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VMS4008 - EQUINE > Equine Neoplasia & chemotherapy > Flashcards

Equine Neoplasia & chemotherapy Flashcards

(71 cards)

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1
Q

Describe what sarcoids are?

A

Fibroblastic transformation of equine dermis
- Locally invasive
- Non-ùetastatic
- rarely regress spontaneously

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2
Q

What aetiology of sarcoids?

A

Association with BPV 1 & 2
- BPV DNa and viral oncogenes can be detected in sarcoid tissues
- harder ot induce dx with BPV

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3
Q

Who are affected by sarcoids?

A

2-8% of horses - all members of equid family worldwide

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4
Q

Disease severity associated with?

A
  • Viral load
  • Individual immune response
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5
Q

What are the 6 different types of sarcoids?

A
  • Occult
  • Verrucose
  • Nodular
  • Fibroblastic
  • Mixed
  • Malevolent
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6
Q

Describe occult sarcoids?

A
  • Represent earliest form of
    the disease.
  • Can remain stable for many
    years.
  • Usually appear as a roughly
    circular hairless area or
    altered hair quality.
  • DDx: Ringworm
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7
Q

Describe verrucose sarcoid?

A
  • Grey, scaly or warty
    appearance.
  • Frequently coalesce into
    larger lesions.
  • DDx: Ringworm or rubs
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8
Q

Describe Nodular sarcoids?

A
  • Easiest to see and identify.
  • Discrete firm nodules under
    the skin.
  • Categorised on whether
    adherent to overlying skin or
    bound to deeper structures.
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9
Q

Describe Fibroblastic sarcoids?

A
  • Fleshy and aggressive
    appearance.
  • Ulcerative.
  • Quick to grow.
  • Often pedunculated.
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10
Q

Described mixed sarcoids?

A
  • Very common presentation.
  • Often verrucose that develop
    nodular component.
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11
Q

what common locations of sarcoids?

A
  • Head and Neck (around eyes, ears and lips)
  • Extremities
  • Axilla
  • Ventral abdomen
  • Inguinal region
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12
Q

Where do they usually arise?

A

areas of previous skin trauma ddx:proud flesh but also spontaneous

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13
Q

What tx options for sarcoids?

A
  • surgical
  • Immune modulation
  • Chemo
    Radiotherapy
  • Cryotherapy
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14
Q

Describe surgical tx?

A

o Ligation (‘banding’)
o Sharp resection
o Laser surgery
o SMART surgery
o (combination therapy)

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15
Q

Describe immune modulation?

A

o Topical (Imiquimod)
o Intralesional (BCG: Mycobacterium
cell wall fraction)

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16
Q

Describe chemo?

A

o Topical (5-FU, AW4-LUDES,)
o Intralesional (5-FU, cisplatin)

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17
Q

Make a table of pros and cons for tx options of sarcoids?

A
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18
Q

ligation sx?

A

cheap and easy

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19
Q

sharp resection?

A
  • Wide mrgins rq (9-16mm reported to be sufficient)
  • Recurrence common w/in 6 months
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20
Q

SMART surgery?

A

one cut one blade

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21
Q

Electrosurgery?

A

high success rate when performed under GA with 12mm margins

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22
Q

Laser surgery?

A

(diode or Carbon laser)
o 60-80% success rate reported (Diode better than CO2).
o Recurrence common particularly with verrucous sarcoids.
o Often favoured over sharp resection.
o Wound heals by secondary intention- prolonged healing

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23
Q

What is used in immunotherapy against sarcoids?

A

Imiquimod - >immune modifier - amplifies local immune response

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24
Q

How good is Imiquimod?

A

Good responses reported
60% resolution
80% reduction in size

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25
Side effects of immunotherapy?
minimal -> alopecia, erythema, depigmentation
26
How to admin imiquimod?
Long course therapy - Applied 2-3 x weekly for 4-6 months - Can be applied by owner (PPE!)
27
Describe AW5 Ludes Cream?
"liverpool cream" - Heavy metals - 5-fluorouracil & thiouracil
28
How does it work (AW5Ludes)?
caustic - causes cell necrosis of sarcoid
29
Considerations of Ludes cream?
- Varying strengths - 3-5 days - Not licensed, compounded product - Only available through Equine Medical solutions and cannot be dispensed to owners
30
Describe the use fo 5-Fluorouracil (5-FU) 5% topical cream?
- Anti-metabolite (inhibits DNa replication with limited effect on normal skin - Only penetrates to depth approx 2mm -> superficial lesions (Verrucose or occult sarcoids)
31
How to apply/ use 5-Fluorouracil?
Daily application for 3-4 weeks - Variable success - Safe for owners to use with precautions -> Carcinogenic an dmutagenic -> gloves, lesion dressings & biological disposal
32
T/F there is an injectable formulation of 5-FU for intra-lesional admin?
TRUE
33
Describe Cisplatin use for intralesional chemo?
- Heavy metal comoiunds which inhibits DNa synthesis - Used to treat small solid tumours or act as adjunct following debulking
34
What two approaches for use fo cisplatin?
1. 1 ml of an aqueous solution of 10 mg cisplatin/ml and 2 ml sesame oil, used at a dose rate of 1 mg cisplatin/cm3 of tumour. 4 injections at 2 wk intervals. 2. Cisplatin impregnated beads, implanted in each 1cm3 of tissue. 2 applications, 1 month interval.
35
How is intralesional chemo done?
- Under GA - Careful with human health
36
what side effects of cisplatin impregnated beads?
alopecia, swelling, scarring -> BUT improved safety profile to intra-lesional injection
37
Describe Cisplatin Electrochemotherapy
* Utilises electrical field pulses to increase cell membrane permeability (electroporation). * Increases cisplatin delivery to tumour. * Requires GA. * No. of treatment depends on size, location and depth of infiltration
38
What is intra-lesional tx with mycobacterium cell wall fraction immunostimulant ?
BCG - attenuated strain of M.bovis - Stimulates local cell mediated immune response - Hard to obtain
39
What product / How to admin for Mycobacterium cell wall intra-lesional tx?
- Immunocidin - Special import license - Injected at 2 week intervals repeated as required
40
Success with mycobact tx?
reasonable 52.9% complete resolution -> good for peri-ocular sarcoids where laser or topical nto an option
41
Describe raidotherapy?
Brachytherapy with gamma radiation -> Gold standard?
42
Describe low and high dose RadioT?
Low dose-> iridium wires implanted into tissues for 2-3 weeks High dose - gamma radiation source delivered in pulses within single treatment period High success rates with or without debulking
43
Limitations of radiotherapy?
- Very expensive - Limited availability - Major safety restrictions - May require long tiem to see effect
44
What else can be used for Radiotherapy?
=> STRONIUM PLESIOTHERAPY - Locally applied - Superficial form of radiotherapy - Limited penetration - Only suitable for small, superficial lesions
45
Benefits of strontium?
- isolation not required - Performed under standing sedation - Cost effective
46
Cryotherapy ?
- Appplication of liquid nitrogen/ C2 to destroy tumor cells - 3 freeze thaw cycles, bringing sarcoid tissues to -20 to -30°C => induces cell rupture => include margin of normal skin
47
When is cryotherapy helpful?
- For occult or verrucose sarcoids - combo therapy to treat tissue following surgical/ laser resection
48
Describe SCC in horses
- Primary SCC is the 2nd most common equine tumours - Metastases common - Restricted to squamous epithelium -> proliferative form, uclerative form
49
What locations most commonly seen?
- Periorbital and genital SCC - Mucous and muco-cutaenous junctions
50
What risk factors to SCC?
- UV light exposure -> non pigmented skin - Also Equine papillomavirus-2 - Genetics
51
Describe Periorbital SCC?
- Mean age 13 yrs - Account for 72% of mucocutaenous SCC - Inc prevalence in Paint, quarterhorses, Apaloosas & draught - Most arise from conjunctiva or cornea - Raised, pink white mass with irregular surface
52
Describe Genital SCC ?
Mean age 19-21yrs - Genital forms in younger animals tend ot have higher rate of malignancy - Evidence that there may be an association with Equine Papillomavirus - Very rare to see ins tallions vs geldings
53
SCC diagnosis?
- Based on clinical presentation - Biopsy required for definitive diagnose (often exisional)
54
DDX for SCC?
- Sarcoid - Papilloma - Proud flesh - Melanoma
55
Tx options for SCC?
* Radiation (Gold standard in suitable sites) * Surgical excision with wide margins. * High recurrence rate. * Cryosurgery * Topical/intralesional chemotherapy * 5FU/Cisplatin/Mitomycin-C
56
How to treat 3rd eyelid lesions?
Surgical excision (resect entire nictitating membrane).
57
How to treat palpebral lesions?
Palpebral lesions – Surgical excision + Cryotherapy/radiotherapy.
58
How to treat corneal lesions?
Lamellar keratectomy + chemotherapy after cornea healed. – Mitomycin C solution.
59
Hwo to treat genital form SCC?
* Surgical resection + adjunctive therapy (cryotherapy). => En-bloc resection of glans penis. * Prolonged topical treatment with 5-fluoruracil.=> Early intervention better – treat when small
60
SCC prognosis depends on what?
1. The site of the lesion and its suitability for any effective therapy 2. The malignancy of the tumour itself 3. The duration of the lesion and failed attempts to treat it 4. The extent of secondary consequences arising from the tumour.
61
T/F SCC in horses tend to be more malignant than in other species?
False - less!
62
T/F Gastric carcinoma, oropharyngeal carcinoma and penile carcinoma in younger geldings usually more malignant than others
true
63
What three different melanomas can we come across?
64
Detail dermal melanoma?
* Affects older grey horses almost exclusively. (Approx 80% prevalence in aged populations) * Single (DM), multiple or coalescent cutaneous spherical nodules. * Most prevalent in perineal skin. (Can also develop in parotid LN and salivary glands.)
65
How does melanoam behave?
- SLOW growth - Can reach considerable size - Ulceration is common
66
Tx for melanoma?
Limited for large lesions - surgical resection early otherwise close monitoring
67
tx for isolated lesions?
Can be treated as soft tissue neoplasm => - Surgical excision +/- adjunctive chemo - Intralesional chemo (cisplatin beads)
68
What si the Melanoma Vaccine?
- Limited evidence to support the use at thsi time but anecdotal evidence promising - Combine with surgical resection
69
Prognosis for melanoma?
- Good if uncomplicated and not inconvenient site - Unpredictabel progression
70
Noeplasia in donkeys?
MSOT common is sarcoid
71
How common is use of systemci chemo in equine therapy?
- RARE - Lymphoma most common to use for - usually prednisolone palliatively 1-2mg PO SID

VMS4008 - EQUINE (30 decks)

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