Clinical Oncology

Question 1

What are the differential diagnoses for a patient with a mass lesion?

Answer 1

Inflammatory lesion e.g. abscess, granuloma
Infectious (Leishmaniasis)
Haematoma
Cyst

Question 2

What is the most common diagnostic method used for a mass lesion and what diagnostics does it tell you?

Answer 2

Fine needle aspiration- tells you the cell type, inflammation vs neoplasia, benign vs malignant

Question 3

What are the three cell types found in tumours?

Answer 3

Round cells
Mesenchymal cells
Epithelial cells

Question 4

What indicates a mass is malignant? (6)

Answer 4

Cellular Pleomorphism (different cell shapes)
Nuclear pleomorphism
Multinucleation
High Nucleus: Cytoplasm ratio
Mitotic figures
Increased cytoplasmic basophilia

Question 5

If cytology is not diagnostic… what now?

Answer 5

Biopsy to look ay tissue architecture, invasion of surrounding tissues, blood vessels/ lymphatics, necrosis, tumour grade

Question 6

What does Immunocytochemistry show us?

Answer 6

Type of antibodies and proteins in the mass- good for refining the diagnosis

Question 7

What does the grade of a tumour depend on? (5)

Answer 7

Mitotic index
Degree of cellular differentiation
Amount of necrosis
Invasion of surrounding tissues
Invasion of vasculature/ lymphatics

Question 8

What two grading systems are used to grade tumours?

Answer 8

Patnaik system- grade 1-3
Kiupel system- divided into low and high grade (no middle ground)

Question 9

What do we mean by staging a cancer patient and how is this done?

Answer 9

assesses the extent of disease using imaging
[called the TNM system]

Question 10

What is the first part of staging a tumour?
Hint- the T

Answer 10

Looks at size, mobility and gives it a grade T1, T2, T3 etc. based on those

Question 11

What is the second part of staging a tumour?
Hint- the N

Answer 11

N= imaging of the internal nodes to decide if metastasis is present
N0 means the closest lymph node is clear of cancer cells
N1 means it is not clear

Question 12

What is the last part of staging a tumour?
Hint- the M

Answer 12

M= Metastasis- uses imaging to scan the whole body and see if any other masses come from the same initial tumour

Question 13

What is the WHO staging for Lymphoma?

Answer 13

classifies staging based on how many lymph nodes and lymph tissues are involved

Question 14

What are paraneoplastic effects?
Give an example

Answer 14

an effect that occurs away from the tumour in distant parts of the body
e.g. hypercalcaemia can occur due to PTH-rp secretion
e.g. hypopglycaemia, thrombocytopenia

Question 15

What are the three main treatment options for cancer in animals?

Answer 15

Surgery
Chemotherapy
Radiotherapy

Question 16

When is surgery indicated as a cancer treatment?

Answer 16

for localised tumours such as carcinomas, sarcomas, mast cell tumours
[often in combination with radiation or chemo]

Question 17

When is Radiation therapy indicated for cancer treatment?

Answer 17

With cancers that have a high risk of recurrence
With cancers where surgery would be too invasive e.g. nasal tumours
To shrink a tumour prior to surgery

Question 18

When is Chemotherapy indicated?

Answer 18

For tumours that have high metastatic potential such as haematopoeitic tumours
Or when surgery/ radiotherapy is not possible

Question 19

What can we do as supportive care for Cancer patients?

Answer 19

Nutritional support & Hydration via IV
Anticipate and treat adverse effects before they occur e.g. give gastric protectants, anti emetics and appetite stimulants

Question 20

When would we give antibiotics with Chemotherapy?

Answer 20

if the chemotherapy causes neutropenia