Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 SA - Oncology > Solid tumours - Oral and Mammary > Flashcards

Solid tumours - Oral and Mammary Flashcards

1
Q

List the clinical signs of oral tumours

A
  • Mass / facial swelling
  • Oral bleeding
  • Dysphagia / pain
  • Halitosis
  • Epistaxis
  • Loose teeth / proliferative lesions noted at dentals (always biopsy)
  • Cervical lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How can you assess a patient for oral tumours?

A
  • Under GA usually required
  • Biopsy (incisional wedge)
  • FNA mass
  • FNA submandibular lymph nodes
  • Assessment of local lymph nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the methods involved in the staging of primary oral tumours

A
  • Many oral tumours are locally invasive
  • Visual assessment underestimates the quantity of disease
  • Radiographs insensitive
  • Advanced imaging: useful for surgical planning especially maxillectomy, required for radiation therapy (RT) planning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How can you assess metastasis from primary oral tumours?

A

Likelihood of distant metastases depends on tumour type
Thoracic imaging:
- XR – 2 x laterals and 1 DV of thorax - inflated
- CT has greater sensitivity
Abdominal imaging also for melanoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Name the 3 most common oral tumours of dogs

A

Malignant melanoma
Squamous cell carcinoma
Fibrosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the treatment of choice for oral tumour management?

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the surgical options for primary oral tumour management

A
  • Maxillectomy/mandibulectomy
  • Margin dictated by histology
  • Surgery very well tolerated in dogs
  • Cats take longer to adapt: feeding tube (up to months)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the margins required for a squamous cell carcinoma and fibrosarcoma

A

2cm+ for SCC
3-5cm+ for FSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

For fibrosarcomas and squamous cell carcinomas, how can the best results be provided?

A

Surgery followed by adjuvant RT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some complications of oral surgery?

A

Dogs generally adapt very well, cat more variable
- Bleeding
- Infection
- Altered cosmetic appearance
- Difficulty prehending food / messy eating
- Salivation
- Mandibular drift
Recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Melanomas are most commonly seen in which pateints?

A

Generally smaller dogs
Generally older dogs – mean 11.4 years
Golden Retriever, cocker spaniel, miniature poodle, ChowChow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the characteristics or oral melanomas

A

Very locally invasive
High metastatic rate – up to 80%
Check both submandibular lymph nodes, regardless of location in mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How are oral melanomas diagnosed?

A
  • Diagnosis based upon melanin containing mesenchymal cells
  • Immunohistochemistry required
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Describe surgery for primary melanomas

A

Surgery associated with high rates of local recurrence
- 22% after mandibulectomy
- 48% after maxillectomy
- 1 year survival 35%
Tumour size and stage significant for survival
Completeness of excision also relevant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe anti-metastatic treatment for oral melanomas

A

Survival time if distant metastasis <3 months
Chemotherapy does not meaningfully extend survival
Plasmid vaccine immunotherapy
- Use in stage II and III disease
- Targets a melano-protein – tyrosinase*
- Only minor local side effects
- Expensive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Is the metastatic rate of oral squamous cell carcinomas high or low?

A

Low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Describe treatment for oral squamous cell carcinomas

A
  • Surgery: rostral mandible best outcome
  • Radiotherapy
  • Combines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Describe medical therapy for oral squamous cell carcinomas

A

When other therapies aren’t possible
Metastatic disease
Neoadjuvant
Piroxicam
Piroxicam + carboplatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe the clinical presentation of a patient with a tonsillar squamous cell carcinoma

A
  • Dysphagia, coughing
  • Enlarged cervical lymph nodes -> abcessation
  • Oral examination reveals enlargement of 1 or both tonsils
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

FNA of enlarged cervical LNs in cases of tonsillar squamous cell carcinomas would reveal?

A

FNA yields necrotic debris and sometimes tumour cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Is the metastatic rate of tonsillar squamous cell carcinomas high or low?

A

High - more than 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe treatment of tonsillar squamous cell carcinomas

A
  • Local control of tonsillar enlargement - surgery or RT
  • Surgery or RT for lymph node metastasis
  • Carboplatin or mitoxantrone chemotherapy might be beneficial
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the prognosis of tonsillar squamous cell carcinomas

A

Prognosis - 7 mths
Patients who receive the most therapy live longest
Control of local/regional disease most important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name the 3rd most common canine tumour?

A

Fibrosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

In which patients are fibrosarcomas most commonly seen?

A

Large breed dogs especially Golden Ret and Labrador
Middle age dog – median age approx 7.5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Describe the characteristics of fibrosarcomas

A

Invasive
Low / moderate metastatic risk - lung and occasionally lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe treatment of fibrosarcomas

A
  • Surgery single most important therapy
  • Multimodal therapy often best: surgery and RT - MST 18 – 26 months
  • RT alone: MST – 7 months
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the surgical margins needed for a fibrosarcoma?

A

3-5cm+

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Describe the main features of a histologically low grade, biologically high grade fibrosarcoma

A
  • Often caudal maxilla
  • Aggressive, rapidly progressing oral tumour with benign histological appearance even after large biopsy (tumours reported as low grade, fibroma or even granulation tissue or epulis)
  • Very locally invasive: aggressive local management with surgery and RT required
30
Q

What are epulides?

A

Non-metastatic lesions arising from gingiva

31
Q

Name two common epulide types seen in small animals

A

Acanthomatous ameloblastoma
Peripheral odontogenic fibroma

32
Q

Describe the behaviour of an acanthomatous amleoblastoma

A

Aggressive local behaviour and bone invasion

33
Q

Describe the behaviour of a peripheral odontogenic fibroma

A

Slow growing firm masses usually not invasive

34
Q

What determines the prognosis of a canine oral osteosarcoma?

A

Site and histological grade
Survival: mandibular > maxillary
14 – 18 mths vs 5 – 10 mths

35
Q

Most dogs with maxillary osteosarcoma tumours tumours die of … ?
Most dogs with mandibular osteosarcoma tumours die of … ?

A

Reoccurrence
Metastasis

36
Q

Name some uncommon oral tumours of dogs

A

Mast cell tumour
Haemangiosarcoma
Extramedullary oral plasmacytoma
Oral lymphoma

37
Q

Rank the 4 most common canine oral tumours in order of frequency

A

1 = malignant melanoma
2 = squamous cell carcinoma
3 = fibrosarcoma
4 = acanthomatous ameloblastoma

38
Q

Name the most common oral tumour of cats

A

Feline squamous cell carcinoma

39
Q

The risk of feline oral squamous cell carcinomas is increased by what factors?

A

Middle aged and older cats
Risk increased by living in a smoker’s household, flea collars, canned tuna

40
Q

Describe the behaviour of feline oral squamous cell carcinomas

A

Locally invasive
?low metastatic rate
Higher metastatic rate if caudal
Present with discomfort, hyporexia

41
Q

Where is the predilection site of feline oral squamous cell carcinomas

A

Base of the tongue

42
Q

Describe the treatment options for feline oral squamous cell carcinomas

A

No really good effective treatment - One year survival usually 10% or less
- Almost never present when surgically resectable: some mandibular tumours
- Can control tumour using radiotherapy

43
Q

How does the location of a feline oral SCC determine outcome?

A

Mandible better than maxilla
Rostral location better
Poor outcome if associated with the tongue

44
Q

Which cats are most commonly affected by a fibrosarcoma?

A

Usually middle aged or older

45
Q

Describe the behaviour of feline oral fibrosarcomas

A

Very locally invasive
Main challenge in local control
Metastatic rate unknown

46
Q

Describe treatment of feline oral fibrosarcomas

A

Main treatment is surgery
- Good outcomes possible with mandibulectomy
- Maxilla more difficult
Insufficient data for radiotherapy

47
Q

Which oral lesion has a ‘popcorn’ appearance on radiography?

A

Multilobular osteochondrosarcoma in dogs
- usually a local problem

48
Q

Describe viral papillomatosis in dogs

A

Wart like lesions affecting oral soft tissues
Usually resolve in 4- 8 weeks
Occasionally persist in immunosuppressed animals

49
Q

Which patients are predisposed to eosinophilic granulomas?

A

Husky and CKCS

50
Q

How are eosinophilic granulomas treated in dogs vs cats?

A

Dog = Surgery and corticosteroids
Cat = Steroids / hypoallergenic diets, RT, surgery

51
Q

List the risk factors for mammary tumours

A
  • Not-neutering
  • Obesity
  • Age
  • Breed
52
Q

How does neutering affect the risk of mammary tumours?

A

Neutering prior to first oestrus – 0.5 % life time risk
Neutering prior to second oestrus – 8 % risk
Neutering prior to third oestrus – 26 % risk
No risk reduction if neutering after the second season

53
Q

What can occur as a consequence of early neutering which must be considered?

A

Urinary incontinence

54
Q

Why is obesity a risk factor for mammary tumours?

A
  • Obesity leads to reduced sex hormone-binding globulin -> increased oestrogen levels
  • Being underweight at puberty -> reduced risk
55
Q

Why is age a risk factor for mammary tumours?

A

Mean age of dogs with benign tumours 7 – 9 years
Mean age of dogs with malignant tumours 9 – 11 years
Mean age of cats 10 – 12 years

56
Q

Which breeds are more at risk of mammary tumours?

A
  • Poodles, Chihuahua, dachshund, Maltese, cocker spaniel and Yorkshire Terrier
  • Siamese cats
57
Q

How should you approach mammary masses?

A
  • > 70% have more than 1 tumour
  • Examine other glands carefully
  • About 50% of canine MG tumours are benign
  • FNA can be useful to exclude other ddx e.g. mastitis, lipoma or mast cell tumour, hyperplasia
58
Q

Why can FNA not be used to determine mammary tumour malignancy?

A

Heterogeneity of mammary tumours makes FNA unreliable for determining malignancy

59
Q

Describe using an excisional biopsy for mammary tumours

A

Excisional biopsy by single or segmental mastectomy reasonable for single lesions without negative prognostic indicators E.g. small, non fixed lesions

60
Q

Mammary tumours over what size have a poor outcome?

A

3cm

61
Q

Describe local and distant staging of mammary tumours

A

Local staging
- Assessment of local lymph nodes
- Consider typical drainage patterns
- Not absolute so assess all nodes
Distant staging
- Thoracic radiographs/CT
- Abdominal ultrasound: visceral metastases
- Mammary tumours can metastasise to bone so carefully consider bone pain

62
Q

What should be considered when performing surgery on intact bitches with mammary tumours?

A
  • 55% develop a new tumour on the ipsilateral side hence consider unilateral chain mastectomy
  • Likely hormone field effect therefore consider bilateral resection in young intact bitches with multiple tumours
63
Q

Describe the excisional margins for canine mammary tumour surgery

A

For mobile lesions – whole gland removal enough
Fixed lesions – need 2 cm margins and removal of affected abdominal fascia / wall

64
Q

Describe the post surgical prognostic factors for mammary tumours

A

Tumour type:
- Benign versus malignant
- Less tissue heterogeneity associated with a poorer outcome (complex vs simple)
- Sarcoma especially osteosarcoma – poorer than carcinoma
Possible prognostic factors:
- Mitotic rate / Ki-67
- Grade
- Hormone receptor expression: lack of expression correlates with poorer outcome

65
Q

Describe the main features of canine inflammatory carcinomas

A

Tumours extremely painful
Easily mistaken for mastitis
Generally all gland affected
FNA yields inflammatory cells and tumour cells

66
Q

Describe treatment of canine inflammatory carcinomas

A
  • Excision not typically feasible: recurrence very common
  • Prognosis generally very poor
  • Treatment is palliative
  • Medical therapy might prolong survival – few months
67
Q

What % of feline mammary tumours are malignant?

A

85-95%

68
Q

Describe the clinical presentation of feline mammary tumours

A

> 60% have more than 1 tumour at diagnosis
Hormone receptor expression frequencies are lower

69
Q

What is a significant differential of feline mammary tumours?

A

Fibroepithelial hyperplasia

70
Q

List the clinical prognostic factors of feline mammary tumours

A
  1. Tumour size
    > 2 cm – MST 6 months
    < 2 cm – MST > 3 years
  2. Lymph node metastasis
    - Lymphatic drainage less predictable than dog
    - Assess inguinal and axillary nodes bilaterally
  3. Distant metastasis
  4. Breed - DSH have better outcome
71
Q

Describe surgery for feline mammary tumours

A

Chain mastectomy preferred to single or regional mastectomy:
- Unilateral when lesions on one side
- Stage bilateral when lesions bilateral

72
Q

When is ovariohysterectomy at the time of mammary excision indicated?

A

Dogs
- For benign mammary tumours OHE at the time of mastectomy halves the chance of a new mammary tumour (to ~ 35 %)
- Benefit of OHE less clear for carcinoma
- But OHE may extend survival in oestrogen receptor expressing mammary tumours and grade 2 tumours
- Unlikely to be detrimental

Y4 SA - Oncology (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions