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Companion Animal Med & Surgery > Oncology Treatment > Flashcards

Oncology Treatment Flashcards

1
Q

Two different ‘goals’ of therapy

A
  1. definitive intent (curative intent)

2. palliative intent-alleviation of clinical signs & symptoms without necessarily aiming to prolong survival

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2
Q

5 factors affecting choice of therapy

A
  1. client expectations (def. vs. palliative)
  2. age of animal
  3. finances
  4. risk aversion & aggressiveness
  5. treatments available (e.g. Sx, radiation therapy, chemotherapy)
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3
Q

Why is excisional biopsy controversial in oncologic surgery?

A

diagnostic, but chance to cure diminished

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4
Q

What is a preferable way to excisional biopsy of planning a definitive surgical procedure?

A

FNA/cytology or needle core biopsy/histopathology

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5
Q

When is the best chance to cure with oncologic surgery?

A

FIRST surgical procedure

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6
Q

Define a “margin”

A

the cuff of grossly normal tissue removed with the tumor

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7
Q

Are skin and fat (aka the components of lateral margins) good barriers to tumor growth?

A

no

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8
Q

Which margins are good barriers to tumor growth?

A

deep margins (things like fascia, bone)

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9
Q

What is the MOST common mistake in oncological surgery?

A

using too low of a surgical dose

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10
Q

What types of surgery are recommended for most solid tumors?

A

radical or wide excision

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11
Q

Four treatment options if margins are incomplete

A
  1. no treatment; monitor
  2. wide resection of surgical wound
  3. postop radiation therapy
  4. staging resection of surgical wound (*rare in vetmed)
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12
Q

Partial Response (PR)

A

at least 30% shrinkage of a tumor in at least one dimension

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13
Q

Progressive Disease (PD)

A

at least 20% enlargement in at least one dimension

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14
Q

___ % of dogs with canine appendicular osteosarcoma have micrometastases

A

90%

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15
Q

Ten Rules of Surgical Oncology

A
  1. a chance to cut is a chance to cure
  2. the OR is not the place to plan surgery
  3. if it’s worth taking out, it’s worth turning in
  4. change gloves and instruments for closure
  5. minimal tumor manipulation
  6. avoid multifilament suture
  7. avoid electrocautery or laser at margins
  8. beware of pseudocapsules
  9. no drains or flaps
  10. don’t compromise surgical dose for concerns about wound closure
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16
Q

Reasons to avoid directly grasping tumor with instruments

A
  1. lead to tissue fragmentation and exfoliation of tumor cells
  2. crush artifact on histopathology
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17
Q

What is a common tumor type for pseudocapsules?

A

Soft Tissue Sarcomas

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18
Q

What are the two types of ionizing radiation used?

A

Electrons and X-rays

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19
Q

Electron radiation is good for what types of tumors?

A

Superficial

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20
Q

Characteristics of X-ray (photon) radiation

A
  • skin-sparing

- penetrate deeper

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21
Q

What unit is used for measuring “dose” of radiation?

A

Gray (Gy)

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22
Q

What % of the biologic effect of RT comes from free-radical formation?

A

70%

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23
Q

Why do we give several small doses of radiation rather than one large one?

A
  1. repair-normal cells repair but dose accumulates in tumor cells because they cannot repair
  2. repopulation of cells depleted by RT
  3. Reoxygenation-since 70% of DNA damage is induced by free-radical formation, oxygenation of tumor is important
  4. reassortment (of tumor cells through cell cycle)
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24
Q

Radiation is prescribed based on _________?

A

normal tissue tolerance

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25
Q

Acute toxicity(radiation) characteristics

A
  • within weeks
  • targets rapidly proliferating tissues
  • painful/unpleasant
  • self-limiting
26
Q

How many patients and within what time frame generally develop late toxicity effects of radiation?

A

1-5% within three years

27
Q

Characteristics of late toxicity from radiation

A
  • years later
  • target slowly-dividing tissues
  • irreversible, progressive, and difficult to treat-can be fatal
28
Q

What constitutes a high total dose of radiation?

A

42-57 gray

29
Q

General protocol for definitive-intent RT

A
  • daily (M-F) treatments for 3-4 weeks

- small dose per fraction (2.25-4.2 Gy)

30
Q

General protocols for palliative-intent RT

A
  • daily (M-F) treatments for a week at 4 Gy per fraction

- weekly treatments for 3-6 weeks at 6-8 Gy per fraction

31
Q

What type of treatment usually works best against microscopic disease?

A

chemotherapy

32
Q

What is one systemic form of cancer that chemo is a good treatment for?

A

multicentric lymphoma

33
Q

How is metronomic chemo administered?

A

small, frequent doses orally

34
Q

How is MTD chemo administered?

A

high doses, infrequently, IV or oral

35
Q

What type of chemo is directly cytotoxic?

A

MTD

36
Q

Toceranib phosphate (Palladia), masitinib, and mesylate (Kinavet) are examples of ______

A

tyrosine kinase inhibitors

37
Q

How do TKIs work?

A

inhibition of VEGF, PDGF, c-Kit, etc.

38
Q

What is the route of administration for TKIs?

A

oral; this is appealing to owners however these drugs still have potentially dangerous side effects and require intense monitoring

39
Q

What is the incidence of side effects with chemotherapy?

A

about 30% of cases; only 5% very severe (hospitalization )

40
Q

Why is diarrhea sometimes a side effect with chemo?

A

GI mucosal inflammation and damage

41
Q

Patients receiving chemo sometimes vomit as a side effect due to activation of ______

A

CRTZ or CNS vomiting centers

42
Q

Most important bone marrow side effect of chemo

A

neutropenia; some drugs have a delayed second nadir at ~21 days

43
Q

Cyclophosphamide unique toxicity

A

sterile hemorrhagic cystitis

44
Q

Doxorubicin unique toxicities

A
  1. extravasation reactions
  2. cardiotoxic-dogs
  3. nephrotoxic-cats
45
Q

Cisplatin unique toxicity

A

pulmonary effects-cats

46
Q

L-asparaginase unique toxicity

A

allergic/anaphylactic

47
Q

CCNU/lomustine unique toxicity

A

hepatotoxic

48
Q

Prednisone may induce drug resistance by what mechanism?

A

induces MDR gene

49
Q

Which class of anti-inflammatories are good for carcinomas?

A

NSAIDs

50
Q

Which class of anti-inflammatories are good for lymphoma?

A

steroids

51
Q

What are some palliative measures that could be done in a patient with cancer that is having difficulty breathing/sleeping?

A
  • bronchodilators
  • intranasal vasoconstrictors (Afrin)
  • palliative RT
52
Q

How does the canine melanoma vaccine work?

A

DNA plasmid encodes tyrosinase which allows antibodies against tyrosinase to be produced which is helpful since tyrosinase is involved in the production of melanin

53
Q

Route of administration for melanoma vaccine

A

transdermal

54
Q

IL-2 is recombinant from _______ and marketed for ________(tumor type)

A

canarypox; feline injection-site sarcomas

55
Q

Steroids are sometimes used as intralesional therapy for _____

A

MCTs

56
Q

What are some definitive treatment options for canine appendicular osteosarcoma?

A
  • amputation
  • limb-sparing surgery
  • stereotactic radiation therapy
57
Q

What are some palliative treatments for canine appendicular osteosarcoma?

A
  • palliative RT
  • bisphosphonates
  • pain management
58
Q

Lifespan of RBCs in dogs & cats

A

dogs: 120 d
cats: 70d

59
Q

Lifespan of platelets

A

5-10d

60
Q

Lifespan of granulocytes

A

4-8 hours

Companion Animal Med & Surgery (12 decks)

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