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Oncology Flashcards

1
Q

can paraneoplastic signs be associated with local tumour growth?

A

no

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2
Q

signs of paraneoplastic syndrome

A

Paraneoplastic signs = cachexia, hypercalcaemia, hypoglycaemia, hypergammaglobinaemia, polycythaemia, anaemia, coagulopathy, fever

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3
Q

hypercalcaemia

A
  • causes: hyperadrenocortisim, renal failure, D hypervitaminosis
  • most common cause = malignancy: lymphoma (mediastinal form), anal gland carcinoma, thyroid carcinoma, mammary tumour, multiple myeloma
  • tumour secretion of parathormone or PTH
  • for mild: no clinical signs, perform rehydration and monitor Ca, P and creatinine daily
  • moderate: clinical signs present, patient should be rehydrated, induce diuresis, in well hydrated patient, can add furosemide after diagnosis prednisolone
  • severe: prominent clinical signs, emergency, in refractory cases add calcitonin, biphosphonated
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4
Q

hypoglycamia

A
  • blood glucose conc below 3.5mmol/L
  • occurs with multiple disorders (hypoadrenocorticism, liver failure, starvartion, sepsis) + PNS
  • signs: patients weak, disoriented with seizures, coma and death
  • insulin should be suppressed: isotonic glucose infusion of hypertonic glucose bodies, administration of corticosteroids and adapted diet
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5
Q

hypergammaglobinema

A
  • increased levels associated with multiple myeloma, although can occur in lymphomas or chornic leukaemia
  • Biochem: high concentration of TP with low or normal albumin
  • electrophoresis
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6
Q

polycythemia

A
  • increase in total number of erythrocytes usually due to: dehydration, hyperadrenocorticism, malignant proliferation, or arising from PNS
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7
Q

anaemia

A
  • occurs in 25% of vet oncology patients
  • majority of anaemia that accompany oncologic conditions; 1. anaemia of chronic disease, 2. autoimmune haemolytic anaemia, 3. micro angioma haemolytic anaemia, 4. bleeding
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8
Q

fever

A
  • need to distinguish whether it’s cancer patient who’s developed a concurrent infection or it’s a cancer patient with fever as part of PNS
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9
Q

diagnosis of paraneoplasitc syndrome

A

anaemia, leukopenia, thrombocytopenia

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10
Q

treatment of paraneoplastic syndrome

A

Removal of the tumour and might need to do symptomatic therapy due to hypercalcaemia

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11
Q

definition of hyper viscosity syndrome

A

increase in protein concentration makes blood hyper-viscous, thickening of the blood

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12
Q

predisposition of hyper viscosity syndrome

A

occurs in 20% of dogs with IgM or IgA monoclonal proteins if the protein level in blood are high – more common in older dogs

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13
Q

cause of hyper viscosity syndrome

A

multiple myeloma and plasma cell tumours, lymphocytic leukaemia or lymphoma, marked polycytemia, chronic autoimmune disease

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14
Q

signs of hyper viscosity sydnrome

A

epistaxis, hypoxia nystagmus, ataxia, coma, retinal bleeding, renal impairment, myocardial hypoxia, cardiomyopathy, anorexia, depression, blindness

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15
Q

diagnosis of hyper viscosity syndrome

A

is a syndrome, not a final diagnosis
- physical exam, background history
- CBC, biochemistry and urinalysis
- look at total plasma protein count

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16
Q

treatment of hyperviscosity

A

fluid supplementation, based on if it’s caused by a cancer or only inflammatory condition

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17
Q

cause of anaemia of chronic diseases

A
  • may be due to decreased red cell production and/or increased red cell destruction
  • multi factorial anaemia due to impaired Fe metabolism, shorter erythrocyte life and in rare cases, bone arrow suppression by tumour cytokines
  • Indicates the presence of a chronic problem, such as chronic infection, autoimmune disease, kidney disease or cancer
  • indicated disseminated and metastatic tumours
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18
Q

cause of anaemia of chronic diseases

A
  • may be due to decreased red cell production and/or increased red cell destruction
  • multi factorial anaemia due to impaired Fe metabolism, shorter erythrocyte life and in rare cases, bone arrow suppression by tumour cytokines
  • Indicates the presence of a chronic problem, such as chronic infection, autoimmune disease, kidney disease or cancer
  • indicated disseminated and metastatic tumours
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19
Q

signs of anaemia of chronic disease

A

most commonly related to the underlying disease, lethargy and poor performance, weight loss, depression, pallor

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20
Q

diagnosis of anaemia of chronic disease

A

bone marrow exam exhibits no significant change

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21
Q

anaemia of chronic disease treatment

A

removing the tumour if neoplasia, correct any deficiency, treat underlying cause

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22
Q

prognosis of anaemia of chronic disease

A

good

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23
Q

microangiopathic haemolytic anaemia (cause, diagnosis, treatment)

A

Cause: as a consequence of blood vessel endothelium damage and fibrin deposition. occurs most commonly with hemangiosarcoma
Diagnosis: schistocytes and haemolysis
Treatment: tumour removal, adj. therapy and supportive transfusion whole blood therapy

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24
Q

malignant lymphoma predisposition

A
  • most frequent of haematopoietic system in dogs, arising from lymphoid tissue
    Predisposition: golden retrievers, GSD, Scottish terriers,
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25
Q

classification of malignant lymphoma

A

(by anatomical location): multi centric, alimentary, mediastinal, extranodal (lungs, kidneys, skin, eyes etc)

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26
Q

forms of malignant lymphoma

A

Multicentric
- occurs in 85% cases
- manifested: bilateral painless swelling of superficial LN, hepatosplenomegaly, spreading to other organs and tissues
- signs: depression, gross lymphadenopathy
- 3 stages:
o 1. initial lymphadenopathy without change in general condition
o 2. moderate weight loss and loss of appetite
o 3. sudden onset of anorexia, weakness, exhaustion and death

Alimentary form
- occurs in 7% cases
- common in cats
- enlargement of intestinal and mesenteric LN (superficial usually unchanged)
- clinically manifested: by progressive weight loss, diarrhoea

Mediastinal form
- occurs in 5% cases
- manifested: by enlarging the mediastinal LN, form characterised by hypercalcaemia
- poor exercise intolerance, respiratory distress

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27
Q

staging of malignant lymhoma

A
  1. single LN
  2. regional lymphadenopathy
  3. generalised lymphadenopathy
  4. liver and/or spleen involvement +/- LN
  5. blood, bone marrow and other organ involvement
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28
Q

diagnosis of malignant lymphoma

A

history, clinical findings, immunocytochemical exams, pathophysiology and immunohistochemical examination
- cytology: FNA
- CBC: thrombocytopenia in 30-50% cases, neutrophilia 25-40%, lymphocytosis in 20% cases
- biochemistry: - lymphoma may result in hypercalcaemia
- X-ray + contrast

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29
Q

treatment of malignant lymphoma

A

combined chemotherapy, vets use: L-asparaginase, vincristine, prednisolone, cyclophosphamide, doxorubicin, surgery and radiation therapy

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30
Q

prognosis of malignant lymphoma

A

poor if not treatment for intermediate/high grade, fair for indolent lymphomas
- if no treatment: average survival 4-6 weeks
- if prednisolone only: average survival 2-3 months
- chemotherapy: survival 4.5-8months

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31
Q

differentials of malignant lymphoma

A

Alimentary form
- malabsorption, inflammatory bowel disease, Addison’s disease, parasites, other cancers
Thymic form
- causes of dyspnoea, thymoma, metastatic disease, ectopic thyroid tumour
Multicentric form
- leukaemia, lymphadenopathy

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32
Q

hemangiosarcoma predisposition

A
  • from blood vessel endothelium
  • most usual in the spleen and near the heart
    Predisposition: mostly middle aged, GSD, golden retriever
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33
Q

signs of hemangiosarcoma

A

weakness, enlargement of spleen, bleeding, if cardiac form = cardiac tamponade, bruising, arrhythmias

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34
Q

diagnosis of hemangiosarcoma

A

histopathology, X-ray (thorax), US abdominal and cardiac and CT of abdomen
- CBC
q

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35
Q

treatment of hemangiosarcoma

A

surgery, if no metastatic, transfusion before, Adj, th = doxorubicin every 2-3 weeks for total of 5 treatments, blood transfusion, radiotherapy, immunotherapy

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36
Q

differentials of hemangiosarcoma

A

abdominal mass, coagulopathies, benign idiopathic pericardial effusion if cardiac tamponade is present

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37
Q

prognosis of hemangiosarcoma

A

survival time 5- 7 months

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38
Q

predisposition of osteosarcoma

A

middle age to older (7 years), Great Dane, rottweiler, intact males and females have increased risk, Large and giant breeds

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39
Q

cause of osteosarcoma

A

unknown, hereditary basis

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40
Q

pathogenesis of osteosarcoma

A

Malignant tumour of bone cells, fast growing, primary bone tumour, usually limbs, high mtc potential (lung)

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41
Q

signs of osteosarcoma

A

depends on location, lameness, swelling, pain

42
Q

diagnosis of osteosarcoma

A

x-ray
bone biopsy

43
Q

treatment of osteosarcoma

A

surgery, radiation, chemo, doxorubicin every 2-3 weeks for total of 5 treatments, analgesia

44
Q

prognosis of osteosarcoma

A

very poor without treatment, pain of primary tumour usually euthanasia

45
Q

predisposition of soft tissue sarcoma

A

generally in older animals, but can be younger of large breeds, golden retriever = fibrosarcoma

46
Q

cause of soft tissue sarcoma

A

unknown, occasionally associated with chronic inflammation

47
Q

pathogenesis of soft tissue sarcoma

A

from connective, muscle and nervous tissue

48
Q

signs of soft tissue sarcoma

A

related to location, firm, fibrous mass

49
Q

diagnosis of soft tissue sarcoma

A

biopsy and histopathology

50
Q

treatment of soft tissue sarcoma

A

surgery and radiation, chemo, NSAIDs

51
Q

prognosis of soft tissue sarcoma

A

based on histological grade, mitotic index and evaluation of margins, medial survival times following surgery range from 480-1796 days

52
Q

predisposition of transitional cell carcinoma

A

occurs most in female dogs, Scottish terriers, west highland, beagles and Shetland sheepdogs

53
Q

pathogenesis of transitional cell carcinoms

A

occurs in bladder and urethra

54
Q

transitional cell carcinoma

A

micro-macro haematuria, decreased urine

55
Q

diagnosis of transitional cell carcinoma

A

CBC, physical exam, biochemistry, urinalysis, Xray, abdominal US and urinalysis, biopsy

56
Q

treatment of transitional cell carcinoma

A

surgery if possible, chemo, palliative care, NSAIDs, radiotherapy

57
Q

prognosis of transitional cell carcinoma

A

dependent on the progression, without treatment most die from complications within a few to several months

58
Q

predisposition of mammary tumours

A

most affected in middle age and older, rare in younger than 5

59
Q

cause of mamamry tumours

A

increased or prolonged exposure to growth promoting hormonal influences

60
Q

signs of mammary tumours

A

lump, advanced stages ulcerated, inflamed

61
Q

diagnosis of mammary tumours

A

CBC, biochemistry, FNA, 5 stages

62
Q

treatment of mammary tumours

A

surgery, NSAIDs

63
Q

prognosis of mammary tumour

A

good if low stage grade

64
Q

anal gland carcinoma predisposition

A

intact male dogs, female, most common 7-12 years, GSD, cockers, daschunds, springer spaniel

65
Q

pathogenesis of anal gland carcinoma

A

High mtc rate (regional LN, liver, lung)

66
Q

signs of anal gland carcinoma

A

swelling, painful defecation, PUPD due to hypercalcaemia, bleeding, bum scooting

67
Q

diagnosis of anal gland carcinoma

A

CBC, urinalysis, x-ray, CT, US of abdomen, histopathology

68
Q

treatment of anal gland carcinoma

A

surgery, radiation and chemo, corticosteroid, stool softeners, increased fibre

69
Q

prognosis of anal gland carcinoma

A

multimodal treatments 544 days

70
Q

differentials of anal gland carcinoma

A

anal sacculitis, perianal gland adenoma, other causes of hypercalcaemia

71
Q

predisposition of melanoma

A

Common in skin, digit and oral cavity, less common in iris and ciliary body of eye
Predisposition: middle age to older, Scottish terrier, dachshund

72
Q

pathogenesis of melanoma

A

malignant proliferation of melanocyte, mts to regional LN, lungs

73
Q

signs of melanoma

A

black-brown pigmented mass, friable, ulcerated, haemorrhagic, hallitosis

74
Q

diagnosis of melanoma

A

cytology, histopathology (FNA), X-ray, CT

75
Q

treatment of melanoma

A

surgery, radiation, immunotherapy, chemo (carboplatin)

76
Q

prognosis of melanoma

A

majority of skin melanomas are benign, melanomas of digits and oral cavity are malignant
- oral = 5 months, feet + lips = 22.5 months, cutaneous = 24.2 months
- stage 1 = 17-18 months, stage 2 = 5-6months, stage 3 = 3 months

77
Q

predisposition of mast cell tumour

A

Most common malignant skin tumour of dog
Predisposition: mean 8.5 years but can be seen in dogs of all ages, bull breeds + brachycephalic, beagle, Boston terrier, boxer

78
Q

pathogenesis of mast cell tumour

A

most common malignant skin cancer, mts: LN, liver, spleen

79
Q

signs of mast cell tumour

A

hairless mass, vomiting, melena, skin mass

80
Q

diagnosis of mast cell tumour

A

cytology or histopathology, CBC (eosinophilia/basophilia)

81
Q

treatment of mast cell tumour

A

surgery, tyrosine kinase inhibitors, H2 blockers (famotidine)

82
Q

prognosis of mast cell tumour

A

good for low-grade tumours; guarded to poor for high -grade

83
Q

differentials of mast cell tumour

A

other skin neoplasia, granuloma, urticarial reaction

84
Q

predisposition of multiple myeloma

A

is rare in cats, around 11 years

85
Q

pathogenesis of multiple myeloma

A

proliferation of plasma cells

86
Q

signs of multiple myeloma

A

lethargy, pain, spleen enlargement, bleeding, weight loss, neurological signs, lameness, PUPD, pyrexia

87
Q

diagnosis of multiple myeloma

A

biochemistry (chronic kidney disease), spike on serum protein electrophoresis, anaemia, urinalysis (often normal), X-ray, histopathology

88
Q

treatment of multiple myeloma

A

chemo, melphalan, prednisolone

89
Q

prognosis of multiple myeloma

A

max survival time = 15 months

90
Q

differentials of multiple myeloma

A

lymphoma, hyper viscosity caused by polycytemia, SLE, drug reaction

91
Q

TNM

A

T = primary tumour
- T0 = no evidence of tumour
- T1= tumour < 1cm + non-invasive
- T2 = 1-3cm +/or locally invasive
- T3 = < 3cm +/or locally invasive
N = regional lymph node
- N0 = no evidence of involvement
- N1 = firm + enlarged
- N2 = firm, enlarged + fixed to tissue
- N3 = involvement beyond regional LN
M = metastasis
- M0 = no evidence
- M1 = to 1 organ system
- M2 = to more than 1 organ system

92
Q

signs of leukaemia

A

weakness, pale MM, lethargy, non specific due to consequences of disease process, inappetence, weight loss, PUPD, bleeding, fever, pallor, petechial haemorrhage

93
Q

diagnosis of leukemia

A

peripheral blood smears, bone marrow aspirate, flow cytometry, CBC (anaemia), biochemistry (renal, hepatic, proteins, calcium), urinalysis, US

94
Q

treatment of leukemia

A

VM protocol, supportive, symptomatic, specific cytotoxic agents

95
Q

prognosis of leukaemia

A

poor, favourable chronic (>18 months), grave for acute (1-2 months)

96
Q

differential of leukemia

A

myelodysplasia, other cause of anaemia, lymphocytosis

97
Q

L-asparagina

A
  • inhibits tumour protein synthesis
98
Q

vincristine

A
  • blocks mitosis and can cause PNS side effects
99
Q

cyclophosphamide

A
  • works at level of DNA replication
  • PO/IV
  • endoxan
100
Q

prednisolone

A
  • decrease inflam edema around tumours
  • adverse effects: secondary adrenal insufficiency, GI disorders, liver damage, blood clotting disorder
101
Q

doxorubicin

A
  • V strong cytotoxic
  • slow IV infusion over 20 minutes  too fast = facial edema + shivering – STOP
  • paravenous = severe tissue irritation, can cause cardiomyopathy, wear protection (gloves, apron, glasses)
102
Q

lymphoma protocol

A

Week 1
- L-asparaginase 10,000 IV
- vincristine 0.7mg/m2 IV
- prednisolone 40mg/m2 q 24 hr + famotidine
Week 2
- cyclophosphamide 250mg/m2 PO + diuretic
- prednisolone 30mg/m2 q 24 hr
Week 3
- vincristine 0.7mg/m2 IV
- prednisolone 20mg/m2 q 24 h + famotidine
Week 4
- doxorubicin 30mg/m2 or 1mg/kg if < 15kg IV
- prednisolone 10mg/m2 q24 + famotidine
Next 4 weeks = repeat of first 4 but have a break on week 10

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