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FCP > Surgery, Biopsies and Chemotherapeutics > Flashcards

Surgery, Biopsies and Chemotherapeutics Flashcards

1
Q

Describe Marek disease virus

A
  • Oncogenic herpesvirus
  • Tumours derived from T lymphocytes
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2
Q

What are the consequences on immune cells due to Marek’s disease virus?

A
  • B lymphocytes and macrophages are killed

- T-lymphocytes are activated to proliferate and form tumour

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3
Q

Outline the control of Marek’s disease virus

A
  • Disinfection
  • Biosecurity
  • All-in, all-out management
  • Vaccination
  • New strains emerging each more virulent, so new vaccines required at each new mutation
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4
Q

Why is diagnosis and staging important prior to treatment of a tumour?

A
  • Extent of treatment depends on tumour type and stage

- With regards to surgery, need to know the surgical margins that will be required

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5
Q

What are the general principles of biopsy?

A
  • Handle tissue gently
  • Position site within probable surgical or radiotherapy field
  • Should be as small as possible, position so as to not increase size of treatment area
  • Sample from different areas of lesion, including junction of normal-abnormal tissue
  • Avoid local dissemination of neoplastic tissue
  • So not breach anatomical planes
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6
Q

What are the indications for incision biopsy?

A
  • When mass will not exfoliate well for FNA, not amenable to core biopsy
  • When cytology or core biopsy results are non-diagnostic
  • Lack of core biopsy equipment
  • If is more likely to achieve diagnosis and grade
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7
Q

What are disadvantages of excisional biopsy?

A
  • Surgical margins unknown, risky
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8
Q

What are the advantages of an excisional biopsy?

A
  • May be cost saving in some cases
  • Diagnosis and treatment are possible within single surgery
  • Good where diagnosis of tumour type and grade will not affect surgical approach
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9
Q

What are the roles of oncological surgery?

A
  • Prophylactic e.g. ovariohysterectomy prior to 1st season, cryptorchid testicles
  • Diagnosis and staging
  • Definitive excision
  • Palliative surgery
  • Cytoreduction in order to treat with adjunctive methods
  • Management of oncologic emergencies
  • Surgery for supportive therapy
  • Treatment of metastatic disease
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10
Q

What are the 3 possible aims of surgical excision of a tumour?

A
  • Curative
  • Cytoreductive
  • Palliative
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11
Q

What is meant by palliative surgical excision of a tumour?

A

Where removal of a tumour that is causing other problems e.g. blocking nasal passages

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12
Q

Compare primary surgery and revisions with regards to success in treating tumours

A
  • Primary best chance for cure
  • Untreated tumours have more normal surrounding anatomy facilitating surgical removal
  • Recurrent tumours may have seeded to previously unaffected areas, need wider, deeper resection
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13
Q

What is meant by surgical dose?

A

How much surgery

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14
Q

What is marginal excision?

A
  • Excision immediately outside the pseudocapsule

- Are leaving behind microscopic volumes of tumour

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15
Q

What is a wide excision?

A

Removal of tumour with complete margins of normal tissue in all directions, so local recurrence is unlikely

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16
Q

What tissues are good natural barriers to spread of cancer cells?

A

Collagen rich, relatively avascular tissues e.g. fascia, ligaments, tendons and cartilage

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17
Q

What tissues are poor barriers to spread of cancer?

A

Fat, subcutaneous tissue, muscle, other parenchymatous organs

18
Q

What is radical excision?

A

Removal of entire anatomical structure or compartment continuing the tumour e.g. limb amputation, mastectomy. Local recurrence is unlikely

19
Q

What is meant by lateral and deep margins of a tumour?

A
  • Lateral are the margins around the visible lesion (ruler used)
  • Deep margins are the margins below the visible lesion
20
Q

In what lesions is a needle only FNA useful?

A

Soft masses and lymph nodes, want to avoid destroying fragile cells with suction

21
Q

In what lesions is a continuous suction FNA useful?

A

Firm masses e.g. firbosarcomas as these do no exfoliate well

22
Q

In what lesions is an intermittent suction FNA useful?

A

Small masses where it is not possible to redirect the needle without exiting the mass

23
Q

What size needle should be used for FNAs?

A

23 gauge

24
Q

What are the indications for a tru-cut biopsy?

A
  • Superficial masses (incl. lymph nodes) that can be palpated and stabilised
  • Internal organs that can be safely accessed via ultrasound guidance
25
Q

What are the contra-indications for a tru-cut biopsy?

A
  • Highly vascular structures
  • Disorders of primary and secondary haemostasis
  • Where structure to be biopsied cannot be stabilised
  • Structure with thin wall that may leak contents following sampling
26
Q

Describe the technique for tru-cut biopsy

A
  • Under heavy sedation or GA
  • Clean and aseptically prepare skin over area to be biopsied
  • Small incision in skin
  • Load needle, advance into sample area
  • Once in, advance stylet to expose the biopsy notch
  • Deploy cutting cannula by depressing the plunger
  • Remove needle from mass
  • Pull plunger back into lock position to remove sample
  • Push stylet forwards to reveal notch with tissue
  • Use fine needle to lift sample off and place in formalin
27
Q

Describe the site preparation for a punch biopsy

A
  • Sedate patient (or GA for ears, nose, toes)
  • Clip with scissors to preserve skin
  • Do not disturb crusts or skin surface, do not prep or scrub skin
  • Draw orientation line along line of hair growth in indelible marker
  • Draw circle around lesion
  • Inject subcut local anaesthetic on this circle, advancing into each previous injection site
28
Q

Outline the method of taking a punch biopsy

A
  • Usually 6-9mm punch, as large as possible
  • Hold perpendicular to skin surface
  • Rotate in one direction only
  • Do not reuse blunt biopsy punches
  • Only through skin, check regularly
  • Grasp sample by subcut tissue and cut connecting tissue
29
Q

What can be used to stabilise thin biopsy samples?

A

Stiff card or wooden tongue depressor, to prevent warping of tissue

30
Q

When should a wedge/ellipse biopsy be used?

A
  • Excision of solitary nodules
  • Transition from normal to lesional skin
  • Vesicles
  • Suspected deep lesions e.g. panniculitis
31
Q

What is the common outcome of all chemotherapeutic drugs?

A

Prevent cellular division and subsequent cell death

32
Q

Outline the common side effects of chemotherapeutics

A
  • Major systems affected are GI and bone marrow
  • Some drug specific side effects
  • Renal and hepatic dysfunction
  • Alopecia in some species/breeds (poodles, Bichon Frise, Old English Sheepdog)
  • Not as severe in humans
33
Q

What drugs are included in the COP protocol?

A

Cyclophosphamide, Vincristine, Prednisolone

34
Q

What drugs are used in the COPH protocol?

A

Cyclophosphamide, Vincristine, Prednisolone and Doxorubicin

35
Q

When are tyrosine kinase inhibitors indicated in cancer treatment?

A

Mast cell tumours

36
Q

How do alkylating agents work?

Give an example of a drug in class and a cancer that it targets.

A

Alkyl group binds to DNA causing cross linkage

Example of drug - Cyclophosphamide, lymphoma

37
Q

How do plant alkaloids work?

Give an example of a drug in class and a cancer that it targets.

A

Bind to tubulin in cells and disrupt the mitotic spindle.

Vincristine - Lymphoma and leukaemia

38
Q

How do anti-metabolites work?

Give an example of a drug in class and a cancer that it targets.

A

Inhibit the use of cell metabolites used in growth and cell division.

Cytarabine - lymphoma

39
Q

How do Anti tumour antibiotics work?

Give an example of a drug in class and a cancer that it targets.

A

Inhibit topoisomerase II causing breakage of DNA and cell death.

Doxorubicin - lymphoma

40
Q

How do platinum analogues work?

Give an example of a drug in class and a cancer that it targets.

A

Bind platinum to DNA causing cross linkage and cell death.

Carboplatin - osteosarcoma and carcinomas

41
Q

How do tyrosine kinase inhibitors work?

Give an example of a drug in class and a cancer that it targets.

A

Inhibit TK receptors.

Masitinib - Mast cell tumours

FCP (14 decks)

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