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Fifa - Small Animal Medicine II > Hematopoietic Malignancies Part 1 > Flashcards

Hematopoietic Malignancies Part 1 Flashcards

1
Q

What is lymphoma ?

A

Lymphoma is a malignant tumor of lymphoid tissue

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2
Q

What is the prevalence of lymphoma?

A

Makes up 80 % of all hematopoietic tumors

and 1/4 of all canine cancer

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3
Q

Which breeds are predisposed to lymphoma?

A

Rottweilers, Boxers, Bull mastiffs, Golden Retrievers

Airdale Terriers

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4
Q

What are the 4 most common type of cancer that results in HYPERCALCEMIA

A

Anal sac adenocarcinoma, myeloma, mammary tumors and lymphoma

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5
Q

What are the clinical signs of canine lymphoma?

A

generalized painless lymphadenopathy

- others are non-specific unless lesion is affecting the organs

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6
Q

How would you dx canine lymphoma ?

A
  1. FNA / Cytology - majority of cases
    IF FNA is not diagnostic –> use 2-5
  2. Biopsy -> Necessary to DETERMINE SUBTYPES through histopathology
  3. PCR for antigen receptor rearrangements (PARR)
  4. Flow cytometry
  5. Immunophenotype
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7
Q

What is a normal lymph node cytology like ?

A

90% small lymphocytes

10% - other cells

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8
Q

What is a reactive lymph node cytology like ?

A

75-80% small lymph nodes
20-25% plasma cells
neutrophils and macrophages

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9
Q

When you see that there is >50% large lymphocytes or lymphoblasts, what grade of lymphoma does that indicate?

A

INTERMEDIATE to HIGH grade lymphoma

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10
Q

What is the advantage of histopathology?

A

Ability to evaluate the archietecture throughout the ENTIRE NODE

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11
Q

What is the most common B cell lymphoid tumor ?

A

Diffuse Large B Cell LSA / High Grade B Cell (50%)

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12
Q

What is the most common T cell/NK lymphoid cancer?

A

Peripheral T cell Lymphoma

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13
Q

What are the three histologic subtypes that have been prognostic

A

Diffuse Large B cell Lymphoma (high grade)
Peripheral T Cell Lymphoma (high grade)
Indolent T Cell Lymphoma (low grade)

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14
Q

How does PARR work?

A

Lymphocytes carry unique DNA sequence

With differentiation, there is rearrangement of genes in response to stimuli

  • B cells carry Ig
  • T cells carry T cell receptor

With neoplastic lymphoid cells - DNA is PERMANENTLY rearranged within the cell - CLONAL/ HOMOGENOUS population

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15
Q

What is immunophenotyping and how is it done?

A

testing that can discern B cell lymphoid cancer or T cell lymphoid cancer

  • immunohistochemistry (on tissue)
  • flow cytometry (cells suspended in fluid)
  • PCR / PARR for lymphoid cancer (on smears)
  • immunocytochemistry (on smears)
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16
Q

Describe the WHO Clinical Staging of Canine Lymphoma

A

Stage I - affects solitary node
Stage II - affects regional nodes-
Stage III - affects peripheral node
Stage IV - LIVER/SPLEEN/ MEDIASTINUM with/without peripheral nodes
Stage V - other ‘weird’ places : bone marrow or non lymphoid tissues

Substage a: animal does not present with systemic signs
Substage b : animal presents with systemic signs

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17
Q

Hypercalcemia is usually associated with B or T cell lymphoma?

A

T

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18
Q

What happens if you do not treat a dog with lymphoma?

A

Develop progressive anorexia, v+, d+

Survival ~ 4-6 weeks

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19
Q

CURES for HIGH GRADE LYMPHOMA are RARE. THERAPY is only PALLIATIVE

A

FACT

20
Q

What are the 6 chemotherapeutic drugs that can be used to treat lymphoma ?

A 
Prednisone 
Doxorubicin 
Vincristine
Cyclophosphamide 
L-Asparaginase 
CCNE
21
Q

Name the 4 criterias for remission

A

Complete response : normal palpation and imaging
Partial response : >30% reduction
Stable Dz: no partial response and no progressive dz
Progressive Dz: >20% increase

22
Q

Name the 4 criterias for remission

A

Complete response : normal palpation and imaging
Partial response : >30% reduction
Stable Dz: no partial response and no progressive dz
Progressive Dz: >20% increase

23
Q

How do you assess response to therapy?

A

physical examination - node assessment and measurements… and palpation of spleen

Imaging may be necessary

24
Q

How do you treat High Grade Lymphoma using a single agent therapy?

A
  1. Glucocorticoids - animal will live for another 1-2 months
  2. Chemo
    - Vincristine
    - Cyclophosphamide
    - L- Aspariginase
    - Lomustine / CCNU
    - 50% response of 203 .months duration
25
Q

What is the STRONGEST chemotherapeutuc agent that you can use for High Grade Lymphoma

A

Doxorubicin

- higher response/longer remission duration of 6-7 months

26
Q

Why are multiple agents preferred for the treatment of High grade lymphoma

A

Larger tumor volume = higher rate of mutations
Inherently resistant neoplastic cells are present

Different mechanisms of action of each agent and you can minimize overlapping toxicities –> BETTER RESPONSE

27
Q

Explain the CHOP based protocol for High Grade LSA

A

Cyclophosphamide
Hydroxydaunorubicin (Doxorubicin)
Oncovin = Vincristine
Prednisone

  • 80-90% response with remission of 9-12 months
28
Q

When does one begin therapy?

A

AFTER a confirmation of lymphoma is obtained

29
Q

Under the many actions of prednisone, a reduction in size of the lesion/ LN is NOT dx for lymphoma or any other cancer.

A

WORD.

30
Q

When does one begin therapy?

A

AFTER a confirmation of lymphoma is obtained

31
Q

Under the many actions of prednisone, a reduction in size of the lesion/ LN is NOT dx for lymphoma or any other cancer.

A

WORD.

32
Q

How does radiation cause cell death

A

Double stranded breaks in DNA

33
Q

MULTI AGENT Chemo are typically NOT used for low grade, small cell lymphoma

A

true

34
Q

How do you treat low grade, small cell lymphoma ?

A

Prednisone and/or chlorambucil for those that have signs or internal involvement.

35
Q

What is the epidemiology of feline LSA ?

A

Higher risk patients - FeLV, FIV and cats exposed to passive cigarette smoke

  • Heritable in Siamese cats - young
36
Q

What is the prognosis for low grade/small cell lymphoma ?

A

GREAT. > 90% alive after 1.5 years of dx

37
Q

What are the three major forms of lymphoma in cats?

A

Lymphocytic = low grade
Intermediate grade - rare
Lymphoblastic - high grade

38
Q

What are the three major forms of lymphoma in cats?

A

Lymphocytic = low grade

39
Q

How can Lymphoblastic / high grade lymphoma(feline) be diagnosed?

A

FNA

40
Q

Where is the most common anatomic location for lymphoma

A

Gastrointestinal

41
Q

Gastrointestinal lymphoma is associated with _____ infection.

A

Helicobacter

42
Q

How do you dx feline lymphoma?

A

Radiographs

Abdominal U/S

43
Q

How do you dx feline lymphoma?

A

Radiographs
Abdominal U/S
Endoscopy
Surgical Exploratory –> BIOPSY !

44
Q

What is Lymphocytic GI lymphoma?

A

Small mature lymphocytes

- can be a challenge to differentiate from IBD

45
Q

Differentiate Lymphocytic GI lymphoma and IBD

A

IBD - mixed population

Lymphoma - monoclonal population of T cells

46
Q

Multi agent chemo is NOT necessary for Feline LymphoCYTIC Lymphoma. How do you tx it then?

A

FACT

Prednisone and Chlorambucil

47
Q

How would you treat LymphoBLASTIC Lymphoma ?

A

COP or CHOP protocol

In cats, doxorubicin alone is ineffective

Fifa - Small Animal Medicine II (6 decks)

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