Intro to Oncology

Question 1

Cancer affects _____ of dogs and _____ of cats

Answer 1

1/3 of dogs and 1/4 of cats

Question 2

Carcinomas generally spread via _______

Answer 2

lymphatics

Question 3

Sarcomas generally spread via_____

Answer 3

hematogenous routes

Question 4

6 Hallmarks of cancer

Answer 4

1. resisting cell death
2. sustaining proliferative signaling
3. evading growth suppressors
4. activating invasion and metastasis
5. enabling replicative immortality
6. inducing angiogenesis

Question 5

What are the “emerging hallmarks” of cancer?

Answer 5

1. deregulating cellular energetics

2. avoiding immune destruction

Question 6

What are the “enabling characteristics” of cancer?

Answer 6

1. genome instability and mutation

2. tumor-promoting inflammation

Question 7

Drugs that interfere with sustaining proliferative signaling

Answer 7

Palladia, Masitinib

Question 8

Therapies/drugs that interfere with tumors ability to avoid immune destruction

Answer 8

Metronomic Chemotherapy, Palladia, Masitinib

Question 9

Therapies/drugs that interfere with induction of angiogenesis by tumors

Answer 9

Metronomic Chemotherapy, Palladia, Masitinib

Question 10

Therapies/drugs that interfere with a tumors ability for replicative immortality

Answer 10

telomerase inhibitors

Question 11

PAPR inhibitors interfere with what characteristic of cancer?

Answer 11

genome instability & mutation

Question 12

Therapies/drugs that inhibit a tumors ability to deregulate cellular energetics

Answer 12

aerobic glycolysis inhibitors

Question 13

Tumor cells often have mechanisms to resist cell death, but this class of drugs acts to interfere with this property.

Answer 13

BH3 mimetics

Question 14

Carcinomas originate from __________

Answer 14

epithelial or glandular tissue

Question 15

Sarcomas originate from ________

Answer 15

mesenchymal cells

Question 16

Types of round cell tumors to be familiar with

Answer 16

1. lymphoma
2. MCT
3. plasma cell tumor
4. histiocytoma
5. TVT

Question 17

Name a breed predisposed to MCTs

Answer 17

Boxers

Question 18

Name a breed predisposed to TCC

Answer 18

Scottish Terriers

Question 19

Name a breed that often gets histiocytomas

Answer 19

Bernese Mtn Dogs

Question 20

Name a tumor type that has a bimodal age distribution in animals

Answer 20

osteosarcoma

Question 21

Why should you stain (diff-quik) one slide in-house?

Answer 21

to ensure you have a diagnostic sample to send off

Question 22

What should you not package cytology samples with or get them near?

Answer 22

formalin! even the vapors can make them nondiagnostic

Question 23

What is one tumor type that seeding IS a high risk if FNA is done?

Answer 23

TCC of lower UT

Question 24

Histopathology characteristics

Answer 24

• more invasive than cytology
• larger sample size
• tissue architecture maintained
• can evaluate surrounding tissue reaction and invasion by the tumor

Question 25

______ is thought of as an indicator of how quickly the tumor is likely to grow and spread

Answer 25

grade

Question 26

Are all tumors graded the same?

Answer 26

no, and not all tumor types have a validated grading scheme

Question 27

Why should resected tissue be submitted even when you had a pre-op diagnosis?

Answer 27

the grade could increase when more tissue is evaluated, possibly changing course of treatment and/or prognosis

Question 28

"TNM" staging stands for _____?

Answer 28

Tumor, Node, Metastasis

Question 29

____% of dogs that have oral melanoma and normal sized lymph nodes have microscopic evidence of metastasis

Answer 29

40%

Question 30

When staging, what else besides palpate regional lymph nodes should you do?

Answer 30

FNA or biopsy

Question 31

What modalities are used for evaluating distant metastasis?

Answer 31

Rads, US, CT or MRI, nuclear scintigraphy, PET/CT

Question 32

You have a bladder tumor in a Scottish Terrier-what next tests do you suggest?

Answer 32

Abd US & Chest x-rays

Question 33

You have a MCT on the left tarsus of a Golden Retriever-what next tests do you suggest?

Answer 33

Abd US

Question 34

You have a soft tissue sarcoma on the maxilla of a Lab-what next tests do you suggest?

Answer 34

Chest x-rays

Question 35

What is a paraneoplastic syndrome?

Answer 35

a disease or symptom that is a consequence of cancer being in the body, but NOT due to local presence of cancer cells

Question 36

What are four reasons paraneoplastic syndromes are important

Answer 36

1. diagnostic aid 2. contributors to morbidity/mortality 3. indicators of tumor biology 4. marker for treatment response/recurrence

Question 37

A cat with alopecia and shiny skin is a classic presentation for ____________

Answer 37

pancreatic adenocarcinoma

Question 38

Two GI paraneoplastic syndromes

Answer 38

1. cancer cachexia | 2. GI ulceration

Question 39

GI ulceration is a paraneoplastic syndrome that is most common with what type of tumors?

Answer 39

MCT

Question 40

How do MCTs lead to GI ulceration?

Answer 40

degranulation of many mast cells at once->increased serum histamine->stimulation of gastric H2 receptors->increased gastric acid secretion->ulceration

Question 41

Three endocrine paraneoplastic syndromes

Answer 41

1. hypercalcemia 2. hypoglycemia 3. ectopic ACTH

Question 42

Hypercalcemia DDX

Answer 42

``` D-vitamin D, dehydration R-renal, raisins A-Addison's, aluminum or vitamin A toxicity G-granulomatous disease, grapes O-osteolytic N-neoplasia S-spurious H-hyperparathyroidism, house plants, humoral hypercalcemia of malignancy I-idiopathic T-temperature (hypothermia) ```

Question 43

Five hematologic paraneoplastic syndromes

Answer 43

1. hypergammaglobulinemia 2. anemia 3. erythrocytosis 4. neutrophilic leukocytosis 5. thrombocytopenia/coagulopathy/DIC

Question 44

Hypergammablobulinemia is associated with ________

Answer 44

multiple myeloma

Question 45

What are some possible causes of anemia?

Answer 45

1. anemia of chronic dz 2. IMHA 3. blood loss 4. microangiopathic hemolysis 5. bone marrow hypoplasia-secondary to hyperestrogenemia

Question 46

What are six cutaneous paraneoplastic syndromes?

Answer 46

1. alopecia 2. flushing 3. nodular dermatofibrosis 4. necrolytic migratory erythema 5. cutaneous necrosis of hind feet 6. pemphigus vulgaris

Question 47

Renal paraneoplastic syndromes

Answer 47

glomerulonephritis/nephrotic syndrome

Question 48

Neurologic paraneoplastic syndromes

Answer 48

1. myasthenia gravis | 2. peripheral neuropathy

Question 49

Misc. paraneoplastic syndromes

Answer 49

1. hypertrophic osteopathy | 2. fever

Question 50

What is the main tumor type that myasthenia gravis is associated with?

Answer 50

thymoma

Question 51

Clinical signs of myasthenia gravis

Answer 51

- exercise intolerance - dysphagia - megaesophagus

Question 52

Myasthenia gravis often responds well to what treatment?

Answer 52

treatment of primary tumor (e.g. often thymoma)

Question 53

Hypertrophic osteopathy is usually secondary to a tumor located where?

Answer 53

lungs

Question 54

Treatments for hypertrophic osteopathy

Answer 54

- remove primary tumor | - supportive care