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Flashcards in Intro to Vet Oncology Deck (42)
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1
Q

What questions should be asked when looking at a mass?

A
  • How long has it been present, is it growing, how fast
  • trauma?
  • is it hot, erythematous or painful? indicates inflammatory lesion, though still could be a tumour
  • solid or fluid filled? fluid could be abscess, cyst, seroma, haematoma or necrotic centred tumour
  • well defined or ill defined? fixed to underlying tissues?
2
Q

What 2 samples can be taken to further inestigate a mass? uses/pros and cons of each?

A

> FNA for cytology
-distinguish inflammaotry [neutrphils and mixed cell population] and neoplastic [one cell type predominates] lesions
-cell morphology can determine benign or malignant masses
-also good for bone marrow and effusions
-cytology NOT useful for tissue architecture, mitotic index, invasion or grading
Biopsy for histopathology (incisional, excisional, puch biopsy, tru-cut, Jamshid core biopsy)
- gold standard
- but expensive and requires sedation or GA
- decide whether malignant and give tumour a grade

3
Q

What are the 3 possible cells of origin of a tumour?

A
  • epithelial
  • mesenchymal (=spindle cell = structural cells bone, cartilage, endothelium)
  • round cell
4
Q

WHat is tumour grade?

A
  • assigned by PATHOLOGIST
  • assessment of mitotic index, cellular differentation, invasion of tissues, necrosis etc.
  • categorised as LOW, MEDIUM or HIGH
  • low grade likely to be benign
  • high grade likely to be malignant
5
Q

What are the 2 numerical grading systems for describing mast cell tumours?

A

> Patnaik 1-3

> KIupel low or high (make people decide)

6
Q

What is tumour staging?

A
  • Performed by the CLINICIAN
  • extent of the disease in the patient
  • looking at primary tumour, lymph nodes and distant distant metastatic disease
7
Q

What system is usually used for staging and what does each descriptor mean?

A

TNM
> Primary tumour
- size, mobility, relationship to surrounding tissues, ulceration and erythema
- may require imaging and endoscopy
> Draining lymph nodes
- size, mobility, relationship to surrounding tissues, texture, consistency
- imaging might be required
- FNA to assess as small nodes can be malignant and larger ones just hyperplastic
> Distant metastasis
- history and PE can give clues eg. coughing
- imaging: radiography or CT, ultraound, , MRI, scintigraphy
- lungs most common site of metastasis
- FNA/biopsy to confirm dx
- liver, spleen, kidneys, heart, skin, bones, CNS may also be site sof metastasis

8
Q

How may the TNM system be refined?

A

Numerical grading
T1: 5cm
N0: no metastasis to regional LNs N1: LNs metastasis
M0: no distant metastasis M1: distant metastasis present

9
Q

How does lymphoma grading systemdiffer to normal?

A

WHO staging system for canine lymphoma
1: single LN or lymphoid tissue in single organ exlcuding BM
2: more than 1 LN in a regional area +- tonsils
3: generalised LN involvement both side of diaphragm
4: liver +- spleen +- stage 3
5: blood bonemarrow or other organ systems +- stages 1-4
> sunstage a= without systemic sounds
b = with systemic signs

10
Q

What is paraneoplastic syndrome?

A

systemic effects of a tumour, occouring at sites distant to the tumour
- result of a secretion of a hormone or hormone-like subsance, enzyme, cytokine, immune mediated mechanisms

11
Q

What 4 baseline tests can be used to assess the cancer patient?

A
  1. haemotology/blood count
  2. Biochem
  3. Urinalysis
  4. COaglation parameters (when indicated)
12
Q

WHat can haemotology/complete blood count show?

A
  • general health status
  • baseline before starting chdemo
  • check for
    > anaemia
    > cytopenia
    > abnormal cells in circulatin
13
Q

What can biochemistry show?

A
  • general health status
  • organ damage and function esp prior to GA and chemo
  • liver and kidney parameters
14
Q

3 common paraneoplastic effects

A
  1. Hypercalceamia due to tumour production of PTH-rp -> renal damage
  2. Hypoglyceamia due to secretion of insulin or insulin like growth factor
  3. Hyperglobulinaemia due to excessive AB production
15
Q

What does urinalysis show?

A
  • underlying renal and other diseases

- do dipstick, sediment and SG

16
Q

Clinical signs associated with hypercalcaemia?

A
  • PUPD
  • depression
  • anorexia
  • weakness
  • bradycardia
17
Q

Clinical signs associated with hypoglyceamia>

A
  • weakness, collapse

- seizures

18
Q

Clinical signs associated with hyperviscosity?

A

due to hyperglobulinaemia and polycythaemia

  • neuro signs
  • seizures
  • retinal detachment
19
Q

Which tumours are associated wth gastric ulceration and vomiting?

A

mast cell tumours -> histamine release

gastrin secreting tumours

20
Q

Clinical signs associated with endocrine problems?

A
  • hyperadernocorticism (pituitary and adrenal)
  • hyper/hypo thyroid
  • acrogmegaly (excess IGF1 pituitary adenoma cats)
  • feminisation (sertoli cell tumour)
  • hypertension (phaeochromocytoma)
  • hypercalcamia (excess PT Hor PTH-rp)
21
Q

What paraneoplastic effect may thymoma have?

A

Immune mediated diseases

  • IMHA
  • IMT
  • polyarthirtis
  • polymyositis
  • myasthenia gravis
22
Q

What is hypertrophic osteopathy?

A

lameness and swelling of long bones

- periosteal new bone on the shafts of long bones associated with intrathoracic masses

23
Q

Which paraneoplastic effects may manifest in the skin?

A

endocrine, immune mediated

24
Q

Why does cancer cachexia occour?

A

Reease of cachexic factors from tumours

25
Q

What i a myeloma?

A

Plasma cell tumour

-> hyperglobulinaemia and thickened blood

26
Q

What are the 7 main cancer treatment options?

A
  1. surgery
  2. radiation
  3. chmo/cytotoxic drugs
  4. molecular targetted drug therapy eg. tyrosine kinase inhibitors
  5. anti-angiogenic therapt (metronomic low dose therapy)
  6. immunotherapy eg. melanoma DNA vax
  7. others eg. photodynamic therapy, electrochemotherapy, bisphosphonates
27
Q

What health and safety points should be remembered with chemotherpay?

A

can be carcinogenic, mutagenic and teratogenic

  • pregnant women and children should not handle the drugs or body fluids from people on chemo
  • do not crush tablets
  • dispense in child proof container always
  • injectables should be drawn up in a sealed area or Phaseal unit
  • work over absorbant pad in case of spillage
  • double glove and wear waterpoorf protective gear
  • use luer-locking syringes not push on
  • double bag excreta and wear protective clothing when cleaning up urine from animals for a couple of weeks
  • dispose as cytotxic waste
  • no contact with saliva
28
Q

What is the main cell type in an injection site sarcoma?

A

Fibroblast

29
Q

How is an injection site sarcoma defined histologically?

A

Neoplasia surrounded by inflammation

30
Q

How does inflammation cause neoplasia?

A

Transforming growth factor released by cytokines breaking down ECM
- cats must be predisposed to developing tumours

31
Q

What is a sarcoma?

A

Malignant mesenchymal cell tumour

32
Q

Are ISSs painful?

A

No unless growth rate so high that ulceration occours

33
Q

Why may ISSs grow so rapidly?

A

Become cystic and blow up

34
Q

What is always necessary for Dx of ISS?

A

CT

35
Q

What is the first test to do on a suspected ISS?

A

Cytology by FNA

36
Q

Should excisional or incisional biopsy be performed on ISSs?

A

Incisional

- once scar is present must be included as part of tumour and any future margins must be in relation to scar

37
Q

What margin is necessary when removing a tumour?

A

3-5cm
- if 3 still need radiation
2 fasical planes below the tumour (may be associated with spinous processes so may have to remove)

38
Q

What is the DDx for ISS? When should you suspect ISS?

A

Granuloma

  • 321 rule
  • present for 3 months, bigger than 2 cm or grows within 1 month = need to biopsy
39
Q

What isthe median survival time of ISS with no surgery?

A

3 months

40
Q

What do whiter and darker areas of a mass on CT indicate?

A
Whiter= vascularised
Darker= cystic or necrotic
41
Q

What should be done prior to durgery if the mass is too large to remove?

A

Radiation or chemo

42
Q

Guidelines for preventing ISS severity?

A
  • rotate injection sites around the legs or tail base (easy to amputate if tumour occours)
  • record where you vaccinate
  • dont over vax
  • try to use non-adjuvant vax