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Year 4 Small Animal Studies > Oncology: Paraneoplastic Syndrome > Flashcards

Oncology: Paraneoplastic Syndrome Flashcards

1
Q

What is the difference between paraneoplastic syndromes vs systemic effects of cancer?

A
  • Paraneoplastic are a consequence of cancer but no due to the location of cancer cells
  • Systemic effects are consequential to the location of tumour cells
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2
Q

How does paraneoplastic syndrome affect the GI?

A
  • Cancer cachexia and anorexia
  • Gastroduodenal ulceration
  • Protein losing enteropathy
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2
Q

How does paraneoplastic syndrome affect the GI?

A
  • Cancer cachexia and anorexia
  • Gastroduodenal ulceration
  • Protein losing enteropathy
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3
Q

What causes cancer cachexia and anorexia?

What are the clinical signs and treatment?

A
  • Anaerobic respiration due glucose utilisation and tumoural hypoxia- increased lactate, altered insulin sensitivity
  • Altered metabolism- cancer cytokines/inflammation
  • Poor appetite in some patients

CS: weight loss, reduced fat mass, lean muscle mass

Treatment: maintain caloric intake, omega 3

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4
Q

How can cancer cause gastroduodenal ulceration?

A

GI tumours can cause gastric or duodenal ulceration

Some tumours produce hormones/metabolites which may increase gastric acid

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5
Q

How can GI cancer cause PLE?

A

Diffuse GI lesions allow protein loss

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6
Q

What are the mechanisms of paraneoplastic haematological effects?

A
  • Loss
  • Reduced production
  • Destruction

Cytoses
Coagulation disorders

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7
Q

How can cancers cause acute/chronic blood loss anaemia?

A

Acute:
* if no haematemesis or melena- splenic
* TP drops before PCV

Chronic
* GI or oral lesions
* CS: lethargy, pallor
* Poorly regenerative microcytic hypochromic anaemia due to iron deficiency

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8
Q

How can cancer cause reduced production cytopenias?

A

Anaemia of chronic inflammatory disease
* Disordered iron storage
* Shortened RBC life span

Myelophthisis- crowding in bone marrow from tumour or suppressive cytokines
* Non-regen normochromic normocytic anaemia
* Diagnosis- bone marrow aspirate

Hyperoestrogenism
testicular tumours- sertoli cell
* Neutrophilia progressing to pancytopenia due to bone marrow hypoplasia

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9
Q

How can cancer cause destruction cytopenias?

A

Paraneoplastic immune mediated anaemia/thrombocytopenia
* Secondary to lymphoproliferative tumours and occasionally other tumours
* Must exclude lymphoproliferative disease

Microangiopathic anaemia
* Systemic effect
* Fibrin networks
* Schistocytes

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9
Q

How can cancer cause destruction cytopenias?

A

Paraneoplastic immune mediated anaemia/thrombocytopenia
* Secondary to lymphoproliferative tumours and occasionally other tumours
* Must exclude lymphoproliferative disease

Microangiopathic anaemia
* Systemic effect
* Fibrin networks
* Schistocytes

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10
Q

What of the following is not a cause of schistocytosis?
1. DIC
2. IMHA
3. Metastatic carcinoma
4. Haemangiosarcoma
5. Lipoma

A

5) Lipoma

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11
Q

What paraneoplastic cytoses can occur?

A

Erythrocytosis
* Renal tumours- increased EPO
* lymphoma, nasal fibrosarcoma, transmissible vereneal, hepatic
* CS: PUPD, neurological, seizures
* Tx- phlebotomy, removal, hydroxyurea

Neutrophilia
* Tumour induced or immune response to tumour

Eosinophilia
* T cell Lymphoma
* Mast cell

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12
Q
  1. Why can cancers cause mono-clonal gammopathies?
  2. What are the CS?
  3. How is it diagnosed?
  4. How is it treated?
A
  1. Excess production of single immunoglobulin by tumour cells
  2. Hyperviscosity of blood- renal failure, ocular
  3. Electrophoresis
  4. Plasmapheresis
Electrophoresis
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12
Q
  1. Why can cancers cause mono-clonal gammopathies?
  2. What are the CS?
  3. How is it diagnosed?
  4. How is it treated?
A
  1. Excess production of single immunoglobulin by tumour cells
  2. Hyperviscosity of blood- renal failure, ocular
  3. Electrophoresis
  4. Plasmapheresis
Electrophoresis
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13
Q

How can tumours affect coagulation?

A

DIC
* Altered consumptive coagulation
* Thromboembolism
* Elevated APTT, PT, FDPs, D dimers

Mainly in association with carcinoma and Haemangiosarcoma

14
Q

What endocrine effects can tumours have?

A
  • Hypercalcaemia
  • Hypoglycaemia
  • Ectopic ACTH syndrome
  • Hyperoestrogenisms

ACTH controls the production of cortisol

15
Q

What are the clinical signs of hypercalcaemia?

A
  • PUPD
  • Dehydration
  • GI signs
  • Weakness
  • Muscle fasiculations
  • Calcification of soft tissues
  • Arrythmias
  • Death
16
Q

How is hypercalcaemia managed in an emergency?

A
  • Rehydrate with saline- 3-4x maintenance
  • Consider furosemide
  • Consider bisphosphates
  • Consider salmon calcitonin
  • Consider prednisolone

Removal of inciting lesion

17
Q

How should hypercalcaemia be worked up?

A
  • Assess tCa and ica
  • Rectal exam- anal gland tumours
  • Assess and aspirate LNs
  • Check history for diet/toxins
  • Imaging of thorax/abdomen
  • PTH/PTHrp/Vitamin D
  • Bone marrow biopsy
  • Consider ACTH stimulation test
18
Q

What is the most common cause of monoclonal gammopathies?

A
  • Myeloma
  • Leukaemia
  • Lymphoma
19
Q
  1. What is the most common cancer with insulinoma?
  2. What are the clinical signs of hypoglycaemia?
  3. How is it managed?
  4. What are the non-neoplastic differentials?
A
  1. Paranasal sinus
  2. Weakness, disorientation, seizures, coma, death
  3. IV glucose, CRI glucose, medical managment- prednisolone, diazoxie, oceotide, removal of tumour
  4. Sepsis, starvation, liver dysfunction, hypoadrenocorticism, lab error
20
Q
  1. What location of tumours is associated with ectopic ACTH syndrome?
  2. How is it diagnosed and managed?
A
  1. Lung tumours
  2. Hyperadrenocortisism tests- exision of lesion
21
Q

What neoplasms can cause neurological signs?

A
  • Systemic effects- neurological mass
  • Paraneoplasttic- myasthenia gravis, peripheral neuropathy
22
Q
  1. What causes myasthenia gravis?
  2. What tumours is is associated with?
  3. How is it treated?
A
  1. Secondary immune mediated disease-type II hypersensitivity
  2. Thymoma- osteosarcoma/lymphoma
  3. Remove tumour- immunosupression

Weakness and Megaoesophagus

23
Q
  1. How can cancer cause peripheral neuropathy?
  2. What tumours can cause it?
  3. How is it treated?
A
  1. Demyelination, myelin globulation and axonal degeneration noted on histology
  2. Lung tumours, insulinoma, lymphoma, MCT, thyroid adenocarcinoma, melanoms
  3. Removal of inciting tumour
24
Q

What cancers are associated with diagnosis of hyperglycaemia?

A
  • Canine T cell lymphoma
  • Canine multiple myeloma
  • Canine anal sac adenocarcinoma
  • Canine thymoma
  • Feline lymphoma
25
Q

What canine paraneoplastic syndromes can be caused?

A
  • Alopecia and malassezzia associated dermatitis
  • Pancreatic associated panniculitits
  • Superficial necrolytic dermatitis
  • Paraneoplastic immune mediated disease
  • Feline thymoma-associated exfoliative dermatitis
  • Cutaneous flushing
  • Nodular dermatofibrosis
26
Q

What are the clinical signs of feline paraneoplastic alopecia

A
  • Alopecia
  • Glistening skin
  • Footpad lesions
  • Malassezia dermatitis
27
Q

What are the differentials for feline paraneoplastic alopecia

A

Dermatophytosis, demodicosis, SIA, telogen defluxion, endocrinopathies, SND

28
Q

What is pancreatic panniculitis?

What cancers can cause it?

A

Inflammation and hydrolysis of adipose tissue

DDx- Pancreatitis
Cancers:
pancreatic carcinoma, adenocarcinoma

29
Q
  1. What does this image show?
  2. What causes it?
  3. How is it diagnosed?
Crusting dermatitis
A
  1. Superficial necrolytic dermatitis
  2. Hepatic disease and pancreatic neoplasia
  3. Distcintive histo and US

Also causes footpad hyperkeratosis

30
Q

What does paraneoplastic pemphigus cause?

What are the potential aetiopathogenesis?

A
  • Autoimmune induced ulceration of the mucosae and mucocutaneous junctions
  • Oral and mucocutaneous ulceration

Aet
* Lymphoma, thymoma, splenic sarcoma, metastatic thymic mass
* Primary immune mediated pemphigus

31
Q
  1. What cancer is associated with feline thymoma-associated exofoliative dermatitis?
  2. What are the cutaneous markers?
A
  1. Thymoma
  2. Exofoliative dermatitis, kerato-sebaceous accumulations, crusting and ulceration
32
Q
  1. What is cutaneous flushing?
  2. What tumours rarely cause it?
A
  1. Periodic release of vasoactive substances by tumours leads to skin colour changes
  2. Pheochromocytoma, lung tumours, mast cell
33
Q

What is seen in middle ages GSDs with bilateral renal cysts or cyst adenocarcinom?

A

Nodular dermatofibrosis

Nodules of well differentiated collagenous nevi mainly on limbs but also heads and trunk

34
Q

What tumours can cause hypertrophic osteopathy?

A

Pulmonary tumours

Shifting lameness, swelling/oedema

35
Q
  1. Why can neoplasms cause pyrexia?
  2. What tumours are more likely to cause it?
  3. How is it treated?
A
  1. Expression of inflammatory cytokines by or in response to the tumour
  2. Lymphoma, renal, hepatic tumours
  3. Removal of the tumour, NSAIDs
36
Q

What tumors are commonly associated with pericardial effusion?

A

Heartbase tumours
* Haemangiosarcomas
* Chemodectomas

Mesotheliomas- pleura or pericardium

Year 4 Small Animal Studies (97 decks)

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