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Internal Medicine > Oncology > Flashcards

Oncology Flashcards

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1
Q

Rate of fluids for tx of hypercalcaemia

A

Saline 3x maintenance

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2
Q

Tumours causing paraneoplastic hypoglycaemia

A

Insulinoma
Smooth muscle tumours
Hepatocellular carcinoma
Lymphoma

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3
Q

Treatment of hypoglycaemia when tumour is not resectable

A

Iv glucose in emergencies (risk if increase in insulin and rebound hypoglycaemia with insulinoma)
Prednisolone
Diazoxide
Glucagon

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4
Q

Paraneoplastic production of ACTH by what tumours

A

Hepatic carcinomas
Abdominal neuroendocrine tumour
Primary lung tumours

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5
Q

Prognosis of patients with bone marrow suppression and pancytopaenia secondary to hyperoestrogenism

A

Poor - bone marrow takes months to recover

Broad spectrum abs required for pancytopaenia

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6
Q

What causes hypertrophic oesteopathy

A

Primary intrathoracic masses

Space occupying lesions in abdomen or thorax

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7
Q

What causes paraneoplastic glomerulonephritis

A

Immune complex formed by tumours

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8
Q

Tumours causing peripheral neuropathy

A 
Lymphoma
Multiple myeloma
sarcomas
Carcinomas
Insulinoma
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9
Q

What causes paraneoplastic myasthenia gravis

A

Thymona

But has been reported with other tumours

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10
Q

Treatment of myasthenia gravis

A

Anticholinesterase agents like Pyridostigmine bromide

Immunosuppression is controversial given risk of aspiration pneumonia

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11
Q

What tumour causes modular dermatofibrosis

A

Renal cystadenocarcinoma

Uterine leiomyomas

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12
Q

Paraneoplastic causes of erythrocytosis

A

Excess EPO production by renal tumour or secondary increased renal EPO production due to tissue hypoxia as a result of tumour compression

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13
Q

Clinical signs of erythrocytosis/polycythaemia

A

Hypertension, hyperviscosity, seizures, ataxia, disorientation

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14
Q

Thymidine kinase

A

Can be used for monitoring tx of lymphoma but needs to be measured before tx

Becomes high again 3 weeks before coming out of remission

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15
Q

Real time PCR for monitoring lymphoma

A

Measures amount of DNA in blood - lower at start better prognosis

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16
Q

Alkylators

A

Chlorambucil
Cyclophosphamide
Lomustine
Melphalan

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17
Q

Anti-tumour antibiotics

Anthracyclines

A

Doxorubicin
Epirubicin
Actinomycin-D
Mitoxantrone

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18
Q

Vinca alkaloids

A

Vincristine and vinblastine

Cell cycle specific - inhibit Microtubules thus preventing motorists spindle

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19
Q

Platinating agents

A

Carboplatin

Inhibits protein synthesis and cell death

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20
Q

Anti-metabolites

A

Cytosine arabinoside

Methotrexate

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21
Q

L-asparaginase

A

Malignant lymphocytes are dependant upon asparagine which l-asparaginase destroys leading to cell death

Much less effective in cats and asparagine is replaced much more quickly

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22
Q

Chemotherapy agents which penetrate the CNS

A 
Prednisolone
L-asparaginase
Cytosine arabinoside
CCNU
Methotrexate
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23
Q

Radiotherapy side effects

A

Dermatitis and moist desquamation
Mucositis/colitis/anusitis
Dry eye

Long term:
Dry eye
Alopecia and leucotrichia
Skin fibrosis and poor wound healing
Small increase in rate of de novo tumours
Degenerative brain lesions
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24
Q

Breeds with a mutation making them susceptible to side effects of anthracyclines and vinca alkaloids

A 
Sheltie
Westie
Rough collie
Border collie
Australian shepherd 
Long haired whippet
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25
Consider dose reduction of which chemo drugs with liver dz
Anthracyclines Vinca alkaloids Cyclophosphamide
26
Consider dose reduction of which chemo drugs with renal dz
Carboplatin Methotrexate Cyclophosphamide
27
side effects of masitinib and toceranib
PLN, hypertension Haemolytic anaemia GI side effects Hepatotoxicity Drug holidays, reduction in doses For hepatotoxicity - denamarin and drug holiday Pancreatitis following toceranib
28
When to treat as septic when on chemotherapy
If sick neutrophil count < 1x10^9/L
29
Chemo drugs causing extravasation injury
Vinca alkaloids Anthracyclines Cisplatin
30
Tx of extravasation injury
Consider immediate debridement for anthracycline extravasation Local infiltration of Hyaluronidase IV administration of dexrazoxane within three hours and again at 24 and 48
31
Doxorubicin and epirubicin specific toxicity
Acute arrhythmias - give slowly and monitor ECG Cumulative cardiotoxicity leading to DCM and heart failure - if heart problems use an alternative drug, pre-treatment echo and at high doses can consider dexrazoxane (protects heart against anthracycline toxicity) Renal toxicity - particularly cats. Cumulative. Monitor urea/crea/USG and give fluids before and after tx in cats
32
Lomustine specific toxicity
Hepatic toxicity - delayed and cumulative - monitor liver enzymes particularly ALT and bile acids. If alt is climbing stop this Do not treat for longer than 6 months and consider SAMe Highly myelosuppressive Renal toxicity - give fluids before and after tx in cats
33
Vincristine specific side effects
Neurotoxicity - peripheral neuropathy and hindlimb weakness that resolves when tx is stopped
34
Chemotherapy for mast cell tumours
Vinblastine and prednisolone - 8 cycle protocol over 12 weeks Lomustine Tyrosine kinase inhibitors
35
Chemotherapy for osteosarcoma and MST
Carboplatin following amputation MST surgery alone 4 months Surgery plus chemo - 11 months
36
Chemotherapy for haemangiosarcoma and MSTs
Doxorubicin I/V every three weeks x five MST 2 months surgery alone and 6 months w tx Metronomic chemotherapy
37
MST for MCTs with vinblastine and prednisolone
All - 570 days | Grade III - 330 days
38
Visceral mast cell tumours MST | Bone marrow MST
90 days | Bone marrow 45 days - poor response to tx
39
What pre-cancerous changes can be seen in cats prior to development of SCCs?
Actinic keratosis
40
MST of nasal/pinnal SCC after surgery?
20 months
41
Treatment of feline mast cell tumours
If compact surgery with narrow margins If diffuse surgery with larger margins Splenectomy if spleen involved Preds can be used but not that effective Vinblastine not to be used as assoc with severe neutropaenia in cats
42
Treatment of feline squamous cell carcinoma
Surgery Radiotherapy (strontium 90 plesiotherapy or sxternal bean radiatiotherapy Photodynamic therapy Cryotherapy
43
How to tell if pleural effusion is idiopathic or secondary to haemangiosarcoma
High troponin with haemangiosarcoma (>0.25ng/ml) If >2.45ng/ml cardiac involvement is likely in a dog with haemangiosarcoma elsewhere Echo if between 0.07 and 0.25
44
Why does detection of c-kit mutation help with mast cell tumours
Diagnosis Determining relatedness between mast cell tumours (because the in tandem duplications May be different) Prognosis (only found in grade I and II MCTs so if a round cell with an ambiguous origin is identified can search for c-kit) Treatment monitoring Could do PCR on tissue aspirates/blood to see if malignant mast cells are present (only need a small amount of dna) could guide treatment - more vs less aggressive
45
Diagnosis of CML and ALL with PCR and monitoring
Detection of bcr-abl fusion gene Can monitor response to tx - ratio of bcr-abl to regular bcr
46
MST of feline injection site sarcoma Nodulectomy v radical excision Non-specialist v specialist
79 days v 325-419days 66 v 274days
47
Most common site of metastasis of FISS
Lungs Then regional LNs Then abdomen - liver/spleen
48
Advantages and disadvantages of pre-surgery neoadjuvant radiotherapy in tx of FISS
Cells not hypoxic so easier targets Smaller radiation field Improves surgical margins by reducing tumour size More wound complications post-surgery Not as good against macroscopic dz as it is against microscopic dz
49
Advantages and disadvantages of post-surgery neoadjuvant radiotherapy in tx of FISS
Radiotherapy more effective against microscopic dz Increased size of radiation field More hypoxic cells Risk of tumour cell repopulation
50
Chemotherapy that can be used with FISS
``` Doxorubicin Carboplatin Mitoxantrone Cyclophosphamide Vincristine ``` Only an option in cats with non-resectable disease where radiotherapy is not available
51
Other adjunctive tx for FISS
Oncept-IL2 injections alongside surgery and radiotherapy TKIs masitinib and toceranib (inhibit PDGF AND PDFR) / in vivtro activity shown
52
Difference between injection site sarcomas and other feline sarcomas
In s/c tissues thought could be in muscular Spread along fascial planes Usually fibrosarcomas More aggressive behaviour - marked cellular and nuclear pleomorphism, necrosis and high mitotic index Rim of inflammatory cells Higher metastic rate Most high grade (60%) May see vaccine adjuvant Material within cells in his top ATG
53
Which types of feline lymphoma are commonly FeLV positive
Mediastinal in young cats and spinal in young cats
54
Aim of immunohistochemistry in lymphoma
To determine phenotype and differentiate between cell types eg mast cells, undifferentiated carcinomas/sarcomas etc
55
Treatment low grade intestinal lymphoma in cats | Primary and rescue
Chloambucil and pred Rescue (if relapse or no response within 3-4 doses): cyclophosphamide single agent Lomustine single agent COP protocol
56
Prognosis low grade | Alimentary LSA feline
Good to excellent 18-24 Months MST (4.1 months without complete remission)
57
Intermediate/high grade alimentary lymphoma in feline | Treatment
Cop / CHOP RESCUE: single agent doxorubicin is not effective in cats L-asparaginase, lomustine, pred - 38% response Mitoxantrone single agent MOPP (mechloretamine, vincristine, procarbazine, pred) TKIs in the future?
58
Prognosis intermediate / high grade feline alimentary lymphoma
Median response 4-9 months longer if good initial response
59
Chemotherapy for oral SCC with likelihood of mets (eg tonsilar) And oral malignant melanoma
Piroxicam with cisplatin or carboplatin Mitoxantrone with RT Melanoma: Carboplatin and intralesional cisplatin Melphalan Immunotherapy!
60
Most common site of metastasis for canine oral malignant melanoma
Lungs

Internal Medicine (11 decks)

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