (squamous cell, adeno, undifferentiated)

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Anisocytosis

Variation in cytoplasmic size

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Anisokaryosis

Variation in nuclear size

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What are the characteristics of malignancy?

Heterogenous, pleomorphic, hyperchromasia of cytoplasm, anisokaryosis

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T/F: Cytopahtology is highly specific and low sensitivity

TRUE

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Multiple similar splenic nodules is associated with what?

Malignancy

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When bone cytology is positive- it is 100% sensitive for what?

OSA

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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

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LN sampling should be based on what?

The sentinel LN

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T/F: LN that is normal size= non-metastatic

FALSE- just because it is normal size doesn’t mean that there is no metastasis

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What is the minimum views needed to be taken on rads?

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