Oncology Flashcards
(113 cards)
1
Q
what is tumour grading?
A
histological features of a tumour
2
Q
what is tumour staging?
A
tumour burden and sites involved
3
Q
what does TNM stand for in tumour grading?
A
T= which primary Tissue is affected N= metastatic spread to lymph Nodes M= distant Metastasis sites
4
Q
which lymph nodes do most tumours spread?
A
go to nearest node towards centre of body
5
Q
where do cranial abdominal tumours spread (LN)
A
sternal lymph nodes
6
Q
thyroid carcinoma LN spread?
A
retropharyngeal LN
7
Q
distal forelimb LN spread?
A
prescapular LN
8
Q
proximal forearm LN spread
A
axillary node
9
Q
if on cytology a tumour sample has 3 or more of these, what does this indicate?
nuclear: multinucleation karygomegaly mitoses nuclear moulding- rapid cell growth large angular or variably sized nuclioli
hypercellarity
pleomorphism
high and variable N:C ratio
A
criteria of malignancy
10
Q
histiocytoma, lymphoma, mast cell tumours and plasmacytomas are which kind of tumours?
A
round cell tumours (lymphocyte origin)
11
Q
trichoblastomas, sebaceous adenomas, hepatoid gland tumour, squamous cell carcinoma and anal sac adenocarinomas are which types of tumour cells?
A
epithelial tumours
malignant forms end in -carcinoma
12
Q
perivascular, nerve sheath tumours. fibrosarcomas and injection site sarcomas are which type of tumour cells?
A
mesenchymal/ spindle cell tumours
malignant end in -sarcoma
13
Q
what does
- excisional biopsy
- insicional biopsy
mean
A
excisional= whole mass is removed + histopathology
benign masses, small masses
incisional= part of mass removed + histopathology
14
Q
what surgical margin should a benign mass have
A
1cm surrounding margin
15
Q
what surgical margin should most carcinomas have
A
1cm surrounding margina dn one fascial plane deep
16
Q
what surgical margin should soft tissue sarcomas and mast cell tumours have
A
2-3cm margins and one deep fascial plane
this is ‘wide’
17
Q
what is a ‘radical’ surgical margin
A
removal of whole tissue compartment
18
Q
Define: primary chemotherapy
A
sole anti cancer treatment in highly sensitive tumour types
19
Q
define adjuvant chemotherapy
A
treatment given after surgery to mop up microscopic residual disease
20
Q
define: neoadjuvant chemotherapy
A
before surgery to shrink tumour size and increase chance of successful resection
21
Q
concurrent chemotherapy
A
simulatatious chemo and radiation therapy
- increases tumour sensitivity to radiation
22
Q
what is the growth fraction of a tumour
A
fraction of cells dividing at any one time
23
Q
what is the mitotic index of a tumour
A
% or number od mitoses per high field power on light microscopy (cells in M phase)
24
Q
what is the mass doubling time of a tumour
A
time it takes for a tumour to double in size
25
what does the gompertzian growth model show?
increasing number of cells in tumour decreases the growth rate
26
```
the following drugs are which kind of chemotherapy agents?
cyclophosphamide
melphalan
chlorambucil
lomustine
```
alkylating agents
| affects DNA replication
27
the following drugs are which kind of chemotherapy agents?
doxorubicin, epirubicin
mitoxantrone
actinomycin D
antitumour antibiotics
| affects DNA replication
28
```
the following drugs are which kind of chemotherapy agents?
cytosine
arabinoside
methotrexare
5- fluorouracil
```
antimetabolites
| affects purine and pyrimidine synthesis
29
the following drugs are which kind of chemotherapy agents?
vincristine
vinblastine
```
vinca alkaloids
(interfere with mitosis)
```
useful for mast cell tumours: vincristine + prednisolone
30
how can L-asparaginase and corticosteroids be used in cancer tx?
both are chemotherapy like drugs
note: do not use steroids if going to start chemo later on as makes resistance higher later on
31
define metronomic chemotherapy
continous low dose chemotherapy, more drug dense
drugs: cyclophosphamide
32
CHOP, CEOP protocols in dog
COP protocol in cat.
are used to tx which tumour type?
lymphoma
33
tumour cell death in radiotherapy occurs due to what?
proton beam inducting apoptosis, permanent cell cycle arrest or mitotic catastrophe
34
what are the 4 Responses to radiotherapy
Repair
Repopulation- cells recruited from G0
Redistribution
Reoxygenation
35
what is fractionation radiation therapy?
2 doses of radiation therapy given at different times
gives time for healthy tissue to repair, but also time for tumour cells to repair :(
36
which tumour characteristics are more sensitive to radiation therapy?
smaller more rapidly dividing
| carcinomas> sarcomas
37
list 3 highly radiosensitive tumours
lymphoma
transmissible venereal tumour
gingival basal cell carcinoma
38
are these tumours moderately or poorly radiosensitive?
- Oral SCC (dogs)
- Oral malignant melanoma (dogs)
- Nasal tumours
- Perianal adenocarcinoma
- MCTs
- Rhinarial SCC (cats)
- Thyroid carcinomas
- Brain tumour
moderate
39
are these tumours moderately or poorly radiosensitive?
- Fibrosarcoma
- Haemangiopericytomas
- Oral SCC in cats
- Osteosarcomas
- Rhinarial SCC in dogs
poor
40
most common oral tumours in dog
malignant melanoma> squamous cell carcinoma> fibrosarcoma
m>s>f
41
most common oral tumours of cat
SCC> fibrosarcoma
| S>F
42
which dog oral tumour is this
Sp/br: smaller older dogs, golden retriever, cocker spaniel, miniature poodle, chow chow
Px: very locally invasive, high metastatic rate
Dx: melanin containing mesenchymal cells, elevated mitotic index
Tx:
- Surgery: Mandibulectomy preferred
- Radiation therapy
- Anti-metastatic treatment- chemo does not extend survival, plasmid vaccine immunotherapy (stimulates response to melanocytes)
malignant melanoma
43
which dog oral tumour is this
low metastatic rate, varies with grade.
Tx:
mandibulectomy preferred, RT a lot better survival than melanoma
Medical: piroxicam, piroxicam +carboplatin
tonsil from is highly metastatic
SCC
44
which dog oral tumour is this
Sp/br: golden retriever and lab, middle aged
Px: often caudal maxilla in younger large breed dogs
B: locally invasive, low/ moderate metastatic risk
Tx: local control mainly- surgery>multimodal >RT alone, smaller tumour better outcome
fibrosarcoma
45
what are epiludes?
non metastatic lesions arising from gingiva
46
which cat oral tumour is this
Sp/br: middle age/older ctas
Px: tends to be base of tongue but can be any location
Risk: ETS, flea collars, canned tuna
B: locally invasive, lower metastatic rate
Tx: none good. Mandible better prog than maxilla. Radiotherapy – accelerated hypofractionated radiation therapy protocols best. Surgery- if resectable better outcome. Electrochemotherapy- emerging.
Prog: best is rostral mandibular, worst is soft tissue lesions affecting tongue
SCC
47
which oral cat tumour is this
Sp/br: middle aged or older
B: locally invasive, metastatic rate unknown
Tx: surgery
fibrosarcoma
48
what tumour are these risk factors for?
| entire female, older, obese, poodles, chihuahua, daschund, maltese
mammary tumour
49
how would mammary tumours present?
what is the pgx for tumour>3cm
palpable fixed tumour, usually more than one.
poor pgx
50
when would you surgically treat a mammary tumour with
a) single mastectomy
b) regional mastectomy
c) bilateral resection
d) chain mastectomy
a) single mastectomy - low risk
b) regional mastectomy - high risk
c) bilateral resection- young intact bitches with multiple tumours
d) chain mastectomy - cats
51
which chemo drug used in mammary tumours?
doxorubicin (+/- cylophosphamide in cats)
prolongs few months
52
with soft tissue sarcomas, what is the cardinal method of sampling ?
3 sections, relies on mass being sphere (tumour cut in half then half again)
53
with soft tissue sarcomas, what is the bread loafing method of sampling ?
cut all the way along in slices
54
with soft tissue sarcomas, what is the pathologist shaved margins method of sampling ?
samples all way round tumour- best but harder.
55
what are outcomes of tumour removal
complete incision
incomplete excision
excision with narrow margins
56
prognosis of soft tissue sarcoma removal without metastatic disease?
>4 years
57
what is the 321 rule for feline injection site sarcomas?
```
ALWAYS INCISIONAL BIOPSY
wide margins (3-5cm with 2 fascial plane deep)
```
mass for >3 months
greater than 2cm diameter
continues to increase in size > 1month after injection
58
how to prevent injection site sarcoma issues
inject in leg and tail rather than neck
59
which tumour type is infiltrative, locally invasive and dont tend to metastasise (excpet sometimes to lung)
soft tissue sarcoma
60
which dogs predisposed to oesteosarcomas
middle age-older large breed dogs, frontlimb> hindlimb
61
what does pamidronate do in osteosarcoma treatment?
it is a bisphosphate, slows bone destruction
62
why is raised ALKP levels an issue after leg amputation to treat osteosarcoma?
ALKP is indirect measure of bone isoenzyme ALKP. suggests metastasis if still raised after removal of leg.
63
boxers and boston terriers are most likely to get which type of tumour?
MCT
Mammary tumour
Histiocytoma
MCT
64
what is the most common type of skin tumour in dogs?
| where else do these form
MCT
subcutaenous tissue, conjunctiva, oral mucosa and GIT
65
what are common sites of metastasis for MCT?
LN, liver, spleen
check with US
66
what is the use of the patnaik grading system?
to grade MCTs
67
which grade (I-III) on the patnaik grading system is this tumour
benign, low recurrence, unlikely to cause death
grade I
68
```
which grade (I-III) on the patnaik grading system is this tumour?
variably metastatic, cause of death in 17-50% of patients, nodal metastasis -poor pgx
```
Grade II
69
```
which grade (I-III) on the patnaik grading system is this tumour
highly metastatic and likely to be cause of death
```
grade III
70
what is the kiupel grading system used for?
MCT- graded low or high
often used alongside patnaik system
71
what surgical margin should be left for grade III MCTs?
3cm and 1 fascial plane deep , not to be used as sole modality
72
what surgical margin should be left for grade I+II MCTs?
1-2cm lateral margins may be enough
73
what are vinblastine/prednisolone, lomustine or TKIs used to treat?
MCTs
74
what tumour would erythema, oedema, pruritis, haemorrhage (dariers signs)
with systemic signs of vomiting, melaena indicate?
MCT
75
in a cat, which form of MCT is this
a) multiple raised hairless masses, rarely metastatic and surgical excision is usually curative?
b) intestinal palpable abdominal mass, metastasis common, site on spleen common, poor pgx
cutaneous MCT
visceral MCT
76
which breed of dogs do Transitional cell carcinomas most likely occur?
scottish terrier
77
which tumour presents with low urinary tract signs (haematuria, stranguria, polakuria)
Occasionally metastasises to bone
high metastatic rate to medial iliac lymph node
and can be wrongly identified as complicated UTIs?
Transitional cell carcinoma
78
what is the common site of TCC tumours
transitional cell carcinoma = urinary bladder tumour
bladder trigone
urethra and prostate in males
79
best way to biopsy TCC?
urinary catheter and prostatic wash> cytology
80
prognosis of TCC?
several months with palliative care (NSAIDS, ABs from C and S)
surgery often impossible due to site, radiotherapy lots of complications
81
which presentation of canine lymphoma is this?
Clinical signs: Vomiting, diarrhoea, weight loss, anorexia, pan-hypoproteinaemia (hypoalbuminemia), evidence of malabsorption. Abdominal masses or diffuse.
Sp/Br: Tends to be aggressive in dogs:
Dx: Diagnosis often delayed.
Pr: There may be progression from other GI disease (IBD?).
GI
82
which presentation of canine lymphoma is this?
most common form
Path: generalised peripheral lymphadenopathy +/- other CS
CS: moderate to marked lymph node enlargement, some dogs clinically well, rapid deterioration, non specific sign: weight loss etc, specific signs: diarrhoea, vomiting, cough ocular signs
Regional oedema if lymph drainage impaired
Multicentric
83
which form of canine lymphoma is this?
Can occur as solitary lesion or as part of multicentric form
Tachypnoea, dyspnoea.
Signs of hypercalcaemia (PU/PD, vomiting/diarrhoea, muscle tremors, anorexia, weight loss).
Occasionally pre-caval syndrome.
Altered position of PMI for cardiac auscultation, displacement of apex beat.
craniomediastinal
84
which form of canine lymphoma is this?
2 forms:
Epitheliotrophic: T cell, solitary or generalized
Typical protocols are COP or lomustine + prednisolone. Retinoids have also been used with moderate success for controlling clinical signs (pruritus) or treatment.
Radiation therapy is very useful for localized mucocutaneous disea
Non-epitheliotrophic: More frequently B cell, More likely to have lesions elsewhere
Different appearances. Progression to raised, erythematous plaques/nodules. Variable pruritus.
In general poorly responsive to chemotherapy
cutaneous lymphoma
85
what are some extra-nodal forms of canine lymphoma?
Hepatosplenic: Aggressive, no peripheral lymphadenopathy.T cell.
CNS: Mass lesion or diffuse. Variable neurological deficits but commonly signs of multicentric or diffuse lesions.
ii. Commonly ocular involvement.
iii. Generally T cell
c. Renal, urinary bladder, heart, muscle etc.
86
define paraneoplastic syndrome
a set of symptoms caused by the tumour but not from the tumour being at that site
87
what test is always used to diagnose lymphoma
cytology or histopathology
88
these paraneoplastic syndromes are common with which tumour?
hypercalcaemia
lymphoma
89
what stages of lymphoma are these
involvement of single lymph node or lymphoid tissue in single organ
stage I
90
what stages of lymphoma are these
| involvement of lymph nodes in a regional area +/- tonsils
grade II
91
what stages of lymphoma are these
| generalised LN involvement
Stage III
92
what stages of lymphoma are these
| hepatic or splenic involement
stage IV
93
what stages of lymphoma are these
| manifestations in the blood and involvement of bone marrow and or other organs
stage V
94
what is the gold standard treatment for lymphoma
multidrug chemotherapy
95
what are some common lymphoma chemo protocols
high dose COP
discontinuous CHOP, CEOP
CHOP= cyclophosphamide, doxorubicin, vincristine, and prednisone
CEOP= cyclophosphamide, epirubicin , vincristine, and prednisone
COP= cyclophosphamide,, vincristine, and prednisone
96
what are common side effects of CHOP/CEOP/COP
GI
cyclophosphamide- sterile haemorrhagic cystitis
doxo/epi- cardiotoxicity
97
what are rescue protocols for lymphoma
if first line tx doesnt work
DMAC
LPP
98
what are mean survival times for
high dose COP
discontinuous CHOP, CEOP
high dose COP- 6-9 months
| discontinuous CHOP, CEOP- 10-12 months
99
what can you use to tx lymphoma if owners dont want to do chemo
prednisolone- not cannot then change mind
100
cats with FeLV and FIV are more likely to devlop which tumour?
feline lymphoma
101
what is best diagnosis of feline lymphoma
excisional biopsy of node > impression smear
wedge biopsy if large
102
can feline lymphoma be staged?
nope
103
treatment options for feline lymphoma?
corticosteroids
| COP/CHOP/CEOP
104
Prognosis of feline lymphoma
- with treatment of high dose COP
- without treatment
1 or 2 years
| 4 weeks
105
what are the classifications of feline leukaemia
acute lymphoid
acute myeloid
chronic lymphoid
chronic myeloid
106
which classification of feline leukaemia is this
very sick, rapidly progressive and fatal
High WBC counts
Concurrent pancytopenias
Poor prognosis (weeks-months) even with chemotherapy
tx: supportive eg blood transfusion,antibiotics, multiagent protocols: COP, CHOP
acute myeloid and acute lymphoid
107
which classification of feline leukaemia is this
proliferation of mature lymphocytes in bone marrow
Rare (T cell > B cell > T-ve, B-ve)
Lymphocyte counts >30x109/L
Decision to treat based on the individual (presence of CS, degree of lymphocytosis)
Treatment with prednisolone/chlorambucil – survival times of 1-3 years reported.
chronic lymphoid leukaemia
108
which classification of feline leukaemia is this
proliferation of mature myeloid cells (normally neutrophils) in bone marrow
Even rarer!
Have to exclude other causes of extreme neutrophilia; infection, immune mediated disease; paraneoplastic syndrome
May undergo blast crisis??
chronic myeloid leukaemia
109
how is leukaemia diagnosed?
haematology and blood smear evaluation
bone marrow biopsy
flow cytometry if peripheral blood
110
what type of feline tumour is this
Aet/path: Systemic neoplastic proliferation of plasma cells results in overproduction of antibody (IgA or IgG)
Can get local disease – extramedullary plasmacytoma which can progress to multiple myeloma
Hyperproteinemia can lead to hyperviscosity syndrome
- Neurological symptoms, retinal detachment, congestive heart failure (cats > dogs), hypertension, coagulopathy
Bone marrow involvement can lead to cytopenias – secondary infections
Renal disease present in 33-50% of dogs (multifactorial due to proteinuria, hypercalcaemia, renal infiltration, urinary infection).
Dx: in dogs must fulfil 2 of the following criteria
1. Monoclonal gammopathy (seen on serum protein electrophoresis)
2. Radiographic evidence of osteolytic bone lesions
3. >5% neoplastic plasma cells or >10-20% plasmacytosis in the bone marrow
4. Bence-Jones proteinuria
Dx in cats: plasma cell infiltration of visceral organs
metastasis: liver spleen (hepatosplenomegaly) and bone marrow (osteolytic bone lesions)
Tx:
Supportive care
• Blood transfusions
• Plasmapheresis
• Antibiotics if secondary infection
• Therapy for hypercalcaemia
Systemic disease
• Prednisolone (~ 40 days)
• Chemotherapy
• Prednisolone 0.5mg/kg SID reducing to EOD – stop after 2 months
• Melphalan 0.1mg/kg SID reducing to 0.05mg/kg SID
• Cumulative myelosuppression is seen – perform haematology q2 weeks then monthly.
• Median survival of 540 days reported (dogs)
Local extramedullary plasma cell disease may be treated surgically if no systemic involvement.
Multiple myeloma
| very rare
111
basic pln for palliative care of cancer patient
1) NSAIDS- meloxicam, carprofen AND paracetamol - DOGS ONLY
2) codeine, tramadol
3) other adjuvants
eg gabapentine- neuropathic pain
oral buprenorphine
tricyclic antidepressant- amitriptyline, clomipramine, fluoextine
NEVER STEROID AND NSAID
112
How to manage GI signs in cancer patient in palliative care
vom/ nausea:
diet
vom/ nausea: maropitant, ondansetron
| avoid raw food- salmonella, lowered immune system
113
pros and cons of steroids in cancer tx
Pros
Useful for round cell tumours (lymphoma, myeloma, mast cell tumour)
Reduce inflammation (brain tumour, radiation therapy side effects)
Can stimulate appetite
Cons
```
Weak analgesia effect
Preclude use of NSAIDS
Muscle wastage
No effects on carcinoma and sarcoma
Can prevent diagnosis
Can create resistance (lymphoma)
```
