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Small Animal Medicine II > Soft Tissue Sarcoma & Osteosarcoma > Flashcards

Soft Tissue Sarcoma & Osteosarcoma Flashcards

1
Q

What do soft tissue sarcomas arise from?

A

connective tissue, muscle, nerves, fat —> common origin = same treatment/prognosis

  • fibrosarcoma
  • nerve sheath tumors
  • rhabdomyosarcoma
  • leiomyosarcoma
  • liposarcoma
    (spindle cell sarcomas!)
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2
Q

How do canine soft tissue sarcomas act?

A
  • locally invasive and grow by path of least resistance
  • low metastatic potential based on grade of tumor
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3
Q

What is the most common presentation of canine soft tissue sarcomas?

A

firm SQ mass that is movable or fixed in place - not as soft as lipomas!

  • generally not painful
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4
Q

What are the 2 major ways of diagnosing canine soft tissue sarcomas? How do they compare?

A
  1. FNA of mass - sarcomas not commonly exfoliative, minimal characteristics of malignancy found
  2. biopsy of mass - more definitive answer, assesses tumor grade
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5
Q

What 2 diagnostics are used to stage canine soft tissue sarcomas?

A
  1. CBC/chem/UA = typically WNL
  2. 3-view thoracic rads = metastasis to lungs due to spread in blood vessels, not lymphatics (no metastasis common at Grades 1-2)
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6
Q

What is considered the best treatment of canine soft tissue sarcoma?

A

surgery with wide and deep margins

  • Grade 3 - may not be curative
  • low grade sarcomas do not commonly grow back
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7
Q

When is radiation therapy used for canine soft tissue sarcomas? What are the 2 options?

A

when resection is incomplete

  1. DEFINITIVE - finely-fractionated post-surgery or stereotactic with gross disease
  2. PALLIATIVE - slow growth of tumors, painful masses
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8
Q

What are the 2 options of systemic therapy used for canine soft tissue sarcoma?

A
  1. CHEMO - Carboplatin or Doxorubicin for grade 3 tumors or post-surgery (not as helpful for gross disease)
  2. METRONOMIC - gross disease with incomplete resection
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9
Q

What is prognosis of canine soft tissue sarcoma like?

A
  • long-term tumor control with complete resection - ~100% for Grades 1-2; 50% for Grade 3
  • long-term control with incomplete resection + radiation = 75%

metastasis is slow —> MST = 1 year for high grade tumors

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10
Q

What kind of soft tissue sarcoma is common in cats? What kind of sarcoma is this? What is thought to cause this?

A

injection site sarcoma (vaccine-associated sarcoma) —> spontaneous uncommon

fibrosarcoma (may be OSA or chondrosarcoma)

adjuvant in radies and FeLV vaccines —> now use non-adjuvanted vaccines

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11
Q

Other than a vaccine, what can injection site sarcoma be associated with?

A

other repeated injections, like Program, Depo-Medrol, or antibiotics due to aberrant inflammatory response

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12
Q

How has administration of vaccines in cats been changed with the occurrence of ISS?

A

aim to more distal aspects of limbs and tails

  • allows for amputation
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13
Q

What is the most common presentation of injection site sarcoma?

A

cat with a firm SQ mass fixed into place between the scapula or distal limb

  • can be painful or uncomfortable
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14
Q

What are the 2 main options for diagnosing ISS?

A
  1. FNA - exfoliates better, malignant mesenchymal cells with nuclei of different sizes
  2. biopsy - incisional based on invasiveness of mass, can see inflammatory cells in tissues or adjuvant within macrophages
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15
Q

How are CBC/chem/UA, thoracic radiographs, and abdominal ultrasounds used to stage ISS?

A

usually WNL, possible neutrophilia and mild anemia

lungs most common place for metastasis

occasional metastasis to abdominal viscera

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16
Q

What is the purpose of performing a CT scan on a suspected ISS?

A
  • observe the extent of tumor for surgical planning (more invasive than it appears!)
  • search thorax and abdomen for metastasis
17
Q

How is surgery used for treating ISS?

A

difficult to achieve wide margin in the interscapular space, preferred amputation for limb/tail masses

18
Q

How is radiation used for ISS treatment?

A
  • DEFINITIVE - always indicated for interscapular masses given the invasiveness of the tumor, still difficult to control
  • PALLIATIVE
19
Q

What systemic therapy is used to treat ISS?

A
  • CHEMO - Carboplatin, Doxorubicin, CCNU* (not as effective for gross disease)
  • METRONOMIC - not as commonly done in cats, unknown effectiveness
20
Q

What is prognosis of ISS like?

A

tends to grow back around the surgery scar regardless of therapy given, but MST of 18 months with surgery, radiation, and chemo

21
Q

What is osteosarcoma? What does it typically involve?

A

primary bone tumor arising from osteoblasts

long bones —> away from the elbow, towards the knee = distal radius most common

22
Q

How does osteosarcoma act? In what animals is this most common?

A

high metastatic rate, less metastasis to flat bones and axial skeleton

large/giant breed dogs

23
Q

What is the typical presentation of osteosarcoma?

A
  • acute/slowly progressive lameness with transient/variable response to empiric pain meds
  • hard, painful mass in typical tumor location
  • pathologic fracture
24
Q

What 3 diagnostics are preferred for osteosarcoma?

A
  1. radiograph of tumor site - bone lysis, moth eaten or sunburst pattern, pathologic fracture
  2. FNA - possible due to weakness of bone affected by tumor, sarcoma cells seen
  3. biopsy - Jamshidi tool
25
Q

Why is a biopsy not always diagnostic for osteosarcoma?

A

normal callous often surrounds the tumor

26
Q

What are some signs on CBC/chem/UA of osteosarcoma? Thoracic radiographs?

A

elevated ALP shows a worse prognosis, hypercalcemia due to osteolysis

metastasis to lungs, other bones, or skin

27
Q

What is the best option for pain control in treating osteosarcoma?

A

amputation of affected limb +/- palliative radiation (no significant effect on tumor otherwise)

  • does NOT prevent metastasis
28
Q

What is the chemotherapy of choice for osteosarcoma?

A

Carboplatin (4-6 doses)

29
Q

What supportive medications can be given to patients with osteosarcoma? Why?

A

bisphosphnates - Zoledronate, Pamidronate

attach to hydroxyapatite receptors on bone and inhibit osteoclastic bone resorption —> may improve bone density

30
Q

Is definitive radiation commonly used for treating osteosarcoma?

A

no - poor response, stereotactic may be better

31
Q

If clients are unable to afford other methods of pain relief for osteosarcoma, what is recommended?

A

oral pain meds

  • NSAIDs
  • Gabapentin
  • Tramadol
  • Tylenol/Codeine
32
Q

How is metronomic therapy used for osteosarcoma?

A

can be used in place of chemotherapy or as maintenance therapy after chemo is complete

  • unclear effect on survival
33
Q

What is the prognosis of osteosarcoma like depending on treatment?

A
  • amputation alone = 3-5 months
  • amputation + carboplatin = 12 months
  • palliative radiation + carboplatin = 7-8 months

risk pathologic fracture if not amputated

34
Q

How does osteosarcoma compare in cats? How does this affect treatment?

A

similar to dogs, but there is a very low metastatic potention

amputation is often curative - chemotherapy not commonly given

Small Animal Medicine II (57 decks)

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