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Oncology - Intro + Lymphoma Flashcards

1
Q

True or False: Cancer is a leading cause of death for dogs and cats.

A

True

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2
Q

What are some things that clients will want to know when you tell them their animal has cancer?

A

Diagnosis, prognosis, quality of life, treatment options, cost, and ‘what to do’

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3
Q

Multimodal treatment is often need for neoplasia. What are the four main treatments?

A

Chemotherapy, surgery, radiation, immunotherapy

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4
Q

What are some general categories that you need to know when treating neoplasia?

A 
What is it? Cytology, biopsy
Where is it? Location, staging
How is it likely to behave? locally, systemically
Treatment options
Expected outcomes/prognosis
Clients' goals/expectations
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5
Q

What are the most common side effects of chemotherapy?

A

Myelosuppression and GI side effects

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6
Q

How does myelosuppression due to chemotherapy present?

A

neutropenia and thrombocytopenia

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7
Q

What GI signs are side effects of chemotherapy?

A

Vomiting, inappetence, and diarrhea

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8
Q

Hair loss is an uncommon side effect of chemotherapy. However when it does occur, what breeds are more affected?

A

Breeds with continual hair growth

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9
Q

____% of chemotherapy patients experience some level of side effect(s).

A

~30%

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10
Q

~___-___% of patients that experience chemotherapy side effects are severe enough to require hospitalization.

A

~5-10%

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11
Q

What % of chemo side effects are severe enough to be life-threatening?

A

<1%

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12
Q

If your patient is febrile/neutropenic due to chemotherapy, what is the recommended treatment?

A

IV antimicrobials

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13
Q

If your patient is dehydrated due to chemotherapy, what is the recommended treatment?

A

IV fluid therapy

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14
Q

What antiemetic works on the emetic center?

A

Cerenia

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15
Q

What antiemetic works on the chemoreceptor trigger zone?

A

Cerenia and metaclopramide

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16
Q

What antiemetic works on the afferent neurons?

A

Ondansetron

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17
Q

What is the antiemetic protocol for in-hospital chemotherapy patients?

A

Ondansetron 0.5 mg/kg SC 30 minutes prior to chemotherapy

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18
Q

What is the antiemetic protocol for at-home chemotherapy patients?

A

Cerenia 2 mg/kg PO q24 hours for 5 days

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19
Q

What are the rescue options for breakthrough vomiting in chemotherapy patients?

A

Ondansetron
Metoclopramide
Mirtazapine

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20
Q

Cerenia (maropitant) treats vomiting by preventing the binding of which ligand to its respective receptor in the emetic center?

a. Serotonin to 5HT3
b. Dopamine to D2
c. Substance P to NK1
d. Histamine to H2

A

c. Substance P to NK1

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21
Q

_______ is a key indicator of quality of life. It is often the first or only sign a pet is not feeling well.

A

Appetite

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22
Q

_______ is considered an acceptable side effect, but ______, ______ ____ and depression are considered unacceptable.

A

Vomiting, inappetence, and weight loss

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23
Q

What type of drug is mirtazapine?

A

Noradrenergic and specific serotonergic antidepressant

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24
Q

What does mirtazapine do on a physiological level?

A

Stimulates 5-HT1 receptors

Strongly antagonizes 5-HT2 and 5-HT3

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25
On a clinical level, what does mirtazapine do?
Decreases nausea/vomiting, appetite stimulant, and possible prokinetic effect
26
What animal is Mirataz (mirtazapine transdermal ointment) FDA approved for use in?
Cats
27
What is the indication for Mirataz?
Management of weight loss in cats
28
What animal is Entyce (capromorelin oral solution) FDA approved for use in?
Dogs
29
What does entyce mimic the action of? What does that do?
Ghrelin - effect at appetite center to increase food intake
30
What type of drug is entyce?
Potent and selective GHSR agonist to increase growth hormone secretion
31
Entyce (capromorelin) increases appetite by mimicking the action of which endogenous hormone in the appetite center? a. Serotonin b. Dopamine c. Leptin d. Ghrelin
d. Ghrelin
32
What is the most important consideration for palliative care?
Quality of life
33
What factors does perceived quality of life encompass?
Level of pain, level of interaction, attitude/activity, appetite, and other (systemic signs)
34
What are the therapeutic (general) options for palliative care?
Pain control, appetite stimulant, antiemetic, hydration, and hospice care
35
What oral medications can be given for palliative care?
NSAID, gabapentin, tramadol, amantadine, and buprenorphine
36
What appetite stimulants can be used for palliative care?
Entyce and mirtazapine
37
What antiemetics can be used for palliative care?
Cerenia and ondansetron
38
Approximately what % of dogs and cats experience clinical side effects following chemotherapy, and what % potentially require hospitalization? a. 10%; <1% b. 30%; 5-10% c. 50%; 20% d. 75%; 30%
b. 30%; 5-10%
39
Where do neoplastic cells originate in canine lymphoma?
in the periphery - NOT in the bone marrow
40
What terms are interchangeable with lymphoma? Which term should be used?
malignant lymphoma and lymphosarcoma Lymphoma should be used
41
What is the incidence of lymphoma?
It is the most common hematopoietic neoplasm - 80-90% of hematopoietic neoplasms
42
What are the ways to classify lymphoma?
Histopathology, cytology, and anatomic site
43
How do we histopathologically classify lymphoma?
High/intermediate grade or low grade
44
How is lymphoma cytologically classified?
Lymphoblastic (large/intermediate cell) or small cell
45
True or False: High/intermediate grade = large/intermediate cell = indolent
False - High/intermediate grade = large/intermediate cell = lymphoblastic
46
True or False: Low grade = small cell = indolent
True
47
Lymphoblastic lymphoma is typically biologically ______ and rapidly _______. It requires ________, more ________. therapy.
aggressive, progressive, aggressive, intense
48
True or False: Indolent lymphoma is typically slowly progressive and may not require any therapy.
True
49
What are the anatomical sites of lymphoblastic lymphoma? What is the most common?
Generalized nodal (most common- 83%), gastrointestinal, cutaneous, mediastinal, and extranodal
50
What is the most common clinical sign of multicentric lymphoblastic lymphoma?
Generalized lymphadenopathy
51
What are the substages of multicentric lymphoblastic lymphoma?
A - clinically normal | B - not feeling well
52
What are the clinical signs associated with stage B lymphoblastic lymphoma patients?
Inappetence, weight loss, vomiting, diarrhea, dyspnea, fever, and PU/PD Signs vary by anatomical site
53
How do tumors cause hypercalcemia of malignancy?
Ectopic production of parathormone (PTH) or PTH-related peptide (PTH-rp) This is the most important - there are others
54
What clinical signs are associated with lymphoblastic GI lymphoma?
Weight loss and lethargy, vomiting and diarrhea, and blood may be present in vomitus or stool
55
What breeds are overrepresented in GI lymphoblastic lymphoma?
Boxer and Shar-Pei
56
What clinical signs are associated with lymphoblastic mediastinal lymphoma?
Respiratory signs, precaval syndrome, and PU/PD (due to increased Ca)
57
Of what origin are mediastinal lymphoblastic lymphomas more likely to be?
T-cell origin
58
What clinical signs are associated with lymphoblastic epitheliotropic (cutaneous) lymphoma?
Single or multiple lesions, flat plaques to nodular disease +/- systemic involvement ~50% are pruritic
59
Of what phenotype are epitheliotropic lymphoblastic lymphoma?
T-cell
60
What diagnostic method is usually adequate for diagnosis of lymphoblastic lymphoma?
Cytology
61
How can you diagnose lymphoma via cytology (what to look for since you aren't a pathologist)?
Cells are larger than a neutrophil Absence of plasma cells Variability in nucleolar size/number
62
What are other common methods for lymphoblastic lymphoma diagnosis?
Fine needle aspirate, punch biopsy or remove node, and pathology
63
What will you see on hematology in patients with lymphoblastic lymphoma?
Anemia, thrombocytopenia, leukopenia, and blasts (stage V)
64
What will you see on chemistry panel in patients with lymphoblastic lymphoma?
Hypercalcemia and hepatic involvement (ALT)
65
What would be the indication to do a bone marrow aspirate in a lymphoblastic lymphoma patient?
Determine if it is a stage V
66
Hypercalcemia is most commonly associated with which form of canine lymphoma? a. Multicentric b. Extranodal c. Mediastinal d. Cutaneous e. Alimentary/GI
c. mediastinal

Small Animal Medicine (100 decks)

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