Flashcards in Oncology and Gastroenterology Deck (242):
Steps in the diagnostic work up of the cancer patient
2. Physical Exam
3. Medical Imaging
4. FNA and Cytology
Physical extent of the tumor
-Size of the primary tumor
- anatomical location of metastases
- Tumor size
- Distant Metastasis
Histiological scoring by pathologist
Extent of body affected, determined by clinician with diagnostic tests
What do you use a CT scan for with Oncology?
radiation treatment planning
What do you use MRI for with Oncology?
What do you use nuclear scintigraphy for with oncology?
When would you perform a non-aspiration sampling technique for Oncology?
round cell tumors
highly vascular tumors
When would you perform an aspiration sampling technique for oncology?
very small lesions where multiple passes are impossible
What would you perform a new methylene blue stain on?
mast cell tumors
removal of a small piece of tissue for laboratory examination
biopsy of a selected portion of a lesion
removal of a mass primarily for diagnostic purposes
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
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
proportion of cells that are proliferating/active in the cell cycle
Cell loss factor
sloughing, necrosis , and apoptosis
Goldie Coldman Hypothesis
once the tumor has reached one million cells, it is likely that chemo resistant cells have developed due to mutations
When is chemotherapy most effective?
during the rapid growth of the tumor
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
What are the "BAG" of adverse effects of Chemo?
B - Bone Marrow toxicity
A - Alopecia
G - Gastrointestinal effects
At what point would we administer prophylactic antibiotics with chemo?
less than 1,000 WBC/uL
What chemo causes the most vomiting?
What are the anti-emetics used to combat the vomiting associated with chemotherapy?
What are the GI effects seen with Chemotherapy?
Vomiting and Diarrhea
In what breed should you avoid Doxorubicin and why?
Dobermans with cardiomyopathy
In what species and age should you avoid Doxorubicin?
Geriatric cat with CRF
What phase of the cell cycle is refractory to chemo?
What chemo drugs target Interphase and Protein and RNA synthesis?
What chemo drugs target DNA synthesis?
What chemo drugs target Protein and RNA Synthesis and Mitotic spindle formation?
What chemo drugs target mitosis and segregation of DNA into daughter cells?
What chemo drugs are cell cycle independent?
Alkylating agents: Cyclophosphamide
Platinum agents: cisplatin
What are the chemo drugs in the Alkylating agents category?
What is the mechanism of action for Alkylating agents?
Alkylate DNA bases
What is the toxicity associated with Cyclophosphamide?
Sterile hemorrhagic cystitis
What causes Sterile hemorrhagic cystitis?
How do you prevent Sterile hemorrhagic cystitis?
Give the medication in the AM and allow the animal to urinate often
What is the toxicity associated with CCNU?
What are the chemo drugs in the Antitumor Antibiotics category?
What is the mechanism of action for Antitumor Antibiotics?
Intercalation into DNA
Inhibition of topoisomerase II
Production of free radicals
Cell membrane damage
What do you use Mitoxantrone to treat?
Mast Cell tumors
What is the toxicity associated with Doxorubicin in dogs?
Cardiotoxic irreversibly after 6 doses
What is the toxicity associated with Doxorubicin in cats?
What are the chemo drugs in the Spindle Toxins category?
Vinca Alkaloids: VIncristine and Vinblastine
Taxanes: Paclitaxel and Docetaxel
What is the mechanism of action for Spindle Toxins?
Cell cycle specific M-phase
bind tubulin/interfere with Mitotic spindle formation or microtubule disassembly
What are the toxicities associated with Vincristine?
What is the reaction associated with Taxanes?
high rate of allergic reactions
What is the mechanism of action for Platinum drugs?
Platinum binds to DNA causing crosslinks
What are the chemo drugs in the Platinum category?
What is the toxicity associated with Cisplatin and cats?
Fatal idiosyncratic pulmonary edema in cats
Cisplat = "Cats go splat"
What are the toxicities associated with Platinum Chemo drugs?
Fatal idiosyncratic pulmonary edema in cats
What are the reasons for chemotherapy failure?
What is the mutation associated with toxicity with chemotherapy?
What do you treat TCC with?
What tumors can be treated with NSAIDs?
Mammary gland tumors
What is the mechanism of action for Toceranib?
Tyrosine kinase inhibitor
Amount of radiation absorbed by the patient
(external beam ration therapy) Radiation delivered from outside the body using a machine to aim high energy x or gamma rays at the tumors
individual administration of dose radiation
What are the 5 Rs of radiation therapy?
Stereotactic radiation therapy
When would you use Cryotherapy?
superficial lesions only
less than 1-1.5 cm
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
Definition of Lymphoma
malignant tumor of lymphoid tissue
How do yo diagnose Lymphoma?
LN Tissue Biopsy
Where does Lymphoma metastasize to?
What syndrome is associated with Lymphoma?
What are the Chemotherapy drugs with activity against Lymphoma?
What is the single strongest agent against Lymphoma?
What are the clinical signs associated with Lymphoma?
Generalized painless lymphadenopathy
secondary to paraneoplastic syndrome
What is the multi agent protocol for High grade Lymphoma?
What is the remission duration associated with Doxorubicin used in the treatment of High grade Lymphoma?
What is the remission duration associated with the CHOP protocol used in the treatment of High grade Lymphoma?
Which has a better prognosis B cell Lymphoma or T cell Lymphoma?
"B is better"
What should you consider in the treatment of localized lymphoma?
Surgery or radiation
How often should you recheck for lymphoma?
every 1-2 months
aspirate small nodes
What treatment would you consider for Low Grade Lymphoma?
What is the MST for low grade Lymphoma?
1.5 years +
How do you diagnose lymphoma in a feline?
BIOPSY: GIT, Liver, Spleen, and nodes
Where is the most common anatomic location for Feline Lymphoma?
What are the clinical signs for GI lymphoma in a feline?
How do you treat Lymphocytic Lymphoma in Felines?
What is the MST for Lymphocytic Lymphoma in Felines?
What is the treatment for GI/Multicentric Lymphoblastic Lymphoma in Felines?
What is the MST for GI/Multicentric Lymphoblastic Lymphoma in Felines?
2.5 years +
What is the treatment for Colonic Lymphoma in Felines?
Surgical biopsy/mass removal
What is the MST for colonic Lymphoma in felines?
What are the clinical signs for Mediastinal/Thymic Lymphoma in Felines?
dull lung sounds
How do you diagnose Mediastinal/Thymic Lymphoma in Felines?
U/S guided FNA
How do you treat Mediastinal/Thymic Lymphoma in Felines?
Surgery or Radiation for localized lesion
What is the Remission time for Mediastinal/Thymic Lymphoma in Felines?
What are the clinical signs for Lymphoid Leukemia?
Vague eight loss
How do you diagnose Lymphoid Leukemia?
How do you treat Acute Lymphoblastic Leukemia?
What is the MST for Acute Lymphoblastic Leukemia?
What are the clinical signs for Chronic Lymphocytic Leukemia?
How do you diagnose Chronic Lymphocytic Leukemia?
Bone marrow aspirate
What is the treatment for Chronic Lymphocytic Leukemia?
Chlorambucil + prednisone if there are clinical signs
What is the MST Chronic Lymphocytic Leukemia?
What are the clinical signs for Multiple Myeloma?
How do you diagnose Multiple Myeloma?
Ultrasound FNA of liver and spleen
Bone Marrow Aspirate
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
What is the treatment for Multiple Myeloma?
Melphalon - oral
Cyclophosphamide and Chlorambucil are effective
What is the MST for Multiple Myeloma in a dog?
What is the MST for Multiple Myeloma in a cat?
8 months +
What are the neoplastic Histiocystic diseases?
Histiocytic Sarcoma Malignant Histiocystosis
What are the non neoplastic Histiocystic diseases?
What is the treatment for Histiocytoma?
Self-limiting: resolve in weeks
Where do you often find Histocytic Sarcoma?
What staging should you perform if you suspect Histocytic Sarcoma?
Regional LN aspirate
Bone marrow aspirate
What is the treatment for Histocytic Sarcoma without metastases?
What is the prognosis for Histocytic Sarcoma without metastases?
1 year +
What chemotherapy can you use with Histocytic Sarcoma?
What are the clinical signs for Polycythemia Vera?
How do you diagnose Polycythemia Vera?
What is the treatment for Polycythemia Vera?
Phlebotomy - 20ml/kg
Chemo: Hydroxyurea, Busulfan or other alkylating agents
What the prognosis for Polycythemia Vera?
What is the most common skin tumor in dogs?
Mast cell Tumors
What are the clinical signs of Mast cell Tumors?
GI signs: anorexia, vomiting
How do you diagnose Mast cell Tumors?
Abdominal Ultrasound: Liver and Spleen aspirates
Bone Marrow aspirate
What is the treatment for Mast cell Tumors?
Surgery - DO NOT USE MORPHINE!
if non-resectable: CCNU, Vinblastine, toceranib, and Prednisone
What is the MST for high grade Mast cell Tumors?
What is the most common form of Feline Mast cell Tumors?
Where is the most common place for cutaneous Mast cell Tumors in cats?
Head and neck
Pinnae and base of ear
How do you diagnose cutaneous Mast cell Tumors in cats?
What is the treatment for cutaneous Mast cell Tumors in cats?
Surgery for localized lesions
if not resectable: CCNU, vinblastine, toceranib, and prednisone
What is the treatment for Diffuse miliary cutaneous Mast cell Tumors in cats?
What is the treatment for splenic Mast cell Tumors in cats?
Surgery + chemo
What is the MST for splenic Mast cell Tumors in cats?
What is the treatment of choice for intestinal Mast cell Tumors in cats?
Feline Vaccine Associated Sarcoma
Tumor development 1 month to 10 years post vaccination
How do you diagnose Feline Vaccine Associated Sarcoma?
Where do Feline Vaccine Associated Sarcoma metastasize to?
What staging is recommended for Feline Vaccine Associated Sarcoma?
What is the treatment for Feline Vaccine Associated Sarcoma?
NO MARGINAL RESECTION
What is the most common primary bone tumor in dogs?
What tumors can spread to the bone?
Where does Osteosarcoma metastasize to?
Where is Osteosarcoma located?
"Towards the knee and away from the elbow"
Mandible and maxilla
What are the contributing factors to Osteosarcoma?
Multiple minor trauma with weight bearing
Fractures with no internal stabilization
Exposure to ionizing radiation
What staging would you want to perform with Osteosarcoma?
Thoracic and Appendicular Radiographs
What are the clinical signs associated with Osteosarcoma?
What has a better prognosis for Osteosarcoma?
What has the worst prognosis with Osteosarcoma?
What is the treatment for Osteosarcoma?
Surgery: Amputation or Limb Sparing
Chemo: Carboplatin, Doxorubicin, Cisplatin
What is the mechanism of action for Bisphosphonates?
reduce bone turnover
What is the most common malignant tumor in the dog?
What is the most common benign tumor in dogs?
What is the most common malignant tumor in cats?
Squamous cell carcinoma
What is the most common thyroid cancer in the dog?
What is the most common thyroid cancer in the cat?
What are the clinical signs of Oral cancer?
Changes in chewing
How do you diagnose Oral cancer?
Where does Melanoma metastasize to?
What staging tests are performed on Melanoma?
What is the treatment for Melanoma?
What is the MST for melanoma?
What is the treatment for Fibrosarcoma?
Surgery + radiation
What is the MST for Fibrosarcoma?
What is the treatment for Canine Squamous cell carcinoma?
What is the MST for Canine Squamous cell carcinoma?
What is the treatment for Feline Squamous cell carcinoma?
Where does Feline Squamous cell carcinoma metastasize to?
What is the MST for Feline Squamous cell carcinoma?
What is the treatment for Feline Fibrosarcoma?
What is the most common benign tumor of the oral cavity?
What is the treatment for Ameloblastoma?
What is the MST for Ameloblastoma?
5 years +
What are the clinical signs of Nasal cancer?
Facial swelling and distortion
What are sites of Metastasis for Nasal Cancer?
What are the staging tests performed for Nasal cancer?
FNA of LNs
What is the treatment for Nasal cancer?
Chemo: CHOP or Carboplatin is palliative
What are the clinical signs of Thyroid cancer in dogs?
How do you diagnose Thyroid cancer in a dog?
NO INCISIONAL BIOPSY!
What staging tests do you perform on thyroid cancer in dogs?
Thoracic radiographs/ CT or MRI!!!!
FNA/Cytology of LNs
MDB + T4
Where does Thyroid cancer metastasize to in dogs?
What is the treatment for Canine Thyroid Tumor?
If non resectable: Radiation
What is the MST for canine Thyroid Tumors?
What is the treatment for Feline Thyroid Tumors?
What is the most common tumor of the Bladder?
Transitional cell carcinoma
What is the most common tumor of the urethra?
Transitional cell carcinoma
What are the clinical signs for canine transitional cell carcinoma?
How do you diagnose canine TCC?
Urinalysis + culture
Why do you not perform FNA on canine TCC?
How do you stage canine TCC?
Where does canine TCC metastasize to?
What is the treatment for canine TCC?
Surgery for apically located TCC
Adjuvant Chemo: Piroxicam and Mitoxantrone
Where does Prostatic cancer metastasize to?
What diagnostic tests should be perform for Prostatic cancer?
Chest radiographs or CT - Lung and bone mets
What is the treatment for canine Prostatic cancer?
What is the MST for canine prostatic cancer?
1-7 months with NSAIDs and Radiation
Radiation + chemo = 14-18months
What mammary glands are most commonly affected with cancer in dogs?
What diagnostic tests should be performed for Mammary gland tumors?
Thoracic and abdominal imaging
Where do Mammary gland tumors metastasize to?
What is the treatment for Canine Mammary tumors?
Chemo: Carboplatin + NSAIDs
What factors are NOT prognostic for Canine Mammary tumors?
Number of tumors
Type of surgery
Where do Feline Mammary gland tumors metastasize to?
What are the diagnostic and staging tests for feline Mammary gland tumors?
Thoracic and abdominal imaging
What is the treatment for Feline Mammary gland tumors?
Chemo: Carboplatin and Piroxicam, Doxorubicin
What is the MST for Feline Mammary gland tumors?
8 months - 3 years
What is the most common Primary Pulmonary Mass in cats?
Where do pulmonary pulmonary masses in dogs metastasize to?
Where do primary pulmonary masses in cats metastasize to?
What are the diagnostic tests for Primary pulmonary masses?
What is the treatment for primary pulmonary masses?
Surgery for solitary lung tumors
What is the MST for canine primary pulmonary masses?
What is the prognosis for primary pulmonary tumors in cats?
What is the treatment of choice for Metastatic pulmonary neoplasia?
What are the diagnostic tests for Thymoma?
What is the treatment for Thymoma?
What is the MST for thymoma in dogs?
2.5months - 2years+
What is the MST for thymoma in cats?
What is the most common cardiac tumor in cats?
What is the treatment for Hemangiosarcoma in dogs?
Surgery: Pericardiectomy + resection
What is the MST for Hemangiosarcoma in dogs?
1 month - 6 months
What is the diagnostic approach for Hemangiosarcoma of the heart?
US guided FNA
Cardiac troponin I
What cancers metastasize to the liver?
Are malignant tumors of the liver more common in dogs or cats?
What are the diagnostic tests for Hepatobiliary neoplasia?
Abdominal ultrasound - FNA
What is the treatment for Hepatobiliary tumors?
What is the prognosis for Hepatocellular carcinoma in cats?
Guarded to poor
What are the diagnostic tests for GI c cancer?
Thoracic imaging for mets
What is the most common SI tumor in dogs?
What is the treatment for Lymphoma in the SI of the dog?
What is the treatment for Carcinoma and Leiomyoma/Leimyosarcoma in the Si of dogs?
What is the most common SI tumor in cats?
What is the treatment for Lymphoma in the SI of the cats?
What is the treatment for Carcinoma and Leiomyoma/Leimyosarcoma in the Si of cats?
What are the most common tumors of the spleen in dogs?
What are the most common tumors of the spleen in cats?
How do you diagnose Splenic Hemangiosarcoma?
Where does Splenic Hemangiosarcoma metastasize to?
What is the treatment for Splenic Hemangiosarcoma?
What is the MST for Splenic Hemangiosarcoma with surgery?
What is the MST for Splenic Hemangiosarcoma with surgery and chemo?
68 days - 200 days
What is the protocol for chemotherapy with Splenic Hemangiosarcoma?
Doxorubicin + (Cyclophosphamide or Deracoxib)
Where does Anal Sac Adenocarcinoma metastasize to?
What staging tests do you perform with Anal Sac Adenocarcinoma?
Thoracic and Abdominal Radiographs
What is the treatment of choice for Anal Sac Adenocarcinoma?
Chemo: Carboplatin or toceranib