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Sarcomas Flashcards

1
Q

Sarcoma cell line

A
  • Connective tissue/mesenchymal tumors
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2
Q

How do sarcomas spread?

A

Blood

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3
Q

What determines sarcoma behavior?

A
  • Tissue of origin

- Grade

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4
Q

What is the most common primary bone tumor in dogs?

A
  • 80% are osteosarcoma
  • Others can be fibrosarcoma, chondrosarcoma, hemangiosarcoma
  • Rare in cats
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5
Q

Signalment for OSA

A
  • Mid-older age
  • Also a peak at 18-24 months
  • Large/giant breeds
  • Males > females
  • Neutered > intact (Rotties)
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6
Q

History for primary bone tumors

A
  • Lameness +/- swelling
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7
Q

Where do OSAs tend to happen on the skeleton?

A
  1. Long bones (appendicular) ** most common

75% metaphyseal

  • Front legs > back legs
    2. Flat bone (axial) - less common; bones of head, ribs, pelvis, vertebrae
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8
Q

Mnemonic for OSA

A
  • Away from the elbow and towards the knee
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9
Q

Diagnosis of OSA in dogs

A
  • Radiographs
  • Cytology (preferred; Alk Phos stain)
  • Histopathology (gold standard)
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10
Q

DIfferentials for canine OSA on radiograph

A
  • Fungal, bacterial osteomyelitis

- MUST ask about travel histroy

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11
Q

Staging OSA - when to do?

A
  • MOST critical if considering definitive therapy like amputation
  • If you’re not going to amputate, the staging you would do will change
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12
Q

Common sites for metastasis for canine OSA

A
  • Lung - MUST examine for staging
  • Bone
  • LN (poor prognostic indicator)
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13
Q

Diagnosis of lung metastasis for canine OSA

A
  • 3 view lung radiographs (<5% have evidence at outset; met more likely to grow after primary tumor removed)
  • CT more sensitive (detects down to 1 mm in size)
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14
Q

If you saw lesions in the chest, would you amputate the osteosarcoma?

A
  • Probably not as good of a candidate for amputation
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15
Q

Bone metastasis diagnosis

A
  • Bone scan or survey bone radiographs
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16
Q

Poor prognostic indicators for canine OSA

A
  • Lung or bone metastasis at outset
  • LN metastasis
  • Elevated alk phos
  • Monocytosis (immune system coercion?)
  • Age? (iffy)
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17
Q

Which cell when elevated in peripheral blood is a poor prognostic indicator for canine osteosarcoma?

A
  • Monocytes!
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18
Q

Prognosis if no therapy for canine OSA?

A
  • PAIN
  • you cannot do this
  • Must have pain control
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19
Q

Prognosis if amputation/no chemo for canine OSA?

A

3-4 months

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20
Q

Prognosis if radiation for pain control with external beam or radionuclide for canine OSA?

A
  • 4-6 months
  • 2 treatments and then come back when they’re painful
  • This is reasonable if they don’t want to amputate
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21
Q

Prognosis for just pain meds for canine OSA?

A
  • 4-6 months
  • NSAIDs/Opioids
  • Would also give bisphosphonates (alendronate; pamidronate; zoledronate)
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22
Q

Aggressive therapy for appendicular tumors and how long?

A
  • Amputation and chemo for 9-12 months
  • Cisplatin > Carboplatin (they use this!) > doxorubicin
  • They use carboplatin as a single agent
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23
Q

Possible new therapy for OSA (hopefully not important)

A
  • Vaccination against Her-2
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24
Q

Limb sparing osteosarcoma

A
  • Not really sure it’s better
  • Big plated leg is a problem
  • Still need chemo
  • Only works for distal radius
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25
Axial OSA treatment
- Often difficult due to inability to remove surgically (vertebrae, pelvis, etc.) - Palliative radiation - Pain meds - Curative radiation (when spine is involved) - Local recurrence happens a lot
26
Survival times for axial tumors when removal is possible and can allow additional chemotherapy (OSA)
- Probably longer than for long bone tumors as metastasis comes slower - Likely only when in mandible or ribs
27
How common is feline OSA?
- Rare but happens | - Met comes slower than in dogs
28
Treatment of choice for feline OSA
- Amputation | - Palliative doesn't make much sense
29
Fibrosarcoma in bone prognosis
- Better than OSA
30
Chondrosarcoma in bone prognosis
- better than OSA unless high grade
31
Hemangiosarcoma bone tumor prognosis
- As bad as anywhere
32
Histiocytic bone tumors prognosis?
- Not sure
33
Plasma cell tumor lymphoma bone tumor prognosis?
- Good?
34
Where do soft tissue sarcomas arise from?
- All sorts of supportive tissues - Fibrosarcoma common - All behave very similarly
35
What's possibly more important than type for soft tissue sarcomas?
- Tumor grade!
36
Signalment for STS
- Usually older, larger dogs | - Any age and breed possible
37
STS presentation
- Usually a mass, but can arise from internal soft tissues as well
38
Biologic behavior of STS****
- Locally aggressive - Invasive - Poorly defined margins
39
Metastatic potential of STS
- SLow to metastasize in general
40
Where do STS metastasize?
- They often spread to lungs more than LNs | - If they spread to LN that's worse
41
What is most predictive of prognosis for STS?
- Grade should be predictive | - Mitotic index may be most important prognostic indicator
42
Grade II vs Grade III STS (mitotic index)
Grade II: 10-19 Grade III: 20+
43
Diagnosis of STS
- Cytology suggestive - Incisional biopsy is required for true diagnosis and grade - Excisional biopsy - be SURE you know your margins!!
44
Staging for STS: Tumor
- Tumor measurement may require imaging - Radiographs rarely adequate - Ultrasound helpful - CT used a lot - MR
45
Staging for STS: Lymph nodes
- If they're big, freak out | - If not, might not matter
46
Staging for STS: Metastasis
- Thoracic examination - Radiographs - CT if high grade or undertaking a life-altering procedure
47
Surgery for STS
- AGGRESSIVE treatment required - 3cm in all directions or 5cm in cats - Submit for histopath or trim to know if you got clean margins
48
Radiation for STS
- Best for minimal disease (incomplete sx margins) - Gross tumor may require higher dose - High dose difficult to achieve in some locations
49
Chemotherapy for STS
- Can do chemotherapy (gold standard doxorubicin) or metronomic chemotherapy (low dose alkylators plus NSAID) - Okay if people can't go for radiation
50
When is chemo or metronomic chemo best for STS?
- Incomplete margins and owners don't want to go for radiation
51
Prognosis and treatment for low grade STS
- Surgery alone can be curative if done properly! | - Surgery with follow-up radiation when margins not adequate
52
Prognosis and treatment for high grade STS
- High potential for metastasis (40%) | - Surgery +/- radiation +/- chemotherapy
53
Prognosis and treatment for non-resectable tumors
- Palliative radiation + metronomic therapy | - They shrink a little and may get a little better quality of life
54
Feline STS - what causes?
- VACCINE associated sarcomas
55
What is the rule of 1, 2, 3 with feline STS?
- Remove a mass at a vaccine site when: 1. Still growing at 1 month 2. Greater than 2 cm in size 3. Still present at 3 months post vaccination - Same rules apply if due to other injections
56
Signalment for feline STS
- Any vaccinated cat (they got 2-3 year old cats)
57
Biologic behavior of feline STS
- Locally extremely aggressive (the most high grade sarcomas) - 10-25% metastasize
58
Staging for feline STS
- Advanced imaging nearly ALWAYS required
59
Surgery for feline STS
- BE careful - Remove with margins the first time - 5cm or 2 facial planes required for cure
60
Radiation for feline STS
- Most helpful as follow-up when margins are clean but <5 cm
61
What happens if you do a bad surgery for feline STS?
- If the first surgery leaves dirty margins, the cat may have no hope for long-term tumor control - Bad surgery - prematurely dead cat
62
Chemotherapy for feline STS
- 10-25% metastasis potential | - Chemo has not been documented to help overall survival but may help shrink the tumor
63
Electrochemotherapy for feline STS
- Gets chemotherapy into the tumor
64
Prevention of feline STS
- Decrease use of vaccines, use canary pox adjuvant vaccine - Never use a killed virus vaccine in a cat which has had a VAS (including family members) - vaccinate low on limbs or over abdominal fat to facilitate tumor removal - Don't vaccinate a cat that has had the problem

Oncology (9 decks)

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