SAM II Final Exam - Oncology Flashcards
T/F: Use of Doxorubicin is a prognosticator in cats with lymphoma
True
Better outcome in cats with doxorubicin use
If the standard of care is recommended to treat an osteosarcoma (curative intent), what is the expected cure rate (2 year survival)?
- 0-5%
- 5-10%
- 15-25%
- 30-40%
15-25%
________ is a neoplastic proliferation of hematopoietic stem cells in the bone marrow
leukemia
What chemotherapeutic drugs are affected by multidrug resistance?
vinca alkyloids, anthracyclines, actinomycin D
What lymph nodes typically experience the most dramatic enlargement in a case of multicentric lymphoma?
mandibular and superficial cervical
Diagnosis in these patients is usually very easy (fine needle aspirate), but it is important to immunophentype!
CD79a-positive stain. Is this a B cell or T cell lymphoma in this dog?
B cell lymphoma
B cells have a fair response to chemotherapy. Once these patients reach remission, it is usually a very durable remission and these patients have a much higher chance (than T cell) of being cured
What type of chemotherapeutic drug is Toceranib?
Tyrosine kinase inhibitor
After treatment with Doxorubricin, how many days should you wait to look for myelosupression?
7 days
What is a side effect of cyclophosphamide therapy caused by acrolein?
- Vesicant
- Sterile hemorrhagic cystitis
- Gastrointestinal toxicity
- Neurotoxicity
Sterile hemorrhagic cystitis
‘Petal’, the 12 year old FN Siamese presents with a mammary mass. What is the first thing you recommend?
- FNA
- Biopsy
- Radical bilateral, staged mastectomy
- Three thoracic radiographs
- Coagulation profile
Three thoracic radiographs
Some side-effects are specific to a particular chemotherapeutic agent or group of agents. Renal damage is most associated with what chemotherapeutic drug?
Cisplatin
Joey (who is a dog) has peripheral lymphadenopathy with a T-cell lymphoma but is otherwise healthy. Lymphoma cells are found in his spleen and liver with FNA but not in the bone marrow. The lymphoma is classified as a Multicentric, T cell, stage IV, substage A. You decide to treat Joey with a 19 week protocol.
He went into remission 1 month after starting CHOP, completed his 19 week protocol. 6 months later he relapsed. What rescue protocol would you use, and what is the expected RR and remission time?
- Doxorubicin, 70-90% RR, remission of 7-9 months
- Cyclophosphamide and Prednisolone combo, 60% RR, 3 months remission
- CCNU (Lomustine) or LOPP, 40% RR, 5 months remission time
CCNU (Lomustine) or LOPP, 40% RR, 5 months remission time
Some side-effects are specific to a particular chemotherapeutic agent or group of agents. Cardiomyopathy is most associated with what chemotherapeutic drug?
Doxorubicin
What drug may be used as a single agent protocol for multicentric lymphoma?
Doxorubicin
- 50-75% complete remission*
- Median survival of 6-8 months*
When staging an oral tumor, what would it mean to say a tumor is a T2a?
The tumor is 2-4 cm in diameter, without bone invasion
- T1: Tumor
- T2: Tumor 2-4 cm diameter
- T3: Tumor >4 cm diameter
- A: without bone invasion
- B: with bone invasion
T/F: Paraneoplastic syndromes often precede the onset of the primary cancer by weeks to months
True
T/F: This presentation is consistent with lymphadenitis
False
This presentation is consistent with _lymphoma_. Note the homogenous population of lymphoblasts (~3-5x the size of RBCs) occupying more than 50% of the cell population
Lymphadenitis would be characterized by a large population of neutrophils
Joey (who is a dog) has peripheral lymphadenopathy with a T-cell lymphoma but is otherwise healthy. Lymphoma cells are found in his spleen and liver with FNA but not in the bone marrow. The lymphoma is classified as a Multicentric, T cell, stage IV, substage A.
When we consider Joey’s lymphoma, which is a negative prognosticator?
- Stage
- Location (multicentric)
- Immunophenotype (T cell)
- Grade
Immunophenotype (T cell)
T/F: Mediastinal lymphoma is most common in younger FIV-positive cats
False
Mediastinal lymphoma is most common in younger _FeLV-positive_ cats
The most commonly used chemotherapeutic drug associated with thrombocytopenia is:
lomustine (CCNU®)
If this toxicity occurs, you MUST stop using the drug
T/F: Oral melanoma may be treated by vaccination
True
- Canine melanoma vaccine - fully licensed for Stage II and III oral melanoma
- Sensitize the dog to Tumor Associated Antigen (TAA) – unique or a mutation
- Xenogeneic DNA vaccine - tyrosinase
-
Dosage
- 0.4 mL dose administered with the Canine Transdermal Device
- Injection site: muscles of the medial thigh just caudal to the femur
- Initial treatment: 4 doses of vaccine at two week intervals
- Booster dose at six month intervals
Refer to the images below. What is the correct criticism for this chemotherapy administration protocol?
- No mask, eye shield, double gloving (nitrile) gloves used
- A catheter does not necessarily need to be placed for Vincristine
- The vet should not be smiling, cancer is serious business
- I don’t see a Phaseal system in place
No mask, eye shield, double gloving (nitrile) gloves used
In dogs, Stage ___ lymphoma is characterized by generalized lymph node involvement
In dogs, Stage III lymphoma is characterized by generalized lymph node involvement
It is important to check hematology prior to chemotherapy and 7 days post-chemotherapy, except when using __________ or __________, which both have a severe delay in the myelosuppressive effect (so we’ll check them 2-3 weeks post-chemo).
It is important to check hematology prior to chemotherapy and 7 days post-chemotherapy, except when using carboplatin or lomustine, which both have a severe delay in the myelosuppressive effect (so we’ll check them 2-3 weeks post-chemo).
Refer to the diagram and indicate at what point CT/MR would be able to detect cancer:
B
Joey (who is a dog) has peripheral lymphadenopathy with a T-cell lymphoma but is otherwise healthy. Lymphoma cells are found in his spleen and liver with FNA but not in the bone marrow. The lymphoma is classified as a Multicentric, T cell, stage IV, substage A.
What treatment would you recommend for Joey if the owner elects curative intent?
- Prednisolone
- Single agent CCNU
- Single agent Doxorubicin
- Multi-agent COP
- Current CHOP (19 week protocol)
Current CHOP (19 week protocol)
T/F: The majority of mammary gland tumors in cats are malignant
True
In cats, MGTs have a tendency to move into the lungs and are associated with high prevalence of developing pleural effusion. We don’t really even biopsy mammary tumors in cats… we just cut them out.
T/F: The use of TMS for 14 days post-doxorubicin markedly reduces the likelihood of needing gastrointestinal antibiotics
True
T/F: Alopecia is the most common side effect associated with chemotherapeutic agents
False
Gastrointestinal effects account for the majority of the side effects
- Anorexia, vomiting, diarrhea, colitis
- Direct effect on gut lining
- Pancreatitis (L-asparaginase)
- Central effect (CTZ) (Cisplatin)
In cats, presentation can be similar for inflammatory bowel disease (IBD) and alimentary lymphoma. Because veterinarians have racked up some sort of good karma throughout the years, the treatment for both of these conditions is essentially the same! Woo!
What is the treatment?
Chlorambucil and prednisolone
What chemotherapeutic agent MUST be included in any chemotherapy protocol for hemangiosarcoma?
Doxorubicin
Note: there doesn’t seem to be much difference in whether Doxorubicin is used alone or as part of a multi-agent therapy
8 year old Golden Retreiver with generalized lymphadenopathy. On FNA, this is what you see.
What is your diagnosis?
lymphoma
There are >50% blasts (consistent with lymphoma). The best treatment for this dog would likely be chemotherapy
Which is correct regarding feline intestinal lymphoma?
- The most common form is high grade, lymphoblastic
- Mostly FeLV positive
- Young siamese are predisposed
- Characterized by diffuse thickening of the muscularis propria on ultrasonography
Characterized by diffuse thickening of the muscularis propria on ultrasonography
T/F: If your patient has normal PTHrp levels, you’re able to easily rule out malignant cancer
False
Normal PTHrp DOES NOT RULE OUT CANCER
What dog breeds are predisposed to developing mammary gland tumors?
poodles, dachshunds, spaniels
What method of administration is NOT associated with reduced risk of the sterile hemorrhagic cystitis (as the result of acrolein toxicity)?
- Divided doses orally over three days
- Administration of Mesna at the same time as IV drug
- Administration of Furosemide period to Cyclophosphamide
- Giving the drug at night
- Salty snacks to encourage drinking
Giving the drug at night
In dogs, Stage ___ lymphoma is characterized by liver and spleen involvement
In dogs, Stage IV lymphoma is characterized by liver and spleen involvement
Nasal lymphoma can often mimic nasal adenocarcinoma. One big difference is sensitivity to radiotherapy. Which tumor type is sensitive to radiotherapy?
lymphoma
Joey (who is a dog) comes to your clinic for a 7 day follow-up check post-cyclophosphamide (CHOP). He is due to receive vincristine. His neutrophil count is 1200 cells/uL (1.2.10^9/L: >3.10^9/L). What do you suggest to Joey’s owner?
- Give the vincristine, but at a 25% reduced dose
- Substitute with a non-myelotoxic drug
- Postpone chemotherapy for 7 days and prescribe antibiotics (TMS)
- Stop chemotherapy altogether
Postpone chemotherapy for 7 days and prescribe antibiotics (TMS)
Anaplastic carcinoma tends to infect the ________ mammary glands in dogs
inguinal (5th set of mammary glands)
Anaplastic carcinomas are highly aggressive and nasty, but only make up ~4%
There are really only two instances in which we utilize bone marrow biopsy in the diagnosis of lymphoma. What are they?
- If we see cytopenias
-
If there is an extranodal lymphoma and we think surgery alone could cure
- (want to be sure there is no cancer anywhere else)
With regard to cancer treatment, what does it mean in veterinary medicine for an animal to be ‘cured’?
Two years of remission while not receiving chemotherapy
In a general sense, what type of tumor is present in this patient?
carcinoma
________ is the most common metastatic intracranial neoplasm
hemangiosarcoma
mechanism of metastasis is hematogenous
How many radiographic views should be taken to assess tumor metastasis?
Three
right lateral, left lateral, and dorsoventral views
Some side-effects are specific to a particular chemotherapeutic agent or group of agents. Cystitis is most associated with what chemotherapeutic drug?
Cyclophosphamide
What is the highest predictor for a dog developing osteosarcoma?
wither height (size of the dog)
- The bigger the dog, the higher the chance of developing osteosarcoma*
- Exceptions: Poodles and Pekingese are also at high risk of developing osteosarcoma*
T/F: Alimentary lymphoma is most commonly seen in dogs
False
- Alimentary lymphoma is most commonly seen in cats*
- Full thickness biopsy is the best technique for diagnosis*
T/F: The majority of mammary gland tumors in dogs are malignant
False
Mammary gland tumors in dogs are ~50% benign, ~50% malignant
T/F: The majority of lymphomas in canines are multicentric
True
80-85% of lymphomas in dogs are multicentric
When is it recommended to give recombinant granulocyte colony stimulating factor (rG-CSF)?
if you’ve accidentally and severely overdosed your patient
and you know that in 7-10 days time there will be a massive myelosuppression
Vincristine and Vinblastine are specific to what phase of the cell cycle?
Mitosis
- Vincristine and Vinblastine are plant alkaloids*
- The benefit of knowing this is that you can predict when the maximum side effects will occur. So if you know that a drug works in a specific stage of the cycle, toxicity to the host will predictably occur ~7 days after.*
________ is the most common form of cutaneous neoplasia in the dog
mast cell tumor (MCT)
T/F: Elevated ALKP is associated with a poorer prognosis in dogs with osteosarcoma
True
T/F: Alkylating agents and anti-tumor antibiotics are cell cycle non-specific
True
Because of this, it can be difficult to predict when the maximum side effects will occur.
T/F: The majority of splenic masses are malignant and the majority of malignancies are hemangiosarcomas
True
2/3 of splenic masses are malignant and 2/3 of malignancies are hemangiosarcomas
In a general sense, what type of tumor is present in this patient?
round cell tumor
If your patient is still persistently hypoglycemic after surgery, what is the drug of choice for medical management?
Diazoxide
- Prevents the release of insulin into circulation
- Very expensive and usually requires a compounding pharmacist for formulation
The chemotherapeutic agent of choice for transmissible venereal tumor (TVT) is:
Vincristine
T/F: The majority of patients with lymphoma are asymptomatic
True
T/F: There is no difference in outcome in cats between T cell and B cell lymphoma
True
T/F: The presence of cancer cachexia is a negative prognosticator
True
-
Cancer cachexia: weight loss and metabolic alterations observed despite adequate nutritional intake
- (whereas alterations observed due to poor nutritional intake is termed cancer anorexia)
The chemotherapeutic agent of choice for mast cell tumors and relapse lymphoma is:
Lomustine (CCNU®)
Lomustine is an alkylating agent
The chemotherapeutic of choice for multiple myeloma is:
Melphalan
- Melphalan is an alkylating agent*
- Treatment for multiple myeloma involves Melphalan and prednisone*
T/F: When using an emetogen (Cisplatin), it is recommended to withhold food on the morning of chemo treatment
True
This will help to avoid food aversion
What is the general guideline for osteosarcoma predilection sites?
away from the elbows, toward the knees
distal radius is most common (except in small dogs, where the femur is most common). The site with the worst prognosis is the proximal humerus (one of the rarest locations)
CD3-positive stain. Is this a B cell or T cell lymphoma in this dog?
T cell lymphoma
T cell lymphomas MAY respond to chemotherapy, but they usually develop a relapse very quickly and they have a very short clinical remission
Depigmented nose with bilateral discharge. What is your diagnosis?
aspergillosis
What cat breed is predisposed to developing mammary gland tumors?
Siamese
T/F: Radiotherapy can provide definitive treatment for osteosarcomas
False
Osteosarcomas are radioresistant. Radiotherapy would be used for palliative treatment only
Some side-effects are specific to a particular chemotherapeutic agent or group of agents. Neuropathy is most associated with what chemotherapeutic drug?
Vincristine
T/F: Multiple myeloma is associated with polyclonal gammopathy
False
Multiple myeloma is associated with _monoclonal gammopathy_ (“finger of death”)
What platinum compound is known to cause fatal pulmonary edema in cats?
Cisplatin
“Cisplatin splats cats”
