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Small Animal Medicine II > Sarcomas > Flashcards

Sarcomas Flashcards

1
Q

What are sarcomas?

A

Connective tissue/mesenchymal tumors

Spread by blood

Different behaviors depending on tissue of origin and grade

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2
Q

Primary Bone Tumors

Kind

A

80% Osteosarcoma

Fibrosarcoma
Chondrosarcoma
Hemangiosarcoma

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3
Q

Primary Bone Tumors

Signalment

A

Mid to older aged dogs; also peak at 18-24 months

Large/giant breeds (rare in toy breeds)

Males > Females

Neutered > Intact (Rotties)

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4
Q

Primary Bone Tumors

Presenting Complaint

A

Lameness

+/- swelling

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5
Q

Canine Osteosarcoma

Bones inolved

A

Long Bones (Appendicular)
75% metaphyseal
Front legs > back legs
Away from the elbow and towards the knee (sometimes distal tibia)

Flat Bone (Axial)
Bones of the head, ribs, pelvis, vertebrae
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6
Q

Canine Osteosarcoma

Diagnosis

A

Radiographs (must differentiate from fungal or bacterial osteomyelitis)

Cytology (Alk Phos staining; takes up stain suggesting osteosarcoma)

Histopathology (definitive diagnosis)

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7
Q

Canine Osteosarcoma

Staging

A

Look at lungs! -> high potential for metastasis to lung (essential to look here)

Metastasis most likely to grow after primary tumor removed!

CT is far more sensitive and recommended if considering amputation (can pick up on smaller sized mets)

1 lung lesion is alright but when there are multiple be careful

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8
Q

Canine Osteosarcoma

If see mets in lung what should you consider?

A

Possibly not amputating the leg

If leg is amputated then do something to decrease lung tumor size (chemotherapy)

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9
Q

Canine Osteosarcoma

Poor prognosis with

A

Lung or bone metastasis (especially if large masses)

Lymph node metastasis

Elevated Alk Phos

Monocytosis

Young age

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10
Q

Canine Osteosarcoma
Treatment and Prognosis
No therapy

A

Painful!

Should at least give NSAIDs and pain meds

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11
Q

Canine Osteosarcoma
Treatment and Prognosis
Amputation/No Chemo

A

3-4 months

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12
Q

Canine Osteosarcoma
Treatment and Prognosis
Radiation for pain control

A

4-6 months

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13
Q

Canine Osteosarcoma
Treatment and Prognosis
Pain Meds (NSAIDs, Opioids)

A

4-6 months

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14
Q

Canine Osteosarcoma
Treatment and Prognosis
Bisphosponates

A

4-6 months

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15
Q

Canine Osteosarcoma

Vaccine?

A

New therapy

Target: Her-2/Neu Listeria

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16
Q

Canine Osteosarcoma

Aggressive therapy for appendicular tumors

A

Amputation and chemotherapy (9-12 months)

Cisplatin (high toxicity)>Carboplatin>Doxorubicin
Carboplatin alternating with Doxorubicin
NSAIDs

Note: can start chemo prior to amputation; just closely monitor wound healing post-sx

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17
Q

Canine Osteosarcoma
Axial tumors
Treatment

A

Difficult due to inability to remove surgically (vertebrae, pelvis)

Palliative radiation (cannot damage CNS)
Pain medication

Local recurrence is common

Surgical removal of mandible/ribs + chemotherapy

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18
Q

Feline Osteosarcoma

Background

A

Rare but it happens

Metastasis seems to come much slower than in dog (takes years)

Amputation = treatment of choice

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19
Q

Soft Tissue Sarcomas

What are they?

A

Tumors arising from supportive tissues, variety of types, all behave very similarly

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20
Q

Soft Tissue Sarcomas

Examples

A 
Fibrosarcoma
Hemangiopericytoma
Nerve sheath tumor 
Leiomyosarcoma 
Synovial cell sarcoma
Liposarcoma
Malignant fibrous histiocytoma
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21
Q

Soft Tissue Sarcoma

What is important to know?

A

Tumor grade!

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22
Q

Soft Tissue Sarcomas

Signalment

A

Larger, older dogs

Any breed or any age really

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23
Q

Soft Tissue Sarcomas

Presentation

A

Usually a mass (SQ)

Tumor can arise from internal soft tissue

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24
Q

Soft Tissue Sarcomas

Biologic Behavior

A

Locally aggressive, invasive, poorly defined margins

Slow to metastasize:
Spread to lungs more than lymph nodes
Grade should be predictive
Mitotic index (most important prognostic indicator): > 20 is grade III (poor prognosis and need large margins)

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25
Q

Soft Tissue Sarcomas

Diagnosis

A

Cytology suggestive

Incisional biopsy; required for true diagnosis and grade

Excisional biopsy; be sure you know margins

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26
Q

Soft Tissue Sarcomas

Diagnostics

A

Imaging:
Radiographs and ultrasound
CT and MRI best for surgery planning

Evaluation of lymph nodes

Metastasis (thorax)
Radiographs
CT for high grade

27
Q

Soft Tissue Sarcomas

Surgery

A

Aggressive!

3 cm in all directions (dog)
5 cm in all directions (cat)

Submit for histopathology

28
Q

Soft Tissue Sarcomas

Radiation

A

Best for minimal disease (incomplete surgical margins)

Gross tumor may require higher dose

High dose difficult to achieve in some locations

29
Q

Soft Tissue Sarcomas

Chemotherapy

A

Doxorubicin (most common)
VAC (Vincristine, Doxorubicin, Cyclophosphamide)
DTIC and Doxorubicin

30
Q

Soft Tissue Sarcomas

Metronomic Chemotherapy

A

Low dose alkylators (cyclophosphamide, lomustine, chlorambucil) and NSAID

31
Q

Soft Tissue Sarcomas
Treatment
Low Grade Tumor

A

Surgery alone can be curative (5-6 years)

Surgery with follow-up radiation when margins not adequate

32
Q

Soft Tissue Sarcomas
Treatment
High Grade Tumors

A

High potential for metastasis (at least 40%)

Surgery +/- radiation +/- chemotherapy

33
Q

Soft Tissue Sarcomas
Treatment
Non-resectable tumors

A

Palliative radiation + metronomic therapy

34
Q

Soft Tissue Sarcomas
Feline (common one)
Cause

A

Vaccine Associated Sarcomas

Iatrogenic; aluminum oxide crystals in tumor (from adjuvant)

Can come about months to years after vaccine administration (record where you have given injections)

35
Q

Soft Tissue Sarcomas

Feline Characteristics

A

Every sarcoma on cats is high grade

36
Q

Vaccine Associated Sarcomas

Rule of 1, 2, 3

A

Remove a mass at a vaccine site when:
Still growing after 1 month
Greater than 2 cm in size
Still present at 3 months post vax

Same for other injections (not necessarily just vax)

37
Q

Soft Tissue Sarcomas

Feline-Signalment

A

Any vaccinated cat

May be genetic; if parent has had a reaction keep that in mind and perhaps stop breeding that cat

38
Q

Soft Tissue Sarcomas

Feline-Biologic Behavior

A 
Locally aggressive (extremely) 
10-25% metastasize
39
Q

Soft Tissue Sarcomas

Feline-Staging

A

Advanced imaging nearly always required

CT or MRI (Sx planning needed due to aggressive nature) - margins are important

40
Q

Soft Tissue Sarcoma

Feline-Therapy

A

Surgery; remove with margins (5 cm required for potential cure)

Radiation most helpful as follow-up when margins are clean but could not get 5 cm margins

41
Q

Soft Tissue Sarcoma

Feline-Margin Importance

A

Bad surgery = prematurely dead cat

If first Sx leaves dirty margins the cat may have no hope for long term tumor control

42
Q

Soft Tissue Sarcoma

Feline-Chemotherapy Effectiveness

A

10-25% metastasis potential

Chemotherapy has not been documented to help overall survival but may shrink tumor

43
Q

Soft Tissue Sarcomas

Feline-Prevention

A

Give all vaccines low on leg

Decrease use of vaccines (every 3 years opposed to every year) or give intranasal

Never use killed virus vaccines in a cat which has had VAS (write a letter as to why)

44
Q

Hemangiosarcoma

Background

A

Arises from vascular endothelial cells (may be of bone marrow origin)

5% of non-skin primary malignant tumors in the dog

45
Q

Hemangiosarcoma

Signalment

A

Large breed dogs; German Shepherd, Golden Retriever, Labrador Retriever but any dog can get them

Mean age: 8-13 years

Male > Female

46
Q

Hemangiosarcoma

Sites

A 
Anywhere blood is:
Spleen
Liver
Right atrium
Kidney
Subcutaneous tissue
Muscle
Oral cavity
Urinary bladder
Pericardium 
Peritoneum
Bone
47
Q

Hemangiosarcoma

Bleeding

A 
Sudden collapse
Weakness
Pallor
Sudden enlargement of mass
Cardiac tamponade; weakness and arrythmia
48
Q

Hemangiosarcoma

Biological behavior

A

Extremely aggressive tumor has a high rate of early development of metastasis

Endothelial cells can go anywhere they want

25% have right atrial involvement
14% have brain metastasis

49
Q

Hemangiosarcoma

Diagnosis

A

Histopathology but may have suggestive features that suggest Hemangiosarcoma

Splenic lesions
Right atrial mass
Ultrasound: fluid filled masses
Aspiration: may only get blood
Plasma troponin 1 found in pericardial fluid
50
Q

Hemangiosarcoma

Splenic lesions rule (Sys Path)

A

2/3 are malignant and 2/3 of those are hemangiosarcoma

51
Q

Hemangiosarcoma

CBC, Chem, UA

A

Normocytic, normochromic anemia

Nucleated RBC

Fragmented cells (schistocytes) = highly suggestive

Neutrophilic leukocytosis

Thrombocytopenia

52
Q

Hemangiosarcoma

Thoracic rads

A

78% of metastasis identified

47% cardiac lesions present identified

Met in lung or heart do NOT take to Sx

53
Q

Hemangiosarcoma

Cardiac ultrasound

A

92% of cardiac lesions detected

25% have right atrial involvement

54
Q

Hemangiosarcoma

Surgery Goal

A

Get bleeding to stop so the patient has a little bit longer with family :(

55
Q

Hemangiosarcoma

Surgical Removal

A

Spleens and some subcutaneous masses

Right atrial mass; removal reported to extend survival but difficult to assess

56
Q

Hemangiosarcoma

Chemotherapy

A

Single agent doxorubicin (once every 2-3 weeks); helps stop growth and bleeding!

Combination:
Doxo + Vincristine + Cyclophosphamide
Doxo + DTIC

57
Q

Hemangiosarcoma

Anti-angiogenesis therapy

A

Minocycline (not much improvement)

Low dose chemotherapy/metronomic therapy: Cyclophosphamide daily or Cyclophosphamide, Lomustine daily, Chlorambucil daily

NSAIDs (not a COX-2 issue though)
Tyrosine Kinase inhibitors

58
Q

Hemangiosarcoma

Prognosis

A

Poor

59
Q

Hemangiosarcoma
Prognosis
Surgery

A

2-3 months

60
Q

Hemangiosarcoma
Prognosis
Surgery + Chemotherapy

A

4-6 months

61
Q

Hemangiosarcoma

Right atrial

A

Doxorubicin (116 days)
Surgery (4 months)
Surgery + Doxo (175 days)

62
Q

Hemangiosarcoma

WSU Protocol

A

Control local disease: surgery and palliative radiation

Doxorubicin x 4

Metronomic chemotherapy follow-up

63
Q

Cutaneous Hemangiosarcoma

Background

A

Light coat color, thin skin dog and cat disease

Likely sunlight induced

Surgically curable if does not invade deeper tissues

Small Animal Medicine II (17 decks)

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