ONCOLOGY - Neoplasia Diagnosis and Management Flashcards
What are the three presentations of neoplasia?
Superficial mass
Clinical signs
Paraneoplastic syndrome
What is paraneoplastic syndrome?
Paraneoplastic syndrome is the range of clinical signs that result from the secretion of substances by neoplastic cells. These substances can cause a range of clinical signs that can be unrelated to the actual tumour itself
What is the first step involved in neoplasia diagnosis based on mass identification?
Taking a thorough patient history
Which six questions should be asked when taking a thorough history?
Has there been any recent trauma or injury?
When was the mass first noticed?
What is the rate of growth of the mass?
Has the patient had any previous masses?
What is the age, sex and breed of the patient?
Is the mass hot or painful?
Why should you ask if the mass is hot or painful when taking a thorough history?
A hot or painful mass could indicate an infectious aetiology rather than neoplasia
Which two techniques can be used to investigate a mass for neoplasia?
Biopsy
Fine needle aspirate (FNA)
What information can be obtained from a biopsy?
Cell type present
How the tumour interacts with surrounding tissue
Allows for tumour grading
What is the main advantage of a biopsy?
A biopsy is diagnostic
What are the main disadvantages of a biopsy?
A biospy requires the animal to be sedated or under general anaesthetic which is both expensive and time-consuming
How much tissue should you take when carrying out a biospy?
When carrying out a biopsy, take as much tissue as you can within reason
What are the five biopsy techniques?
Incisional (wedge) biopsy
Excisional (whole mass) biopsy
Surface grab biopsy
Punch biopsy
Needle core biopsy
When is an incisional (wedge) biopsy most appropriate?
An incisional (wedge) biopsy is most appropriate when the mass is large or in a location that makes removal challenging
When is an excisional (whole mass) biopsy most appropriate?
An excisional (whole mass) biopsy is most appropriate when the mass is small and easily accessible
When is a surface grab biopsy most appropriate?
A surface grab biopsy is most appropriate for a mucosal tissue biopsy
When is a punch biopsy most appropriate?
A punch biopsy is most appropriate for a skin biopsy
What are the two types of needle used for a needle core biopsy?
Tru-cut needle
Jamshidi needle
When is a tru-cut needle most approproate for a needle core biopsy?
A tru-cut needle is used for a soft tissue biopsy
When is a Jamshidi needle most appropriate for a needle core biopsy?
A Jamshidi needle is used for a bone/bone marrow biopsy
Which biopsy technique would you use for this oral mass? Justify your answer.
Surface grab biopsy as this is the most appropriate technique for mucosal tissues
Which biopsy technique would you use for this skin mass? Justify your answer.
Punch biopsy or an incisional (wedge) biopsy as both of these techniques are appropriate for skin sampling, especially for large lesions such as this
Which biopsy technique would you use for these skin lesions? Justify your answer.
Excisional (whole mass) biopsy as there multiple small lesions and one of the whole lesions could be biopsied
How do you carry out a fine needle aspirate (FNA)?
Use a needle and syringe to aspirate the cells from the mass, expel and smear the aspirate onto a glass slide, stain the slide and examine under the microscope or send the sample to cytology
What information can be obtained from a fine needle aspirate (FNA)?
Cell type present
What are the main advantages of a fine needle aspirate (FNA)?
Fine needle aspirates (FNA) are quick, cheap and easy
What is the main disadvantage of a fine needle aspirate (FNA)?
A fine needle aspirate (FNA) is does not provide a definitive diagnosis as only the cells can be examined and thus you cannot examine how the tumour is interacting with the surrounding tissues
What is tumour grading?
Tumour grading is the assessment of the degree of malignancy of a tumour
Who carries out tumour grading?
Pathologists
Which seven factors are assessed by pathologists to determine the grade of a tumour?
Cellular differentiation
Cellular pleomorphism (variation)
Mitotic index/count
Invasiveness
Necrosis
Overall cellularity
Inflammation
Describe how pathologists carry out a mitotic index/count
Pathologists will count the number of mitotic cells over ten high power fields (hpf), which is equivalent to 2.37mm2 of tissue
What is the tumour grading scheme?
High grade tumour
Intermediate grade tumour
Low grade tumour
How should a high grade tumour be treated?
A high grade tumour should undergo aggressive treatment and chemotherapy
How should an intermediate grade tumour be treated?
An intermediate grade tumour should undergo local treatment with or without chemotherapy
How should a low grade tumour be treated?
Local surgery is usually sufficient for a low grade tumour
What is tumour staging?
Tumour staging is the assessment of the anatomical extent of a tumour in terms of the primary site and any metastases
Who carries out tumour staging?
Clinicians
What are the four purposes of tumour staging?
To help decide on the extent of treatment required
To help determine prognosis
Provides a precise record of tumour extent at that period of time
To monitor how the tumour changes with time
What is the TNM classification system used for tumour staging?
The TNM system is a system used to descibe the extent and spread of neoplasia throughout the body. T describes the size and extent of the primary tumour; N describes the extend of the spread of neoplasia to nearby lymph nodes; and M describes metastasis
What do you use to determine the size of the primary tumour for tumour staging?
Rulers
Calipers
How do you determine the invasiveness of the primary tumour for tumour staging?
Assess for local invasion using palpation and diagnostic imaging such as radiography, ultrasound, CT and MRI
How should you investigate for neoplasia in nearby lymph nodes for tumour staging?
Palpate lymph nodes
Diagnostic imaging
Fine needle aspirate (FNA)
Biopsy
What is the best diagnostic imaging technique to visualise lymph nodes?
CT
What are sentinel lymph nodes?
Sentinel lymph nodes is a term used to describe the first lymph nodes most likely to drain the primary tumour area and thus the lymph nodes most likely to become neoplastic
Which technique can be used to identify sentinel lymph nodes?
Sentinel mapping
What should be done if the senitel lymph nodes are neoplastic?
If the senitel lymph nodes are neoplastic, surgically remove the lymph node and carry out more aggresive treatment
How should you investigate for external metastasis for tumour staging?
Physical examination
How should you investigate for internal metastasis for tumour staging?
Diagnostic imaging such as endoscopy, radiography, ultrasound, CT and/or MRI
Which two techniques can be used to confirm metastasis?
Biopsy
Fine needle aspirate (FNA)
What can be done in a radiograph to gain an optimal view of the lungs to investigate for metastasis?
Put the animal under general anaesthesia and carry out a manual breath hold
Which three views should be carried out when radiographing the lungs to investigate metastasis?
Left lateral
Right lateral
Dorso-ventral (DV)
When is euthanasia sometimes the only option for cancer treatment?
If the cancer is too advanced
If there is concurrent disease
Financial limitations
What should always be done before determining a course of cancer treatment?
Tumour grading
Tumour staging
What are the two main classifications of cancer treatment?
Local treatment
Systemic treatment
What are the two main methods of local cancer treatment?
Surgery
Radiotherapy
What are the two main methods of systemic cancer treatment?
Immunotherapy
Chemotherapy
Select combinations of systemic AND local treatment
What are the three treatment options most appropriate for a primary tumour (T)?
Surgical excision
Radiotherapy
Combined surgery and radiotherapy
What are the three treatment options most appropriate for sentinel lymph nodes?
Surgical excision
Radiotherapy
Chemotherapy if the neoplasia has high metastatic potential
What are the two treatment options most appropriate for metastases?
Chemotherapy
Immunotherapy
When performing oncological surgery for tumour excision, what are the three possible aims of the surgery?
Definitive/curative surgery
Cytoreductive surgery
Palliative surgery
What is cytoreductive surgery?
Cytoreductive surgery is excising as much as the tumour as possible to reduce the tumour in the body even if complete removal is not possible followed by other treatments such as radiotherapy or chemotherapy
What is palliative surgery?
Palliative surgery refers to surgery that aims to improve quality of life for patients with advanced or incurable cancer
What are the four methods of definitive/curative tumour excision?
Marginal excision/excisional biopsy
Local excision
Wide local excision
Radical local excision
When would a marginal excision/excisional biopsy be the most appropriate surgical technique for tumour excision?
Excisional biopsy
Encapsulated benign tumours (i.e. Lipoma)
Why is a marginal excision/excisional biopsy not very reliable for definitive/curative treatment?
A marginal excision/excisional biopsy is not very reliable for definitive/curative treatment because this method involves removing only a small margin (1-2mm) of healthy tissue around the tumour which may not be sufficient to remove all of the cancer cells
What is the typical margin of healthy tissue removed during a local excision?
1cm
When would a local excision be the most appropriate surgical technique for tumour excision?
Benign, non-invasive tumours
What is the typical margin of healthy tissue removed during a wide local excision?
2 - 3cm and one fascial plane
When would a wide local excision be the most appropriate surgical technique for tumour excision?
Malignant tumours
What is the typical margin of healthy tissue removed during a radical local excision?
3 -5cm margins including all tissue i.e skin, connective tissue, vessels and nerves down to tumour free fascial planes
When would a radical local excision be the most appropriate surgical technique for tumour excision?
Large, infiltrative malignant tumours
Recurrent tumours