Presentations and diagnosis of neoplasia

Question 1

How are neoplastic lesions named?

Answer 1

First half of tumour name (prefix) tells you the cell or tissue of origin
Second half of tumour name (suffix) tells you if it is benign or malignant
Benign: -oma e.g., haemangioma
Malignant: -sarcoma or -carcinoma e.g., haemangiocarcoma

Question 2

What are benign and malignant tumours from glandular epithelium called?

Answer 2

Benign - adenoma
Malignant - adenocarcinoma

Question 3

Give examples of common benign tumours in dogs

Answer 3

Question 4

What tumour is this?

Answer 4

lipoma

Question 5

What tumour is this?

Answer 5

papilloma - tumour of the protective epithelium

Question 6

What tumour is this?

Answer 6

sebaceous adenoma

Question 7

Give examples of common malignant tumours in dogs

Answer 7

Question 8

What tumour is this?

Answer 8

mast cell tumour
- primarily present on skin
- release histamine => inflammation at site

Question 9

What tumour is this?

Answer 9

lymphoma

Question 10

What tumour is this?

Answer 10

mammary carcinoma
- hard and nobbly

Question 11

What tumour is this?

Answer 11

osteosarcoma

Question 12

What tumour is this?

Answer 12

haemangiosarcoma:
- commonly a splenic mass

Question 13

Give examples of common malignant tumours of cats

Answer 13

Mast cell tumour
Lymphoma - more commonly internal in cats
Mammary carcinoma
Osteosarcoma
Haemangiosarcoma
Squamous cell carcinoma

Question 14

What tumour is this?

Answer 14

squamous cell carcinoma
- common in white cats/sections of white

Question 15

Give examples of common tumours of horses

Answer 15

Question 16

What tumour is this?

Answer 16

sarcoids

Question 17

What tumour is this?

Answer 17

squamous cell carcinoma

Question 18

What tumour is this?

Answer 18

Melanoma

Question 19

What are metastatic tropisms?

Answer 19

Cancer cells from different tumour types have favoured sites for colonisation
Dependent on:
- ability of tumour cells to adapt to microenvironment of distant tissues
- layout of circulation e.g., cancer cells in the gut will travel to liver first

Question 20

Which tumours commonly metastasise in lungs?

Answer 20

Question 21

Which tumours commonly metastasise in bone?

Answer 21

Question 22

Which tumours commonly metastasise to the liver, spleen, kidney?

Answer 22

Question 23

Where will prostate cancer commonly metastasise?

Answer 23

Brain
Lungs
Liver
Bone marrow

Question 24

Why is metastasis important?

Answer 24

90% of cancer deaths are due to cancerous growths at sites in the body distant from the primary tumour
Once cancer has metastasised, it limits treatment options and prognosis

Question 25

What are the common presenting signs of neoplasia?

Answer 25

Pain Visible lump(s) Reduced appetite Vomiting Weight loss Increased drinking Change in toileting Change in breathing/cough Off legs/reluctance to walk Seizures/neurological changes Can be vague and non-specific e.g., just not quite themselves

Question 26

What direct effects of neoplasia cause clinical signs?

Answer 26

Space occupying lesions: - compression e.g., brain tumour => neurological signs - obstruction e.g., tumour obstructing GIT => vomiting, anorexia - pain e.g., osteosarcoma => lameness Bleeding: - Tumour ulcerates - chronic low-level bleeding e.g., gastric carcinoma => malaena (black poo), haematemesis (blood in vomit), lethargy - Tumour ruptures - acute haemorrhage e.g., splenic haemangiosarcoma => collapse

Question 27

Describe the indirect causes of clinical signs in neoplasia

Answer 27

Effusions: - pericardial - pleural - abdominal Infection: - usually secondary to necrosis Paraneoplastic syndromes: - caused by products of tumour cells, not the tumour mass

Question 28

Why is it important to identify paraneoplastic syndromes?

Answer 28

Can be life-threatening May help diagnose the primary tumour Can affect response to treatment Affect quality of life

Question 29

Give examples of paraneoplastic syndromes that affect the haematological system

Answer 29

Anaemia Thrombocytopaenia - Several mechanisms: - increased consumption - increased sequestration - immune mediated destruction Coagulopathies: - hypercoagulability - Disseminated intravascular coagulation (DIC)

Question 30

Give examples of paraneoplastic syndromes that effect the GIT

Answer 30

Ulceration: - mast cell tumours => increase histamine => increased gastric acid secretion => ulceration - presents as melaena and haematemesis

Question 31

Give examples of dermatological paraneoplastic syndromes

Answer 31

Question 32

Give examples of neuromuscular paraneoplastic syndromes

Answer 32

Question 33

give examples of endocrine paraneoplastic syndromes

Answer 33

Hypercalcaemia = assume cancer until proven otherwise

Question 34

Describe hypercalcaemia of malignancy

Answer 34

Cancer is the most common cause of hypercalcaemia in dogs (and top 3 in cats) Caused by parathyroid hormone-related protein (PTHrP) produced directly by tumour cells Acts on bones and kidneys to stimulate calcium release into blood

Question 35

What other common paraneoplastic syndromes are there?

Answer 35

Question 36

What is hypertrophic osteopathy?

Answer 36

rapid periosteal new bone growth affecting distal limbs. Most commonly associated with lung tumours (primary or metastatic)

Question 37

What are the different types of biopsy?

Answer 37

Fine needle aspiration (FNA) - for cytology Surgical biopsy (incisional and excisional) - for histopathology

Question 38

What is the difference between incisional and excisional biopsy?

Answer 38

Incisional - take a small piece of mass before surgical removal Excisional - remove whole mass and send for labs

Question 39

When are incisional and excisional tumours favoured?

Answer 39

Incisional best for planning surgery afterwards so can determine margins etc. Excisional best when tumour type is highly suspected and pre-op biopsy will not affect outcome e.g. bleeding splenic mass

Question 40

What are the pros and cons of FNAs

Answer 40

Question 41

What are the pros and cons of surgical biopsy?

Answer 41

Question 42

In what situations is a biopsy not encouraged?

Answer 42

When knowledge of the tumour type will not influence the treatment plan e.g. a bleeding splenic mass is a life-threatening emergency that requires surgical removal regardless of tumour type When the biopsy process may itself cause tumour spread or compromise future treatment e.g. bladder transitional cell carcinomas seeding metastases