Oncology Part 1 Flashcards
what is the most common clinical presentation of canine lymphoma?
stage 3 (generalized peripheral lymphadenopathy) or 4 (hepatosplenic), substage a (asymptomatic)
multicentric
intermediate-high grade
B cell
list 5 prognostic factors of canine lymphoma
stage 1/2 > 3/4 > 5
substage A > B
B cell > T Cell (except indolent t cell)
hypercalcemia = poor
primary hepatic or GI = poor
list the various immunophenotyping types for canine lymphoma
IHC
ICC
PARR
Flow cytometry
what is the gold standard immunophenotyping test for canine lymphoma?
IHC but expensive and requires biopsy
what drugs are in the CHOP protocol
vincristine
cyclophosphamide
doxorubicin
prednisone
canine indolent lymphoma (T cell) treatment and prognosis?
solitary - remove LN
multicentric - chemo when warranted (prednisone w/ chlorambucil)
good prognosis, live yrs
aggressive canine lymphoma treatment and prognosis?
CHOP
MST longer w B cell then T cell
feline small cell lymphoma type II
T or B cell?
clinical presentation?
treatment?
prognosis?
T cell
indolent, chronic diarrhea, vomiting, acute weight loss
chlorambucil + prednisolone, GI support
good prognosis 2.5-3yr
feline large cell lymphoma type I
T or B cell?
clinical presentation?
treatment?
prognosis?
- response to chemo MST
- no response to chemo MST
- steroids only MST
T cell
aggressive, acute diarrhea, hyporexia, weight loss
CHOP
worse prognosis 1.5 months
- 6-8mo
- 4-6wk
- 1-2mo
feline large B cell tumors
clinical presentation?
treatment?
prognosis?
- response to chemo MST
- no response to chemo MST
- steroids only MST
aggressive, acute diarrhea, hyporexia, weight loss
CHOP
worse prognosis 3.5 months
- 6-8mo
- 4-6wk
- 1-2mo
what canine breeds are at most risk of TCC
Scottish terrier (highest risk, 18x)
Shetland sheepdog
Beagle
Wirehaired fox terrier
West highland white terrier
what test can you do to test for TCC? when should it be used?
B-RAF test (urine sample)
screening test - should not be used alone to make treatment decisions
what is the field carcinogenesis effect? what tumor type is this associated with?
TCC
microscopic carcinogenic cells distant to primary tumor but within the same organ
etiology of TCC?
multifactorial
most dogs with TCC are what grade?
intermediate-high
T2 (invasion of bladder wall)
in a dog with TCC, if you want to evaluate the pelvic urethra which diagnostic is preferred?
cystoscopy
difficult to see w/ US or CT
Be able to describe the % risk of benign and malignant mammary tumors in dogs vs cats
dogs 50% benign, 50% malignant
cats 85-90% malignant
Be able to describe the difference in surgical approach to mammary tumors between dogs vs cats
dogs - lumpectomy or mammectomy
cats - chain mammectomy
dog and cat breeds overrepresented with mast cell tumors
boxer - low grade
shar pei - high grade
siamese cats
diagnostics for MCT?
FNA
local LN palpation + FNA
what are the 3 criteria that must be met in order to skip pre-surgical staging for a MCT?
- LN negative
- no negative prognostic factors (location, breed, recurrence, ulcer, Gi signs)
- appropriately large
what are the tests used to stage MCT patients?
cbc, chem, UA
thoracic rads
FNA of LN
abdominal US
+/- tumor biopsy
what is the treatment of choice for patients with MCT.
aggressive surgical excision is the treatment of choice ~ 3cm
do the number of cutaneous mast cell tumors influence outcome? prognosis?
no - doesn’t influence outcome
85% 2-5yr survival w/ sx alone for multiple low-int grade
There are 9 prognostic factors for dogs with MCT.
how do these prognostic factors affect prognosis?
- histologic grade
- clinical stage
- location
- growth/proliferation/ulceration
- local recurrence
- mitotic index
- age
- sex
- breed
- histologic grade (low/int > high)
- clinical stage (LN mets poor)
- location (haired skin > mucus membranes)
- growth/proliferation/ulcer (poor)
- local recurrence (poor)
- mitotic index predicts outcome (higher the worse)
If you have a young siamese cat with multifocal masses on the head/neck what would you be suspicious of? treatment?
histiocytic - macrophages and mast cells
no treatment - spontaneous regression
in cats, are cutaneous or visceral mast cell tumors generally worse? prognosis for visceral?
visceral worse
splenic - 18mo MST
GI - 240 days
what is a difference between splenic and GI mast cell tumors in cats?
peripheral mastocytosis common in splenic form NOT GI
Palladia (Toceranib) MOA? what are the most common side effects to be aware of when using it?
KIT kinase inhibitor
GI - vomit, diarrhea, anorexia, GI bleeds
chemotherapy options for dogs vs cats with MCT
dogs - pred/vin
cats - CCNU (lomustine), palladia, pred/vin
when can you use tigilanol tiglate for MCT?
non-metastatic cutaneous MCT
non-metastatic SQ MCT located at or distal to the elbow/hock in dogs
any cytological grade < 10cm3
must be accessible to injection
what EKG findings can you often see with HSA?
VPCs w/ splenic tumors
electrical alternans w/ cardiac effusion/tamponade
how can you get a definitive diagnosis of HSA?
explore laparotomy and splenectomy with histopathology
List the unique surgical considerations with splenic HSA
mortality
hemorrhage
thromboembolic events
DIC
cardiac arrhythmias
tumor seeding
what is the prognosis following surgery or surgery plus chemotherapy with HSA
surgery - 19-86 days
MST surgery + chemo = 6mo
1yr survival less than 10%
what is the treatment and prognosis for dermal HSA to visceral HSA.
dermal - surgery is often curative, 18mo to >4yrs w/ prognosis being better if predisposed breed, solar changes and on ventral abdomen
visceral - surgery (best), radiation or chemo
what type of adrenal tumor is more likely to invade the caudal vena cava? which side is not likely to invade it?
pheochromocytoma
right side not likely
screening test for Cushings?
urine cortisol:creatinine ratio
Diagnostic test for Cushings?
LDDST
Diagnostic test for pheochromocytoma?
urine normetanephrine:creatinine ratio (most reliable) or plasma-free normetanephrine
dogs with hyperadrenocorticism are at risk of what?
- infection
- thromboembolic disease
- dehiscence
what are the treatment options for a pheochromocytoma?
Phenoxybenzamine (𝛼-adrenergic antagonist)
𝛽-adrenergic antagonist (e.g. atenolol) the day of surgery if tachycardia present
what should you perform the morning after surgery of an adrenalectomy?
what would you expect if…
- successful surgery?
- failed surgery?
- failed surgery or wrong diagnosis?
ACTH-stim test
success = cortisol <1
failed = cortisol elevated
failed/wrong diagnosis = cortisol normal
why are adrenal masses becoming an incidental finding? when should these be removed?
abd imaging more common (US or CT)
remove if >2cm bc malignant
what LN would you want to FNA if a thyroid tumor is suspected?
retropharyngeal LN
Prognostic factors for a thyroid tumor
- attachment/invasiveness (freely > invasive)
- > 20cm (negative)
- medullary thyroid carcinomas (positive)
- vascular invasion
- bilateral tumors (decent prognosis, maybe more mets)
treatment options for thyroid tumor
surgery
radiation therapy
I-131 (good alternative)
chemo - unknown benefit
prognosis of insulinomas in dogs?
malignant, will met to liver/LN
rarely get a cure
how can you diagnose an insulinoma?
whipples triad
paired [insulin] is measured on serum in which hypoglycemia is documented
components of whipples triad?
hypoglycemia
neuroglycopenic signs
resolution of clinical signs with glucose supplementation
what imaging can help diagnose an insulinoma?
ultrasound (Se 35-70%)
CT
insulinoma treatment?
surgery
what is a risk after surgical excision of an insulinoma?
pancreatitis form manipulation
what will the dog have to be treated for if both the pancreatic duct and accessory pancreatic duct are sacrificed in surgery for an insulinoma?
exocrine pancreatic insufficiency
what is a postoperative concern after having an insulinoma removed?
patient may have diabetes mellitus and may need insulin therapy life long or transient
what is the treatment of choice for nasal tumors in dogs? prognosis?
radiation therapy
MST 18mo
what is the treatment of choice of nasal planum SCC in cats?
cryotherapy! small superifical lesions and can be repeated (2 cycles, rapid freeze, slow thaw)
in cats with nasal tumors, do lymphosarcoma or carcinomas have a better prognosis?
LSA
most common differentials for a mediastinal mass?
thymoma
lymphoma
a cytology of a mediastinal mass is lymphocyte rich…what are your differentials?
thymoma or lymphoma
flow cytometry of a mediastinal mass shows a population of both CD4+ and CD8+ cells, what is your diagnosis?
thymoma
in regard to mediastinal masses, what are the treatment choices for
- lymphoma
- thymoma?
- chemodectoma?
lymphoma - chemo
thymoma - surgery
chemodectoma - radiation
diagnostics to determine hypercalcemia as a paraneoplastic syndrome of mediastinal mass?
if serum Ca elevated run ionized Ca
can also run PTH and PTHrp
diagnostics to determine Myasthenia Gravis as a paraneoplastic syndrome of mediastinal mass?
edrophonium chloride
pyridostigmine bromide
neostigmine bromide
diagnostics for a solitary lung tumor
thorax rads
CT
FNA (rarely tru cut biopsy)
pros and cons of CT imaging for a solitary lung nodule
pro: more sensitive - lymphadenopathy and other lesions
cons: doesn’t distinguish resectability or inform invasiveness/adhesions
