Surgical oncology Flashcards

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1
Q

What are the phenotypic characteristics of neoplasia?

A
  1. Self sufficiency in growth signals
  2. Insensitivity to anti-growth signals
  3. Tissue invasion and metastasis
  4. Limitless replicative potential
  5. Sustained angiogenesis
  6. Evasion of apoptosis
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2
Q

What can activate oncogenes?

A

Chromosomal translocation, gene amplification, point mutations and vital insertions

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3
Q

What are the stages of cell progression toward a malignant phenotype?

A

Initiation, promotion, progression

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4
Q

What are the only neoplasms with established heritability in dogs?

A

Osteosarcoma in scottish deerhounds, renal cystadenocarcinoma and nodular dermatofibrosis in German shepherds

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5
Q

What is an oncogene?

A

A mutated version of a normal gene that drives the formation of cancer

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6
Q

What are the main classes of proteins that translation of oncogenes lead to the transcription of?

A

Growth factors, growth factor receptors, cytoplasmic kinases/Ras, transcription factors, antiapoptotic proteins

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7
Q

What is the mechanism of action of Toceranib (Palladia)?

A

It is a tyrosine kinase inhibitor. This is used in dogs exhibiting mutation of the c-kit receptor which leads to a constitutively active c-kit receptor tyrosine kinase receptor and increased proliferative activity

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8
Q

What is the ‘two-hit hypothesis’?

A

For mutations in tumor suppression genes to occur both alleles need to be damaged

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9
Q

What are the two groups of tumour suppression genes?

A

Gatekeeper and caretaker

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10
Q

Mutations of what tumour suppression gene have been identified as a prognostic factor for osteosarcoma and canine mammary tumours?

A

p53 gatekeeper gene

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11
Q

Do canine neoplastic tissues express increased or decreased levels of telomerase activity?

A

Increased - potentially leading to increased replicative potential. Telomerase is responsible for adding sequences onto the end of telomeres which undergo shortening with each cellular replication (end replication problem)

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12
Q

What are the three major routes of metastasis?

A

Hematogenous, lymphatic, direct seeding

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13
Q

What is the most common route of carcinoma and round cell tumour metastasis?

A

Lymphatic

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14
Q

What is the most common route of sarcoma metastasis?

A

Hematogenous

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15
Q

What type of ultrasonography can be useful in differentiating between benign and malignant splenic neoplasms?

A

Enhanced harmonic ultrasound

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16
Q

What are the common oncologic indications for nuclear scintigraphy?

A

Diagnosis of osteosarcoma metastasis, identification of ectopic or metastatic disease with functional thyroid tumours, assessment of GFR prior to nephrectomy (all technetium 99), or somatostatin scans to assess for metastatic lesions in dogs with functional insulinomas

17
Q

Does CT or MRI have higher contrast resolution?

A

MRI

18
Q

How does PET (positron emission tomography) work?

A

F-fluorodeoxyglucose (FDG) is administered and is taken up preferentially by tumour cells (typically higher glucose metabolism). It is trapped inside tumour cells following uptake as it is not utilized in the glycolytic pathway. Can be combined with CT scan (PET-CT) for anatomic and physiologic information.

19
Q

What size metastatic lesions can thoracic radiography and CT scans detect?

A

Radiography: 6mm
CT scan: 1mm

20
Q

What does the TMN system of tumour classification stand for?

A

Tumour, node, metastasis

21
Q

To what organ is doxorubicin toxic?

A

Cardiotoxic

22
Q

To what organ is cisplatin toxic?

A

Nephrotoxic

23
Q

What are the surgical doses of tumour excision?

A

Intralesional (debulking), marginal, wide, radical

24
Q

What are the commonly recommended lateral margins for carcinomas, sarcomas and benign tumours?

A

Benign: 1cm
Carcinomas: 1cm
Sarcomas: 2-3 cm (1cm may be adequate for low grade tumours)

25
Q

What are the recommendations for lateral margins in canine mast cell tumours?

A

Can consider proportional margins for small or low grade tumours (recurrence in only 1/40 dogs in study with predominantly low grade tumours).

Simpson et al: 1cm may be adequate for grade 1 tumours, 2cm for grade 2 (only 75% of grade II tumours completely excised with 1cm margins, 100% with 2cm).

High grade tumours recommend 3cm, although no definitive literature

26
Q

What tissues constitute an adequate deep margin?

A

Bone, cartilage, fascia

27
Q

What is generally responsible for tumour recurrence following marginal excision with a malignant neoplasms?

A

Microscopic satellite tumour cells that exist outside the tumour capsule

28
Q

What are the four potential techniques to manage unplanned marginal resections that result in incompletely excised malignancies?

A
  1. No treatment
  2. Staging resection of the surgical wound
  3. Wide resection of the surgical wound
  4. Combination with radiation therapy or chemotherapy
29
Q

With staging resection of the surgical wound what percentage of soft tissue sarcomas had no evidence of residual tumour despite initial incomplete excision?

A

78%

30
Q

Is lymph node size an accurate predictor of metastasis?

A

No - in 100 dogs with malignant melanoma 40% of dogs with normal sized LNs had metastasis, and 49% with enlarged LNs did not

31
Q

In what percentage of dogs was concurrent tumour excision and axial pattern flap reconstruction associated with incomplete excision in one study?

A

39%

32
Q
A