Oncology

Question 1

Breed dispositions for cancer-

Answer 1

Pugs, Boston terriers, Boxers–> MCT
Bernese Mountain Dogs–> Histiocytic sarcoma
Boxers, Basset Hounds, Bulldogs–> lymphoma
Belgian Tervurens, chows–> gastric adenocarcinoma
GSD–> hemangiosarcoma, Nodular dermatofibrosis– renal carcinoma and uterine leiomyoma

Question 2

Intact male dogs are predisposed to what tumor? What about neutered male dogs? What about female dogs?

Answer 2

Male intact is usually perianal adenoma

Neutered males is usually prostatic carcinoma (usually an adenocarcinoma)

Females is usually urinary tumors like TCC

Question 3

How do P-glycoprotein substrate chemo drugs work and what are some examples?

Answer 3

They are called “immunomodulators” which are used to harness the body’s own immune system to respond to cancer cells with minimal SE as compared to chemotherapy/radiation

they are usually not stand-alone therapies

Examples are: Vincristine, Vinblastine, Vinorelbine, Doxorubicin, +/- Mitoxantrone

Question 4

Unique SE to 5-Fluorouracil-

Answer 4

Fatal neurotoxicity in cats (and in dogs with very high doses)

Question 5

Unique SE to Vincristine

Answer 5

peripheral neuropathy – interferes with microtubule formation so interferes with neuron transmission/transduction pathways. Patients may have pins and needle feelings in paws

Question 6

Unique SE to Cisplatin–

Answer 6

Fatal pulmonary edema in cats

Question 7

Unique SE to Mechlorethamine-

Answer 7

severe vesicant which means sloughing of the skin when outside of the vein

Question 8

Unique SE to Cyclophosphamide-

Answer 8

sterile hemorrhagic cystitis because one of the byproducts ends up in urine and is caustic to bladder wall so give in the morning and make sure p is well hydrated
May need to also give Furosemide with it and if you see any cystitis STOP THE DRUGGG

Question 9

Unique SE to CCNU–

Answer 9

hepatotoxicity and this is one of the ones we need to really watch the neutrophils

Question 10

Unique SE to Doxorubicin-

Answer 10

Severe vesicant and will slough skin if outside of the vein, Hypersensitivity/anaphylaxis, cumulative cardiotoxic in dogs, arrhythmogenic, cumulative nephrotoxicity in cats

Question 11

What chemotherapy drugs cross the BBB?

Answer 11

5-FU
Cytosar
Hydroxyurea
CCNU
Procarbazine

Question 12

Sensitivity to radiation therapy (RT) of cancers in order

Answer 12

Round cell tumor> carcinoma> sarcoma

Question 13

What is the TOC for LSA and what is the % response rate?

Answer 13

Chemo is the TOC for LSA and there is a 80-90% response rate

Question 14

Hypercalcemia, mediastinal LN enlargement, and boxers/ wolfhounds/ huskies/ shih tzu’s = ____ cell Lymphoma

Answer 14

T cell Lymphomas

Question 15

T cell is usually in dogs/cats and B cell is usually in dogs/cats

Answer 15

T cell is usually in dogs and B cell is usually in cats

Question 16

There is an approx. 60X increase risk of cats getting lymphoma if they are ___ positive and it is usually ___ cell secondary to….

Answer 16

FeLV positive; it is usually T cell secondary to viral integration into the genome

Question 17

____ has approx. 5x the increased risk in cats who have it for ___ cell LSA secondary to…

Answer 17

FIV; B cell; secondary to immunosuppression

Question 18

What is acute lymphoid leukemia in cats?

Answer 18

Neoplastic blast cells taking over the bone marrow resulting in pancytopenia (decreased RBCs, WBCs, and platelets)

Question 19

pancytopenia means…

Answer 19

low RBCs, WBCs and platelets

Question 20

evans syndrome is…

Answer 20

IMHA and immune-mediated thrombocytopenia

Question 21

MCT in dogs

Answer 21

do not need chest rads, need FNA of liver and spleen, TOC is surgery and chemotherapy
MCT is the number one most common cutaneous tumor of dogs

Question 22

MCT in cats

Answer 22

cats get internal MCT and MCT are not as common in cats as they are in dogs, 3 unique variations are cutaneous, splenic/visceral, and intestinal
TOC is splenectomy/sx and chemo

Question 23

Hepatobiliary tumors in cats are usually ____ but are ____ in dogs

Answer 23

Benign; malignant

Question 24

50% of canine liver tumors are _____ tumors and usually have no mets if _______

Answer 24

Hepatobiliary; usually no mets if they are massive/solitary

Question 25

AGASACA

Answer 25

cocker spaniel is the poster child, occurs in females and males but is more common in those that are spayed/neutered, mets are 50-80% of cases and include the LN, liver, spleen, lungs, and bones LN mets are common at presentation but DISTANT mets are uncommon TOC is multimodal

Question 26

Nasal tumors in dogs from most common to lesser commonality

Answer 26

Adenocarcinoma>SCC> Fibrosarcoma> osteosarcoma

Question 27

Oral tumors in dogs from most common to lesser commonality

Answer 27

Melanoma> SCC> Fibrosarcoma> osteosarcoma

Question 28

Nasal tumors in cats from most common to lesser commonality

Answer 28

SCC> lymphoma RT is the TOC like with in dogs, cats have a lot worse of a prognosis

Question 29

elevated globulins usually point toward what cancer types?

Answer 29

Multiple myeloma and plasma cell tumors

Question 30

ISS

Answer 30

Injection site sarcomas 4 months to 3 years post vaccine, may be genetic bc higher incidence found in siblings 3-2-1 rule Still present after 3 months after the vaccine >2 cm in diameter still growing 1 month post-vaccination INCISIONAL biopsy only locally invasive, non painful, firm, deeper than what we can palpate, slow/late mets but mets to lungs after awhile TOC is sx and RT +/- chemo if confirmed mets or "hot" tumors which are tumors with high mitotic count, vascular invasion, etc.

Question 31

Dolichocephalic dogs get this type of brain tumor whereas brachycephalics get this type of brain tumor

Answer 31

Dolichocephalic dogs get meningiomas whereas brachycephalics get this gliomas

Question 32

Hemangiosarcoma predilection sites

Answer 32

Spleen, right atrium, skin

Question 33

Hemangiosarcoma notes

Answer 33

Early, aggressive mets to the liver, lung, mesentery, brain, mets in > 80% of P with HSA on presentation HSA is the most common tumor to met to the brain, hematogenous spread or can have direct implantation Sarcoma= cancer of connective tissue cells Carcinoma= cancer of epithelial cells | Remember, HSA is sarcoma of the conn. tissue around the blood vessels

Question 34

Double 2/3's rule

Answer 34

2/3 of splenic masses in dogs are neoplastic 2/3 of those neoplastic masses are hemangiosarcomas

Question 35

What is definitive diagnosis and TOC for HSA?

Answer 35

Definitive diagnosis is biopsy and TOC is chemo (Doxorubicin aka red death) Chemo is not a front line but can hopefully slow down any metastatic disease Prognosis for HSA -with no tx- days to weeks -with sx alone 1-3 months because mets get them -sx for mass and chemotherapy- may double your time so MST 6-8 months

Question 36

____ % of thyroid tumors are bilateral and bleed a lot so AVOID incisional biopsies

Answer 36

60%

Question 37

Midline mass on the neck of an older dog is what until proven otherwise?

Answer 37

Thyroid carcinoma until proven otherwise despite what cytology might say

Question 38

Pheochromocytoma

Answer 38

mets rate is about 40%, they are uncommon and are usually hidden masses with a lot of CS Hormone testing may find metanephrine which is a break down product of epinephrine and norepinephrine and if it is 4X the normal range means likely has a pheochromocytoma

Question 39

what is the TOC for pheochromocytoma? What is the prognosis? What is NOT a tx option for them?

Answer 39

sx if adrenal mass is more than 2cm and is causing CS, can also do RT Will NOT respond to CHEMO; Prognosis is MST 2-3 YEARS with sx resection, otherwise variable to guarded (if tumor is more than 5cm and/or caudal vena cava invasion)

Question 40

________ , ______ and _____ are cancers that may be very Palladia responsive

Answer 40

thyroid carcinomas; renal adenocarcinomas; and insulinomas

Question 41

What are the staging tests recommended for oral tumors?

Answer 41

Cytology of both mandibular LN and thoracic radiographs

Question 42

How do canine oral melanomas differ from SCC and fibrosarcoma in regard to behavior and Tx?

Answer 42

Melanomas that have no pigment resemble sarcomas on histopathology Requires immunohistochemistry to differentiate the two Needed because they act different and tx is different- for melanoma, it responds fairly well to definitive curative RT with 4 fractions, and we need systemic disease Tx unlike sarcomas which TOC is surgery

Question 43

"High/Low" Fibrosarcomas

Answer 43

Golden ret. is the post child, histologically low grade but biologically high grade usually are on the hard palate between the canine and carnassial teeth

Question 44

Steps of cleaning- chemo protocol

Answer 44

Step 1 deactivation (bleach/Clorox wipes) saline/water Step 2 Deconamination (alcohol, water, peroxide, bleach) saline/water Step 3 clean to remove organic debris (bleach/Clorox) saline/water Step 4 Disinfecting (Bleach/Clorox, oxidizing agent, phenols, etc.)

Question 45

uveal melanoma

Answer 45

arises from the anterior segment, is BENIGN in dogs and MALIGNANT in cats CS are heavy pigmentation (but sometimes tan/white), dyscoria- abn pupil shape, blindness, ocular pain, iris thickening

Question 46

___ melanoma is ALWAYS benign in dogs and is seen mostly in what breed?

Answer 46

Limbus melanoma; seen in GSD

Question 47

Lymphoma mets to the eye

Answer 47

via hematogenous spread to the uveal tract, causing anterior uveitis and hyphema (bleeding into the eye), usually stage 5 bc this is mets to distant sites (eyes), more likely to be B-cell and usually presents as nodular lesions within the eye

Question 48

Histiocytic tumors predisposed breeds

Answer 48

Bernese mtn. dog, flat coated retriever, mini schnauzers

Question 49

What are the subtypes of histiocytic sarcoma?

Answer 49

Localized- lung, periarticular (stifle and elbow mostly), spleen Hemophagocytic - rare but bad prognosis, usually has hypocholesterolemia, hypoalbuminemia, thrombocytopenia, regenerative anemia Disseminated- has affinity for lymphocytic regions like lymphoma (LSA)- liver, spleen, lungs, BM, etc.

Question 50

CCNU patients need to also be on what supplement?

Answer 50

Denamarin

Question 51

What characteristic lab work do we see with hemophagocytic histiocytic sarcoma?

Answer 51

hypocholesterolemia, hypoalbuminemia, thrombocytopenia, regenerative anemia

Question 52

Histiocytoma

Answer 52

Langerhans cells in origin, avoid immunosuppression **DO NOT put these p on pred** looks like button ulcer, benign usually in younger dogs and will spontaneously regress

Question 53

What is a good ddx in a patient that has symptoms that seem out of the normal to the disease esp. if the lesion is in a typical location and a predisposed breed?

Answer 53

Histiocytic sarcoma

Question 54

Keep what form of cancer on your radar for evans syndrome (where immune system makes antibodies against the body’s own RBC and attacks its own blood cells) or IMHA dogs, remember to look at all bloodwork abnormalities

Answer 54

Hemophagocytic Histiocytic sarcoma

Question 55

What test is a good GP test to run if you suspect a patient has TCC (recurrent UTI's and older p/maybe predisposed breed)

Answer 55

BRAF test can also do traumatic catheterization

Question 56

What is the most common type of renal cancer?

Answer 56

Renal adenocarcinoma MANY of them express KIT so use Palladia which a receptor kinase inhibitor

Question 57

What are the top 4 at risk breeds for TCC/UC?

Answer 57

Scottie terrier Sheltie Westie Eskimo dog Veggies are protective, ayoooo

Question 58

Why are NSAIDs effective against TCC/UC?

Answer 58

Do chemo indefinitely (do not expect tumor to shrink

Question 59

why do NSAIDS help?

Answer 59

Because they are COX-2 inhibitors and these tumors way over express COX

Question 60

What are the pros and cons and limitations of surgery for TCC/UC?

Answer 60

For most cases, exlap and biopsy is the diagnostic test of last resort because super invasive, high risk of seeding and costly since such a major sx Pros- can do in GP, get histopath, potentially therapeutic if away from the trigone Cons- anesthesia, INVASIVE, VERRRYYY high risk of seeding, will not usually be curative

Question 61

what is the general approach to therapy for TCC/UC and general prognosis?

Answer 61

Do BRAF testing (need 40mL free catch urine) Can do traumatic catheter if in GP Can scope/biopsy if in referral setting EXlap/surgery is last resort, very high risk of seeding, major surgical procedure/invasive

Question 62

Do not have to worry about neutrophil count with what chemo drug? Otherwise, we need neutrophils to be above what level?

Answer 62

Elspar aka L-asparginase; Neutrophils need to be more than 2,000 on CBC

Question 63

MCT are most common where in dogs and where in cats?

Answer 63

In the skin of dogs (the most common cutaneous mass of dogs), and GI tract of the cat

Question 64

explain PARR for differentiating lymphoma types

Answer 64

Cancer cells originate along the same cellular line and proliferate so they would all originate from the same cell and that would mean they should all have the same DNA So with PARR, we are looking to see if this is the same cell line proliferating based off the same origin "monoclonal" = suggestive of a neoplastic process

Question 65

Dogs with generalized lymphadenopathy rule outs--

Answer 65

Ehrlichia, Blastomycosis, Lymphoma +/- chronic pyoderma or atopy

Question 66

What is flow cytometry and how is it used to aid the diagnosis of lymphoma?

Answer 66

Flow cytometry- run all cells through a laser and establish the different sizes and Regularity. Same as with CBC where the cells are brought into single file line Through a laser "they FLOW past a laser horizontally/perpendicular to the cells) And based off the make up inside of the cell, the laser will pick up the size of the cells And that is how we know WBC which are bigger than RBC which is bigger than a platelet and looks at nucleus inside of WBC to see what type of WBC it is

Question 67

Lymphocytosis with diffuse lymphadenopathy likely means...

Answer 67

LSA In the bone marrow

Question 68

Stages of Lymphoma--

Answer 68

Stage 1- single LN Stage 2- multiple regional LN (on one side of the diaphragm) Stage 3- generalized lymphadenopathy (both sides of the diaphragm) Stage 4- spleen and/or liver involvement +/- lymph nodes Stage 5- bone marrow, ocular, cutaneous, renal, nasal, CNS, GI, anything other than LN/spleen/or liver

Question 69

Negative prognostic factors of LSA?

Answer 69

T cell, hypercalcemia, substage B (has CS), prolonged prior pred use, young age, hepatosplenic, high stage

Question 70

"B is bad but T is terrible"

Answer 70

///

Question 71

Remission definition

Answer 71

elimination of all clinically evident disease

Question 72

Rescue chemo

Answer 72

chemo done after the initial protocol fails to bring the p into remission

Question 73

T zone lymphoma

Answer 73

Indolent, low grade variant primarily affecting the LN and bone marrow, 85% have lymphadenopathy and more than 50% have lymphocytosis, usually feeling fine but may be slightly off, really good prognosis (MST like 2-3 years)

Question 74

Darrier's sign

Answer 74

Palpation of the tumor may cause wide release of Histamine and can double to triple in size, give Benadryl to make it smaller and less irritated looking again. May also see bruising because heparin released from MCT along with histamine, proteolytic enzymes, etc.

Question 75

Diagnosis of MCT

Answer 75

FNA- can get a diagnosis easily on FNA usually, MCT is a round cell tumor and round cells do exfoliate pretty well

Question 76

____ dogs are predisposed to MCT but are usually low grade and have better prognosis

Answer 76

Brachycephalic breeds

Question 77

any dog with one ____ will have a higher risk of more in the future

Answer 77

MCT

Question 78

Grades of MCT explained...

Answer 78

The lower the grade, the better they do so grade 1 has no to very slow rate of mets (low cellular turnover rate so low mitotic index score). Grade 3 has high mitotic count, growing fast, invading deep tissues, and worse prognosis overall. About 80% of MCT you find in practice will come back as Grade 2, not all grade 2's are created equal-- may be closer to grade 1 or closer to grade 3 which does not help us a ton because in the middle of good and bad prognosis, which is frustrating for tx and future discussion with the owners. Use low grade and high grade two tier/Kiupel to see if it is closer than grade 1 or grade 3 if it is grade 2

Question 79

TOC for MCT

Answer 79

Surgery is the most important TOC for all MCT of ALL grades!!! Second best option is chemotherapy because first most common site to mets is all draining LN so radiation therapy (RT) is only good for localized lesions

Question 80

Where do MCT like to metastasize????

Answer 80

Usually mets to draining LN and then liver and spleen and rarely bone marrow

Question 81

_____ MCT Are usually LESS aggressive than ____ tumors

Answer 81

Subcutaneous; cutaneous

Question 82

What anatomical locations of MCT carry a WORSE prognosis???

Answer 82

Subungual (nails), digits, muzzle, oral, preputial/scrotal, GI tract, mouth haired skin and eye conjunctiva are some locations that have good prognosis

Question 83

What two long term drugs for p with MCT???

Answer 83

Diphenhydramine and proton pump inhibitors

Question 84

what is the second most common feline skin tumor?

Answer 84

cutaneous MCT in felines with the head and neck being the most common location

Question 85

What is the most common cause of feline splenic disease and are usually sick on presentation?

Answer 85

Splenic/Visceral MCT

Question 86

What is the post child breed for HSA? What is the second runner-up???

Answer 86

Top poster child is GSD and the second runner up is Golden Retriever

Question 87

If you have a dog with an undiagnosed splenic mass that is causing hemoabdomen, do you autotransfuse the patient after removing the splenic mass even though you do not know if it is a benign splenic mass (splenic hematoma or hemangioma) or malignant (hemangiosarcoma)????

Answer 87

Yes, still transfuse it because likelihood of you causing metastasis is super low bc cells are already in circulation and you will save them and do not have to worry about finding blood that is compatible and do not have to worry about the speed in which you give it because you know the patient is hypovolemic anyway. The downside of autotransfusion is you are only giving back the red blood cells, not the clotting factors or anything like that. !!!!!! Throw in some whole blood/plasma if they are going into DIC

Question 88

What is the difference between SQ and cutaneous/dermal HSA in relation to their different MST????

Answer 88

sun exposure

Question 89

HSA layers of the skin different prognosis-----

Answer 89

The dermal hemangiosarcoma has a fair prognosis as long as it is removed before it can invade to the subcutaneous tissues. Hemangiosarcomas that develop in the subcutaneous tissue (not on the skin but under it) or spread to the subcutaneous area from the outer skin behave more malignantly.