Oncology

Question 1

what is CR?

Answer 1

complete response
disappearance of all measurable disease

Question 2

what is PR?

Answer 2

partial response
reduction in volume of all disease, no new lesions

Question 3

what is SD?

Answer 3

stable disease

Question 4

what is PD?

Answer 4

progressive disease

Question 5

prednisone can have anti-tumor effects on which cancers?

Answer 5

lymphoma
multiple myeloma
mast cell tumor

Question 6

prednisone can help control clinical signs in which cancers?

Answer 6

insulinoma
CNS tumor
paraneoplastic hypercalcemia

Question 7

indications for radiation therapy?

Answer 7

1. adjuvant
2. neoadjuvant
3. primary therapy
4. palliation

Question 8

what are some complications of biopsies?

Answer 8

hematoma
surgical site infection
exophytic tumor growth

Question 9

limitations of FNA cytology on tumor

Answer 9

no info on structure, grade and if benign or malignant

Question 10

limitations of needle-core on tumor

Answer 10

size of tumor that is amenable
may penetrate naive tissue/plane
risk of procedure (bleeding, air)

Question 11

when should you do an excisional biopsy?

Answer 11

curative intent resection
high suspicion is benign
palliation

Question 12

when should you absolutely not do an excisional biopsy

Answer 12

injection site sarcoma

Question 13

do you cut parallel or perpendicular to tension lines?

Answer 13

parallel

Question 14

what are these
1. aseptic technique
2. gentle tissue handling
3. hemostasis
4. preserve blood supply
5. eliminate dead space
6. accurate tissue apposition
7. min tension

Answer 14

halsted principles

Question 15

what type of approach?
narrow, high risk for leaving microscopic disease

Answer 15

marginal

Question 16

what type of approach?
2 cm outwards to account for active zone or microsatellites

Answer 16

wide

Question 17

what type of approach?
tumor removal and significant amount of normal tissue around it (e.g. entire muscle)

Answer 17

radical

Question 18

definition:
palliative vs curative/definitive vs cytoreduction

Answer 18

surgical intent

Question 19

definition:
how much tissue is taken (marginal, wide, radical)

Answer 19

surgical dose

Question 20

definition:
tissue plane of dissection, “cutting edge”, which is continuous with what remains in wound bed

Answer 20

surgical margin

Question 21

are active or passive drains preferred?

Answer 21

active (closed)

Question 22

what should never be done with reconstruction?

Answer 22

releasing incisions

Question 23

what cases with seromas are high risk?

Answer 23

LN/ventral neck
high motion areas
inguinal
pre-op radiation therapy

Question 24

what are the major determinants of metastasis?

Answer 24

1. histotype (highly metastatic)
2. histologic grade
3. primary tumor size

Question 25

examples of highly metastatic tumors

Answer 25

HSA OSA malignant melanoma AGASACA

Question 26

examples of tumors whose high grades have high chances of mets?

Answer 26

mast cell tumor soft tissue sarcoma

Question 27

what is the Ewing Mechanistic Theory?

Answer 27

First site to which cancer metastasizes is the closest one in which there are small blood vessels (first capillary bed)

Question 28

what is the Paget seed and soil theory?

Answer 28

Cells are dispersed randomly but only grow in organs which provide the correct factors necessary for growth of that particular tumor

Question 29

what is the rate limiting step in metastasis?

Answer 29

survival and proliferation in new microenvironment

Question 30

why do tumors develop its own blood supply?

Answer 30

bc they should not be able to grow beyond 1 mm unless they have their own blood supply

Question 31

how do tumors develop their own blood supply - differ between the classical and vasculogenesis theory?

Answer 31

classical theory: ingrowth of endothelial cells from existing vessels vasculogenesis theory: endothelial precursors

Question 32

treatments that might target tumor blood vessels

Answer 32

1. block angiogenic growth factors w/ Avastin or Palladia 2. give angiogenesis inhibitors - angiostatin, endostatin 3. target cytotoxic drugs to growing endothelial cells 4. metronomic chemotherapy (small amounts more frequently)

Question 33

what do you call cancer-associated alterations in bodily structure and/or function that are not directly related to the physical effects of the primary or metastatic tumor

Answer 33

paraneoplastic syndromes

Question 34

hypercalcemia of malignancy MOA

Answer 34

PTHrp

Question 35

hypercalcemia of malignancy associated tumor types in dogs

Answer 35

AGASACA lymphoma multiple myeloma

Question 36

hypercalcemia of malignancy associated tumor types in cats

Answer 36

lymphoma SCC

Question 37

hypercalcemia of malignancy treatment

Answer 37

**treat underling tumor!** IV or SQ fluids furosemide bisphosphonates (pamidronate, zoledronate) prednisone (must have definitive diagnosis before starting)

Question 38

hypertrophic osteopathy (HO) MOA

Answer 38

poorly understood vagal n stimulation from thorax or humoral mechanism through increased VEGF, growth hormone and PDGF

Question 39

hypertrophic osteopathy (HO) associated tumor types

Answer 39

primary lung tumors osteosarcoma mets to lungs

Question 40

hypertrophic osteopathy (HO) treatment

Answer 40

**remove underlying tumor!** if secondary to mets from OSA - palliative pain management (oral analgesics), bisphosphonates (pamidronate, zoledronate), talk about euthanasia

Question 41

how does radiation therapy kill cells?

Answer 41

ionizing radiation at or near DNA, can be direct or indirect mostly mitotic cell death some apoptotic death

Question 42

stereotactic body radiation therapy type of fractions? what is required?

Answer 42

hypofractionated requires CT, immobilization and target localization (OBI or contour)

Question 43

how does stereotactic body radiation therapy spare normal tissues?

Answer 43

by avoidance

Question 44

what is IMRT?

Answer 44

intensity modulated radiation therapy

Question 45

what does IMRT do? fractionation? what does it require?

Answer 45

non-uniform dose delievery fractionated or hypofractionated requires on board imaging

Question 46

when do acute radiation effects occur? which systems are involved?

Answer 46

within 3 months skin, GI, hematopoietic

Question 47

when do early delayed radiation effects occur? which systems are involved?

Answer 47

2 weeks - 4 months neurologic tissues

Question 48

when do late radiation effects occur? which systems are involved?

Answer 48

3 months - year lung, kidney, heart, bone, liver

Question 49

should you use skin care products (aquaphor, lidocaine jelly, A/D) for the acute treatment of the skin from radiation effects?

Answer 49

no - controversial

Question 50

treatment for pneumonitis due to radiation

Answer 50

glucocorticoids rest O2

Question 51

toceranib can be a problem with which type of radiation

Answer 51

GI radiation

Question 52

concurrent use of what chemotherapeutics is not recommended

Answer 52

dacarbazine lomustine doxorubicin cisplatin gemcitabine paclitaxel toceranib

Question 53

why can concurrent antioxidants interfere with radiation cell killing

Answer 53

antioxidants prevent ROS but ROS cause indirect killing of cancer cells

Question 54

Pentoxifylline and vitamin E can be given to help what chronic conditions to treat what

Answer 54

skin CNS bone lungs radiation fibrosis