Oncology and Gastroenterology Flashcards Preview

RUSVM Small Animal Medicine II 2017 > Oncology and Gastroenterology > Flashcards

Flashcards in Oncology and Gastroenterology Deck (242):
1

Steps in the diagnostic work up of the cancer patient

1. History
2. Physical Exam
3. Medical Imaging
4. FNA and Cytology
5. Biopsy
6. Histopathology

2

Clinical Stage

Physical extent of the tumor
-Size of the primary tumor
- anatomical location of metastases
- Tumor size
-Nodal Metastasis
- Distant Metastasis

3

Histiological grade

Histiological scoring by pathologist

4

Stage

Extent of body affected, determined by clinician with diagnostic tests

5

What do you use a CT scan for with Oncology?

pulmonary metastases
Bony invasion
radiation treatment planning

6

What do you use MRI for with Oncology?

Neurological diagnosis
Surgical planning

7

What do you use nuclear scintigraphy for with oncology?

bony metastases

8

When would you perform a non-aspiration sampling technique for Oncology?

Lymph nodes
round cell tumors
highly vascular tumors

9

When would you perform an aspiration sampling technique for oncology?

Hard/firm lesions
very small lesions where multiple passes are impossible
second attempt

10

What would you perform a new methylene blue stain on?

mast cell tumors
lipomas

11

Biopsy

removal of a small piece of tissue for laboratory examination

12

Incisional biopsy

biopsy of a selected portion of a lesion

13

Excisional biopsy

removal of a mass primarily for diagnostic purposes

14

When would you perform an incisional biopsy?

when the therapy is determined by tumor type
when extent of resection is determined by tumor type
when planning is needed because tumor is in a difficult area to reconstruct
when tumor type and predicted behavior would affect the decision to treat

15

What are the indications for Chemotherapy?

Patients with measurable tumor known to be sensitive to chemo
Adjunct therapy to suppress occult micro-metastasis after local therapy
Palliative non-resectable or metastatic cancer
to downstage/reduce a chemosensitive tumor before definitive therapy
to sensitize tissues to radiation

16

Growth fraction

proportion of cells that are proliferating/active in the cell cycle

17

Cell loss factor

sloughing, necrosis , and apoptosis

18

Goldie Coldman Hypothesis

once the tumor has reached one million cells, it is likely that chemo resistant cells have developed due to mutations

19

When is chemotherapy most effective?

during the rapid growth of the tumor

20

What have we learned from the Goldie Coldman Hypothesis?

Chemo should be initiated early in the course of disease
a protocol containing multiple agents is ideal

21

What are the "BAG" of adverse effects of Chemo?

B - Bone Marrow toxicity
A - Alopecia
G - Gastrointestinal effects

22

At what point would we administer prophylactic antibiotics with chemo?

less than 1,000 WBC/uL

23

What chemo causes the most vomiting?

Cisplatin

24

What are the anti-emetics used to combat the vomiting associated with chemotherapy?

Meropitant
Metaclopramide
Ondanzetron

25

What are the GI effects seen with Chemotherapy?

Vomiting and Diarrhea

26

In what breed should you avoid Doxorubicin and why?

Dobermans with cardiomyopathy

27

In what species and age should you avoid Doxorubicin?

Geriatric cat with CRF

28

What phase of the cell cycle is refractory to chemo?

G0

29

What chemo drugs target Interphase and Protein and RNA synthesis?

L-Asparaginase

30

What chemo drugs target DNA synthesis?

Antimetabolites
Doxorubicin????

31

What chemo drugs target Protein and RNA Synthesis and Mitotic spindle formation?

Vinca Alkaloids
Taxanes

32

What chemo drugs target mitosis and segregation of DNA into daughter cells?

Vinca Alkaloids
Taxanes

33

What chemo drugs are cell cycle independent?

Alkylating agents: Cyclophosphamide
Platinum agents: cisplatin
Doxorubicin

34

What are the chemo drugs in the Alkylating agents category?

Cyclophosphamide
Chlorambucil
Melphalan
CCNU
Ifosfamide

35

What is the mechanism of action for Alkylating agents?

Alkylate DNA bases
crosslinks
induce apoptosis

36

What is the toxicity associated with Cyclophosphamide?

Sterile hemorrhagic cystitis

37

What causes Sterile hemorrhagic cystitis?

Acrolein

38

How do you prevent Sterile hemorrhagic cystitis?

Give the medication in the AM and allow the animal to urinate often

39

What is the toxicity associated with CCNU?

Hepatotoxicity

40

What are the chemo drugs in the Antitumor Antibiotics category?

Doxorubicin
Mitoxantrone
Epirubicin

41

What is the mechanism of action for Antitumor Antibiotics?

Intercalation into DNA
Inhibition of topoisomerase II
Production of free radicals
Cell membrane damage

42

What do you use Mitoxantrone to treat?

Mast Cell tumors

43

What is the toxicity associated with Doxorubicin in dogs?

Cardiotoxic irreversibly after 6 doses

44

What is the toxicity associated with Doxorubicin in cats?

Nephrotoxic

45

What are the chemo drugs in the Spindle Toxins category?

Vinca Alkaloids: VIncristine and Vinblastine
Taxanes: Paclitaxel and Docetaxel

46

What is the mechanism of action for Spindle Toxins?

Cell cycle specific M-phase
bind tubulin/interfere with Mitotic spindle formation or microtubule disassembly

47

What are the toxicities associated with Vincristine?

Myelosuppressive
GI
Peripheral neuropathy
tissue irritation

48

What is the reaction associated with Taxanes?

high rate of allergic reactions

49

What is the mechanism of action for Platinum drugs?

Platinum binds to DNA causing crosslinks

50

What are the chemo drugs in the Platinum category?

Cisplatin
Carboplatin

51

What is the toxicity associated with Cisplatin and cats?

Fatal idiosyncratic pulmonary edema in cats
Cisplat = "Cats go splat"

52

What are the toxicities associated with Platinum Chemo drugs?

Vomiting
Nephrotoxicity
Fatal idiosyncratic pulmonary edema in cats

53

What are the reasons for chemotherapy failure?

Pharmacologic
Kinetic issues
Cellular resistance
MDR/ABCB1

54

What is the mutation associated with toxicity with chemotherapy?

MDR-1

55

What do you treat TCC with?

Piroxicam (NSAID)

56

What tumors can be treated with NSAIDs?

Carcinomas:
Bladder
Prostate
Oral cavity
Nasal
Mammary gland tumors

57

What is the mechanism of action for Toceranib?

Tyrosine kinase inhibitor

58

Radiation Dose

Amount of radiation absorbed by the patient

59

ERBT

(external beam ration therapy) Radiation delivered from outside the body using a machine to aim high energy x or gamma rays at the tumors

60

Fraction

individual administration of dose radiation

61

What are the 5 Rs of radiation therapy?

Repair
Repopulation
Redistribution
Reoxygenation
Radiosensitive

62

SRS

Stereotactic radiosurgery

63

SRT

Stereotactic radiation therapy

64

When would you use Cryotherapy?

superficial lesions only
less than 1-1.5 cm

65

What is the premise for the use of Electrochemotherapy?

electrical impulse can open channels in cells that chemotherapy has the potential to enter into those cells

66

Definition of Lymphoma

malignant tumor of lymphoid tissue

67

How do yo diagnose Lymphoma?

FNA/Cytology
LN Tissue Biopsy

68

Where does Lymphoma metastasize to?

LNs
Liver
Bone marrow

69

What syndrome is associated with Lymphoma?

Paraneoplastic syndrome

70

What are the Chemotherapy drugs with activity against Lymphoma?

Prednisone/Dex
Doxorubicin
Vincristine
Cyclophosphamide
L-Asparaginase
CCNU

71

What is the single strongest agent against Lymphoma?

Doxorubicin

72

What are the clinical signs associated with Lymphoma?

Generalized painless lymphadenopathy
weight loss
anorexia
lethargy
secondary to paraneoplastic syndrome
Anemia

73

What is the multi agent protocol for High grade Lymphoma?

CHOP

74

What is the remission duration associated with Doxorubicin used in the treatment of High grade Lymphoma?

6-7 months

75

What is the remission duration associated with the CHOP protocol used in the treatment of High grade Lymphoma?

9-12 months

76

Which has a better prognosis B cell Lymphoma or T cell Lymphoma?

B cell
"B is better"

77

What should you consider in the treatment of localized lymphoma?

Surgery or radiation

78

How often should you recheck for lymphoma?

every 1-2 months
aspirate small nodes

79

What treatment would you consider for Low Grade Lymphoma?

Prednisone
Chlorambucil

80

What is the MST for low grade Lymphoma?

1.5 years +

81

How do you diagnose lymphoma in a feline?

MDB
FNA/cytology
Radiographs
Endoscopy
Surgical Exploratory
BIOPSY: GIT, Liver, Spleen, and nodes

82

Where is the most common anatomic location for Feline Lymphoma?

GI tract

83

What are the clinical signs for GI lymphoma in a feline?

inappetance
vomiting
weight loss
diarrhea

84

How do you treat Lymphocytic Lymphoma in Felines?

Prednisone
Chlorambucil

85

What is the MST for Lymphocytic Lymphoma in Felines?

2 years

86

What is the treatment for GI/Multicentric Lymphoblastic Lymphoma in Felines?

CHOP protocol

87

What is the MST for GI/Multicentric Lymphoblastic Lymphoma in Felines?

2.5 years +

88

What is the treatment for Colonic Lymphoma in Felines?

Surgical biopsy/mass removal
Chemo

89

What is the MST for colonic Lymphoma in felines?

3-4 months

90

What are the clinical signs for Mediastinal/Thymic Lymphoma in Felines?

Dyspnea
dull lung sounds

91

How do you diagnose Mediastinal/Thymic Lymphoma in Felines?

Radiographs
U/S guided FNA

92

How do you treat Mediastinal/Thymic Lymphoma in Felines?

CHOP Protocol
Surgery or Radiation for localized lesion

93

What is the Remission time for Mediastinal/Thymic Lymphoma in Felines?

6 months

94

What are the clinical signs for Lymphoid Leukemia?

Vague eight loss
Vomiting
Diarrhea
lethargy
lymphadenopathy
splenomegaly
Thrombocytopenia
Anemia
neutropenia

95

How do you diagnose Lymphoid Leukemia?

MDB
Flow cytometry

96

How do you treat Acute Lymphoblastic Leukemia?

Prednisone
CHOP

97

What is the MST for Acute Lymphoblastic Leukemia?

5 months

98

What are the clinical signs for Chronic Lymphocytic Leukemia?

Anorexia
Weight loss
lethargy

99

How do you diagnose Chronic Lymphocytic Leukemia?

Bone marrow aspirate
Flow Cytometry

100

What is the treatment for Chronic Lymphocytic Leukemia?

Chlorambucil + prednisone if there are clinical signs

101

What is the MST Chronic Lymphocytic Leukemia?

1-3 years

102

What are the clinical signs for Multiple Myeloma?

lethargy
inappetance
lameness
CNS signs
bleeding

103

How do you diagnose Multiple Myeloma?

MDB
MONOCLONAL GAMMOPATHY!
Radiographs
Ultrasound FNA of liver and spleen
Electrophoresis
Bone Marrow Aspirate

104

What are the four requirements for Multiple Myeloma?

1. Plasma cell infiltrate in bone marrow or other organs (spleen or liver)
2. Monoclonal gammopathy in serum
3. Monoclonal gammopathy in urine
4. Osteolytic bone lesions

105

What is the treatment for Multiple Myeloma?

Melphalon - oral
Prednisone
Cyclophosphamide and Chlorambucil are effective

106

What is the MST for Multiple Myeloma in a dog?

18 months

107

What is the MST for Multiple Myeloma in a cat?

8 months +

108

What are the neoplastic Histiocystic diseases?

Histiocytic Sarcoma Malignant Histiocystosis

109

What are the non neoplastic Histiocystic diseases?

Cutaneous Histiocytosis
Systemic Histiocytosis

110

What is the treatment for Histiocytoma?

Self-limiting: resolve in weeks

111

Where do you often find Histocytic Sarcoma?

Skin/SQ
Spleen
Lung

112

What staging should you perform if you suspect Histocytic Sarcoma?

Regional LN aspirate
Thoracic radiographs
Abdominal ultrasound
Bone marrow aspirate

113

What is the treatment for Histocytic Sarcoma without metastases?

Surgery
radiation

114

What is the prognosis for Histocytic Sarcoma without metastases?

1 year +

115

What chemotherapy can you use with Histocytic Sarcoma?

CCNU/Doxorubicin
Prednisone

116

What are the clinical signs for Polycythemia Vera?

Lethargy
Anorexia
seizures/ataxia

117

How do you diagnose Polycythemia Vera?

MDB: erythrocytosis
Ultrasound
Radiographs

118

What is the treatment for Polycythemia Vera?

Phlebotomy - 20ml/kg
Chemo: Hydroxyurea, Busulfan or other alkylating agents

119

What the prognosis for Polycythemia Vera?

1-3 years

120

What is the most common skin tumor in dogs?

Mast cell Tumors

121

What are the clinical signs of Mast cell Tumors?

pruritic
asymptomatic
GI signs: anorexia, vomiting
Hives
Wheezing
Hypotension
Anaphylactoid rxns

122

How do you diagnose Mast cell Tumors?

FNA/Cytology
Staging:
LN aspirate
Abdominal Ultrasound: Liver and Spleen aspirates
Thoracic radiographs
Bone Marrow aspirate

123

What is the treatment for Mast cell Tumors?

Surgery - DO NOT USE MORPHINE!
Radiation therapy
if non-resectable: CCNU, Vinblastine, toceranib, and Prednisone
Symptomatic therapy

124

What is the MST for high grade Mast cell Tumors?

6-12 months

125

What is the most common form of Feline Mast cell Tumors?

Mastocystic

126

Where is the most common place for cutaneous Mast cell Tumors in cats?

Head and neck
Pinnae and base of ear

127

How do you diagnose cutaneous Mast cell Tumors in cats?

FNA/cytology

128

What is the treatment for cutaneous Mast cell Tumors in cats?

Surgery for localized lesions
if not resectable: CCNU, vinblastine, toceranib, and prednisone

129

What is the treatment for Diffuse miliary cutaneous Mast cell Tumors in cats?

CCNU
Vinblastine
Prednisone
Toceranib
Symptomatic therapy

130

What is the treatment for splenic Mast cell Tumors in cats?

Surgery + chemo

131

What is the MST for splenic Mast cell Tumors in cats?

12-19 months

132

What is the treatment of choice for intestinal Mast cell Tumors in cats?

Chemo

133

Feline Vaccine Associated Sarcoma

Tumor development 1 month to 10 years post vaccination

134

How do you diagnose Feline Vaccine Associated Sarcoma?

FNA/Cytology
Tissue biopsy

135

Where do Feline Vaccine Associated Sarcoma metastasize to?

Lungs
Skin
LNs

136

What staging is recommended for Feline Vaccine Associated Sarcoma?

CT scan
Thoracic radiographs

137

What is the treatment for Feline Vaccine Associated Sarcoma?

Surgery
NO MARGINAL RESECTION

138

What is the most common primary bone tumor in dogs?

Osteosarcoma

139

What tumors can spread to the bone?

Anal sac
Mammary
TCC

140

Where does Osteosarcoma metastasize to?

Lungs
Bones

141

Where is Osteosarcoma located?

"Towards the knee and away from the elbow"
Mandible and maxilla

142

What are the contributing factors to Osteosarcoma?

Multiple minor trauma with weight bearing
Metallic implants
Chronic osteomyelitis
Fractures with no internal stabilization
Exposure to ionizing radiation
Bone infarcts

143

What staging would you want to perform with Osteosarcoma?

Thoracic and Appendicular Radiographs
FNA
Bone Scintigraphy

144

What are the clinical signs associated with Osteosarcoma?

Lameness
swelling
PAIN
pathologic fractures

145

What has a better prognosis for Osteosarcoma?

Location: Mandible

146

What has the worst prognosis with Osteosarcoma?

Scapular Osteosarcoma

147

What is the treatment for Osteosarcoma?

Surgery: Amputation or Limb Sparing
Radiation Therapy
Chemo: Carboplatin, Doxorubicin, Cisplatin
Pain Meds
Bisphosphonates

148

What is the mechanism of action for Bisphosphonates?

reduce bone turnover

149

What is the most common malignant tumor in the dog?

Melanoma

150

What is the most common benign tumor in dogs?

Ameloblastoma

151

What is the most common malignant tumor in cats?

Squamous cell carcinoma

152

What is the most common thyroid cancer in the dog?

Thyroid carcinoma

153

What is the most common thyroid cancer in the cat?

Thyroid Adenoma

154

What are the clinical signs of Oral cancer?

Ptyalism
Odor
Changes in chewing
Decreased appetite
Oral bleeding

155

How do you diagnose Oral cancer?

FNA
Incisional biopsy
CT SCAN!

156

Where does Melanoma metastasize to?

Lungs
Liver
Submandibular LNs

157

What staging tests are performed on Melanoma?

CT SCAN!
Thoracic radiographs
Abdominal ultrasound
LN aspirate

158

What is the treatment for Melanoma?

Surgery
Radiation
Chemo: Carboplatin

159

What is the MST for melanoma?

7-17 months

160

What is the treatment for Fibrosarcoma?

Surgery + radiation

161

What is the MST for Fibrosarcoma?

18-26 months

162

What is the treatment for Canine Squamous cell carcinoma?

Surgery
Radiation

163

What is the MST for Canine Squamous cell carcinoma?

26-36 months

164

What is the treatment for Feline Squamous cell carcinoma?

Surgery
Radiation

165

Where does Feline Squamous cell carcinoma metastasize to?

LNs

166

What is the MST for Feline Squamous cell carcinoma?

14 months

167

What is the treatment for Feline Fibrosarcoma?

Surgical excision
Radiation

168

What is the most common benign tumor of the oral cavity?

Ameloblastoma (Epulis)

169

What is the treatment for Ameloblastoma?

Surgical resection
Radiation

170

What is the MST for Ameloblastoma?

5 years +

171

What are the clinical signs of Nasal cancer?

Nasal discharge
Sneezing
Epistaxis
Facial swelling and distortion

172

What are sites of Metastasis for Nasal Cancer?

Lungs
LNs

173

What are the staging tests performed for Nasal cancer?

Thoracic radiographs
FNA of LNs

174

What is the treatment for Nasal cancer?

Radiation!
Chemo: CHOP or Carboplatin is palliative
NSAIDs

175

What are the clinical signs of Thyroid cancer in dogs?

Dysphagia
Dysphonia
Horner's syndrome
Hyperthyroidism

176

How do you diagnose Thyroid cancer in a dog?

Ultrasound/CT scan
FNA/cytology
NO INCISIONAL BIOPSY!

177

What staging tests do you perform on thyroid cancer in dogs?

Thoracic radiographs/ CT or MRI!!!!
Scintigraphy
FNA/Cytology of LNs
Ultrasound abdomen
MDB + T4

178

Where does Thyroid cancer metastasize to in dogs?

Lungs
LNs
Bones
Abdomen

179

What is the treatment for Canine Thyroid Tumor?

Surgery
If non resectable: Radiation

180

What is the MST for canine Thyroid Tumors?

2-3 years

181

What is the treatment for Feline Thyroid Tumors?

Surgery
Methimazole

182

What is the most common tumor of the Bladder?

Transitional cell carcinoma

183

What is the most common tumor of the urethra?

Transitional cell carcinoma

184

What are the clinical signs for canine transitional cell carcinoma?

Hematuria
Dysuria
Stranguria
Pollakiuria

185

How do you diagnose canine TCC?

MDB
Urinalysis + culture
Abdominal imaging
Radiographs
Ultrasound bladder
Cystoscopy

186

Why do you not perform FNA on canine TCC?

tumor seeding

187

How do you stage canine TCC?

Abdominal ultrasound/CT

188

Where does canine TCC metastasize to?

LN
Lungs

189

What is the treatment for canine TCC?

Surgery for apically located TCC
Cystectomy
Adjuvant Chemo: Piroxicam and Mitoxantrone

190

Where does Prostatic cancer metastasize to?

Lungs
LNs
Bone

191

What diagnostic tests should be perform for Prostatic cancer?

FNA
Abdominal radiographs
Ultrasound
Chest radiographs or CT - Lung and bone mets

192

What is the treatment for canine Prostatic cancer?

Piroxicam (NSAIDs)
Radiation therapy
Urethral stents

193

What is the MST for canine prostatic cancer?

1-7 months with NSAIDs and Radiation
Radiation + chemo = 14-18months

194

What mammary glands are most commonly affected with cancer in dogs?

Caudal (4,5)

195

What diagnostic tests should be performed for Mammary gland tumors?

Thoracic and abdominal imaging

196

Where do Mammary gland tumors metastasize to?

Lungs
Liver
Bone

197

What is the treatment for Canine Mammary tumors?

Lumpectomy
Mammectomy
Mastectomy
OHE recommended
Chemo: Carboplatin + NSAIDs

198

What factors are NOT prognostic for Canine Mammary tumors?

Number of tumors
Glands involved
Type of surgery
Age
breed
weight

199

Where do Feline Mammary gland tumors metastasize to?

LNs
Lungs
Pleura
Liver
Kidneys
Adrenals

200

What are the diagnostic and staging tests for feline Mammary gland tumors?

Thoracic and abdominal imaging
CT

201

What is the treatment for Feline Mammary gland tumors?

Complete mastectomy
OHE
Chemo: Carboplatin and Piroxicam, Doxorubicin

202

What is the MST for Feline Mammary gland tumors?

8 months - 3 years

203

What is the most common Primary Pulmonary Mass in cats?

Adenocarcinoma

204

Where do pulmonary pulmonary masses in dogs metastasize to?

Lung
LN
Bone
Nervous system

205

Where do primary pulmonary masses in cats metastasize to?

Digits

206

What are the diagnostic tests for Primary pulmonary masses?

Thoracic Radiographs
FNA/US
Cytology
CT scan

207

What is the treatment for primary pulmonary masses?

Surgery for solitary lung tumors

208

What is the MST for canine primary pulmonary masses?

13 months

209

What is the prognosis for primary pulmonary tumors in cats?

115 days

210

What is the treatment of choice for Metastatic pulmonary neoplasia?

Chemotherapy

211

What are the diagnostic tests for Thymoma?

Thoracic radiographs
US FNA
Cytology
Flow cytometry

212

What is the treatment for Thymoma?

Surgery

213

What is the MST for thymoma in dogs?

2.5months - 2years+

214

What is the MST for thymoma in cats?

5 years

215

What is the most common cardiac tumor in cats?

Lymphoma

216

What is the treatment for Hemangiosarcoma in dogs?

Surgery: Pericardiectomy + resection
Chemo: Doxorubicin

217

What is the MST for Hemangiosarcoma in dogs?

1 month - 6 months

218

What is the diagnostic approach for Hemangiosarcoma of the heart?

MDB
ECG
Echocardiogram
US guided FNA
Cardiac troponin I

219

What cancers metastasize to the liver?

Lymphoma
mast cell
histiocytic sarcoma

220

Are malignant tumors of the liver more common in dogs or cats?

dogs

221

What are the diagnostic tests for Hepatobiliary neoplasia?

MDB
Abdominal imaging
Abdominal ultrasound - FNA
CT scan

222

What is the treatment for Hepatobiliary tumors?

surgery

223

What is the prognosis for Hepatocellular carcinoma in cats?

Guarded to poor

224

What are the diagnostic tests for GI c cancer?

MDB
Abdominal radiographs
contrast radiography
Abdominal ultrasound
Thoracic imaging for mets

225

What is the most common SI tumor in dogs?

Lymphoma

226

What is the treatment for Lymphoma in the SI of the dog?

Chemo

227

What is the treatment for Carcinoma and Leiomyoma/Leimyosarcoma in the Si of dogs?

Surgery

228

What is the most common SI tumor in cats?

Lymphoma

229

What is the treatment for Lymphoma in the SI of the cats?

Chemo

230

What is the treatment for Carcinoma and Leiomyoma/Leimyosarcoma in the Si of cats?

Surgery

231

What are the most common tumors of the spleen in dogs?

Sarcomas

232

What are the most common tumors of the spleen in cats?

Spleen

233

How do you diagnose Splenic Hemangiosarcoma?

Abdominal Radiographs
Abdominal ultrasound
Thoracic radiographs
Thoracic/Cardiac ultrasound
Abdominocentesis
FNA/Cytology

234

Where does Splenic Hemangiosarcoma metastasize to?

Liver
Lungs

235

What is the treatment for Splenic Hemangiosarcoma?

Stabilize!
Surgery

236

What is the MST for Splenic Hemangiosarcoma with surgery?

1.5-3 months

237

What is the MST for Splenic Hemangiosarcoma with surgery and chemo?

68 days - 200 days

238

What is the protocol for chemotherapy with Splenic Hemangiosarcoma?

Doxorubicin + (Cyclophosphamide or Deracoxib)
Toceranib

239

Where does Anal Sac Adenocarcinoma metastasize to?

LNs
Lungs

240

What staging tests do you perform with Anal Sac Adenocarcinoma?

Thoracic and Abdominal Radiographs

241

What is the treatment of choice for Anal Sac Adenocarcinoma?

Surgery
Radiation
Chemo: Carboplatin or toceranib

242

What is the MST for Anal Sac Adenocarcinoma?

1-1.5 years