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CVSOH BVSc3 > Oncology > Flashcards

Oncology Flashcards

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1
Q

What is cancer?

A

Persistent, purposeless proliferation of host cells, often to the detriment of the host

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2
Q

What are overactive oncogens?

A

Tumour promoting genes that are secondary to mutation

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3
Q

What is the most common gene alteration in human cancer?

A

Loss of P53

Is a tumour suppressor gene that stops mitosis if there is any DNA damage

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4
Q

What does neoplasia mean?

A

New/abnormal growth

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5
Q

What are the two features that tumours are described according to?

A

Tissue of origin

Status

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6
Q

What are benign squamous epithelial tissue tumours called?

A

Papilloma

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7
Q

What are benign glandular epithelial tissue tumours called?

A

Adenoma

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8
Q

What are malignant squamous epithelial tissue tumours called?

A

Squamous cell carcinoma

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9
Q

What are malignant glandular epithelial tissue tumours called?

A

Adenocarcinoma

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10
Q

What are benign bone mesenchymal tissue tumours called?

A

Osteoma

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11
Q

What are benign blood vessel mesenchymal tissue tumours called?

A

Haemangioma

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12
Q

What are malignant bone mesenchymal tissue tumours called?

A

Osteosarcoma

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13
Q

What are malignant blood vessel mesenchymal tissue tumours called?

A

Haemangiosarcoma

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14
Q

What are lymphocyte tumours called?

A

Lymphoma

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15
Q

What is the growth fraction?

A

The proportion of actively dividing cells in a tumour

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16
Q

When is a tumour most susceptible to treatment?

A

When the cells are rapidly dividing rather than when the growth fraction reaches a plateau

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17
Q

What type of tumour is an exception bcos it maintains a high growth fraction?

A

Lymphoreticular tumour - lymphoma

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18
Q

What stage of the cell cycle is resistant to drugs/radiation?

A

G0 - resting

Important as reservoir of cells can repopulate tumour

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19
Q

In what stage of the cell cycle is chemotherapy most effective?

A

M phase - mitotic

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20
Q

What stage of the cell cycle is most radioresistant?

A

S phase

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21
Q

What does the tumour grade depend on?

A

The mitotic rate

Cellular and nuclear characteristics

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22
Q

What are clues of local invasion of the tumour?

A

Indistinct boundaries
FIxed in more than one plane
Thickened adjacent tissue
Spontaneous bleeding

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23
Q

What are the 4 methods of metastatic spread?

A

Blood
Lymphatics
Transcoelomic - across pleural/peritoneal spaces
Iatrogenic - seeding

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24
Q

What are paraneoplastic syndromes?

A

Signs arising fron the indirect effect of tumours production and release of biologically active substances

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25
What is a haematologic paraneoplastic syndrome?
Anaemia
26
What is myelophthisis?
When neoplastic invasion directly affects the bone marrow
27
What does myelophthisis cause?
Cytopenias - decreased production of WBC, RBC etc
28
What is leukaemia?
When abnormal cells are released into the blood from the bone marrow
29
How can tumours affect blood cell production?
Myelofibrosis - Replacement of bone marrow with scar tissue
30
What are 3 causes of blood loss form tumours?
Local haemorrhage Gastric ulcer from mast cell tumour Bleeding disorder - thrombocytopenia
31
What can mast cell tumours cause?
Hyperhistaminaemia
32
What local effects does hyperhistaminaemia cause?
Oedema Localised bleeding Delayed wound healing
33
What systemic effects does hyperhistaminaemia cause?
Anaphylactic shock | Gastroduodenal ulcer
34
What is an immune mediated reaction that cancer can cause?
Cross reactivity between cancer cells and healthy cells
35
What is the most common paraneoplastic syndrome in dogs?
Hypercalcaemia
36
What causes hypercalcaemia as a paraneoplastic syndrome?
Tumours release a substance called parathyroid hormone-related peptide
37
What are 3 clinical signs of hypercalcaemia?
PUPD Muscle weakness Dehydration/renal failure
38
What are the two kinds of biopsy?
Cytology | Histopathology
39
What can cytology determine?
The nature of the tumour eg. Epithelial, mesenchymal
40
What are some types of cytological methods?
Fine needle aspirates Touch preparations Cytospins
41
What are the features of malignancy?
``` degree of differentiation cell pleomorphism multiple nuclei anisocytosis nuclear : cytoplasmic ratio mitotic figures clumping of chromatin nuclear pleomorphism multiple nucleoli ```
42
What are some types of histological examination?
Surgical - incisional and excisional Needle Punch biopsy
43
What is an incisional surgical biopsy?
Where a piece of the tumour and some healthy tissue is removed
44
What is an excisional surgical biopsy?
Remove entire cancer plus healthy tissue around it
45
What are 3 rules of biopsy?
Avoid superficial ulceration/inflammation/necrosis Ensure adequate depth Try to include a boundary
46
What does clinical staging aim to identify?
Cytological grade Local invasion Metastatic spread
47
What is the most common staging system used for cancer?
TNM T - primary Tumour N - regional lymph Nodes M - Metastasis
48
What determines T in the TNM staging system?
Size and extent of the primary Tumour - up to T4
49
What determines N in the TNM staging system?
The amount of involvement of the regional lymph Nodes - up to N4
50
What does M determine in the TNM staging system?
Whether Metastasis is present or not - up to M2
51
What is M1 and M2 in the TNM staging system?
M1 - single metastasis | M2 -multiple metastasis
52
What is remission?
When all clinical evidence of cancer has disappeared, but occult cancer cells remain and relapse will occur at some point
53
What is the only thing that has a chance of curing cancer?
Complete surgical excision
54
When is local excision used?
Only for truly benign tumours | eg. Fibroma, lipoma
55
What constitutes wide local excision?
Wider margins - 1 cm | In two tissue planes
56
When is wide local excision used?
Locally invasive tumours eg. basal/squamous cell carcinoma Mast cell tumour
57
What is compartmental excision?
Resection - removes every tissue compartment with the tumour involves
58
When is compartmental excision used?
Solid soft tissue sarcomas that infiltrate wider than 1-2cm
59
What is the most common type of radiation therapy?
External beam radiation therapy
60
What is brachytherapy?
Radioactive substance emits gamma rays or beta particles close to the tumour Either on surface or implanted into tumour
61
What type of brachytherapy is used to treat thyroid tumour?
Radioiodine treatment
62
What is the most common source of external beam in external beam radiation therapy?
Linear accelerator
63
When should radiation therapy be used?
Malignant primary tumour with no local/distant metastasisq
64
What does the response to radiation of the cancer cells depend on?
Radiosensitivity of the cells - rapidly dividing cells are more sensitive Dose and energy of radiation
65
What are some acute reactions to radiation therapy?
``` Skin reddening Vesiculation Desquamation Severe exfoliative dermatitis Localised hair loss ```
66
What are some late toxicity symptoms of radiation therapy?
``` Depigmentation Dermal fibrosis Osteonecrosis Neural necrosis Blindness (enucleation) Neurologic signs ```
67
When should chemotherapy be used?
In the early stages - depends on growth fraction as rapidly dividing cells are most susceptible
68
What does the response to chemo depend on?
Tumour growth rate | Drug resistance
69
What does fractional cell kill mean?
Cytotoxic drugs only kill a constant fraction of cancer cells - according to first order kinetics
70
What is the consequence of fractional cell kill?
Difficult to fully eradicate all cancer cells - if start with low number, an even lower number still remain
71
How do you get around the issue of fractional cell kill?
Use chemotherapy protocol - multiple doses | Surgical debulking
72
What is primary cytotoxic drug resistance?
Cancer is resistant in the first place
73
What is secondary cytotoxic drug resistance?
Cancer develops resistance due to mutations and selection of resistant clones
74
What is multidrug resistance I?
Mutation of the gene encoding the ATP binding cassette export pump Leading to accumulation of the drug in the cells
75
Which chemo drugs are affected by multidrug resistance I?
Ivermectin Doxorubicin Vincristine Vinblastine
76
What are some safety issues with chemo drugs?
``` Cause DNA damage so Carcinogen - cause cancer Teratogen - damage foetus Irritant Mutagenic ```
77
How does coat change during chemo?
Cats only lose whiskers Some dog breeds susceptible to coat loss Others just lose beard
78
What are two other side effects of chemo other than coat loss?
GI toxicity | Myelosuppression - neutropenia
79
What is myelosuppression?
Decreased bone marrow activity
80
When is myelosuppression an issue? What should you do?
When neutrophil count is <2x10^9 - at risk of sepsis | Stop chemo, give antibiotics
81
What can happen if given topically/extravascular?
Phlebitis - tissue necrosis
82
What does vesicant mean?
Severe irreversible tissue injury and necrosis
83
What are some drugs that are vesicants?
Vincristine Cisplatin Doxorubicin
84
How to reduce chance of extravasation/perivascular leakage?
Administer through IV catheter | Flush catheter with saline
85
What is sterile haemorrhagic cystitis?
Metabolites in urine are bladder irritant
86
What are acute and chronic cardiotoxicities due to chemo?
Acute - tachyarrhythmias | Chronic - cardiomyopathy
87
How often do you give chemo drugs?
3 week cycles
88
What are the 3 phases of chemotherapy protocol?
Induction Maintenance Rescue
89
What is the aim of induction in the chemotherapy protocol?
Aim to reduce tumour burden into remission
90
When is rescue phase of the chemotherapy protocol?
When the tumour relapses or doesnt respond to initial therapy
91
What tumours are highly sensitive to chemotherapy?
Lymphoma | Myeloma
92
What tumours are poorly sensitive to chemotherapy?
Slow growing sarcomas Carcinomas Melanomas
93
What are the two most common chemotherapy protocols used for lymphoma?
COP - cats CHOP - B cell dogs LOP - T cell dogs
94
What drugs are in the COP protocol?
Cyclophosphamide Prednisolone Vincristine
95
What drugs are in the CHOP protocol?
Cyclophosphamide Prednisolone Vincristine Hydroxydaunorubicin - doxorubicin
96
What is first-line chemotherapy?
When chemo is used at first in systemic diseases that cant debulk Might respond well as have high growth fraction
97
What is adjunctive chemotherapy?
Used alongside surgery/radiotherapy
98
When is adjunctive chemotherapy used?
For solid tumours eg. carcinoma, sarcoma
99
What is metronomic chemotherapy?
Palliative daily low doses of chemotherapy drugs
100
What is chemoembolisation?
When chemo drugs are injected into blood vessel supplying tumour Then block tumour with synthetic material
101
What are the main mechanisms of chemotherapy drugs?
Alkylating agents Platinum compounds Plant alkaloids Antibiotics
102
How do alkylating agents work to be cytotoxic?
They add an alkyl group to guanine which damages DNA | Cause inter/intra strand crosslinks
103
When do alkylating agents work in the cell cycle?
They are not cell cycle specific
104
What are some examples of alkylating agent chemo drugs?
Cyclophosphamide Chlorambucil Melphalan
105
How do platinum compounds woth to be cytotoxic?
They covalently bind to DNA causing DNA damage Cause inter/intra strand crosslinks (Similar to alkylating agents)
106
What are some examples of platinum compounds chemo drugs?
Cisplatin | Carboplatin
107
What type of tumour are platinum compounds used for?
Osteosarcoma
108
What is important to note about platinum compounds?
They are nephrotoxic to cats - dont use
109
How do anti-metabolites work?
Inhibit the use of cellular metabolites during the cell growth/division
110
What are 5 examples of anti- metabolites?
``` Cytarabine Methotrexate 5-fluorouracil Azathioprine Hydroxyurea ```
111
What is cytarabines mechanism of action?
Cytosine analogue
112
What phase does cytarabine damage DNA in?
S phase
113
What type of tumour is cytarabine used for?
Lymphoma/leukaemia
114
What is methotrexates mechanism of action?
Folate analogue - folate is necessary for purine and pyrimidine synthesis so DNA synthesis cant occur
115
What type of tumour methotrexate used for?
Lymphoproliferative disorders
116
What is 5-fluorouracils mechanism of action?
Uracil incorporates into DNA interfering with function/synthesis
117
What are the sides effects of 5-fluorouracil?
Myelosuppression | Neurotoxicity
118
What is azathioprines mechanism of action?
Inhibits purine/DNA synthesis
119
What is azathioprine used to treat?
Lymphoma Leukaemia IMPA
120
What are the main side effects of azathioprine?
Myelosuppression Liver disease Pancreatitis
121
What can you give azathioprine to?
Most dogs | NOT cats
122
What is hydroxyureas mechanism of action?
Inhibits DNA synthesis
123
What is hydroxyurea used to treat?
Polycythaemia vera
124
What is polycythaemia vera?
Tumour of RBC precursors producing excess RBCs
125
What are some examples of cytotoxic antibiotics?
Doxorubicin Mitoxantrone Actinomycin D
126
What is the most effective agent for most cancers?
Doxorubicin
127
What is doxorubicin mechanism of action?
Multimodal eg. DNA intercolation Alkylation of DNA Inhibits DNA polymerase
128
Are some examples of plant alkyloids?
Vincristine | Vinblastine
129
What is vincristine used to treat?
Lymphoma
130
What is vinblastine used to treat?
Mast cell tumours
131
What is the mechanism of action of vincristine/vinblastine?
Inhibits microtubule formation | Interferes with mitotic spindle
132
What are tyrosine kinase inhibitors used to treat?
Tumours expressing c-kit mutation | eg. Mast cell tumours
133
What is the main adverse effect of tyrosine kinase inhibitors?
GI toxicity
134
What are the two tyrosine kinase inhibitors?
Toceranib | Masitinib
135
What is the main enzyme used as a chemotherapeutic drug?
L-asparaginase
136
What is the mechanism of action of L-asparaginase?
Destroys circulating asparagine necessary for protein synthesis
137
What is important about administering L-asparaginase?
Inactivated by rubber so give immediately after reconstitution from powder Must be given SC or IP
138
How do NSAIDs help with chemotherapy?
Induce apoptosis
139
What are glucocorticoids used to help treat?
Lymphomas | Decrease inflammation and swelling
140
What are the 4 haematopoietic tumours?
Lymphoma Lymphoid leukaemia Myeloproliferative disorders Myeloma/plasma cell tumours
141
What is a viral cause of lymphoma?
FeLV
142
What is a lymphoma?
A neoplastic disease arising from the lymphoreticular system
143
Where do lymphomas primarily affect dogs?
Lymph nodes
144
How are lymphomas diagnosed?
Cytology | Histological appearance of lymph node/organ
145
How are lymphomas classified?
Histological classification and grade Anatomical area Immunophenotype - B or T cell
146
How are lymphomas histologically classified?
Cell size, mitotic rate
147
What does flow cytometry tell you about the lymphoma?
What surface proteins there are - 'cluster of differentiation molecules' Whether it is B cell or T cell
148
What type of lymphoma is more likely to cause hypercalcaemia?
T cell lymphoma
149
What anatomical form of canine lymphoma is the most common?
Multicentric - lots of lymph nodes
150
What type of system do you use to stage canine lymphoma?
WHO Anatomical site Stage Substage
151
What are the 5 anatomic sites of lymphoma?
``` Generalised Alimentary Thymic Skin Leukaemia Extra-nodal ```
152
What are the stages of the WHO staging system of lymphoma?
Go from only involving one lymph node to generalised to blood/bone marrow involvement
153
What are the substages of the who staging system of lymphoma?
Clinically well | Clinically unwell
154
Which type of lymphoma has a poorer prognosis?
T cell Large cell Stage V substage b Male dog
155
What can be given palliatively to treat lymphoma?
Prednisolone - corticosteroids
156
What is the most effective drug against lymphoma?
Doxorubicin | Used in CHOP protocol or alone
157
What is the name for cutaneous lymphoma?
Mycosis fungoides
158
What is the best treatment for cutaneous lymphoma?
Lomustine and prednisolone
159
What is the most common anatomical form of lymphoma in cats?
Alimentary
160
What chemotherapy protocol is better tolerated in cats?
COP | Cats dont like doxorubicin
161
What is the remission rate for feline lymphoma?
Only 50-70%
162
What is the median survival time for feline lymphoma?
8 months with COP protocol
163
What is leukaemia?
Neoplastic proliferation of haematopoietic stem cells
164
How are leukaemias classified?
Stem cell origin - lymphoid or myeloid | Degree of differentiation
165
What type of leukaemia has a poorly differentiated form?
Acute leukaemia - poor prognosis | And vice versa
166
How is leukaemia diagnosed?
Bone marrow evaluation Blood smear examination Imaging Flow cytometry
167
What type of stem cell origin is more common in leukaemia?
Lymphoid more common than myeloid
168
What type of degree of differentiation is more common?
Poorly differentiated - acute leukaemia more common
169
What is a key marker of acute lymphoid leukaemia?
Marked lymphoblast population in the blood and bone marrow
170
What is aleukaemic leukaemia?
Bone marrow infiltration but absent peripheral lymphoblast
171
What age is chronic lymphoid leukaemia most common in?
Older patients compared to acute
172
What type of cells are a marker of chronic lymphoid leukaemia?
Mature lymphocytes - peripheral lymphocytosis
173
What is a myeloproliferative disorder?
Rare nonlymphoid bone marrow cell disorder
174
What is the most common myeloproliferative disorder?
Polycythaemia vera
175
What is the prognosis for chronic myeloproliferative disorders?
Guarded | May undergo a blast crisis - fatal leukaemia phase
176
What is polycythaemia vera?
Abnormal proliferation of erythroid precursor in the bone marrow
177
What does polycythaemia vera cause?
Hyperviscosity - high PCV
178
What are the clinical signs of polycythaemia vera?
Neuro signs Blindness Heart failure
179
What are plasma cell tumours?
When plasma cells/immunoglobulin producing B cell precursor cell lineage transforms into a neoplastic population
180
What are the 3 most important plasma cell tumours?
Multiple myeloma IgM macroglobulinaemia Solitary plasmacytoma
181
What is a multiple myeloma?
Monoclonal proliferation of malignant plasma B cells
182
What is a sign of multiple myeloma?
Abnormal amounts of one type of immunoglobulin
183
What are the clinical signs of multiple myeloma?
Hypercalcaemia Renal failure Anaemia Bone lesions
184
What do solitary plasmacytomas progress to?
Multiple myelomas
185
What are histocytes?
Migrate from bone marrow to blood and differentiate to macrophages and dendritic cells
186
What should the margin be for surgical excision of carcinomas?
1 cm margins - metastasis more of a problem
187
What should the margin be for surgical excision of sarcomas?
3cm margins - local invasion more of a problem
188
What should the margin be for surgical excision of round cell tumours?
1-3cm margins - variable
189
What can excessive tension cause?
Compromise to circulation Ischaemia Dehiscence Necrosis

CVSOH BVSc3 (60 decks)

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