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SP2 Oncology > Lecture 13 2/24/25 > Flashcards

Lecture 13 2/24/25 Flashcards

1
Q

What are the multifactorial components of canine lymphoma etiology?

A

-genetic
-epigenetic
-environmental
-immune-mediated

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2
Q

What are the three categories of lymphoma classifications?

A

-anatomic location
-histologic grade
-immunophenotype

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3
Q

What are the anatomic locations of lymphoma, from most to least common?

A

-multicentric/nodal (most common in dogs)
-alimentary
-cranial mediastinal
-atypical; cutaneous, CNS, ocular, etc.

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4
Q

Which lymph nodes can normally be palpated during exam?

A

-submandibular
-prescapular
-popliteal

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5
Q

Which lymph nodes can only be palpated with pathologic changes?

A

-axillary
-inguinal

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6
Q

What are the characteristics of multicentric/nodal lymphoma?

A

-non-painful, generalized lymphadenopathy
-often asymptomatic early on
-50% have liver and spleen involvement
-20% have cranial mediastinal lymph node involvement
-eventually infiltrates bone marrow

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7
Q

What are the clinical signs of alimentary lymphoma?

A

-vomiting
-diarrhea
-weight loss
-lethargy

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8
Q

What are the diagnostic findings in alimentary lymphoma?

A

-hypoproteinemia
-GI mass or diffuse intestinal thickening
-mesenteric lymphadenopathy

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9
Q

What are the clinical signs of mediastinal lymphoma?

A

-dyspnea
-cough
-exercise intolerance

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10
Q

What are the diagnostic findings in mediastinal lymphoma?

A

-cranial mediastinal mass
-possible pleural effusion
-hypercalcemia

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11
Q

What is the main differential for mediastinal lymphoma?

A

thymoma

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12
Q

What is the most common site for atypical lymphoma in dogs?

A

cutaneous

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13
Q

What are the clinical signs of cutaneous lymphoma?

A

-alopecia
-pruritus
-depigmentation
-scales/plaques/nodules
-ulceration
-possible peripheral lymphadenopathy

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14
Q

How is cutaneous lymphoma diagnosed?

A

-skin biopsy
-possible immunohistochemistry; always T cell lymphoma

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15
Q

What are the characteristics of intermediate/high grade lymphoma?

A

-more common
-aka large cell lymphoma
-involves immature cells/lymphoblasts
-shorter survival

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16
Q

What are the characteristics of low grade lymphoma?

A

-less common
-aka small cell lymphoma
-involves mature cells/lymphocytes
-longer survival

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17
Q

What is immunophenotype?

A

cell subtype based on surface markers/antigens

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18
Q

What are the lymphoma immunophenotypes in dogs?

A

-B cell; expresses CD21 and CD79a
-T cell; expresses CD3, CD4, and CD8

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19
Q

What are the characteristics of FNA cytology as a lymphoma diagnostic tool?

A

-100% sensitivity, 96% specificity for intermediate/large cell LSA
-quick
-cheap
-non-invasive

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20
Q

What are the characteristics of biopsy/histopath. as a lymphoma diagnostic tool?

A

-may be needed to diagnose small cell LSA
-can help to identify small cell LSA from reactive lymph nodes

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21
Q

Which tests are used to stage lymphoma?

A

-physical exam
-CBC/chem/lytes/UA
-thoracic rads
-abdominal rads/ultrasound
-bone marrow examination
-immunophenotyping

22
Q

Which findings on physical exam indicate poorer lymphoma staging?

A

-peripheral lymphadenopathy
-organomegaly

23
Q

Which findings on CBC indicate a poorer lymphoma staging?

A

-anemia
-thrombocytopenia
-neutrophilia
-lymphocytosis

24
Q

Which findings on chem/lytes indicate a poorer lymphoma staging?

A

-hypercalcemia
-increased liver enzymes
-increased total bilirubin

25
What are the characteristics of urinalysis as a lymphoma staging tool?
-no lymphoma-specific abnormalities -used to evaluate renal function and rule out UTI
26
What are the characteristics of thoracic rads as a lymphoma staging tool?
-will find abnormalities in 60-75% of cases -20% will have cranial mediastinal masses; negative prognostic indicator
27
What are the characteristics of abdominal ultrasound as a lymphoma staging tool?
-50% of cases will have liver or spleen abnormalities -no prognostic significance
28
When is bone marrow examination done on lymphoma patients?
when cytopenias are found on CBC
29
What are the characteristics of flow cytometry?
-identifies B vs T cell based on surface receptors -requires many live cells -detects CD3 on T cells -detects CD21 and/or CD79a on B cells
30
What are the characteristics of PARR?
-identifies TCR or immunoglobulin receptors -clonality indicates malignancy -not as sensitive as immunophenotyping -requires DNA samples
31
What are the WHO lymphoma stages?
1: one lymph node 2: multiple nodes on the same side of the diaphragm 3: generalized lymphadenopathy 4: liver and/or spleen involvement 5: bone marrow, peripheral blood, and/or atypical location
32
What are the two substages of WHO lymphoma stages?
a: healthy b: sick
33
What are the treatment options for canine lymphoma?
-chemotherapy as the mainstay -radiation therapy for localized lesions -surgery for biopsy or to alleviate obstructions/single lesions -supportive care; IV fluids, anti-nausea meds, antibiotics
34
What are the different categories of treatment response?
CR: complete remission PR: partial remission; at least 30% reduction in lesion diameter sum SD: stable disease PD: progressive disease; at least 20% increase in lesion diameter sum
35
What are the characteristics of a frontline protocol?
-protocol of choice to induce remission -finite number of treatments -highest response rates and duration of remission
36
What are the frontline protocol options for lymphoma?
-CHOP (multi-drug) -doxorubicin alone -COP (CHOP minus doxorubicin)
37
What are the characteristics of CHOP?
-includes cytoxan, adriamycin, vincristine, and prednisone -response rates of 85-95% -MST of a year
38
What are the characteristics of single agent doxorubicin?
-response rates around 85% -better response in B cell lymphoma -MST around a year -less frequent visits -less expensive
39
What are the characteristics of COP?
-multiple schedule variations -shorter survival time than protocols including doxorubicin -less expensive -less frequent visits after first month
40
What are the characteristics of a rescue chemo protocol?
-protocol used at time of relapse -indefinite length of treatment -lower response rates and durations
41
When is CCNU preferred?
-CNS lymphoma due to ability to cross BBB -epitheliotrophic lymphoma
42
What are the characteristics of prednisone usage?
-used if chemo is out of question -should not be given to asymptomatic/minimally symptomatic patients if owners are considering chemo -does not prolong MST (2 months), just improves QOL
43
What are the three options in the event of relapse?
-re-induce with same protocol if dog has been in remission > 8 weeks -rescue protocol if dog has been in remission < 8 weeks -no additional chemo/prednisone only
44
What is the rule of thumb regarding remission?
second remissions last half as long as the first if re-inducing with a frontline protocol
45
What are the characteristics of tanovea?
-small molecule drug; not classic chemo -inhibits DNA synthesis and proliferation to cause apoptosis -mostly used as a rescue drug; inferior to CHOP -causes derm. side effects and idiopathic pulmonary fibrosis -not for use in westies; predisposed to lung side effects
46
What are the characteristics of laverdia?
-small molecule drug; not classic chemo -mediocre response in patients -common side effects of decreased appetite, anorexia, and vomiting -can treat side effects with prednisone
47
What are the MSTs for various treatment options for canine LSA?
-12 months with multi-agent chemo protocol -2 months with no treatment -2 months with pred.; better QOL
48
What are the main prognostic indicators for canine LSA?
-clinical substage; "a" dogs do better -immunophenotype; B cell has better prognosis -histologic grade; small cell is better
49
What are the lesser prognostic indicators for canine LSA?
-hypercalcemia; neg. indicator -cranial mediastinal mass; neg. indicator -WHO stage; early stage better than late, but not strongly prognostic -response to treatment; early response better -treatment type; inclusion of doxorubicin is pos. indicator -pre-treatment with pred.; neg. indicator
50
What are the characteristics of prednisone treatment as a negative prognostic indicator?
-induces the MDR-1 mediated resistance to chemotherapy; drugs are eliminated at faster rates -should not be done in asymptomatic/minimally symptomatic dogs if owners are considering therapy -can still be done for a few days in dogs that are symptomatic

SP2 Oncology (27 decks)

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