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Oncology > Sarcomas > Flashcards

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
Q

Axial OSA treatment

A
  • 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
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26
Q

Survival times for axial tumors when removal is possible and can allow additional chemotherapy (OSA)

A
  • Probably longer than for long bone tumors as metastasis comes slower
  • Likely only when in mandible or ribs
27
Q

How common is feline OSA?

A
  • Rare but happens

- Met comes slower than in dogs

28
Q

Treatment of choice for feline OSA

A
  • Amputation

- Palliative doesn’t make much sense

29
Q

Fibrosarcoma in bone prognosis

A
  • Better than OSA
30
Q

Chondrosarcoma in bone prognosis

A
  • better than OSA unless high grade
31
Q

Hemangiosarcoma bone tumor prognosis

A
  • As bad as anywhere
32
Q

Histiocytic bone tumors prognosis?

A
  • Not sure
33
Q

Plasma cell tumor lymphoma bone tumor prognosis?

A
  • Good?
34
Q

Where do soft tissue sarcomas arise from?

A
  • All sorts of supportive tissues
  • Fibrosarcoma common
  • All behave very similarly
35
Q

What’s possibly more important than type for soft tissue sarcomas?

A
  • Tumor grade!
36
Q

Signalment for STS

A
  • Usually older, larger dogs

- Any age and breed possible

37
Q

STS presentation

A
  • Usually a mass, but can arise from internal soft tissues as well
38
Q

Biologic behavior of STS**

A
  • Locally aggressive
  • Invasive
  • Poorly defined margins
39
Q

Metastatic potential of STS

A
  • SLow to metastasize in general
40
Q

Where do STS metastasize?

A
  • They often spread to lungs more than LNs

- If they spread to LN that’s worse

41
Q

What is most predictive of prognosis for STS?

A
  • Grade should be predictive

- Mitotic index may be most important prognostic indicator

42
Q

Grade II vs Grade III STS (mitotic index)

A

Grade II: 10-19

Grade III: 20+

43
Q

Diagnosis of STS

A
  • Cytology suggestive
  • Incisional biopsy is required for true diagnosis and grade
  • Excisional biopsy - be SURE you know your margins!!
44
Q

Staging for STS: Tumor

A
  • Tumor measurement may require imaging
  • Radiographs rarely adequate
  • Ultrasound helpful
  • CT used a lot
  • MR
45
Q

Staging for STS: Lymph nodes

A
  • If they’re big, freak out

- If not, might not matter

46
Q

Staging for STS: Metastasis

A
  • Thoracic examination
  • Radiographs
  • CT if high grade or undertaking a life-altering procedure
47
Q

Surgery for STS

A
  • AGGRESSIVE treatment required
  • 3cm in all directions or 5cm in cats
  • Submit for histopath or trim to know if you got clean margins
48
Q

Radiation for STS

A
  • Best for minimal disease (incomplete sx margins)
  • Gross tumor may require higher dose
  • High dose difficult to achieve in some locations
49
Q

Chemotherapy for STS

A
  • Can do chemotherapy (gold standard doxorubicin) or metronomic chemotherapy (low dose alkylators plus NSAID)
  • Okay if people can’t go for radiation
50
Q

When is chemo or metronomic chemo best for STS?

A
  • Incomplete margins and owners don’t want to go for radiation
51
Q

Prognosis and treatment for low grade STS

A
  • Surgery alone can be curative if done properly!

- Surgery with follow-up radiation when margins not adequate

52
Q

Prognosis and treatment for high grade STS

A
  • High potential for metastasis (40%)

- Surgery +/- radiation +/- chemotherapy

53
Q

Prognosis and treatment for non-resectable tumors

A
  • Palliative radiation + metronomic therapy

- They shrink a little and may get a little better quality of life

54
Q

Feline STS - what causes?

A
  • VACCINE associated sarcomas
55
Q

What is the rule of 1, 2, 3 with feline STS?

A
  • 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
Q

Signalment for feline STS

A
  • Any vaccinated cat (they got 2-3 year old cats)
57
Q

Biologic behavior of feline STS

A
  • Locally extremely aggressive (the most high grade sarcomas)
  • 10-25% metastasize
58
Q

Staging for feline STS

A
  • Advanced imaging nearly ALWAYS required
59
Q

Surgery for feline STS

A
  • BE careful
  • Remove with margins the first time
  • 5cm or 2 facial planes required for cure
60
Q

Radiation for feline STS

A
  • Most helpful as follow-up when margins are clean but <5 cm
61
Q

What happens if you do a bad surgery for feline STS?

A
  • If the first surgery leaves dirty margins, the cat may have no hope for long-term tumor control
  • Bad surgery - prematurely dead cat
62
Q

Chemotherapy for feline STS

A
  • 10-25% metastasis potential

- Chemo has not been documented to help overall survival but may help shrink the tumor

63
Q

Electrochemotherapy for feline STS

A
  • Gets chemotherapy into the tumor
64
Q

Prevention of feline STS

A
  • 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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