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Y3 SPRING > SA MED - ONCOLOGY > Flashcards

SA MED - ONCOLOGY Flashcards

1
Q

% of dogs that lived to 10+ years old died of cancer

A

45%

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2
Q

Characteristics of malignant cell growth according to Hanahan and Weinberg

A
  • self sufficiency in growth signals
  • insensitivity to anti-growth signals
  • evasion of apoptosis
  • limitless replicative potential
  • sustained angiogenesis
  • tissue evasion and metastasis
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3
Q

What is malignant transformation?

A

Mutation in DNA or epigenetic changes that alter the genetic code of a somatic cell, endowing it with limitless replicative potential or other growth or survival advantage

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4
Q

Three stages of malignant transformation

A
  1. Initiation (initial, change, rapid)
  2. Promotion (more mutations or changes over years by initiating agent or normal hormones/GFs)
  3. Progression (more mutations toward malignant phenotype)
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5
Q

Four types of changes that lead to aberrant differentiation (malignant transformation)

A
  1. Activation of oncogenes
  2. Inactivation of tumor suppressor genes (p53)
  3. Altered repair capacity of DNA
  4. Defective apoptosis
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6
Q

Name for benign epithelial glandular tissue

A

Adenoma

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7
Q

Name for malignant epithelial glandular tissue

A

Adenocarcinoma

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8
Q

Name for benign connective tissue mass

A

Tissue type + OMA

Ex: fibroma

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9
Q

Name for malignant connective tissue mass

A

Tissue type + SARCOMA

Ex: fibrosarcoma

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10
Q

What is the name of the neoplastic growth curve?

A

Gompertzian growth

Best time to treat would have been before you could even palpate it

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11
Q

Is cancer always painful?

A

No

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12
Q

Does the presence of a mass diagnose cancer?

A

No - could be cyst, granuloma, abscess, etc.

Sample to know which!

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13
Q

Cytologic criteria of malignancy

A
  • anisokaryosis
  • anisocytosis
  • multiple, irregular, large nucleoli
  • multinucleation
  • mitotic figures
  • altered nucleus-cytoplasm ratio
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14
Q

Three basic cell types

A

Round cells
Mesenchymal cells
Epithelial cells

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15
Q

On cytology you see cells sticking together, cell walls are visible. What type of tumor would this suggest?

A

Epithelial

aka city dwellers

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16
Q

On cytology, you see lots of circular cells with round nuclei, not clumped together. What type of tumor would this suggest?

A

Round cell

Aka free spirits

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17
Q

On cytology you see cells with indistinct borders, the cells are elongated and spindle shaped with elongated nucleus. Sample exfoliated poorly. What type of tumor do you suspect?

A

Mesenchymal

Aka small town

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18
Q

Advantages of incisional biopsy (5)

A

Do not usually require anesthesia

Provides diagnosis to prepare for next step

Less likely to contaminate nearby clean tissue

To determine **what further staging tests may be needed* prior to removing the mass

Important when tx would be altered by knowing the tumor type or other characteristics

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19
Q

Disadvantages to incisional biopsy (2)

A

Requires second procedure for treatment

Can be non-diagnostic or misleading on grade

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20
Q

What must be known prior to excision biopsy?

A

Extent of the tumor

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21
Q

What is liquid biopsy?

A

Detect metabolic marker or circulating tumor cells or pieces of tumor DNA that are circulating in the blood stream

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22
Q

How is biologic behavior of tumors determined?

A

GRADE

Also histologic type, location, and other tumor-specific factors

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23
Q

Do patients usually die from primary tumor or metastasis?

A

Metastasis

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24
Q

Metastasis cascade (5)

A
  1. Cell detachment and vascular invasion
  2. Transport and survival in circulation (evasion of host defense mechanisms in blood or lymphatics)
  3. Aggregation with platelets and fibrin and arrest at new location
  4. Extravasation into the surrounding parenchyma
  5. Establishment of new growth
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25
Q

What pattern of metastasis do carcinomas have?

A

Lymphatic

Can still go to lungs, but go to regional LN first

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26
Q

What pattern of metastasis do sarcomas have?

A

Hematogenous

Check lungs/liver/LN involvement in sarcomas
Carriers a very poor prognosis

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27
Q

What pattern of metastasis do round cell tumors have?

A

Lymphatic and hematogenous

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28
Q

What is included on a pathology report?

A

Histologic diagnosis
Margins
Invasiveness
GRADE

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29
Q

What is a grade?

A

Attempt to predict which tumors will metastasize or carry a poorer prognosis

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30
Q

What is a mitotic index?

A

Number of cells in mitosis in ten high power (40X) fields

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31
Q

What is the TLM method of staging?

A

Determination of what the tumor has actually done to the patient at time of diagnosis

Includes: tumor, LNs, and metastasis via blood (always poor prognosis)

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32
Q

What does the TLM method of staging help? (4)

A

Aids in determining prognosis

Aids in forming a treatment plan

Aids in monitoring response to treatment

  • Guides a good clinical workup
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33
Q

How to stage a tumor

A
  1. PE and history (usually do bloodwork too)
  2. Evaluate the tumor (measure size, take rads/US)
  3. Evaluate LNs
  4. Evaluate for metastasis
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34
Q

Compare CT vs MRI

A

CT
* best for bony masses
* best for screening for metastasis

MRI
* extremely good detail
* best for local soft tissue exams

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35
Q

T staging
N staging
M staging

A

T: primary tumor

N: lymph node evaluation

M: evaluate for metastasis

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36
Q

Tumor histology and grade tell you what?

A

Histology - where it goes

Grade - how far

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37
Q

What is cancer cachexia?

A

Profound state of malnutrition and weight loss despite adequate nutrition.

Has a clinical significance in humans - decreased QOL and survival time

Not really a problem in dogs

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38
Q

What is the mechanism of cancer cachexia?

A

Glucose is preferred substrate of cancer cells

Tumor cells do incomplete metabolism of glucose (get 2 ATP vs 36 ATP in normal cells)

Expends a lot of energy as the host must now do gluconeogenesis

Causes protein wasting, decreased immune function / wound healing

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39
Q

Treatment for cancer cachexia

A

Remember, mainly a problem in CATS

Provide 30-50% of non-protein calories as FAT

Provide 1.5-3X normal calories

Make sure energy is given via GI tract (oral)

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40
Q

What is one of the most common causes of hypercalcemia in cats/dogs?

A

Cancer:

  • lymphoma
  • anal sac apocrine gland adenocarcinoma
  • multiple myeloma
  • thymoma
  • parathyroid gland adenomas
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41
Q

Mechanisms of hypercalcemia as a Paraneoplastic syndrome

A

Depends on tumor type

  • PTHrp
  • true hyperparathyroidism
  • vitamin D like factors
  • tumor production of osteoclast activating factor
  • direct bone lysis
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42
Q

Treatment of hypercalcemia from paraneoplastic syndrome

A

Treat underlying disease once diagnosis is reached

  • saline diuresis (0.9% NaCl IV)
  • furosemide (inhibits Ca reabsorption at loop of Henle)
  • Glucocorticoids (careful, only if you have DX first. If you give before dx, can mask lymphoma)
  • bisphosphonates
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43
Q

What is the bisphosphonate that Dr. Fidel loves?

A

Zoledronate

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44
Q

MOA of Zoledronate

A

Bisphosphonate used to treat hypercalcemia

Directly inhibits bone resorption

Causes apoptosis of osteoclasts

Depository effect on bone reabsorption

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45
Q

Signs of hypoglycemia

A

Weakness, tremors, seizures

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46
Q

Treatment for hypoglycemia

A

Unlike hypercalcemia, ok to TX before diagnosis of cause is reached

  • feed frequently, high protein better than high carb
  • glucose solutions PO or IV (careful if insulinoma)
  • glucocorticoids (cause an increase in hepatic gluconeogenesis)
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47
Q

Tx for insulinomas

A
  • Remove tumor
  • Streptozotocin (anti neoplastic agent w/ affinity for pancreatic islet cells)
  • Toceranib
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48
Q

What types of tumors can cause polycythemia?

A

Those that cause ectopic EPO production

  • renal tumors
  • lymphosarcoma
  • hepatic tumors
  • nasal fibrosarcoma
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49
Q

Signs of polycythemia

A

Neuro: motor/sensory depression, dullness, lethargy, seizures

Hemorrhage: epistaxis, hyphema

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50
Q

Tx for polycythemia as a paraneoplastic syndrome

A
  • Remove primary tumor
  • Phlebotomy
  • Hydroxyurea
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51
Q

You see hypertrophic osteopathy (lots of painful new bone growth along shafts of long bones), what should you do next?

A

Check the chest/abdomen for mass

Connection between mass and new bone growth is unclear, but there is definitely a connection

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52
Q

Treatment for hypertrophic osteopathy

A

Tx/remove primary tumor
Corticosteroids
NSAIDs
Bisphosphonates
Vagotomy (rarely done; more of a human med thing)

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53
Q

What should always be on your differential list for fever of unknown origin?

A

Cancer

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54
Q

CBC abnormalities often seen in cancer patients

A
  • Anemia (from blood loss, chronic inflammation, IMHA, BM suppression, chemotherapy etc)
  • Leukocytosis (from chronic inflammation and granulopoietic factors)
  • Thrombocytopenia (from all four mechanisms)
  • Thrombocytosis (immune mediated)
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55
Q

Signs of hypergammaglobulinemia (3)

A

PU/PD
Neuro signs
Bleeding

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56
Q

DfDX for monoclonal gammopathy (3)

A

Plasma cell tumors
Lymphoma/leukemia
Ehrlichia

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57
Q

What paraneoplastic syndrome can a thymoma cause?

A

Myasthenia gravis
Produces anti ACh receptor antibodies

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58
Q

Which chemotherapy causes seizures and death in cats?

A

5-flurouracil

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59
Q

What tumor can cause alopecia and gross shiny skin on cats?

A

Pancreatic

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60
Q

Causes of cutaneous flushing

A

Pheochromocytoma
Mast cell tumor

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61
Q

Nodular dermatophytosis in GSDs is linked to what?

A

Renal cysts or cystadenocarcinomas

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62
Q

Which treatment modality cures the most patients?

A

Surgery

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63
Q

Why are second/subsequent surgeries more difficult if you don’t get clean margins during the first surgery?

A

B/c surgery alters vascularity, immune system, and tissue planes

This will allow recurring tumors to become more aggressive

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64
Q

How does radiation kill cells?

A

Deposits energy (ions) on/near DNA which breaks the DNA

When the cell tries to divide, it will die

This kills a constant proportion of cells, and doesn’t distinguished between normal/cancer cells

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65
Q

Limitations to radiation therapy

A

Surrounding normal tissue must tolerate radiation

Anesthesia requirements to give the radiation (b/c animal can’t move)

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66
Q

Four R’s of radiation therapy

A

Repair
Repopulation
Re-oxygenation
Redistribution

These four things help normal cells repopulate/kill more cancer cells (why we fractionate radiation dose)

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67
Q

What is fractionation of radiation therapy?

A

Helps kill tumor and save normal cells

It is basically a time period to allow reoxygenation/redistribution in the tumor, and repopulation and repair in the normal cells

Large total dose in small fractions

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68
Q

Is radiation better for smaller or larger tumors?

A

Smaller

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69
Q

Acute effects of radiation (up to three months post)

A

Hair loss
Most dermatitis (aloe Vera, aqua-horse)
Mucositis (flush mouth w/tea)
Intestine or bladder inflammation
Nervous tissue
Inflammation/edema

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70
Q

“Normal” late effects of radiation
(Can be years after treatment)

A

Alopecia
Hyperpigmentation
Cataracts

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71
Q

Bad/unacceptable late effects of radiation

A

Skin fibrosis
Bone necrosis

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72
Q

What is sterotactic radiation?

A

One (or very few) high dose(s) of radiation

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73
Q

Pros of stereotactic radiation (2)

A

May kill cells not rapidly dividing better than multiple lower doses

May damage blood supply better

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74
Q

Mechanism of chemotherapy

A

Act on rapidly dividing cells by interfering w/ DNA synthesis or cell division

Highly non-specific, targets macro difference (rapidly growing cells)

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75
Q

List the alkylating agents

A

Cyclophosphamide
Lomustine
Melphalan
Chlorambucil

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76
Q

List the antimetabolite chemo drugs

A

Methotrexate
Cystosine arabinoside
Espar
Rabacfosadine
Azothioprine

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77
Q

List the anti tumor abx chemo drugs

A

Doxorubicin
Mitoxantrone
Bleomycin

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78
Q

List the spindle cell poisons chemo drugs

A

Vincristine
Vinblastine
Taxol
Vinorelobine

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79
Q

List the platinum chemo drugs

A

Crisp Latin
Carboplatin

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80
Q

What is the only therapy for metastatic disease?

A

Chemotherapy

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81
Q

What types of tumor cells can chemo kill?

A

Can only kill tumors w/“liquid” growth (dividing) and genomic stability (if tumor mutates, drug is useless)

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82
Q

Limitations of chemo

A
  • resistance
  • drug delivery issues (ex: tumor in CNS)
  • side effects to normal tissue (BAAG)
  • Drug specific side effects in each class
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83
Q

Which chemo drugs affect the kidney?

A

Cisplatin
Doxorubicin (cats)
Lomustine

Monitor bloodwork for signs of kidney damage

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84
Q

Which chemo drug has side effects on the heart?

A

Doxorubicin

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85
Q

Which chemo drugs cause side effects in the bladder?

A

Cyclophosphamide (cystitis)

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86
Q

Which chemo drugs cause side effects in the pancreas?

A

Laparotomy
Doxorubicin

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87
Q

Which chemo drugs cause side effects in the nervous system?

A

Vincristine (peripheral neuropathy)
5-FU (seizures in cats)

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88
Q

Which chemo drugs cause side effects in the liver?

A

Lomustine

Monitor bloodwork

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89
Q

Which chemo drugs cause side effects in the lungs?

A

Cisplatin (will kill cats)
Bleomycin
Lomustine
Tanovea

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90
Q

Advantages to using multiple drugs in a chemo protocol (3)

A

You can use a lower dose of each drug, which means fewer side effects

Using multiple drugs decreases the risk of development of resistance

Single drugs are unlikely to cure bulky disease

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91
Q

What two types of tumors are the only ones that chemo alone can cure?

A

Lymphoma and germ cell tumors

TVTs also fit this category

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92
Q

What is adjuvant therapy?

A

Chemo combined with some other modality to reduce tumor burden

(Esp when you have a tumor that’s not rapidly dividing)

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93
Q

When is the greatest chance for cure with adjuvant chemo in combination with surgery? Before, during, or after surgery?

A

Shortly after surgery

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94
Q

Administration considerations in choosing a new chemo protocol

A

Practice factors, can you safely handle these drugs?

Client factors (can they come in weekly, biweekly, etc)

Patient (size, personality)

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95
Q

Chemotherapy:

Dose calculation usually based on what?

What kind of system to limit exposure?

A

BSA (m2)

Closed system

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96
Q

How to give quick IV chemo

A

Use lateral saphenous or cephalon vein (dogs)
Use medial saphenous in cats

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97
Q

How to give chemo slowly

A

Infusion - decreases cardiac toxicity

Be careful, severe tissue reaction if extravasated

Place catheter, wrap so vein is visible

Flush w/saline

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98
Q

When is cryotherapy successful?

A

Only when tumor is small and superficial

(Small SCC)

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99
Q

What is photodynamic therapy?

A

Combo of photosensitizing agent and light for superficial tumors (can’t diffuse any deeper)

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100
Q

What is electrocheotherapy?

A

Combo of:

Traditional chemo drugs (usually bleomycin)
Pulsed electricity to facilitate drug uptake

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101
Q

Define survival

A

Length of time post diagnosis an animal will live, usually quoted as a median

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102
Q

Define time to recurrence or relapse

A

End of treatment to tumor reappearance

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103
Q

Define time to tumor progression/recurrence

A

Same as time to recurrence* but tumor may have never actually gone away

  • end of treatment to tumor reappearance
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104
Q

Define prognostic indicator

A

Anything that can be evaluated that predicts how patient may respond to treatment and for how long

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105
Q

New targets in cancer therapy

A

Signal transduction
Angiogenesis
Evasion of apoptosis
Immune tolerance
Cell cycle dysregulation
Tissue invasion and metastasis

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106
Q

How is signal transduction a target for cancer treatment?

A

Mutated signal proteins involved in signal transduction are often oncogenic and are present in most cancer types

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107
Q

Why is aberrant expression of growth receptors / mutated signal transduction proteins bad for the patient?

A

It will increase:

  • potential for tumor proliferation, invasion, and metastasis
  • angiogenesis

Also will shorten patient survival, cause poor response to chemo, and decrease patient prognosis

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108
Q

What is the main signal transduction molecule that is targeted in cancer treatment?

A

Receptor tyrosine kinases (RTKs)

  • These are the main mediators that transmit extracellular signals into the cell
  • Control cellular differentiation and proliferation
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109
Q

How to RTKs fit into cancer development (3)

A

Constitutive RTK signaling causes dysregulated cell growth and cancer:

This can be from
- over expression of RTK proteins
- functional alterations from mutation that cause a gain of function
- abnormal stimulation that increases RTK activation

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110
Q

Primary targeted families of RTKs (3)

A

EGFR-HER-2

C-KIT (to tx MCTs)

VEGFRs (receptor involved in angiogenesis)

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111
Q

What are the two drugs that are RTK inhibitors

A

Toceranib phosphate

Masitinib (not available in US anymore)

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112
Q

What to remember to tell owner about RTK inhibitors

A

Once you start these drugs, must continue giving them for life (or until they stop working)

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113
Q

What species can you use RTK inhibitor in?

A

Dogs/cats

Too expensive in horses/other LAs

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114
Q

Why does tumor endothelium represent a valuable target for cancer therapy?

A

B/C it is molecularly distinct from normal vasculature, and the tumor growth is dependent on vascular growth

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115
Q

Two categories of drugs that target tumor blood vessels

A
  1. Biological: Ab/peptides that deliver toxins/pro apoptotic effects to tumor endothelium
  2. Small molecules: agents that exploit differences between tumor and normal endothelium, induce severe vascular dysfunction
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116
Q

What drugs are in the biologic category of drugs that target tumor blood vessels?

A

Avastin (Ab directed at human VEGF)

None for vet use exist yet :(

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117
Q

What drugs are in the small molecule category of drugs that target tumor blood vessels?

A

Toceranib (VEGF is an offsite target, this is an RTK inhibitor)

Thalidomide (illegal to use in US)

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118
Q

What are vet strategies to target tumor blood vessels?

A

Metronomic chemo:
Low, daily dosing of chemo drugs (theory is stops endothelial cells from multiplying)

Toceranib:
RTK inhibitor that directly inhibits VEGF signaling

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119
Q

Why is apoptosis important for tumor growth?

A

Evasion of apoptosis is necessary for tumor growth

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120
Q

How do tumors avoid the immune system

A

Likely via a variety of mechanisms, but above all they are recognized as self so the body won’t attack

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121
Q

Types of immune therapy to treat cancer

A
  1. Active, nonspecific, immune stimulation
  2. Active specific - tumor vaccine
  3. Passive - Ab admin
  4. Target/destroy T reg cells
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122
Q

Examples of active, nonspecific immune stimulation to treat cancer

A
  • intact bacteria
  • chemical agents like COX2 inhibitors, fenbendazole, cimetidine
  • vitamins/minerals
  • IL2, IFNa

Basically anything that will cause immune activation

123
Q

Two goals of tumor vaccine

A

Activate T cells (increases MHC on cell surface)

Activate APCs

124
Q

What passive (Ab) therapy exists in vetmed to treat cancer?

What is passive immunotherapy?

A

None yet

Antibodies

125
Q

What types of drugs target T regulatory cells (cancer increases T regs which is a problem, prevent immune destruction of cancer)?

A

Metronomic chemo

Cimetidine

126
Q

When is COX2 induced? (5)

A

Inflammatory states
Growth factors
Mitogenic substances
Oncogenes
Hypoxia

127
Q

What is the primary culprit in COX2 and cancer?

A

PGE2

128
Q

What does PGE2 do in cancer? (5)

A

Converts pro-carcinogens to carcinogens

Stimulates tumor cell growth

Prevents apoptosis

Promotes angiogenesis

Suppresses immune system

129
Q

What is a good NSAID to treat cancer with?

A

Piroxicam

Even better when combined with chemo

130
Q

Hat is the main tumor type that NSAIDs help treat?

A

Carcinomas

131
Q

> 90% of hemolymphatic neoplasias are what?

A

Lymphoma

132
Q

Are most k9 lymphomas B or T cell?

A

B cell

133
Q

How to diagnose B vs T cell lymphoma

A

Cytology:
- flow cytometry
- immunocytochemistry
- PARR assay

Histopatholgy:
- immunohistochemistry

134
Q

Stage I lymphoma

A

Single node or organ like the spleen

135
Q

Stage II lymphoma

A

Group of nodes on one side of diaphragm

136
Q

Stage III lymphoma

A

Generalized lymphadenomegaly

137
Q

Stage IV lymphoma

A

Spleen or liver involvement

138
Q

Stage V lymphoma

A

BM, CNS, or other organs involved

139
Q

A vs B lymphoma

A

Add the letter to the stage number
A = no symptoms
B = symptoms/feels sick

140
Q

Tests to stage lymphoma

A

CBC/Chem/UA (blood smear)

Thoracic rads

Image abdomen: U/S more sensitive and specific than rads

BM aspirate

141
Q

Is staging important for lymphoma?

A

Not really; owners may request

Need to consider cost of staging; can they still afford treatment after paying for staging tests?

142
Q

Prognosis of k9 lymphoma

A
  • Extremely sensitive to chemo, but usually not curable
  • 90% will achieve remission with chemo
  • Avg survival is one year; worse prognosis with higher grade/stage of tumor
143
Q

What worsens the prognosis of k9 lymphoma? (7)

A
  • Substage b (likely T cells and hypercalcemic)
  • Stage > III
  • Hypercalcemic
  • Icteric (liver likely failing)
  • Hypoproteinemic (liver failure)
  • T cell lymphoma
  • Prior prolonged treatment with glucocorticoids
144
Q

5 most common drugs to treat K9 lymphoma (and their classes)

A

Prednisone (corticosteroid)

Vincristine (mitotic spindle interrupter)

Cyclophosphamide (alkylation)

Doxorubicin (antitumor abx)

Elspar (L-aspariginase — enzyme metabolite) for relapse

145
Q

What to do at relapse of K9 lymphoma

A
  • Start same protocol over if more than six months from induction
  • switch to a new protocol with new drugs (esp if T cell)
  • use a rescue protocol
146
Q

When can you do radiation therapy or surgery for lymphoma?

A

Surgery
If sure only single node or organ (ex: spleen)

Radiation
Local treatment only if you’re sure no lymphoma elsewhere (ex: nasal LSA in cats)

147
Q

Feline lymphosarcoma (LSA) may be related to:

  • young
  • old
  • environment
A

Young FeLV —> mediastinal

Older FeLV —> GI or abdominal

Second hand smoke

148
Q

High grade vs low grade lymphoma in cats

A

Small cell (more chronic) —> low grade

Large cell —> high grade

149
Q

Tx of high grade lymphoma in cats

A

Same as dogs, but cats get more side effects

If single node (grade I) can do radiation

150
Q

Prognosis for feline lymphoma

A

Worse than dogs, but more unpredictable

151
Q

What is leukemia?

A

Proliferation of neoplastic hematopoietic cells in the bone marrow

Relatively rare

152
Q

Signs of leukemia

A

Weakness, depression, anorexia
Fever
Bleeding
Signs of hypercalcemia
Can be asymptomatic

Usually discovered on bloodwork

153
Q

Which is worse prognosis: acute or chronic leukemia?

A

Acute

154
Q

What is acute leukemia?

How to diagnose?

A

Presence of blasts and very high numbers

Worse prognosis

Flow cytometery or cytochemical stains to determine cell origin

155
Q

What is chronic leukemia?

A

Over abundance of one mature cell type in high numbers

Most commonly lymphocytic

156
Q

What is aleukemic leukemia?

A

No abnormal cells in the peripheral blood (proliferation in the bone marrow)

157
Q

Best to worst prognosis for leukemia

A

Chronic lymphocytic leukemia (best)

Acute lymphocytic leukemia

Acute non-lymphocytic leukemia (worst)

158
Q

Plasma cell tumors
- cell type
- prognosis

A

mature B cells

can be localized and benign

Local therapy is adequate :)

159
Q

Multiple myeloma

  • what is it
  • prognosis
  • 2 suspicious signs
A
  • metaplastic plasma cell tumors
  • can be managed (1.5y)
  • punched out lesions in bones
  • hypergammaglobulinemia
160
Q

MCT signalment in dogs

A

Any age dogs, older cats, Boxers, Bostons, Labs, Schnauzer, Beagle

No gender

161
Q

How do MCTs usually present in dogs

  • most commonly
  • less likely
  • “special” sign
A

External skin masses

Primary internal mass is rare

Darier’s sign: puff up, red

162
Q

How do MCTs usually present in cats?

A

Equal incidence of external and internal tumors

So primary complaint is not always a skin mass

163
Q

What is in the granules in MCTs?

A

Histamine, heparin, other bio active molecules that cause systemic signs

164
Q

Paraneoplastic syndromes from MCT (6)

A

GI ulcers

Impaired local healing

Coagulopathy

Urticaria

Eosin / basophilia

Rare: hypotensive shock

165
Q

What is required to grade a MCT?

A

Histopathology

166
Q

How are MCTs graded?

A

On a three tiered system

  • pathologist may use a 2 level grading scheme
  • oncologists like having both systems
167
Q

Grade 1 MCT facts including prognosis

A

Well differentiated, superficial
Prognosis: nearly always good

168
Q

Grade 2 MCT facts including prognosis

A

Well to medium differentiation, SQ involvement
Prognosis: variable

169
Q

Grade 3 MCT facts including prognosis

A

Poorly differentiated
Prognosis almost always poor

170
Q

What marker about MCTs is important to oncologists?

A

Mitotic index

171
Q

What is the cutoff for mitotic index to tell you the MCT is less likely to recur or met?

A

Less than 5 mitoses/10 hpf

172
Q

How to stage MCTs (all grades)

A

Depends on grade and owner desire

For all three grades:
- LN check (+/- imaging)
- basic database, Buffy coat smear

173
Q

How to stage Grade 3 and most Grade 2 MCTs

A

In addition to LN check and basic database:

Abdominal U/S +/- liver/spleen aspirates

174
Q

How to stage Grade 3 and high grade Grade 2 MCTs

A

In addition to last flash card, also add on a BM aspirate

175
Q

You have a low grade/stage MCT, surgically approachable. What is your treatment plan?

A

Surgery with 3 cm margins is gold standard

176
Q

You have a low grade/stage MCT, not surgically approachable. What is your treatment plan?

A

Electrochemotherapy

Radiation therapy - if the tumor is dividing otherwise doesn’t work

177
Q

You have an intermediate grade MCT. What is your treatment plan?

A

Surgery for local disease

If Mets are found or if mitotic index greater than five, chemotherapy may also be needed

178
Q

What treatment is needed for high grade, any stage MCTs?

A

Chemotherapy

179
Q

Symptomatic therapy for MCTs

A

Basically, these block the effects of the granules:

  • H1 blocker, diphenhydramine to prevent bronchoconstriction/vasodilation
  • H2 blockers (famotidine, cimetidine etc) to prevent GI ulcers
  • Prednisone
180
Q

What specific chemo drugs are used to treat MCTs

A

Vinblastine, Lomustine, and Prednisone (WSU protocol)

Sometimes just Vinblastine and pred

Hydroxyurea

181
Q

What to know about tyrosine kinase inhibitors as treatment for MCTs

A
  • Can use Toceranib or Masitinib (not in US)
  • 50% chance for response
  • toxicity an issue
  • once a pet is put on these, MUST STAY ON FOR LIFE
182
Q

What are some other therapies for MCTs?

A

Tiglanol tigalate injection

  • it basically causes local tissue necrosis at site of injection, including the MCT
  • 89% were “cured”
  • only do in locations were necrosis is acceptable
183
Q

You see a feline skin MCT. What can you tell an owner?

A

Most are benign; can cure with surgery

184
Q

What are the two aggressive forms of MCTs in cats

A
  1. Splenic/visceral (often involve LNs as well)
  2. Gastrointestinal
185
Q

How will a cat with an aggressive internal form of MCT often present?

A

Vomiting due to increased histamine from granule release

186
Q

What diagnostics might you do to diagnose a feline mast cell tumor?

A
  • abdominal aspirate (common intestinal mass)
  • Buffy coat smear or CBC (often circulating mast cells)
187
Q

TX for feline internal MCT

A
  • Corticosteroids, H1/H2 blockers
  • remove tumor from spleen/intestine
188
Q

Prognosis for feline internal MCTs

A

Splenic/visceral form: prolonged, > 3 years

GI: median 1.5 years

189
Q

What is the most common dog breed that gets histiocytic sarcomas?

A

Flat Coat Retriever

190
Q

How will biopsy reports for histiocytic sarcomas often read?

A

“Round cell sarcoma, histiocytic tumor possible”

191
Q

Cell of origin for histiocytic sarcomas

A

Macrophages or dendritic APCs

192
Q

Presentation of histiocytic sarcomas

A

Can by anywhere but often associated with muscle groups/joints; quite painful

193
Q

Seeing _____ on a cytology highly suggests histiocytic sarcoma

A

Giant multi-uncleared cell

194
Q

How to stage a histiocytic sarcoma

A

Check draining lymph nodes
Check lungs
Abdomen: look at liver and spleen

195
Q

Tx for histiocytic sarcomas (3 options)

A

Surgery: if in removable spot, minimal morbidity, with NO metastatic disease found (amputate, then Lomustine)

Radiation: palliative care, also combo w/ Lomustine

Chemo: Lomustine can be only treatment or combined with above two

196
Q

Prognosis for histiocytic sarcomas

A

Rarely curable but will initially respond to tx even if metastatic disease is present

197
Q

What chemo drug is used to treat histiocytic sarcomas?

A

Lomustine
PO so GP can give

198
Q

What is a histiocytoma:

  • cell
  • behavior
  • appearance
A

Langerhans cell proliferation

Spontaneously will regress, or can remove if owner wants

Looks like a dermal nodule on a young dog; often on limbs

199
Q

What is histiocytic sarcoma - hemophagocytic form:

  • breed
  • most likely cell
  • common sign
A

A different form of histiocytic sarcoma (malignant histiocytic is) common in Bernese Mountain dogs but can occur in other breeds

Phagocytic macrophages
Cancerous cells; like to destroy RBCs, so present with SEVERE ANEMIA

No treatment at this time

200
Q

What type of tumor is a histiocytic sarcoma

A

Round cell tumor

201
Q

What is more important in soft tissue sarcomas, type or grade?

A

Tumor grade more important

202
Q

Signalment for ST sarcomas

A

Larger, older dogs but any age/breed can get

Usually present with mass but often have internal mass but often have internal mass as well

203
Q

Biologic behavior of ST sarcomas

A

Locally aggressive, invasive, poor margins

Grade should be predictive

Mitotic index is important prognostic indicator

204
Q

What do the mitotic indexes in ST sarcomas mean?

A

0-10 grade I likely won’t met
10-19 grade II
> 20 grade III

205
Q

How to diagnose ST sarcoma

A

Incisional biopsy is best choice b/c w/excisional biopsy you risk not getting margins, these are expansive weird shaped tumors so need to make a plan before surgery

206
Q

How to stage a ST sarcoma

A

Measure the tumor: rads rarely enough, often need US/CT/MRI

Check LNs

Check lungs for Mets (use CT not rads if high grade tumor)

207
Q

Margins for surgical removal of ST sarcoma

A

3 cm
Submit all the tissue for histopath

208
Q

Tx for ST sarcomas - overview

A
  • surgery clean is gold standard
  • radiation: best if disease is minimal or dealing with bad margins then you have no choice
  • chemo: often not needed b/c don’t often met
  • metronomic chemo: especially if you don’t get clean margins
209
Q

Metronomic chemo to treat ST sarcomas

A

Especially helpful if you didn’t get clean surgical margins

Use low dose alkylatiors (cyclophosphamide, Chlorambucil) plus an NSAID

210
Q

Chemo as treatment for ST sarcoma

A

Often not needed, can be used if there is minimal disease present

VAC (vincristine, doxorubicin, and cyclophosphamide)

211
Q

Tx for low grade ST sarcoma (most common type)

A

Surgery alone can be curative if done right

Bad margins: follow up with radiation and/or metronomic chemo

212
Q

Tx for high grade ST sarcoma

A

High potential for metastasis

Surgery
+/- radiation
+/- chemo (less likely needed)

213
Q

What to remember about feline ST sarcomas

A

Worse than dog sarcomas
Associated with vaccines

214
Q

Rule of 1-2-3 for feline ST sarcomas (vax associated sarcomas)

A

Remove mass at vax site when:

Still growing at one month
> 2 cm
Still present 3 months post vax

215
Q

Biologic behavior of feline ST sarcomas and how this dictates staging

A

Locally extremely aggressive, 10-25% will met

Advanced imaging almost always required

216
Q

Tx for ST sarcoma in a cat

A

A bad surgery (dirty margins) will kill the cat

You really should refer these to a surgeon

  • surgery with 5 cm margins
  • radiation: really not needed if you got good margins
  • chemo: not documented to extend survival but may help shrink the tumor
  • metronomic chemo: cats don’t like being pilled SID so not really a good idea
217
Q

Prevention of feline ST sarcomas

A
  • Be cautious with vax program
  • NEVER use killed virus vax in cat which has had VAS (including family members of the cat)
  • vax low on limbs or in abdominal fat pouch
  • always record vax location and lot number, company will pay
218
Q

80% of primary bone tumors are ____

A

Osteosarcoma

219
Q

Signalment of osteosarcoma

A
  • mid/older dogs; also now seeing some at 18-24 months of age
  • large/giant breeds
  • males > females
  • Neutered > intact at least in Rotties
220
Q

Where are the tumors in osteosarcoma

A

> 75% are in metaphysis of long bones
Front > back legs
Away from elbow, towards the knee
Flat bones (axial) can occur but more rare

221
Q

Cytology to diagnose osteosarcoma

A

Use Alk Phos staining

222
Q

How to diagnose an osteosarcoma

A

Gold standard is histiopath

Can be hard to get good biopsy, will often amputate then submit leg (could be a different tumor type so you really should do the histo)

223
Q

How to stage osteosarcoma

A
  • check lungs: high potential for met to lungs via blood; CT more sensitive than rads
  • can LSA met to other bones
224
Q

What to tell owners about lung Mets post amputation

A

Mets are most likely to grow after the primary tumor is removed

225
Q

Poor prognosis for osteosarcomas that:

A
  • lung/bone met from onset
  • LN met: not normal for a sarcoma === bad
  • tumor in bad location that can’t be removed
  • elevated ALP
226
Q

Tx for K9 osteosarcoma

A

There is no curative tx
All txs are palliative

227
Q

Palliative treatment for osteosarcoma

A
  • amputation/no chemo: not recommended b/c metastatic lesions will grow after surgery
  • radiation for pain control
  • pain meds like NSAIDs, opioids
  • Amputation w/chemo: CARBOPLATIN (less toxic than Cisplatin) or Doxorubicin as second choice
228
Q

Tx for axial osteosarcomas

A

Surgery often impossible due to location (vertebrae, pelvis, etc)

Palliative radiation, pain meds, +/- chemo

229
Q

Feline osteosarcoma

A
  • rare but can happen
  • metastasis comes much slower than in dogs
  • surgery is tx of choice
230
Q

What is a hemangiosarcoma?

A

Sarcoma that arises from vascular endothelial cells

Basically blood vessels gone bad

231
Q

Signalment for hemangiosarcomas

A

Large breeds: Goldens, GSD, Labs (any breed can get)

Mean age 8-13 years, as young as 3 years

232
Q

Biologic behavior of hemangiosarcomas?

A

Extremely aggressive, high rate of early metastasis

25% have right atrial involvement at diagnosis

14% have brain involvement at diagnosis

233
Q

Presentation of hemangiosarcoma

A

Sudden collapse, weakness, pallor from bleeding

Sudden cardiac tamponade: arrhythmias, bleeding

Sudden enlargement of a mass

234
Q

Hemangiosarcoma common sites

A

Can be anywhere there is blood

Spleen, liver, right atrium most common

235
Q

You see a splenic lesion - what do you already know?

A

2/3 of splenic lesions are malignant and 2/3 of those malignant lesions are hemangiosarcomas

236
Q

How to diagnose hemangiosarcoma

A

Histopath like always, but you can see some things and be highly suspicious:

  • splenic lesion, splenic rupture
  • R atrial mass
  • biopsy / cytology only yielding blood
  • schistocytes or acanthocytes in blood smear
  • DIC
237
Q

How to stage hemangiosarcoma

A

Required for all cases:

  • basic database: anemia, fragmented RBCs, thrombocytopenia
  • thoracic rads: mets to lungs quickly, check for R atrial mass

Nice to have but not required:
Coag panel, EKG, AUS, cardiac U/S

238
Q

Tx for hemangiosarcoma

A

Surgical removal
- radiation: shrinks skin/heart base masses
- chemo: doxorubicin is best, so combo protocols are rare
- metronomic chemo: cyclophosphamide daily; this is anti angiogenic tx
- NSAIDs

239
Q

Prognosis for hemangiosarcoma

A

Poor
Surgery alone for splenic: 2-3 months median survival
Surgery + chemo: 4-6 months
R atrial: doxorubicin + chemo longest survival of about 175 days

240
Q

WSU protocol for hemangiosarcoma

A
  • control local disease with surgery or palliative radiation
  • doxorubicin 4X
  • follow up with metronomic chemo
  • repeat doxorubicin when measurable progression of tumor occurs
  • at least six month survival in most cases
241
Q

Cutaneous hemangiosarcoma

A

Likely from sunlight in light coat colored dog/cat
If tumor doesn’t invade into deep tissues, surgically curable disease
Repeated lesions can met internally and cause serious disease

242
Q

External carcinomas

A

Glandular: mammary and apocrine gland adenocarcinoma
Skin: SCC

243
Q

What increases K9 mammary tumors?

A
  • historically, synthetic progestin use
  • obesity
  • eating home cooked meals, likely b/c obese
244
Q

Presentation of K9 mammary tumors

A
  • 70% of the time occurs as a mammary mass at glands 4/5
  • inflammatory tumor is rare, but looks similar to MCT so be careful
  • Inflamed plaque like lesion/nodules on skin, edema in mammary area
  • any respiratory, neuro signs, or bone pain is from metastasis
245
Q

Biologic behavior of mammary tumors

A

50% if intact
50% are malignant
50% of malignant tumors are low grade
Older dogs with large tumors more likely to be malignant

246
Q

Staging of K9 mammary tumor

A
  • LN evaluation
  • chest rads are a must
  • check for widespread metastasis; aggressive tumors do this
247
Q

TX for K9 mammary tumors

A

Surgery!
Be aggressive, don’t just shell out the mass
Complete mastectomy not usually done; take one gland ahead and one behind the tumor

248
Q

Other tx for K9 mammary tumors

A

Chemo: difficult to assess efficacy; can do Doxorubicin

Radiation therapy: only when local control is a problem

249
Q

What does prognosis of K9 mammary tumors depend on?

A

Size, completeness of removal during surgery, and presence of ulceration

250
Q

Feline mammary tumor basics

A

> 75% are malignant
The third most frequent tumor in cats
Any cat with a mammary mass
MUST be taken VERY seriously

251
Q

Signalment for feline mammary tumors

A

Short haired most common
Siamese 2X risk of other breeds
Female, spayed
Previous hx of synthetic progestins or estrogens increases risk 3x

252
Q

Biologic behavior of feline mammary tumors

A

80% are adenocarcinomas

Highly aggressive, metastasis is common

253
Q

How to stage feline mammary mass

A

Stage before surgical removal

Assess tumor and all mammary glands

Assess draining LNs (including axillary for cranial glands)

Thoracic rads

U/S especially if cat is sick

254
Q

Surgery for feline mammary tumors

A

Complete radical mastectomy

Include at least the closest LN (axillary for 1 & 2, inguinal for 3/4)

Occasionally require bilateral mastectomy

255
Q

Treatment for feline mammary tumor

A

Surgery: radical mastectomy

Chemo: more useful compared to dogs
Doxorubicin, Doxorubicin + cyclophosphamide, or carboplatin

256
Q

Prognosis of feline mammary tumors

A

10-12 months
Size of tumor at time of diagnosis is most important indicator of survival (< 8cm is best prognosis)

257
Q

What are anal sac tumors in most cases?

A

Carcinomas or adenocarcinomas

Remember, can be any tumor type

258
Q

Perianal adenoma: what is it and who does it happen in?

A

Benign tumor near the anus

Happens in intact males

Tx = neuter

259
Q

Perianal gland carcinomas: are they good/bad, who does it happen in?

A

Bad, they are malignant
Possible male predominance

260
Q

Apocrine gland anal sac adenocarcinomas: signalment

A

Malignant anal sac tumors
Median 10.5 years
Breeds: some spaniels, GSD, but any breed can get
+/- hypercalcemia

261
Q

How to stage anal sac adenocarcinoma

A

Basic database (look for signs of hypercalcemia, present in up to 50% of cases)

Chest rads

Image abdomen b/c 50% will have already met to LNs by time of diagnosis (sublumbar LN)

262
Q

Tx for anal sac carcinomas

A

Surgery: remove mass and anal sac, plus LNs PRN

Radiation: mass/nodes

Chemo: Carboplatin/Cisplatin, tyrosine kinase inhibitors

263
Q

Prognosis for anal sac carcinomas with treatment

A

Survival can be long

264
Q

What are the two most common nail bed tumors in dogs?

A

Melanoma
SCC

265
Q

How do you stage nail bed tumors?

A

Aspirate local LN
Chest rads to check for mets

266
Q

Tx for nail bed tumors

A

Surgery - remove the whole toe

Melanoma vax for melanoma

267
Q

Prognosis for melanoma nail bed tumor

A

Better than oral melanomas in dogs, can live 1-2 years before mets develop

268
Q

Prognosis for SCC nail bed tumor

A

Can be cured w/ surgery if single digit

Certain breeds (Black Standard Poodles, Giant Schnauzers, etc) can get tumors in multiple toes; this can lead to poor QOL

269
Q

Signalment for urothelial carcinomas

A

Small breed older dog
Female
Scotties / Shelties may be overrepresented

270
Q

Presentation of urothelial carcinomas

A

Pollakiuria
Stranguria
Dysuria
Urinary obstruction
So basically like a UTI

271
Q

Biologic behavior of urothelial carcinomas

A

The main issue is locally they can block the trigone, if animal can’t urinate they will die

272
Q

Staging urothelial carcinomas

A

Thoracic rads
Abdominal imaging: U/S if possible
CT: only if planning for radiation
BRAFF mutation in urine: Detects 80% of tumors

273
Q

Tx for urothelial carcinomas

A

Surgery: only if tumor is at apex, can’t resect all of trigone

Chemo: Mitoxantrone

Palliative radiation is best for rescue or to unobstruct

274
Q

Prognosis of adenocarcinoma of intestines

A

Depends on surgical margins

Most chemo is ineffective

44% metastasize but can be late

275
Q

Prognosis of leiomyoma/sarcoma in intestines

A

Depends on surgical margins
Doxorubicin may help

276
Q

Prognosis of GI stromal tumors (GIST)

A

Low metastatic potential so that’s good
Chemo is meh
Tyrosine kinase inhibitors are helpful

277
Q

Feline hepatic tumors: prognosis

A

Benign tumors are common

Be careful using U/S to make a diagnosis

278
Q

Canine hepatic tumors: prognosis

A

Malignant tumors common but often low grade

Surgical removal if possible

Chemo not helpful

279
Q

Treatment for primary lung tumors

A

Surgery is treatment of choice

Chemo: minimally effective, could try Vinorelbine

NSAIDS +/- metronomic chemo may work

280
Q

Good prognostic indicators of primary lung tumors

A

Adenocarcinoma
Low grade
< 5 cm diameter
Peripheral location
Negative nodes
No CS
Usually survive 1-2 years

281
Q

Poor prognostic indicators of primary lung tumors

A

SCC, poorly differentiated tumors
> 5 cm diameter
Pleural effusion
CS present
Positive nodes
Evidence of mets
1-8 month median survival

282
Q

K9 oral melanoma facts

A

High probability of metastasis
Often friable
Can be amelanotic; harder to diagnose
Take chest rads, LN biopsy, tumor biopsy to stage

283
Q

TX for k9 oral melanoma

A

Surgery: can live up to one year

Radiation: palliative, must be high fractions otherwise melanomas don’t respond

Merial (?) melanoma vax if owner can afford

284
Q

K9 oral SCC facts

A

Second most common oral dog tumor
Metastasis uncommon unless its in tongue or tonsil

285
Q

Tx for k9 oral SCC

A

Surgery: usually doesn’t met until late in disease, so if done early this is a surgical cure!

286
Q

K9 oral SCC in tongue facts

A

50% metastasize

Prognosis is usually poor

Surgery alone can give them 8 months

287
Q

K9 oral SCC in tonsil facts

A

Prognosis is bad

Metastasis is common, even into abdomen

288
Q

Tx for k9 oral SCC in tonsil

A

Surgery and radiation will give them 3.5 months

Chemo is helpful: Carboplatin can give a year or more of survival when added on to protocol

289
Q

K( oral fibrosarcoma facts

A

Third most common tumor type

Metastasis uncommon but may depend on grade

Sometimes they are flat and look like gingival hyperplasia

These are often low grade, but that actually makes them hard to treat b/c chemo/radiation target dividing cells

290
Q

Name for benign oral epulide in dog

A

Fibromatous or ossifying epilus

291
Q

Name for malignant oral epulide in dog

A

Acanthomatous ameloblastoma

This is the best malignant tumor a dog can have b/c it wont metastasize

292
Q

Treatment for acanthomatous ameloblastoma

A

Surgery: 90% cure rate

Radiation: 85% cure rate

Owner can choose which one they want

293
Q

Feline SCC oral

A

Most common type in cats
Metastasize late

294
Q

Treatment for feline oral SCC

A

It is difficult!
Surgery alone: only if small and rostral

Palliative care: pain meds + feeding tube will give them about 2 months

Surgery + radiation: 12 months

Accelerated radiation w/ Carboplatin: 5 months

295
Q

Feline oral fibrosarcoma facts

A

Second most common oral tumor

Bone involvement is common

Metastasis is rare

296
Q

Treatment for feline oral fibrosarcoma

A

Surgery: it is rare to get clean margins, so meh

Radiation: cure is rare; used as palliative tx to slow progression for ~6 months

297
Q

Simple trick to check for nasal tumor

A

Retropulse the eyes

298
Q

Biologic behavior of dog/cat nasal tumors

A

Locally aggressive

Metastasis as high as 50% at necropsy

299
Q

What type of tumor are nasal tumors most commonly?

A

2/3 are carcinomas
Adenocarcinomas, SCC, TCC

300
Q

What should you do before biopsy of a nasal tumor?

A

Image the tumor with CT (or rads if you have to)

301
Q

How to biopsy a nasal tumor

A

Be aggressive!

Do the “blind trans-nasal core biopsy” which means stick a straw up their nose, then put biopsy needle through straw to sample

Cats: use coffee straws

302
Q

Treatment for nasal tumors

A

Curative radiation therapy: survival 8-23 months depending on tumor type

303
Q

Treatment for thyroid tumors

A

Lots
Surgery
External radiation
Radioactive iodine
Long term thyroid supplementation
Tyrosine kinase inhibitors (Toceranib)

Y3 SPRING (40 decks)

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