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CVSOH1 Oncology and Pathology > Oncology 5 > Flashcards

Oncology 5 Flashcards

1
Q

What do all lymphomas have in common?

A

They originate from lymphoreticular.

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2
Q

Multicentric (nodal) lymphoma…
1. Examples of clinical signs.
2. Approx. frequency in dogs.
3. Approx. frequency in cats.

A
  1. Painless lymphadenopathy, PUPD (hypercalcaemia), other non-specific signs.
  2. 80%.
  3. 20-30%.
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3
Q

Alimentary lymphoma…
1. Examples of clinical signs.
2. Approx. frequency in dogs.
3. Approx. frequency in cats.

A
  1. Vomiting, weight loss, diarrhoea, maybe palpably thickened intestinal loops and palpable abdominal mass.
  2. 7%.
  3. 50-70%.
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4
Q

Cutaneous lymphoma…
1. Examples of clinical signs.
2. Approx. frequency in dogs.
3. Approx. frequency in cats.

A
  1. Wide variety of non-specific changes – generalised or solitary. May progress from scaly alopecia to thickened erythematous ulcerative lesions. May or may not be pruritic.
  2. 6%.
  3. 0.2-3%.
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5
Q

Mediastinal lymphoma…
1. Examples of clinical signs.
2. Approx. frequency in dogs.
3. Approx. frequency in cats.

A
  1. Dyspnoea, tachypnoea (from space-occupying effect and/or pleural effusion), pre-caval syndrome +/- PUPD.
  2. 3%.
  3. 10-20%.
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6
Q

Extra-nodal e.g. bone, nasal, CNS…
1. Examples of clinical signs.
2. Approx. frequency in dogs.
3. Approx. frequency in cats.

A
  1. Site-dependent.
  2. 3%.
  3. 1-10%.
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7
Q

Diagnosing lymphoma.

A
  • FNA of enlarged LNs of affected organs for cytology is frequently rewarding – avoid submandibular where possible (more likely to see a mixed picture).
  • ## Biopsy if FNA non-diagnostic.
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8
Q

Further staging of lymphoma.

A
  • Tailored to individual and circumstances.
  • Aids decisions regarding chemotherapy.
  • For prognosis: -
    – Haematology.
    – Biochemistry.
    – Thoracic radiographs –> mediastinal mass negative prognostic factor.
    – Abdominal US –> Stage III and IV = same outcome.
    – FNA +/- tissue biopsy.
    – immunophenotyping (immunocyto. / histochemisty).
    – Bone marrow aspirate if haematological abnormalities.
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9
Q

WHO staging system for lymphoma.

A
  • Firstly, anatomical site.
  • Then stage:-
    – I = involving single node or lymphoid tissue in single organ.
    – II = involvement of multiple LNs in a region.
    – III = generalised lymphadenopathy.
    – IV = III plus liver/spleen involvement.
    – V = blood / bone marrow involvement.
  • Then substage: -
    – a = clinically well (w/o systemic signs).
    – b = clinically unwell (w/ systemic signs).
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10
Q
  1. How do you classify lymphoma grade?
  2. How else can lymphoma be classified?
A
  1. small/large cell OR high/intermediate/low.
  2. By immunophenotype. i.e. B cell or T cell.
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11
Q

Classifications w/ worse prognosis.

A

T cell lymphomas.
Large cell type.
Higher stages.
Substage b.
Male.
Presence of hypercalcaemia.
Forms that are not multicentric.
Pre-treatment w/ steroids.

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12
Q

Classifications w/ better prognosis.

A

B cell.
Small cell type.
Lower stages.
Substage a.
Being female.
Absence of hypercalcaemia.
Multicentric form.
Avoidance of steroid pre-treatment.

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13
Q

CHOP protocol for lymphoma treatment.

A

Median survival time = 12 months.
75-90%.
25%.

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14
Q

COP protocol for treatment of lymphoma.

A

Median survival time = 6-9 months.
70-80% remission.

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15
Q

Single agent doxorubicin every 3 weeks protocol for lymphoma treatment.

A

Median survival time = 6-9 months.

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16
Q

Single agent prednisolone protocol for lymphoma treatment.

A

Median survival time = 2-3 months.

17
Q

MST if no treatment.

A

4-6wks.

18
Q

What drugs are used in CHOP protocol?

A

Cyclophosphamide.
Hydroxydaunorubicin (doxorubicin).
Oncovin (vincristine).
Prednisolone.

19
Q

What drugs are used in COP protocol for lymphoma treatment?

A

Cyclophosphamide.
Oncovin (vincristine).
Prednisolone.

20
Q
  1. ‘Positives’ to cat lymphoma.
  2. Negatives of cat lymphoma.
A
  1. Solitary disease more common than in dogs so surgical treatment and/or radiotherapy possible in these cases.
    – Nasal lymphoma can go into prolonged remission.
    – Old cats w/ ‘small cell’ alimentary lymphoma can have remission periods of 2yrs w/ ust oral prednisolone and chlorambucil.
  2. – More likely to be substage b.
    – Chemotherapy challenging due to their small size.
    – Cats do not tolerate doxorubicin well.
    – Generally respond less well to treatment.
    – COP protocol MST = 8m and remission rates only 50-70%.
    – ~30% achieve longer-lasting complete remission of >1.5yrs.
21
Q
  1. What can resistance to lymphoma treatments be caused by?
  2. When is euthanasia appropriate?
A
  1. Insufficient dosing.
    Failure to achieve therapeutic concentration at ‘sanctuary sites’. e.g. CNS.
    Multi-drug resistance (MDP-1 gene expression).
    – expression of p-glycoprotein transmembrane drug efflux pump.
    – induced by pre-treatment w/ steroids.
  2. When QoL is inadequate.
22
Q
  1. What is leukaemia?
  2. 2 leukaemia subdivisions.
A
  1. Neoplastic proliferation of haemopoietic cells originating from within the bone marrow.
    • Lymphoid i.e. originating from lineages of lymphocytic cells e.g. common lymphoid progenitor, NK cells, lymphocytes, plasma cells.
      - Non-lymphoid (aka myeloid) e.g. originating from neutrophil, basophil, eosinophil, monocyte, megakaryocyte, mast cell and erythrocyte cell lineages.
23
Q

How else can we classify leukaemia?

A
  • Acute – poorly differentiated, generally rapid disease course.
  • Chronic – well differentiated, generally insidious diseases.
24
Q

Clinical signs and general features of leukaemia.

A
  • Infiltration of neoplastic cells into bone marrow impedes production of normal haemopoietic cells.
    – can cause variable degrees of ‘penias’ as seen upon haematology e.g.: -
    –> Anaemia –> usually non-regenerative.
    –> Thrombocytopenia.
    –> Neutropenia.
  • High numbers of circulating neoplastic cells are usually seen (e.g. lymphocytosis) due to circulating neoplastic ‘lymphoblasts’.
  • Infiltration of liver and spleen generally common.
25
Q

How is a lymphoid leukaemia different to lymphoma?

A

Location of the cancer cells is different.
- Leukaemia – found primarily in bone marrow and blood.
- Lymphoma – exist mainly in LNs and lymph system.
Stage V lymphoma can look similar to lymphoid leukaemia, but patients w/ lymphoid leukaemia are unlikely to have significant lymphadenopathy.
Acute lymphoid leukaemia tends to affect younger patients, has a worse prognosis and is less responsive to chemo compared to lymphoma.

26
Q

General diagnostic principles for leukaemia.

A

Haematology and blood smear examination for leukaemia.
AND
Bone marrow aspirates and bone marrow biopsy.

27
Q

General treatment principles of leukaemia.

A

Chemotherapy.
But for chronic leukaemias, treatment may not be warranted: -
– may have no clinical signs and impact on patient welfare.
– may live like this for many years.

CVSOH1 Oncology and Pathology (9 decks)

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