Exam 2 Spring Flashcards

Question

Paraneoplastic Polycythemia; Tumor Types, Clinical Signs, Treatment

Answer 1

Tumor  Renal cell tumors  Lymphosarcoma  Hepatic tumors  Nasal fibrosarcoma Clinical Signs  motor or sensory depression, dullness, lethargy, seizures  Epistaxis  hyphema Treatment  Phlebotomy  Remove or treat primary tumor  Hydroxyurea

Answer 2

Tumor  large thoracic or abdominal cavity mass Clinical Signs  Pain, reluctance to move  “swollen legsor swollen joints”  Periosteal proliferation of new bone along the shafts of long bones Treatment  Treat or remove primary tumor  Corticosteroids  NSAIDS  Bisphosphonates  Vagotomy

Answer 3

prescapular node  Front leg popliteal node  Hind leg below knee inguinal node  Hind leg above knee  ventral abdomen sublumbar (intenal iliac) nodes  Anal  perianal area hilar nodes  Lungs sternal node  Abdomen

Answer 4

o Intra-abdominal masses or organ infiltration Tumors on caudal half of body w/ tendency to metastasize via lymph  MCT, perianal gland tumors, mammary tumors Tumors w/ high propensity for vascular or lymphatic metastasis  spleen and liver  grade III MCT, histiocytic tumors, lymphoma, hemangiosarcoma o Unknown primary

Answer 5

Spleen  Mast cell tumor  Histiocytic Sarcomas  lymphoma Liver  Mast cell tumor  lymphoma  MSA in cats

Answer 6

Clinical Signs  PU/PD  Neuro signs  Bleeding Tumors  Plasma cell  LSA/leukemia Diagnosis  Monoclonal gammopathy  Protein electrophoresis  Bence-jones proteinuria

Answer 7

Tumor  thymoma Diagnosis  Anti Ach receptor antibody test

Answer 8

5 Flurouracil  seizures and death Vincristine  peripheral neuropathy

Answer 9

Cutaneous flushing  Pheochromocytoma  Mast cell tumors Nodular dermatofibrosis in German Shepherd dogs  Linked to renal cysts or cystadenocarcinomas Alopecia  Pancreatic carcinoma in cats  thymoma Shiny skin in cats  Pancreas tumors

Answer 10

o Benign & malignant tumors recur if incompletely excised o Surgery alters vascularity, immune system, and tissue planes which allows recurring tumors to be more o Second surgery is not a replacement for good first surgery Limitations  not useful if tumor has or will metastasize  Cosmesis and functionality, removed tissue must be expendable

Answer 11

o Deposition of energy on or near DNA o Direct and indirect actions o Breakage of DNA o Cells die when they try to divide o Kills a constant proportion of cells o Damages normal and cancer cells Limitations  Must be Local disease  Surrounding normal tissue must tolerate radiation  Radiation sensitive tumor type  Anesthesia requirements

Answer 12

Repair * Normal cells will repair their DNA ~6hrs after radiation Repopulation * Normal cells tell neighbors to start divide * “wound healing” Re-oxygenation * Need oxygenation up front but re-oxygenation probably doesn’t happen Redistribution * Those in mitosis are more sensitive * Cells not in mitosis withstand radiation better

Answer 13

 Time period which allows reoxygen and redistribution in tumor, & repopulation and repair in normal cells  Large total dose (tumor control)  Small fraction (less late effects)

Answer 14

Superficial * Use electrons Deep * Use photons

Answer 15

 Hair loss  Moist dermatitis  Mucositis (conjunctiva, oral cavity, nasal passages)  Intestine or bladder inflammation  Nervous tissue inflammation/edema  Crusting, oozing skin

Answer 16

o A few very large doses of radiation versus many small ones o May kill cells not rapidly dividing better than traditional therapy. o May damage blood supply almost more than tumor o Can only be done if dose is very closely conformed to the tumor

Answer 17

 Only therapy for systemic or metastatic dz  Act on rapidly dividing cell populations by interfering w/ DNA synthesis or cell division  Variety of drugs with a variety of mechanisms  Works via log kinetics  kills a constant proportion of cells with each dose  Highly non-specific  exploits a macro difference in cells (rapid growth)  Randomly developed

Answer 18

Alkylating Agents * Chlorambucil, * Cyclophosphamide, * Lomustine, * Melphalan Antimetabolites Antitumor Antibiotics * Bleomycin, * Doxorubicin * Mitoxantrone, Spindle Cell Poisons * Vinblastine * Vincristine * Vinorelobine * Taxols Platinum drugs * Carboplatin * Cisplatin

Answer 19

 Multiple drug resistance develops over time due to cell mutation or inherent characteristics  Drug delivery/drug getting to tumor  Side effects to Bone marrow, Alopecia/ Hair loss, Allergic reactions, GI

Answer 20

Kidney * Cisplatin, * Doxorubicin (cat), * Lomustine Heart * Doxorubicin Bladder * Cyclophosphamide Pancreas * Elspar * Doxorubicin Nervous System * Vincristine * 5 FU (especially cats) Hepatic * Lomustine Lungs * Cisplatin (cat), * Bleomycin, * Lomustine, * Tanovea

Answer 21

o single drugs are unlikely to cure bulky disease o multiple drugs may help fight development of resistance o toxicity may be less with low doses of multiple drugs versus large doses of single drugs

Answer 22

Primary  Only curative for germ cell tumors, lymphoma, venereal tumors Adjuvent  Chemo combined with something else to reduce tumor burden.  Important when tumor is not rapidly growing or sensitive to drugs  Greatest chance for cure is shortly after surgery

Answer 23

o Quick IV OR o Slow Infusion to decrease cardiac toxicity o Severe tissue reaction if extravasated o Catheter wrapped so that vein is clearly visible

Answer 24

Cryotherapy  Only successful when tumor is small and superficial Photodynamic Therapy  Combination of a photosenzitizing agent and light  Superficial tumors only (limited by diffusion of light) Electrochemotherapy  traditional chemotherapy drugs (commonly Bleomycin)  PLUS pulsed electricity to facilitate drug uptake

Answer 25

o Mutated signal proteins often oncogenic o Increased potential for proliferation, invasion, metastasis o Increased angiogenesis o Shortened survival of patients o Poor response to standard chemotherapy o Poor prognosis

Answer 26

o main mediators of the signaling network that transmit extracellular signals into the cell o control cellular differentiation and proliferation How do they cause cancer  Overexpression of RTK proteins  Functional alterations caused by mutations in the corresponding genes -> Gain of function  Abnormal stimulation by autocrine growth factor loops -> Increased stimulation

Answer 27

Mechanism  Block signalling  Must be used for life or signal starts again Drugs  Toceranib phosphate (Best)  Masitinib (not available in US)  Significant GI and potential bone marrow suppression from both

Answer 28

o Most effective in prevention of metastasis or regrowth Vascular disrupting agents (VDAs)  Given only intermittently  designed to induce rapid and selective vascular shutdown in tumors Suppression of endothelial cell growth and recruitment from bone marrow  given continously  Most useful when tumor burden is low

Answer 29

Small molecules that exploit differences between tumor & normal endothelium to induce severe vascular dysfunction * Toceranib** * Thalidomide Metronomic Chemo * Low dose daily dosing of traditional drugs * Theory- stop endothelial cells from multiplying in, and homing to neoplastic tissues

Answer 30

Chlorambucil * Urothelial carcinomas * MCT, STS, Thyroid Cyclophosphamide * soft tissue sarcomas * inflammatory immune response as well as anti-angiogenisis Lomustine * Don’t use * renal and hepatic toxicty Satraplatin (oral platinum agent)

Answer 31

Active Nonspecific  Bacteria, cell components, or chemical agents  Increase immune system generally Active Specific  Genetically engineered antigen source designed to stimulate an immune response against an established tumor  Tumor vaccine to activate T-cells Passive  Monoclonal antibodies specific for tumor  None work in vet med so far

Answer 32

o Destroy immunosuppressive environment around the tumor o Metronomic chemo o Cimetidine

Answer 33

o Correct the genetics of the tumor o Stimulate cytokine production o Limited by transduction efficiency (ability to get into cell)

Answer 34

o Many tumors have up-regulation of Cox-2 o Especially carcinomas o Meloxicam easiest for cats o Selective Cox-2 might be better than general (Firocoxib)

Answer 35

o One of the most common cancers seen in the dog o Can occur in any organ in the body o Majority are B cell in origin o Extremely sensitive to chemotherapy but usually not curable o 85-90 % will achieve remission with chemotherapy o Average survival is ~ 1 year o May cure more patients if we allowed more side effects Diagnosis & Phenotyping  Flow cytometry (best but difficult)  Immunocytochemistry  PARR assay  Histopathology  Immunohistochemistry

Answer 36

 I- Single node (or organ)  II- Group of nodes on one side of diaphragm  III- Generalized lymph node involvement  IV- Spleen or liver involvement  V- Bone Marrow, CNS, or other organs Sub-stages  a- no symptoms  b- symptoms / sick

Answer 37

 Substage b  Stage greater than III  T-cell  Hypercalcemia  Icterus  Hypoproteinemia  Prior prolonged treatment with glucocorticoids

Answer 38

No therapy * ~1mo Prednisone * ~2mo Cyclophosphamide, Vincristine, & Prednisone (COP) * ~4-6mo Elspar + COP * 4-6mo COP + Doxorubicin +/- Elspar (Madison Wisconsin Protocol) * ~8-9mo

Answer 39

Surgery * Only if we are sure it is a single node / organ Radiation therapy * Selected locations, particularly nasal LSA in cats (careful staging) * Half body radiation therapy * Whole body radiation therapy and bone marrow transplantation

Answer 40

 COP +/- Elspar (intermediate grade)  Madison Wisconsin 6 month protocol (internal forms)  Single node or nasal radiation therapy useful but be sure the cat has stage I disease only  More side effects than in dogs

Answer 41

No treatment * 1-2 months With chemotherapy * 3-8 months Nasal LSA * 18-24mo Stage V (CNS or bone marrow) * Poor prognosis FeLV (+) * 6 mo

Answer 42

 Weakness/ depression/ lethargy / anorexia  Fever  Bleeding  hypercalcemia  lymphadenopathy,  splenomegaly  neurologic signs  ocular signs- uveitis or hyphema  bone pain, lameness, joint swelling

Answer 43

 Flow cytometry of blood or anticoagulated bone marrow  Bone marrow exam Acute * Presence of blasts and very high numbers (100,000- 800,000) * May require cytochemical stains or flow cytometry to determine cell origin Chronic * Over abundance of one mature cell type in high numbers (>30,000) * Most commonly lymphocytic Aleukemic * anemia, thrombocytopenia, or pancytopenias

Answer 44

Acute Lymphocytic Leukemia * more aggressive treatment than solid forms * Anthracycline and Elspar +/- Cytosar Acute Non-Lymphocytic Leukemia * Prognosis is extremely poor * Combinations of cytosine arabinoside and an anthracycline ASAP * lots of support! Chronic Lymphocytic leukemia * Chlorambucil (2-6 mg/m2) every other day alternating with prednisone * Survivals can be quite long-1-3 years

Answer 45

Plasma cell tumors  localized and benign  skin, oral cavity, GI tract, anywhere  local surgery, radiation or electrochemotherapy  Need to rule out systemic disease Multiple myeloma  metastatic plasma cell tumors  Presents as punched out bone lesions (diagnosed via aspirate of BM or lesion)  Hypergammaglobulinemia  Treat systemically w/ Melphalan and Prednisone  Can have very long survivals if managed properly (1.5 years)

Answer 46

Clinical Signs  Can look like anything  Often present w/ flushing & swelling (Darier’s sign)  Dogs w/ external skin masses  Cats w/ systemic signs or skin masses  GI ulceration  impaired healing locally  coagulopathy  hypotensive shock- rare  urticaria  eosinophilia, basophilia Diagnosis  Cytology w/ round granular cells  Histo required for grading

Answer 47

 No grades for SQ but usually less aggressive Grade 1 * Well differentiated * superficial * Prognosis nearly always good * Stage w/ Lymph node check, CBC, Chem Grade 2 * Well to medium differentiation * SQ involvement * Variable prognosis * Stage w/ Lymph node check, CBC/Chem, ultrasound, spleen/liver aspirate Grade 3 * Poorly differentiated * Prognosis nearly always very poor * Stage w/ Lymph node check, CBC/Chem, ultrasound, spleen/liver aspirate, bone marrow aspirate <5 mitotic index * less likely to recur or metastasize >5 mitotic index * More likely to recur or metastasize

Answer 48

Low grade and stage & surgically approachable * should be treated with surgery * 3cm margins is best. Low grade and stage but not surgically removable * Electrochemotherapy * Radiation therapy- but the tumor needs to be dividing for this to work Intermediate grade * usually treatable as local disease * if metastases are found or mitotic index is high -> chemotherapy High grade regardless of stage * chemotherapy as part of therapy.

Answer 49

H1 blocker * diphenhydramine * Prevent bronchoconstriction, vasodilation H2 blocker * cimetidine, ranitidine, famotidine * omeprazole * Prevent gastric ulceration Corticosteroid * Prednisone * Decrease immune reaction to histamine

Answer 50

 Vinblastine, Lomustine, prednisone (WSU) Toceranib * Decent response * Long-term * Toxicity Tigalate injection * Causes major local inflammatory reaction to blast hole into skin and destroy tumor

Answer 51

o Can be on skin (less common) o Splenic/Visceral o Gastrointestinal o Often present for vomiting o Mass in abdomen, aspirate yields mast cells (3rd most common intestinal mass in cats) o Often circulating mast cells in blood (Buffy coat smear or on CBC) Treatment  Corticosteroids, H1 and H2 blockers  Remove tumor- spleen or intestine  Splenic form- stop therapy after surgery (longer survival than GI)  Intestinal form may require therapy for life

Answer 52

o Round Cell Tumors o macrophages or dendritic antigen presenting cells Clinical Signs  Masses often associated with muscle groups or joints but can be anywhere  Quite painful Diagnosis  May require IHC stain  Granular, round, multinucleated cell on cytology Treatment  Surgery if removable with minimal morbidity and no metastatic disease found  Radiation therapy (palliative protocol)  Chemotherapy with Lomustine as follow up to local control or as only therapy

Answer 53

o Langerhans cell proliferation o Presents for dermal nodule in a young dog, often on extremities. o Spontaneously regress or removal curative

Answer 54

o Malignant Histiocytosis o Most likely phagocytic macrophages o Most common in Bernese Mountain dog, but can occur in other breeds o Present for severe anemia o Coombs's negative o No effective treatment at this time

Answer 55

o Arise from supportive tissue o Grade maybe more important than type Biologic Behavior  Locally aggressive, invasive, poorly defined margins  Slow to metastasize  Spread to lungs more than LN’s  Mitotic index may be most important prognostic indicator  10-19 grade II  >20 is grade III Diagnosis  Cytology (suggestive)  Incisional or excisional biopsy (definitive) Staging  Tumor measurement w/ US, CT, MR  Lymph nodes  Thoracic rads for metastasis

Answer 56

Surgery * 3cm margins in all directions * Submit all tissue for histo Radiation * Best for minimal disease or incomplete surgical margins * Gross tumor requires higher total dose or coarse fractioned therapy (more dose each fraction) * High dose difficult to achieve in some locations Chemo * Doxorubicin * VAC (Vincristine, Doxorubicin, Cyclophosphamide) * Doxorubicin and DTIC Metronomic Chemo * Low dose cyclophosphamide or chlorambucil plus NSAID

Answer 57

Low grade tumor * Surgery alone can be curative (done properly!) * Surgery with follow-up radiation or metronomic chemo when margins not adequate High grade tumors * High potential for metastasis (at least 40%) * Surgery +/- radiation +/- chemo Non-resectable tumors * Palliative radiation + metronomic therapy?

Answer 58

o Associated w/ vaccines Rule of 1-2-3  remove a mass at a vaccine site when…  1 - Still growing at 1 month  2 - Greater than 2 cm in size  3 - Still present at 3 months post vaccination Biological Behavior  Locally extremely aggressive  10-25%metastasize Staging  Tumor needs to be measure w/ MR Prevention  Never use killed virus vaccines in a cat which has had a VAS (including family members)  Vaccinate low on limbs or over abdominal fat to facilitate tumor removal  Always record where vaccine was given and lot number- Drug companies will pay for therapy.  Remove any thing suspicious promptly with margins

Answer 59

Surgery * be careful, plan well, remove with margins the first time! * 5 cm or 2 facial planes required for cure * If the first surgery leaves dirty margins the cat may have no hope for long term tumor control! Radiation * Most helpful pre or post surgery as adjuvant therapy when margins are clean but < 5 cm. * Radiation of gross disease or dirty margins use palliative protocols Chemo * May help shrink tumor (not much evidence)

Answer 60

Signalment  mid to older aged dogs, also peak at 18-24 months  Large / giant breeds  males > females  neutered > intact Clinical Signs  Lameness  Swelling Diagnosis  Rads initially  Cytology w/ Alk Phos staining  Histo is gold standard but difficult to get biopsy

Answer 61

 Lung rads & CT (better) for mets  Bone scan or rads for mets  Poor prognosis w/ lung, bone, or lymph node mets or elevated Alk Phos

Answer 62

No therapy o pain Amputation / no chemo o 4-6mo Radiation for pain control, or pain meds o 4-6mo Bisphosphonates o 6mo+

Answer 63

Appendage tumors o Amputation & chemo (Doxorubicin) o Vx against Her-2/Neu/EGFR o Radiation and then amputation o Losartan for dirty margins Axial Tumors o Difficult to treat o Removal if possible +/- chemotherapy o survival longer than for long bone tumors because metastasis comes slower o palliative radiation and chemo for oral osteosarcomas

Answer 64

o Rare o Mets much slower than dogs o Amputation is treatment of choice

Answer 65

Origin  Arises from vascular endothelial cells (may be of bone marrow origin)  Common on spleen! Signalment  Large breed dogs (German shepherd, golden retriever and Labs)  Mean age 8-13 years (as young as 3 years)  Possible male predominance Biologic Behavior  Extremely aggressive tumor that has a high rate of early development of metastasis  Endothelial cells can go anywhere they want to and can arise in multiple sites simultaneously.  25% have right atrial involvement at diagnosis  14% can have brain metastasis at diagnosis

Answer 66

Clinical Signs  Mass on Spleen, liver, right atrium, Kidney, SQ tissues/muscle, oral cavity, urinary bladder, pericardium and peritoneum, bone.  Bleeding  sudden collapse, weakness, pallor  sudden cardiac tamponade  Sudden enlargement of a mass Diagnosis  requires histo but many suggestive features can point to the diagnosis  Splenic lesions  Evidence of splenic bleeding or rupture  Right atrial masses with pericardial hemorrhage  Ultrasound appearance of cellular fluid filled masses- any location.  Aspiration for cytology, or biopsy yielding only blood.  Schistocytes or Acanthocytes in blood smear  Evidence of DIC- elevated coags or D-dimers or FDP’s  Plasma troponin 1 concentration high in pericardial fluid

Answer 67

Treatment  Surgical removal of spleen, right atrial mass, some SQ masses  Radiation for SQ or heart base masses  Chemo w/ Doxorubicin  Metronomic chemo w/ cyclophosphamide or chlorambucil  Usually always need some type of systemic treatment Prognosis  Poor  Better if SQ

Answer 68

CBC, Chemistries, UA * normocytic normochromic anemia, NRBC, fragmented red cells (schistocytes, acanthocytes) * neutrophilia, thrombocytopenia Thoracic rads- essential * Identify mets * Identify cardiac lesions Cardiac Ultrasound * Identify cardiac lesions (better than rads)

Answer 69

o Light coat color, thin skin dog and cat disease o Likely it is sunlight induced o If the tumor does not invade into deeper tissues this a surgically curable disease o If a patient keeps getting cutaneous lesions it can metastasize internally and cause serious disease

Answer 70

Signalment  Female  Intact  Spayed late  Use of synthetic progestins  obesity Clinical Signs  Mammary mass  inflamed plaque like lesions or multiple nodules in the skin  diffuse edema in the mammary area.  respiratory, neurologic signs or bone pain secondary to metastasis (rare) Biologic Behavior  50% are malignant  50% of malignant are low grade  Most important factors are size, completeness of removal, and presence of ulceration  Inflammatory are extremely aggressive

Answer 71

Diagnosis  Cytology is never diagnostic for malignant versus benign but can help diagnose something other than a mammary tumor  Requires histopathology Staging  Evaluate local tumor  Lymph node palpation, aspiration, removal and histopathology  Thoracic rads!!  Aggressive mammary tumor can have widespread metastasis- liver, bone, CNS Treatment  Lumpectomy still means usually one gland ahead and one behind allowing for good margins to be taken (BIG margins)  Chemo w/ Doxorubicin  Radiation if local control is difficult

Answer 72

o More than 75% of feline mammary neoplasms are malignant o Mammary tumors are at least the third most frequent tumor seen in the cat o Any cat presenting with a mammary mass must be taken very seriously. Signalment  Female  10-12yrs  Short haired  Spayed at later age  Synthetic progestins Clinical Signs  Mammary mass  Met lesion of LN, lungs, or bone Biologic Behavior  Most are adenocarcinoma  Highly aggressive  Mets very common

Answer 73

Diagnosis  Requires histo Treatment  Complete radical mastectomy  Include At LEAST closest LN  May need bilateral mastectomy  MAYBE radiation  Chemo w/ doxorubicin (more helpful than dog) Prognosis  Survival of 10-12 months  Smaller tumor = better survival  Aggressive surgery is important

Answer 74

Most Common Tumor  Perianal adenoma (benign)  Perianal gland carcinomas (malignant)  Apocrine Gland Anal Sac Adenocarcinomas (malignant) Staging  CBC, Chem, UA look for hypercalcemia  Thoracic rads  Image the abdomen for liver & spleen mets

Answer 75

 Surgery to remove mass & LNs  Radiation of mass & LNs  Chemo w/ carbo/cisplatin or tyrosine kinase inhibitors

Answer 76

Staging * Aspiration of local node * Thoracic rads Treatment * Surgery * Melanoma vaccine Prognosis * Better than oral * can go 1-2 years before metastasis develops

Answer 77

Staging * aspiration of local node * thoracic imaging Treatment * Surgery Prognosis * Can be cured/controlled long term if single digit * Some dogs develop tumors in multiple toes (Black standard poodles, Giant schnauzers, Russian terriers and this can lead to poor quality of life

Answer 78

o Uroepithelial Carcinoma Signalment  Usually small breed older dog,  Female>Male,  Neutered> Intact  Scottish terriers and Shelties may be overrepresented Possible causes  older flea control products (dips),  lawn chemicals,  obesity Presentation  Pollakiuria,  stranguria,  dysuria,  urinary obstruction

Answer 79

Biologic Behavior  Generally cause signs locally and can cause the death or euthanasia of the animal  Uroepithelial carcinoma can metastasize but generally not detected initially and often not the cause of death Staging & Diagnosis  Thoracic rads  Abdominal ultrasound  CT- only needed if planning radiation  Trans-abdominal aspiration & Cytology  BRAFF mutation in urine

Answer 80

Surgery alone * 12-13 months Radiation intra-operatively * 15 months Stereotactic radiation * 10 - 21 months NSAID alone * 6 months Chemotherapy plus NSAID * Piroxicam plus Mitoxantrone * 12 months

Answer 81

Presentation  Palpation of mass in abdomen  Gastric- weight loss, vomiting, melena  Small intestine- melena, diarrhea, weight loss  Colon- diarrhea, weight loss, hemtochezia  Hepatobilliary- weight loss, inappetance, vomiting, PU/PD Staging  Abdominal ultrasound  Thoracic rads  +/- Cytology of mass and all other masses found  Exploratory Treatment  Chemo for lymphoma  Surgery on adenocarcinomas & hepatic tumors  Surgery & Chemo on leiomyoma/sarcoma  Tyrosine kinase inhibitors for GI stromal tumors

Answer 82

Clinical Signs  Labored breathing or cough/dyspnea, tachypnea  Difficulty swallowing/ regurgitation  Poor blood circulation (low blood pressure, sudden collapse)  Paraneoplastic association of hypertrophic osteopathy Diagnosis & Staging  Thoracic rads  Thoracic CT  Cardiac or trans-esophageal ultrasound  Biopsy & needle aspirates very difficult and risky

Answer 83

* Depends on size of tumor, type of tumor and presence or absence of metastasis * Surgery is generally the treatment of choice * Chemotherapy minimally effective but Vinorelbine may be better * Maybe NSAID’s +/- metronomic chemotherapy

Answer 84

Good o adenocarcinoma or papillary carcinoma, o low grade tumors o < 5cm diameter o Peripheral location o negative node o no clinical signs o 1-2yr survival Bad o squamous cell carcinoma o poorly differentiated tumors o high grade tumors o > 5cm diameter o pleural effusion o presence of clinical signs o positive nodes o evidence of metastasis o 1-8mo survival

Answer 85

o Fleshy friable mass o May be black (can be amelanotic) o Most common oral tumor in dogs Diagnosis/Staging  Thoracic rads  Lymph node aspiration or biopsy  Tumor biopsy  Tumor imaging Therapy/Prognosis  Surgery- 7-9 months  Radiation- 8 months  Chemo – doesn’t really work  Melanoma vx may or may not work

Answer 86

o Ulcerated inflamed mass o Second most common canine oral mass Locations  Rostral mandible unlikely to metastasize  tongue 50% metastasize  tonsils VERY likely to metastasize Diagnosis  Cytology can be diagnostic  Recommended to do biopsy Staging  Thoracic rads  Rads of tumor/ CT/ MR  May need imaging to identify lymph nodes and to sample them Treatment  Surgery- small, superficial, and rostral  Radiation- small, superficial, and rostral  Surgery + radiation occasionally necessary

Answer 87

o Flat, boring o Metastasis VERY uncommon o Difficult to treat because often impossible to get 3cm margins o Biopsy for grade, invasiveness, bone involvement o Stage w/ thoracic rads & CT of mass Treatment  Surgery - must have 3cm margins  Radiation - must dose higher than 50 Gy or large fraction size  Surgery + Radiation is best approach, but still rarely curative

Answer 88

Staging * Biopsy * Thoracic rads * Local rads / CT Treatment * Surgery w/ small margins * Radiation

Answer 89

o Inflamed proliferative mass, or ulcer, or facial distortion o Most common oral tumor Treatment  Sx only if VERY small  Radiation  If in tonsil, it’s often cured with radiation

Answer 90

o Diffuse proliferative tissue o Bone involvement common o Metastasis rare Treatment  Sx but hard to achieve clean margins  Radiation can shrink tumor

Answer 91

Clinical Signs  Nasal discharge & bleeding  Cats w/ deformed faces Biologic Behvaior  Locally aggressive  Metastasis 50% Diagnosis  Image prior to biopsy w/ rads, CT, or MRI Staging  CBC, Chemistries, UA  Thoracic radiographs  Lymph node palpation and aspiration  CT of the tumor Treatment  Surgery (doesn’t work well)  Maybe chemo  NSAIDs help  Curative radiation usually best