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Flashcards in SA Oncology Deck (345)
1

How do you usually assess staging of oral tumours?

Under GA
FNA or biopsy
Assess local lymph nodes in all cases (can contain tumour even if not enlarged)
Advanced imaging eg CT

2

How do you carry out distant staging of oral tumours?

Depends on tumour type
Thoracic imaging adequate for some
Abdominal imaging also for melanoma (can migrate to abdomen as well as thorax)

3

When doing surgical removal of an oral tumour, what margins should you include?

At least 2cm

4

What would be your first choice for management of an oral tumour?

Surgery (over radiotherapy) where excision is possible

5

Give some complications of performing oral tumour surgery in cats and dogs

Bleeding, recurrence, infection, altered cosmetic appearance, difficulty prehending food, salivation, mandibular drift after hemi-mandibulectomy
Small number of cases may never eat normally again

6

Give some clinical signs of oral tumours in small animals

Mass/facial swelling
Oral bleeding
Dysphagia/pain
Loose teeth/ proliferative or ulcerative lesions noticed at dentals
Halitosis
Epistaxis (if invading nasal cavity)
Cervical lymphadenopathy

7

How much mammary tissue should you remove with low-risk lesions?

Single mastectomy (single gland)

8

What excision margins should you use for mobile and fixed mammary tumours?

Mobile: whole gland removal is enough
Fixed: need 2cm margins and removal of affected abdominal fascia/wall

9

Is it advisable to neuter dogs at the time of mastectomy when removing mammary tumours?

Might reduce the risk of further tumour development, and improve survival of dogs with complex carcinoma

10

What is Ki-67?

Marker of dividing cells

11

A FNA taken of a canine inflammatory carcinoma would show what?

Inflammatory cells and tumour cells

12

What is the prognosis of canine inflammatory carcinomas?
Explain

Poor prognosis
Excision not typically feasible
Recurrence very common
Treatment is palliative
Medical therapy might prolong survival by a few months

13

Which systemic therapy drugs could you use when treating canine mammary tumours?

5-FU and cyclophosphamide shown to be beneficial in one small study
Pre-operative desmopressin prolongs survival in higher grade tumours

14

What % of feline mammary tumours are malignant?

85-95%

15

How does mammary tumour size affect mean survival time in cats?

> 2 cm: MST= 6 months
< 2 cm: MST= > 3 years

16

Which lymph nodes should you asses when investigating feline mammary tumours?

Inguinal and axillary bilaterally

17

Regarding feline mammary tumours, is it better to perform chain mastectomy or regional mastectomy?

Chain in cats, regional in dogs

18

What is the optimum treatment plan for feline mammary tumours?

Surgery and chemotherapy (doxyrubicin/cyclophospamide)

19

Why should you radiograph the abdomen as well as the thorax when staging melanoma?

Melanomas may migrate to the abdomen as well as thorax

20

What treatment would you recommend for a fibrosarcoma or squamous cell carcinoma?

Surgery followed by adjuvant radiotherapy generally gives better results than surgery alone

21

Why is radiotherapy alone a reasonable treatment option for oral melanoma?

Surgery is associated with high rates of local recurrence

22

How is diagnosis of melanoma achieved?

Melanin-containing mesenchymal cells on histology
Some tumours don't contain melanin and IHC (immunohistochemistry) is required for diagnosis

23

How aggressive are oral melanomas?

Locally invasive
High metastatic rates (up to 80%)

24

Describe some anti-metastatic treatments for melanoma

Chemotherapy can cause shrinkage of tumours but does not appear to extend survival
Plasmid vaccine immunotherapy

25

How aggressive are oral squamous cell carcinomas?

Low metastatic rate
Low recurral rates (eg 10% for mandible)

26

What is the third most common canine tumour?

Fibrosarcoma

27

What medical therapy can you use to treat oral squamous cell carcinoma?

Piroxicam (NSAID) +/- carboplatin (chemo drug)

28

Give some clinical signs of a tonsilar squamous cell carcinoma

Dysphagia, coughing
Enlarged cervical lymph nodes -> abscessation
Enlargement of one or both tonsils

29

What is the metastatic rate of tonsilar squamous cell carcinoma?

> 70%

30

How do you treat tonsilar squamous cell carcinoma?

Local control of tonsilar enlargement: surgery or radiotherapy
Surgery or radiotherapy for lymph node metastasis
Carboplatin or mitoxantrone chemotherapy might be beneficial

31

Fibrosarcomas mostly affect which types of dogs?
Of which age?

Large breed dogs eg labrador
Middle aged (7.5 years on average)

32

How aggressive are fibrosarcomas?

Invasive
Low/moderate metastatic risk (lung and occasionally lymph nodes)

33

How would you treat a fibrosarcoma?

Surgery, but high recurrence rate (40-60%) (MST=12 months)
Multimodal therapy ofen best (surgery plus radiotherapy) (MST=18-26 months)
Can do radiotherapy alone (MST=7 months)
Smaller tumours= better outcomes

34

Describe a low histological grade, high biological grade sarcoma of the mouth

Aggressive, rapidly-progressing oral tumour with benign histological appearance even after large biopsy
Very locally invasive

35

How would you treat a low histological grade, high biological grade sarcoma of the mouth?

Surgery and radiotherapy as very locally invasive

36

What are epulides?

Benign lesions arisimg from the gingiva

37

What are the 2 types of epulides?

Acanthomatous: aggressive local behaviour, bone invasion
Peripheral ondontogenic fibroma: slow growing firm masses, usually not invasive

38

How do you treat an osteosarcoma?

Surgery (radiotherapy does not extend survival)
Complete excision vital

39

Does a mandibular or maxillary osteosarcoma have a better prognosis?

Mandibular (14-18 months vs 5-10 months)

40

What is the local recurrence rate of an oral osteosarcoma?

>80%

41

What is the most common feline oral tumour?

Squamous cell carcinoma

42

What 3 factors increase the risk of a cat developing oral squamous cell carcinoma?

Use of flea collars
Exposure to smoking
Canned foood inc tuna

43

What is the most common site of a feline oral squamous cell carcinoma?

Base of tongue

44

How aggressive is a feline oral squamous cell carcinoma?

Invades bone
Low metastatic risk (higher risk in caudal lesions)
Recurrence after surgery is common

45

Which tumour type can be described as having a 'popcorn' appearance on radiographs?

Multilobular osteocondrosarcoma

46

How does viral papillomatosis appear?
Do you treat it?

Wart-like lesions affecting oral soft tissues
Usually resolve in 4-8 weeks

47

Which dog breeds are more prone to oral eosinophilic granulomas?
Where are they found?

Husky, cavalier king charles spaniel
Found on the ventral and lateral aspects of the tongue

48

How do you treat an eosinophilic granuloma?

Surgery and corticosteroids

49

Where are oral eosinophilic granulomas found in cats?
How do you treat them?

Upper lip, mear midline
Steroids/hyperallergenic diets, radiotherapy, surgery

50

From when is there no risk reduction in neutering of mammary tumours?

No risk reduction after second season

51

How does obesity lead to increased risk of mammary tumours?

Obesity -> reduced sex hormone-binding globulin -> increased oestrogen levels

52

What is the mean age of dogs with benign mammary tumours?
What about malignant mammary tumours?

Benign: 7-9 years
Malignant: 9-11 years

53

What is the mean age of cats who develop mammary tumours?

10-12 years

54

Which dog breeds are more prone to mammary tumours?

Poodles, chihuahuas, dachshund, maltese, cocker spaniel, yorkshire terrier

55

Which cat breeds are more prone to mammary tumours?

Siamese

56

How can you diagnose mammary tumours?

Can use FNA to exclude other ddx
Excisional biopsy

57

How can you stage a mammary tumour?

Local staging: assessment of local lymph nodes
Cranial 2 glands drain to axillary lymph node
Caudal 2 glands drain to inguinal lymph node
Middle gland drains either way
Distant staging: thoracic radiographs, abdominal US, consider bone pain as mammary tumours can metastasize to bone

58

Where do lymphomas arise?

Arise from lymphoreticular cells (T or B cells)
Normally arise from lymphoid tissue but can arise from virtually any tissue

59

Give 2 dog breeds that are pre-disposed to lymphoma

Boxers
Bull mastiffs

60

Give some factors that may predispose a dog to lymphoma

Genetic and molecular factors
Infectious diseases
Toxins (eg pesticides)
Immunological factors (animals on immunosuppressive tx are more likely to develop lymphoma)

61

What age of dog is more likely to develop lymphoma?

Middle aged to older
(Although can affect any age)

62

What are the 5 presentations of lymphoma?

Multicentric (can appear in any location, mainly lymph nodes)
Craniomediastinal
Alimentary
Cutaneous
Extra-nodal (CNS, renal, heart, bladder)

63

What clinical signs would you see in a dog with multicentric lymphoma?

Generalised peripheral lymphadenopathy +/- other clinical signs
Some dogs clinically well
Rapid deterioration
Non-specific signs (weight loss, inappetence/anorexia, lethargy, pyrexia)
Specific signs (diarrhoea, cough, vomiting, ocular signs)
Regional oedema if lymph drainage is impaired

64

What clinical signs would you see in a dog with cranial mediastinal lymphoma?

Tachypnoea, dyspnoea
Signs of hypercalcaemia (muscle tremors, PUPD, vomiting/diarrhoea, anorexia, weight loss)
Occasionally vena cava syndrome (obstruction of vena cava -> pleural effusion, dyspnoea, ascites, subcutaneous oedema)
Altered PMI of heart on auscultation (heart is caudal to where we expect to find it)

65

Give some clinical signs of alimentary lymphoma in dogs

Weight loss, anorexia, pan-hypoproteinaemia (hypoalbuminaemia), evidence of malabsorption
Abdominal/diffuse masses
Occasionally multicentric lymphadenopathy
Tends to be aggressive in dogs

66

Wha are the 2 forms of cutaneous lymphoma?

Epitheliotrophic: T cells, solitary or generalised
Non-epitheliotrophic: more frequently B cells, more likely to have lesions elsewhere

Different appearances. Progression to raised, erythematous plaques/nodules. Variable pruritus.

67

Is cutaneous lymphoma responsive to chemotherapy?

Poorly responsive

68

Describe extranodal CNS lesions in dogs

Mass lesion or diffuse
Variable neurological deficits
Commonly ocular involvement
Generally T cell

69

What is meant by a paraneoplastic syndrome?

A syndrome (set of signs and symptoms) that is a consequence of the tumour but is not due to the presence of tumour cells in that location

70

What signs of neoplastic syndrome may you see with lymphoma?

Hypercalcaemia
Immune-mediated diseases (eg pemphigus, IMHA) (as Neoplastic B cells can release monoclonal immunoglobulins)
Monoclonal gammopathies
Neuropathies
Cachexia

71

How do you diagnose canine lymphoma?

Cytology or histopathology
Ancillary tests:
-PARR (false positives and negatives)
-Flow cytometry (false positives and negatives)
-Immunohistochemistry

72

Elements of which virus have been found in tumour tissue in cats with lymphoma?

FeLV
These cats, however, are FeLV negative

73

Cats have a 80x increased risk of lymphoma if they have which two viruses?

FeLV and FIV

74

What is meant by 'extranodal' lymphoma?

Lymphoma originating in non-lymphoid tissue

75

Cats of what age are affected by multicentric lymphoma?

Middle aged

76

Do cats with multicentric lymphoma tend to have regional or generalised lymphadenopathy?

Regional

77

Give the clinical signs of multicentric lymphoma in cats?

Non-painful regional lymph node enlargement
Anorexia
Depression
Non-specific malaise
Pyrexia
(PUPD)

78

What condition do dogs get secondary to lymphoma which cats do not?

Hypercalcaemia

79

Which age of cats is more likely to get cranial mediastinal lymphoma?
Is a certain breed more prone?

Younger (2-3 years old)
Siamese

80

Give the clinical signs of cranial mediastinal lymphoma in cats

Respiratory distress
Regurgitation/distress (mass is compressing oesophagus)
Weight loss
Lethargy, exercise intolerance
Cough (rare)
Palpable reduction in compressibility of cranial thorax
Deceased lung sounds
May have pleural effusion

81

What is the most common type of lymphoma in cats?
What age of cats are affected?

Alimentary
Older cats (>10 yrs old)

82

Give the clinical signs of alimentary lymphoma in cats?

Insidious weight loss
Anorexia
Diarrhoea
Malabsorption/PLE
Occasionally vomiting (secondary gastritis)

83

Give the 3 main categories of extranodal lymphoma in cats and their clinical signs

CNS (signs depend on site)
Nasal/retrobulbar (nasal discharge, epistaxis, obstruction, exopthalmus)
Renal (malaise, anorexia, renomegaly, azotaemia)

84

Cutaneous lymphoma in cats usually takes which form?

Non-epitheliotropic

85

Is cutaneous lymphoma in cats responsive to chemotherapy?

Generally no

86

How do you diagnose lymphoma in cats?

FNA
Excisional/wedge biopsy of node

87

Which types of lymphoma in cats are more likely to be high grade?

Cranial mediastinal
Extranodal
Alimentary

88

How do you treat lymphoma in cats?

No treatment
Corticosteroids
Multi-drug chemotherapy (high dose COP is best for cats)

89

What is the mean survival time for cats with lymphoma without therapy?
What about with high dose COP?

4 weeks
COP: 1 yr=49%, 2 yr=40%

90

Give some side effects of chemotherapy in cats

Myelosuppression (check haem prior to every bolus) (intermittently check urine in case of UTIs)
Hair loss (whiskers)
GI signs

91

What must you do in a cat with alimentary lymphoma when surgically excising the mass lesion?

Biopsy lymph nodes (even if they look normal)

92

What supportive therapy can you give to a cat with alimentary lymphoma?

Vitamin B12 (as disease is malabsorptive)
Appetite stimulants

93

What rescue therapy can you use in cats with lymphoma?

Doxorubicin or Lomustine

94

What is a rescue therapy?

Drug given when animal develops a drug resistance to chemotherapy drugs and relapses

95

What is leukaemia?

Neoplastic proliferation of WBCs in bone marrow which then enters systemic circulation

96

How is leukaemia classified?

By cell type and progression
Acute vs chronic
Lymphoid or myeloid

97

What is the prognosis like for acute feline leukaemias?

Poor
Weeks-months when with chemotherapy

98

What treatment is available for acute feline leukaemia?

Supportive therapy: blood transfusion, antibiotics, barrier nursing
Multi-drug chemotherapy (addition of cytarabine infusions may improve response)

99

Chronic leukaemia in cats is more commonly a proliferation of which cell?

T cell

100

How do you treat chronic leukaemia in cats?
What is the survival time?

Prednisalone/chlorambucil
1-3 years

101

How do you diagnose leukaemia?

Haematology with manual differential and smear evaluation
Flow cytometry of peripheral blood to determine if lymphoid or myeloid
Staging to evaluate extent of disease (thoracic radiographs, abdominal US, cytology of liver/spleen)
Bone marrow biopsy (cytology plus histology)

102

What is multiple myeloma?

Systemic neoplastic proliferation of plasma cells
Results in overproduction of antibody (IgA or IgG)

103

Give some clinical signs of multiple myeloma?

Hyperproteinemia which can lead to hyperviscosity syndrome (neuro symptoms, retinal detachment, congestive heart failure, hypertension, coagulopathy)
Bone marrow involvement can lead to cytopenias
Renal disease in 33-50% of dogs
Hypercalcaemia
Hyperglobulinaemia
Proteinuria
May see circulating plasma cells on haematology

104

How do you diagnose multiple myeloma?

Haematology, biochemistry, urinalysis
Serum protein electrophoresis
Imaging (hepatosplenomegaly)
Cytology: liver, spleen, bone marrow

105

In order to be diagnosed with multiple myeloma, dogs need to fulfil two of which four criteria?

1. Monoclonal gammopathy (prescence of M protein- produced by plasma cells- in blood)
2. Radiographic evidence of osteolytic bone lesions
3. >5% neoplastic plasma cells or >10-20% plasmacytosis in bone marrow)
4. Bence-Jones proteinuria

106

What treatment can you use for multiple myeloma?

Supportive care:
-Blood transfusions
-Plasmapheresis
-Antibiotics if secondary infection
-Therapy for hypercalcaemia

Systemic disease:
-Prednisolone
-Chemotherapy (prednisolone plus Melphalan)

Local extramedullary plasma cell disease may be treated surgically if no systemic involvement

107

What are the 3 immunophenotypes of lymphomas?

B-cell
T-cell
Null phenotype (neither T nor B)

108

What has a better prognosis: B-cell phenotype lymphoma or T-cell phenotype lymphoma?

B-cell
'B-cell is better, T-cell is terrible'

109

Give the 5 stages of lymphoma

1: Single lymph node/organ affected
2: Many lymph nodes affected in 1 half of the body
3: Generalised lymph nodes affected
4: Hepatic and/or splenic involvement
5: Bone marrow/blood/CNS involvement

110

How do you carry out staging of lymphoma?

Haematology (abnormal cells on smear-may see large blast cells instead of normal lymphocytes)
Biochemistry (hypercalcaemia in dogs, look for neutropenia which would indicate myelosuppression and bone marrow involvement)
Aspirate or biopsy of lymph nodes
Thoracic radiographs, abdominal US
Bone marrow biopsy

111

What is the medial survival time for dogs with lymphoma who don't receive any treatment?

4-6 weeks if asymptomatic

112

What is the medial survival time for dogs with lymphoma who are on prednisolone alone?

1-2 months

113

High dose COP is made up of which drugs?

Cyclophospamide
Vincristine (onchovine)
Prednisolone

114

What is the medial survival time for dogs with lymphoma who receive high dose CHOP treatment?

10-12 months

115

Why may epirubicin be used instead of doxorubicin in COPH treatment for lymphoma?

Doxorubicin can affect heart contractility

116

Give some side effects of chemotherapy in dogs

GI toxicity: vomiting, diarrhoea, nausea (chemotherapy kills rapidly dividing cells eg cells in gut lining)
Myelosuppression: neutropenia, thrombocytopenia, anaemia
Sterile haemorrhagic cystitis (cyclophospamide)
Cardiotoxicity (doxorubicin)
Hepatotoxicity (Lomustine)

117

Surgery for lymphoma in dogs could be considered for which types?

Early stage 1 disease
Rare Hodgkins lymphoma
Possibly extranodal lymph one

118

What should you consider when treating CNS lymphoma?

Many drugs do not penetrate the BBB

119

Which drugs can be used to control clinical signs of cutaneous lymphoma?

Retinoids (related to vitamin A, regulate epithelial cell growth)

120

What rescue protocols can you use in dogs with lymphoma?

DMAC (dexamethosone, Melphalan, actinomycin-D, citarabine
CCNU (Lomustine), L-asparaginase, prednisolone
Single agent anthracyclines (doxorubicin/Epirubicin if not already in COP protocol)

121

How often should you see patients who are in complete remission and no longer on treatment for lymphoma?

Monthly at least for the first 6 months, then every 2-3 months

122

When should you restage lymphoma?

When there are no sentinel lymph nodes to follow
When patient is not doing as well as expected/clinical signs don't resolve
At the end of an induction phase
At the end of a discontinuous protocol

123

Give some GI problems seen with neoplasia

Cancer cachexia/ sarcopenia complex
Cancer anorexia
Gastro-duodenal ulceration
Protein-losing enteropathy

124

How does cancer cachexia/sarcopenia and anorexia occur?

1. Cancer cells preferentially use glucose for energy. Poor tumour blood flow leads to anaerobic respiration -> increased lactate production and altered insulin sensitivity
2. Cancer related cytokine production and inflammation can affect metabolism
3. Some patients suffer poor appetite but can see changes even with normal appetite

125

Give some clinical signs of cancer cachexia/ sarcopenia and anorexia

Weight loss, reduced fat mass, lean muscle loss, poor tolerance of treatment

126

How can you treat cancer cachexia/sarcopenia and anorexia?

Maintain/increase calorific intake by giving low carbohydrate, high fat diet
Omega 3 PUFA may be beneficial in reducing inflammation related changes

127

Why do GI tumours often have associated gastric or duodenal ulceration?

Due to poor blood supply and altered wall structure (can rupture or bleed-> anaemia)
Some tumours produce hormones/metabolites -> gastric acid -> ulceration (eg gastronomas)

128

Dogs with mast cell tumours have elevated what in their blood?
Give some consequences

Histamine
Can causes GI signs, ulceration and bleeding

129

Describe protein-losing enteropathy in dogs with cancer

Not specific for cancer but seen particularly with GI lymphoma
Diffuse GI lesions can allow protein loss
Low total protein, globulin and albumin, often with diarrhoea
Low albumin can lead to ascites
Other effects due to loss of proteins that bind hormones, clotting factors etc

130

How does acute and chronic anaemia occur with neoplasia?

Acute: systemic effect due to haemorrhage from a tumour
Chronic: systemic effect due to low grade haemorrhage from a tumour, or systemic effect secondary to PNS ie excess histamine/gastrin -> ulceration

131

Give some clinical signs of acute blood loss anaemia associated with neoplasia

Hypovolaemia
Shock
Anaemia initially non-regenerative then becomes regenerative

132

Give some clinical signs of chronic blood loss anaemia associated with neoplasia

Lethargy
Pallor
Poorly regenerative microcytic hypochromic anaemia due to iron deficiency

133

What is myelopthisis/myelopthisic anaemia?
Which cytopenias are seen?
How do you diagnose?

Crowding out of stem cells in the bone marrow by tumour cells
Tumours might produce suppressive cytokines

Neutropenia then thrombocytopenia then non-regenerative anaemia (normochromic, normocytic)

Diagnose by bone marrow aspirate

134

What is a common cause of non-regenerative anaemia?

Chronic inflammatory disease
Anaemia is due to disordered iron storage, and shortened RBC life span
Cancer is a cause

135

Give some clinical signs of hyperoestrogenism caused by testicular tumours

Initially neutrophilia then bone marrow hypoplasia
Neutropenia, thrombocytopenia, non-regenerative anaemia
Feminisation signs, symmetrical alopecia, pendulous prepuce, hyperpigmentation, penile atrophy, gynecomastia, prostatic metaplasia

136

What clinical sign is typical of immune-mediated disease?

Petecchiation

137

Give a tumour type that can cause microangiopathic anaemia

Haemangiosarcoma

138

How does microangiopathic anaemia occur?

Fragmentation and shearing of RBCs caused by fibrin networks
Schistocytosis is a key indicator

139

Eosinophilia is most commonly associated with which neoplasia types?

Mast cell tumour, T cell lymphoma

140

What is a monoclonal gammopathy?

Excess production of a single immunoglobulin (antibody) by tumour cells (eg multiple myeloma)

141

How would you recognise a case of monoclonal gammopathy?

Elevated serum globulins on biochemistry
Clinical signs due to hyperviscosity (neuro signs including seizures and coma, cardiac signs), reduced immune function, renal failure, coagulopathies, ocular disorders
Gammopathies detected by electrophoresis of serum and urine (Bence Jones proteins)

142

How do you treat monoclonal gammopathies?

Plasmapheresis and tumour-directed treatment

143

What coagulation problems can occur with neoplasia?

Altered platelet function
Infarcts/thromboembolism
Disseminated intravascular coagulation

144

Which tumour types commonly cause hypercalcaemia?

Lymphoma, anal sac adrenocarcinoma, hyperparathyroidism

145

Give some clinical signs of hypercalcaemia

PUPD
Dehydration
GI signs (inappetence, vomiting)
Weakness
Muscle fasciculation
Calcification of soft tissues (esp kidneys)
Arrythmias
Death

146

How would you manage a severe case of hypercalcaemia?

Initially rehydrate with NaCl 0.9% (3-4 x maintenance)
Then continue fluids
Continue furosemide
Consider bisphosphonates (toxic to osteoclasts -> slows Ca release from bone)
Consider salmon calcitonin
Consider prednisolone

147

How would you do a hypercalcaemia work up?

Asses tCa, if high asses ionized calcium, also consider phosphate
Rectal exam for anal gland carcinomas
Aspirate lymph nodes
Check history for diet/toxin exposure
Imaging of thorax and abdomen, US neck esp if high calcium and low phosphate
PTH/PTHrp/vit D
Bone marrow biopsy
Consider ACTH stimulation test if other signs are consistent with hypoadrenocorticism

148

Hypoglycaemia is most commonly seen with which tumour type?

Insulinoma

149

Give some clinical signs of hypoglycaemia

Weakness, disorientation, seizures, coma, death

150

How would you manage hypoglycaemia?

Emergency: IV glucose, CRI glucose if necessary
Medical management: prednisolone, diazoxide, octreotide
Remove inciting tumour

151

Ectopic ACTH syndrome is associated with which tumours located where?

Lung tumours

152

How do you diagnose ectopic ACTH syndrome?

Positive for hyperadrenocorticism tests + localisable tumour
No signs of adrenal-associared hyperadrenocorticism

153

How can a tumour cause myasthenia gravis?

Tumour produces ACHr antibodies -> cross-react with acetyl choline receptors

154

Myasthenia gravis is most commonly seen with which tumour type?

Thymoma

155

Give some clinical signs of myasthenia gravis

Weakness
Exercise intolerance
Dysphagia
Megaoesophagus and regurgitation

156

Feline paraneoplastic alopecia (FPA) is seen in cats of which age?

Older cats (7-16 years)

157

Give some clinical signs of feline paraneoplastic alopecia

Alopecia (non-pruritic, symmetrical, initially affects ventral abdomen and limbs)
Glistening skin
Footpad lesions (scale, crusting, painful fissures)
Malassezia dermatitis (eyes, nose, claw beds, may be pruritic)

158

What is superficial necrolytic dermatitis?

Dermatitis associated with hepatic disease and pancreatic neoplasia
Associated amino acid deficiency -> keratinocyte degeneration and skin necrosis
Secondary to increased hepatic metabolism of amino acids
Footpad hyperkeratosis and crusting dermatitis
Lethargy, inappetance, sometime diabetes mellitus

159

What is panniculitis?

Inflammation of subcutaneous fat

160

What would you see on a slide with pancreatic panniculitis?

Inflammation and hydrolysis of adipose tissue

161

What causes pancreatic panniculitis?

Pancreatic enzymes released into bloodstream -> hydrolysis of fat in tissues -> inflammation
Associated with pancreatitis, pancreatic carcinoma, adenocarcinoma

162

Which tumour types are associated with paraneoplastic pemphigus?

Lymphoma, thymoma, splenic sarcoma, metastatic thymic mass

163

How would you recognise paraneoplastic pemphigus?

Vesicles which rapidly rupture
Severe ulceration of oral cavity and mucocutaneous junctions
Lesions often bilaterally symmetrical
Clawbeds and pressure points may be affected

164

How would you diagnose paraneoplastic pemphigus?

Impression smear cytology
Typical lesion distribution and histopathological changes
Haematology, biochem, urinalysis
Thoracic and abdominal radiography
Abdominal US
FNA cytology and/or biopsy of primary tumour

165

How would you manage paraneoplsatic pemphigus?

Surgical/medical management of primary neoplasm
Immunosuppressive therapy rarely effective for cutaneous lesions
Poor prognosis

166

What is FTAED?

Feline thymoma-associated exfoliative dermatitis
Generalised exfoliative dermatitis, mostly associated with thymoma
Keratosebaceous accumulations, crusting and ulceration
Older cats

167

What is cutaneous flushing?

Periodic release of vasoactive substances by tumours resulting in skin colour changes
Mainly in dogs with mast cell tumours

168

What is nodular dermatofibrosis?

Well-differentiated, collagenous nodules mainly on limbs but also heads and trunk
Seen in middle aged GSDs with bilateral renal cysts or cyst adenocarcinoma
No treatment

169

What is hypertrophic osteopathy?

Palisading periosteal proliferation along the shafts of long bones
Associated with pulmonary tumours, cause unknown

170

Give some clinical signs of hypertrophic osteopathy

Shifting lameness
Swelling/oedema
Limbs feel warm and uncomfortable to touch

171

How do you diagnose hypertrophic osteopathy?

Radiography of long bones and pelvis
Clinical signs

172

How do you treat hypertrophic osteopathy?

Remove inciting cause (tumour)
Prednisolone
Pain relief
Bisphosphonates

173

Why might you get pyrexia with a tumour?

Expression of inflammatory cytokines by or in response to the tumour

174

Which tumours are more likely to have an associated pyrexia?

Lymphoma, renal cancers, hepatic tumours

175

Hypercalcaemia occurs secondary to which tumour type?

Anal sac adenocarcinoma

176

What is the differene between grading and staging of tumours?

Staging= how far it has spread (extent of disease)
Grading= histopathological features

177

What are the stages of oral tumours?

TNM
T= primary tumour
N= metastatic disease in local and regional lymph nodes
M= distant metastatic disease

178

Does ulceration usually imply a tumour is malignant or benign?

Malignant

179

Give some risks of performing a bipsy when investigating neoplasia

-Haemorrhage
-Seeding of tumour cells
-Compromise of future surgery
-Damage to adjacent structures

180

Describe a needle core biopsy

-Cylinder of tissue is removed from the lesion by a specialised needle (eg Trucut, Cook's- semi automated)

181

Give some advantages of needle core biopsies

-Larger sample size than aspirate (some evaluation of architecture)
-Inaccessible tissues can be accessed percutaneously
-Multiple samples can be taken
-Superficial lesions can be biopsied under sedation and LA

182

Give some disadvantages of needle core biopsies

-Smaller sample size than other biopsy methods
-Greater risk of complications than aspirate (esp for intracavitatory biopsies)
-Noot good for lymph nodes

183

Which tool would you use to take a bone core biopsy?

Jamshidi needle

184

What is the most common type of incisional biopsy?

Inverted wedge

185

Give some advantages of taking an incisional biopsy

-Good evaluation of architecture
-Can do histopathological grading
-More tissue

186

Give some disadvantages of taking an incisional biopsy

-GA normally required
-Increased time
-More expensive

187

What should you make sure you don't do when taking an incisional wedge biopsy?

-Disrupt the tumour bed, as you'll make it larger
-Should avoid major structures, and necrotic, damaged or infected areas

188

What are surface pinch and grab biopsies used for?

-Accesible surfaces (resp tract, GI tract, urogenital tract)
-Nasal tumours
-Very small biopsies so always take multiple biopsies

189

What are punch biopsies used for?

-Cutaneous and other superficial lesions only
-NOT lymph nodes

190

What is an excisional biopsy?

-Entire abnormal area is removed
-Only used when knowledge of tumour type will not affect treatment

191

What are the only 3 cases where an excisional biopsy can be performed without first diagnosing the tumour type?

-Haemorrhagic splenic mass
-Mammary tumours
-Pulmonary tumours
-Must still stage first!

192

Are most skin tumours in cats and dogs benign or malignant?

-Dogs: benign
-Cats: malignant

193

Give some contraindications for excisional biopsy of skin lesions

-Rapidly growing mass
-Ill-defined or poorly demarcated lesion
-Peritumoural oedema or erythema
-Skin ulceration
-Injection site masses in cats
-FNA suspiscious of mast cell tumour or soft tissue sarcoma
-Non-diagnostic FNA

194

What % of mineral contect of bone must be lost for lysis to be apparent on a radiograph?

>60%
-Lack of obvious lysis does not mean there is no bony involvement

195

How can you investigate whether or not a tumour has metastasized to lymph nodes?

-Palpation (esp increased firmness, enlargement)
-Imaging (radiography, US)
-FNA
-Biopsy (wedge biopsy)

196

Where do thyroid carcinomas tend to metastasize to?

Retropharyngeal lymph nodes

197

Where do tumours of the distal forelimb metastasize to?

Prescapular lymph nodes

198

Where do tumours of the proximal forelimb metastasize to?

Axillary lymph node

199

Give some common sites for neoplasia metastasis

-Lung
-Parenchymatous organs (liver, spleen, kidney)
-Bone
-Skin
-CNS
-Distant nodes

200

How would you differentiate lung metastases from pleural osteomas?

Osteomas are denser, have jagged edges

201

Give the basic steps of tumour metastasis

-Vacularisation of tumour
-Invasion of tumour cells into vasculature
-Dissemination (evasion of host immunity)
-Arrest (adhesion to normal cells)
-Extravasation (enzymes)
-Proliferation

202

What are the 2 ways that tumours can metastasise?

-In the circulatory system
-In the lymphatic system

203

Give some examples of tumours which spread via the circulatory system

-Sarcomas
-Malignant melanoma

204

Give some examples of tumours which spread via the lymphatic system

-Mast cell tumours
-Carcinomas
-Malignant melanomas

205

Give the stages of primary tumours

Tis: pre-invasive carcinoma
T0: no evidence of tumour
T1: tumour <2cm diameter
T2: tumour 2-4cm diameter
T3: tumour >4cm diameter
T_a: no bone invasion
T_b: bone invasion

206

Give some tumour types that are highly metastatic

-Oral/mucosal malignant melanoma
-Visceral and subcutaneous haemangiosarcoma
-Long bone osteosarcoma
-High-grade mast cell tumours
-Most mammary carcinomas in cats

207

Which tumour types don't metastasise?

-Oral basal cell carcinoma
-Haemangiopericyotma
-Schwannoma/neurofibroma
-Benign tumours

208

Where do mast cell tumours tend to metastasize to?

Liver and spleen

209

Where would the contents of the abdomen be pushed by a renal mass?

Ventrally

210

What are the main differentials for a maxillary mass in a cat?

-Squamous cell carcinoma (most common in cats)
-Fibrosarcoma
-Lymphoma

211

What are the main differentials for a firm mass on the distal tibia in a large dog?

-Osteosarcoma
-Osteomyelitis
-Fibrosarcoma

212

What are the main differentials for a history of L sided mucoid nasal discharge, occasionally stained with blood?

-Foreign body
-Polyp
-Nasal adenocarcinoma (most common in a dog)
-Lymphoma

213

Spindle cells indicate the presence of what?

Sarcoma

214

What is chemotherapy?

The use of systemic treatments to destroy or control the growth of neoplastic cells

215

Give some indications for chemotherapy

-Systemic tumours
-Risk of metastatic disease eg haemoangiosarcoma
-Palliative treatment
-Delay/prevent local tumour recurrence
-Radiation sensitisation

216

What are the 3 classes of chemotherapy?

Primary chemotherapy
Adjunctive chemotherapy (used with either surgery or radiation, chemo usually done last)
Neoadjunctive chemotherapy (chemo before surgery eg to reduce size of tumour)

217

How do chemotherapy drugs affect cells?

-Affect DNA synthesis, RNA synthesis, protein synthesis, cell cycle progression
-Drugs may be cell stage specific or active at all stages (less so G0, meaning cells in this stage may be resistant to chemo)

218

What is meant by the 'growth fraction' of a tumour?

The fraction of cells actively dividing at any given time

219

What is meant by the 'mitotic index' of a tumour?

% or number of mitoses per high power field on light microscopy

220

What is meant by the 'mass doubling time' of a tumour?

Time taken for the tumour to double in size

221

Give some factors which affect chemotherapy success

-Growth fraction and mass doubling time
-Inherent tumour sensitivity
-Tumour cell heterogeneity
-Inherent tumour cell resistance/acquired drug resistance
-Drug dosage
-Interval between treatments
-Tumour blood supply/oxygenation

222

Which stage of tumour growth will chemotherapy be most effective in and why?

Early stages, as there will be rapid growth (high growth fraction, low mass doubling time) so more cells will be i the chemotherapy-resistant phases of the cell cycle

223

Give an example of a tumour which is relatively chemo-sensitive, and one which is poorly chemo-sensitive

Quite chemo-sensitive: lymphoma
Poorly chemo-sensitive: melanoma

224

What is P-glycoprotein 1?

Pumps drugs out of cells, can lead to drug resistance (eg of cancer cells to chemo)

225

Why do we want a tumour to have a good blood supply when we are using chemotherapy?

-Better drug delivery
-Higher growth fraction (more cells are in chemo-sensitive stages of cell cycle)
-If there isn't a good blood supply, there will be areas of anoxia (low ph, build up of toxic metabolites)

226

Why are larger tumorus harder to treat medically?

Tend to outgrow their blood supply -> inadequate drug delivery

227

Give a typical chemotherapy protocol

COP: cyclophosphamide + vincristine + prednisolone
CHOP: + doxorubicin/epirubicin

228

What are doxorubicin and epirubicin?

-Chemo drugs (antracyclines)
-Antitumour antibiotics, affect DNA replication

229

What are cyclophosphamide and lomustine?

-Chemo drug
-Alkylating agents, affect DNA replication

230

What is vincristine?

Chemo drug that interferes with mitosis

231

What are cisplatin and carboplatin?

Chemo drugs (platinum compounds) that affect DNA replication

232

Which chemotherapy drugs affect purine and pyrimidine synthesis?

Antimetabolites eg 5-fluorouracil, cytosine arabinoside

233

What is the difference between drug density and intensity?

-Drug density= how often the drug is administered
-Drug intensity= drug dose delivered per time unit (mg/m2/week)

234

Why do we have an interval between delivery of chemotherapy drugs?

To allow normal tissues to recover

235

Give some possible immediate toxicity reactions to chemotherapy drugs

Occurs <24 hrs after treatment
-Anaphylaxis/hypersensitivity/erythema (L-asparaginase, cisplatin, antracyclines, cytosin)
-Cardiac arrhythmias (doxorubicin, epirubicin)
-Emesis (platinum compounds, antracyclines)

236

Give some possible toxicity reactions to chemotherapy drugs that occur 1-5 days after treatment

-GI toxicity (most agents)
-Perivascular reactions (antracyclines, platinums, vinka alkaloids)
-Pancreatitis (corticosteroids, asparaginase, azathioprine, platinum compounds)

237

What clinical signs would you see if an animal experienced GI toxicity from chemotherapy drugs?

-Direct damage to enterocytes
-Anorexia, vomiting, nausea, diarrhoea

238

How would you treat GI toxicity from chemotherapy drugs?

-Treat more aggressively than non-chemo patient as if they also develop bone marrow toxicity, sepsis could occur (disrupted mucosal barrier + neutropenia)
-Symptomatic tx: anti-emetics, anti-diarrhoeals, ABs, IVFT, gastroprotectants, appetite stimulants

239

Give some possible toxicity reactions to chemotherapy drugs that occur 7-10 days after treatment

-Myelosuppression (most drugs)
-Damage to haematopoietic stem cells
-Neutropenia
-Thrombocytopenia

240

How would you treat a patient on chemotherapy medication that develops pyrexia and neutropenia?

-May be septic!
-Translocation of bacteria from patient's own GI flora
-Stop all cytotoxics
-Supportive therapy
-Bactericidal ABs (aerob/anaerob, continue for 3-7 days after recovery)

241

How would you treat a patient on chemotherapy medication that develops neutropenia without pyrexia?

-Give ABs snf discontinue drugs if neutrophil count is <1x10^9/L
-Otherwise may require drug postponement

242

Give some other toxicities that can occur after 10 dyas of starting chemotherapy

-Cumulative cardiotoxicity (DCM)
-Alopecia (rare)
-Sterile haemorrhagic cystitis
-Hepatotoxicity
-Nephrotoxicity
-Peripheral neuropathy with vincristine

243

What should you not give cisplatin to?

Cats (can cause fatal non-cardiogenic pulmonary oedema)

244

How can 5-fluorouracil negatively affect cats?

Can cause fatal CNS signs

245

Which chemotherapy drugs are perivascular irritants?

-Vincristine and vinblastine
-Doxorubicin, epirubicin, actinomycin

246

How would you treat extravastion (leakage) of doxorubicin/epirubicin/actinomycin D?

-Apply cold packs
-Topical DMSO
-Dexrazoxane
-Consider immediate surgical debridement (as they are perivascular irritants)

247

How would you treat extravastion (leakage) of vincristine/vinblastine?

-Apply warm compress
-Topical DMSO

248

What is metronomic chemotherapy?

-Continuous low-dose chemotherapy
-Main target is tumour blood supply
-Stimulation of immune response
-Direct action on tumour cells
-Inhibition of circulating endothelial cells (CECs)

249

Which chemotherapy drugs are usually used for metronomic chemotherapy?

Low dose cyclophosphamide with piroxicam (or other NSAIDs) (SID or EOD)

250

Why may tyrosine kinase inhibitors be used in chemotherapy?

Inhibit the activation of specific signalling pathways involved in some cases of mast cell tumours in dogs

251

If a dog had a red-orange ulcerative tumour on its lip, what is it likely to be?

Histiocytoma

252

Spaying a bitch before its 1st season reduces its likelihood of mammary tumours by how much?

85%

253

Which neoplasia does castration prevent?

Testicular (not prostatic)

254

Which neoplasias does spaying prevent?

Ovarian, uterine, mammary (if done before 1st season)

255

When tumours metastasize to the lungs, is there usually 1 metastasis or many small ones?
What can we use to treat this?

-Many small ones
-Chemo is good at reducing no of small metastases

256

Why is tumour removal not often done in the mouth?

Not always possible to get 3cm margins

257

How would you manage an insulinoma?

-Medical and dietary management
-Chemo/radiotherapy not effective

258

Why is the first surgery the best chance of cure when performing oncological surgery?

-Untreated tumours have more normal surrounding anatomy
-Inappropriate surgery -> tumour seeding
-Most active parts of tumour are at the edges
-If tumour recurs, there is less normal tissue for closure

259

What surgical margins should you use when removing tumours?

3cm

260

What is the maximum number of ribs you can surgically remove?

5-6

261

When might you use antibiotic prophylaxis when surgically removing a tumour?

-If debilitated patient
-If clean-contaminated/contaminated/dirty surgery
-If surgery >90 mins long

262

When removing a tumour, how could you allow tumour manipulation without the risk of tumour seeding?

Place 'stay' sutures in normal surrounding tissue

263

What should you do during surgery after removing a tumour?

Saline lavage (won't wash out any remaining tumour cells but allows removal of blood clots, necrotic tissue, and possible unattached tumour fragments)

264

How can you reduce tumour cell contamination/seeding during surgical removal?

-Saline lavage
-Change drapes, gloves, and instruments after removing tumour

265

Which types of tumours are more likely to be exfoliative?

Tumours of ectodermal origin eg squamous cell carcinoma, mast cell tumour

266

Why might you remove a lymph node when treating neoplasia?

-If it is histologically proven to contain tumour cells
-Appears grossly abnormal at surgery
-If surgical margins dictate you remove it

267

Should you provide pain relief during oncological surgery?

-Yes as procedure can cause severe post-operative pain
-Give pre-, intra- and postoperative analgesia

268

What are the main differentials for a maxillary mass in a dog?

-Fibrosarcoma
-Squamous cell carcinoma
-Melanoma
-Acanthoma
-Dental tumours
-Osteosarcoma
-Basal cell carcinoma

269

Which radiographic view would you use if you wanted to view the accessory lung lobe?

Ventrodorsal

270

What is the mean survival time of a dog with a fibrosarcoma?

10-12 months

271

Why does radiotherapy not kill all cancer cells at once?

Only targets cells that are rapidly dividing

272

What is brachytherapy?

-Advanced cancer treatment
-Radioactive sources are placed in/near tumour, giving a high radiation dose to tumour while reducing radiation exposure in the surrounding healthy tissue
-Can be direct (strontium 90) or implantation (iridium wires) or systemic (iodine 131 in cats)

273

What is teletherapy?

-External beam radiotherapy
-Most common form of radiotherapy (cobalt 60)

274

How does high energy electromagnetic radiation work in killing cancer cells?

-Radiation is unlikely to hit DNA (as it's so small)
-Instead, damage is caused by ionisation of surrounding water molecules -> free radicals are generated -> free radicals damage DNA
-> Apoptosis, permanent cell cycle arrest, mitotic catastrophe

275

Is it easier to kill a hypoxic or euoxic cell with radiation therapy?

-Euoxic
-In hypoxic cells, DNA damage is rapidly repaired, so 2.5-3 times as much radiation is required to kill hypoxic cells
-Oxygen inhibits the repair of free radical induced damage

276

Electrons are used in radiotherapy for which types of tumours?

-Superficial (useful when you want to target skin but not underlying organs) as they lose energy as they pass through tissue

277

What is fractionation?

The practice of giving multiple small doses of radiation instead of one big one

278

Why is it better to give a single bigger dose of radiation than give two smaller doses at separate times?

Cells can repair themselves between treatments (esp with malignant melanoma)

279

What is the standard fractionation protocol for radiation?

-M-W-F (Monday, Wednesday, Friday)
-Once weekly if palliative

280

Give some limitations of fractionation for animals

-GA required
-Cost
-Owner compliance

281

Why may slower-dividing tissues be more radio-resistant?

Fewer cells are rapidly dividing therefore fewer cells are in the sensitive phases

282

Are larger or smaller tumours more sensitive to radiation?
Why?

-Smaller
-More rapidly dividing, higher growth fraction, more cells in sensitive phases
-Less likely to contain large numbers of hypoxic cells (O2 prevents repair of cell damage)
-Easy to dose accurately and evenly

283

Are carcinomas or sarcomas more sensitive to radiation?

Carcinomas

284

Give some tumour types which are highly sensitive to radiation

-Lymphoma
-Transmissable venereal tumour
-Gingival basal cell carcinoma (acanthoma)

285

How soon after radiation therapy do side effects usually show?

3-4 weeks
-Can be months or years in slowly dividing tissues (eh bone, neural tissue)

286

Give some acute side effects of radiation therapy
Which cells do they affect?

-Affect rapidly dividing cells (eg mm, skin)
-Erythema/desquamation (skin peeling)
-Develop soon/after tx
-Resolve within a few weeks of cessation of therapy

287

Give some late side effects of radiation therapy
Which cells do they affect?

-Affect slowly dividing cells (eg bone, neural tissue)
-Alopecia, skin fibrosis, reduced healing capacity, ischaemic necrosis of brain or bone tissue

288

For which tumour types may you perform radiotherapy and then removal surgery?

Osteosarcoma and soft tissue sarcomas
(occasionally)

289

Why may you perform radiotheraphy before surgical tumour removal?

-Reduces tumour burden
-Eliminates small number of tumour cells at the periphery of the lesion

290

Give a negative effect of doing radiotherapy before surgical tumour removal

Can have a negatve impact on wound healing

291

What is the most commonly diagnosed skin tumour in the dog?

Mast cell tumour

292

Which dog breeds are more prone to mast cell tumours?

Boxers (low-grade), boston terrier, Shar peis (high-grade)

293

Where do mast cell tumours usually metastasize to?

Local lymph nodes

294

Describe the clinical presentation of a mast cell tumour in dogs

-Cutaneous mass of variable external appearance
-Anywhere in the body
-Usually solitary
-May have local effects: erythema, oedema, pruritus, haemorrhage
-May have systemic signs: vomiting, melaena, rarely collapse and acute death

295

What do mast cells look like?

Large, round cells with intracytoplasmic granules containing histamine, heparin and proteases

296

How do you diagnose mast cell tumours?

FNA: round cells with characteristic purple granules

297

What should you do when staging mast cell tumours?

-FNA of local lymph nodes
-Abdominal US (liver, spleen, LNs)
-Thoracic radiography (rarley metastasize to lungs, but check sternal LNs)

298

Why is buffy coat examination not an accurate method for staging mast cell tumours?

-Increased no of mast cells in buffy coat does not indicate metastasis as any inflammatory condition can increase systemic mast cells

299

What is the best system for grading mast cell tumours?

-Patnaik grading system
-3 grades (1=low-grade, well differentiated, 3=high-grade, poorly differentiated)

300

How do you treat mast cell tumours in dogs?

Often multimodal approach is required: surgery, radiotherapy (after surgery if incompletely excised), chemotherapy (before surgery to shrink tumour)

301

Which margins should you use when surgically removing a mast cell tumour?

3cm plus 1 fascial plane

302

Which chemotherapy protocol would you use for mast cell tumours in dogs?

-Vinblastine with prednisolone
-Lomustine
-TKIs (tyrosine kinase inhibitors)

303

What are the 2 forms of mast cell tumour in cats?

-Cutaneous form (cutaneous raised hairless masses, multiple tumours)
-Visceral forms: splenic or intestinal (palpable abdominal mass)

304

How do you treat cutaneous mast cell tumours in cats?

Surgical excision usually curative

305

How do you diagnose cutaneous mast cell tumours in cats?

Cytology

306

How do you treat splenic mast cell tumour in cats?

Splenectomy

307

Transitional cell carcinomas typically affect which part of the bladder?

Trigone

308

Do transitional cell carcinomas have a low or high metastatic rate?

High to medial iliac lymph nodes and other organs (eg liver, spleen, bones)

309

Which dog breed is more prone to transitional cell carcinomas?

Scottish terrier

310

Give the clinical signs of transitional cell carcinomas

-Lower urinary tract signs (stranguria, pollakyuria, haematuria)
-Occasionally signs related to bone metastasis (lameness) or renal dysfunction

311

How do you diagnose transitional cell carcinomas?

-Histopathologial diagnosis although cytology can sometimes be very suggestive
-Risk of seeding with FNA

312

How do you treat transitional cell carcinomas?

-Chemotherapy
-Can use NSAIDs alone or NSAIDs with mitoxantrone (chemo drug)

313

What is the prognosis like for transitional cell carcinomas?

-Poor long term prognosis, but quality of life can be maintained for several months (MST=6-8 months)

314

What is a sarcoma?

A malignant cancer of mesenchymal origin

315

Which 2 sarcomas are highly likely to metastasize?

-Osteosarcoma
-Haemangiosarcoma

316

All sarcomas have a predilection to metastasize where?

Lungs

317

What surgical margins would you use when surgically removing a soft tissue sarcoma?

3cm plus 1 fascial plane

318

How can you predict the success of a tumour removal?

-Ask pathologist for margin analysis (aim is for complete excision ie no tumour cells on edge of margin)
-If there are tumour cells within <3mm of tissue edge, possibility of residual tumour tissue left in patient

319

What treatmnt options do you have if there is miscroscopic disease remaining or narrow excision margins after tumour removal surgery?

-Further wide surgical excision
-Adjuvant radiation therapy (highly effective)
-Metronomic chemotherapy (usually cyclophosphamide and an NSAID)
-Active monitoring (monthly for at least a year)

320

What should you look out for when using chemotherapy (cyclophosphamide and NSAID)?

-Risk of sterile haemorrhagic cystitis-monitor urine
-Stop if haemturia and no UTI

321

What is the prognosis like for soft tissue sarcoma?

-If no metastatic disease: >4 years with successful surgery +/- radiotherapy

322

What would you see histologically in a feline injection site sarcoma?

-Malignant fibroblasts
-Often high lymphocyte numbers (inflammation)

323

When should you be suspiscious of a feline injection site sarcoma?

-3-2-1 rule:
-Persists longer than 3 months after an injection
-Is >2cm
-Increases in size after 1 month after an injection

324

How do you treat feline injection site sarcomas?

-Surgical removal with 3-5cm margins (can involve removal of spinous processes of vertebrae)
-Best of performed by a specialist

325

What other treatment should you carry out if you can only perform an incomplete resection/marginal resection of a feline injection site sarcoma?

-Radiotherapy
-Radiotherapy plus chemotherapy (anthracycline-based chemo eg doxorubicin)

326

Give a risk associated with anthracycline-based chemotherapy (ie doxorubicin/epirubicin)

Risk of nephrotoxicity

327

What is a haemangiosarcoma?
Give some properties

-Tumour of blood vessel walls
-Can affect any tissue but most commonly spleen
-Highly invasive and metastatic

328

Give some clinical signs of a haemangiosarcoma

Most commonly associated with bleeding:
-Shock, collapse, haemoabdomen, pericardial effusion (if right auricular appendage affected)
-Intramuscular- bruising in the dependent part of limb

329

Give some clinical pathology changes seen with haemangiosarcoma

-Anaemia and sometimes schistocytes (sheared RBCs)
-In early stages, effusion and reduced TP precedes anaemia
-Low platelet count
-Prolonged coagulation tests and DIC

330

What % of splenic tumours are haemangiosarcomas?

50%

331

How do you treat splenic haemangiosarcomas?

-Surgical excision of spleen or mass
-Tumours are responsive to radiation

332

What is the prognosis like for haemangiosarcomas?

Poor: even with chemo and surgery, MST=4-6 months

333

Give some sarcomas of the bone

-Osteosarcoma
-Chondrsarcoma
-Histiocytic sarcoma

334

Do osteosarcomas have a high or low metastatic risk in dogs and cats?

Dogs: metastatic
Cats: lower metastatic risk

335

Osteosarcomas typically affectwhich dogs?

-Middle aged and older dogs
-Typically large breeds (eg Rottweiler)
-Usually FL, near knee

336

Give some clinical signs of an osteosarcoma

Sudden and progressive pain and lameness

337

Give some radiographic changes seen with osteosarcoma

-Bone lysis
-Soft tissue swelling
-New bone- palisades perpendicular to bone
-Periosteal elevation
-Zone of transition

338

How do you diagnose osteosarcoma?

-Radiographic changes
-Cytology or histology

339

What are the treatments options for osteosarcoma?

-Amputation (feel pain-free after 1 weel)
-Analgesics (multi-modal approach)
-Bisphosphonates to slow bone destruction
-Radiation therapy to reduce sensation
-Bone stabilisation and fixation (patient will never be pain-free, high rate of joint infections)
-Chemotherapy (if no gross metastases; carboplatin or anthracyclines)

340

How can you investigate whether or not there are metastases after amputaion due to osteosarcoma?

-Measure total alkaline phosphatase (indirect measure of bone isoenzyme ALKP)
-If stays high after amputation -> risk of metastases
-If high but decreases after amputation -> good prognosis

341

What is a histiocytic sarcoma?

-Highly metastatic sarcoma arising from histiocytes (antigen-presenting cell)
-Can affect liver, lung, spleen, bone, brain, joints

342

How do you treat a histiocytic sarcoma?

-Best results with multi-modal therapy (surgery, radiation and chemo)

343

Give some tumour types that are poorly sensitive to radiotherapy

Fibrosarcomas
Haemangiopericytomas
Oral SCC
Osteosarcomas
Rhinrial SCC (dogs)

344

What is the gold standard treatment for canine lymphoma?

Multidrug chemotherapy (high dose COP)

345

Are perianal (hepatoid) gland tumours usually benign or malignant?

Benign