Surgical oncology

Question 1

When are incisional biopsies esp important?

Answer 1

• for when the surgical site would make excision with margins difficult

Question 2

When might excisional biopsy be indicated once a mass has been diagnosed as MCT?

Answer 2

• if surgery site allows for wide margins

Question 3

What are the Patnaik MCT grades?

Answer 3

Grade I = benign
Grade II = intermediate
Grade III = malignant

Question 4

What are the Kiupel MCT grades?

Answer 4

• low-grade
• high-grade

Question 5

How might lower-grade MCTs be managed?

Answer 5

• excision and monitoring

Question 6

How might higher-grade MCTs be managed?

Answer 6

• may have spread to LN, liver, spleen, bone marrow -> need to be staged

Question 7

What components of a MCT would mean it is classed as ‘low-grade’?

Answer 7

• mitotic index of 0
• well-differentiated cells

Question 8

How might you stage an MCT once it is determined to be high-grade?

Answer 8

• FNA/MRI LN
• US ± FNA spleen
• bone marrow aspirate

Question 9

What options are there for non-resectable MCTs?

Answer 9

• tyrosine kinase inhibitors
• Mastinib
• Tigilanol tillage

Question 10

What is the blood supply of the spleen?

Answer 10

• rich blood supply via single splenic artery and drains via splenic vein into hepatic portal system

Question 11

What is the most common cause of splenic dz in cats?

Answer 11

• splenic MCT (approx 1/2 MCTs in cats are splenic)

Question 12

If splenic MCT has metastasised, is splenectomy worthwhile?

Answer 12

• yes
• good median survival time of 12-18m

Question 13

When haemoabdomen is present with splenic mass, what does the likelihood of neoplastic disease increase by?

Answer 13

• 50%

Question 14

What are the 2 main splenectomy techniques?

Answer 14

1. tie off all vessels in hilarity region
2. tie off short gastric vessels within gastrosplenic ligament and splenic artery & vein

Question 15

Which is the risk of tying off short gastric vessels for splenectomy?

Answer 15

• risk of damaging surrounding tissues and blood supply

Question 16

What are the surgical complications of splenectomy?

Answer 16

• bleeding due to damaging major vessels
• arrhythmia
• depletion of clotting factors or thrombocytopenia resulting in coagulopathy

Question 17

What is the mets rate of haemangiosarcoma?

Answer 17

• > 90% to lungs, liver, LN, brain, potentially skin
• another common site is the right atrium

Question 18

What is the primary tx for haemangiosacroma?

Answer 18

• surgery + thoroughly check abdo for mets

Question 19

What adjunctive therapy is usually indicated following surgical resection of haemangiosarcoma?

Answer 19

• chemo

Question 20

What is the average survival time following splenectomy alone for tx of haemangiosarcoma?

Answer 20

• 3 months

Question 21

What is the average survival time following splenectomy + chemotherapy for tx of haemangiosarcoma?

Answer 21

• 6 months
• pts often die of diffuse mets

Question 22

What is the chemo of choice as adjunct to splenectomy for haemangiosarcoma tx?

Answer 22

• doxorubicin q3w

Question 23

Non-neoplastic causes of splenomegaly

Answer 23

• nodular lymphoid hyperplasia
• haematoma
• abscess
• granuloma

Question 24

What would you expect the PCV of a true haemoabdomen to be

Answer 24

• similar to normal blood

Question 25

Would you expect a true haemoabdomen to clot when tapped? why?

Answer 25

- no - blood loses fibrin when in contact with abdo space

Question 26

When performing a splenectomy due to neoplasia, what other organ is it vital to check for mets that would poorly impact prognosis if affected?

Answer 26

- liver