Term
| What is the major goal of chemotherapy? |
|
Definition
| -maximize survival while maintaining good quality of life (QOL) |
|
|
Term
| What are some of theminor goals of chemotherapy? |
|
Definition
-induce and maintain remission
-delay metastasis
-control local disease |
|
|
Term
| What are the indications for chemotherapy? |
|
Definition
-systemic cancer that is chemo-responsive
-metastatic cancer
-cytoreduction prior to surgery: AKA neoadjuvant treatment
-after incomplete resection: AKA adjuvant treatment
-radiation sensitization
-palliation |
|
|
Term
| What are the contraindications for chemotherapy? |
|
Definition
-organ dysfunction b/c it alters drug metabolism
-substitute for surgery: chemotherapy is not a primary treatment for the majority of tumors |
|
|
Term
| Describe the graph of tumor growth. Is it linear? |
|
Definition
| -Gompertzian growth: initially fast then plateaus |
|
|
Term
| Do smaller or larger tumors grow more quickly? Why? |
|
Definition
-smaller tumors = faster cell division
-mroe sensitive to chemotherapy an dradiation therapy |
|
|
Term
| What does chemotherapy target? |
|
Definition
-rapidly dividing cells
-affects tumor and normal cells: bone marrow, intestinal epithelium, hair follicles (BAG set of side effects) |
|
|
Term
| What does the term "BAG set of side effects" mean? |
|
Definition
| -Bone marrow suppression + Alopecia + Gastrointestinal |
|
|
Term
| Which side effect of chemotherapy is the dose limiting toxicity of many agents? |
|
Definition
|
|
Term
| Delay treatment of chemotherapy if <_____ neutrophils or <_____ platelets. |
|
Definition
|
|
Term
| From chemotherapy: Neutropenia + fever = emergency! Why? What are the possible sources of infection? |
|
Definition
-neutrapenia = inability to fight infection
-GI tract translocation, pneumonia, pyoderma, oral infection, urinary tract, surgical site, radiation site, IV catheters, implants |
|
|
Term
| Descrive empirical antibiotic therapy. |
|
Definition
| -broad spectrum antibiotic or combinations based on culture or expectation of bacteria present (oral or intravenous) |
|
|
Term
| What are some of the oral antibiotics used for empirical antibiotic therapy? What about IV antibiotics? |
|
Definition
-Oral: trimethoprim/sulfa, Clavamox, Amoxicillin and Baytril
-IV: Ampicillin/cefazolin and Baytril, Timentin or Unasyn, Baytril and metronidazole |
|
|
Term
| At what neutrophil count is the patient hospitalized? |
|
Definition
|
|
Term
| Which breeeds are predisposed to alopecia from chemotherapy? Why are they predisposed? |
|
Definition
-Poodles, terriers, Old English Sheep dogs, Biichon, Maltese
-they have an extended anagen phase of hair growth: hair not fur |
|
|
Term
| Why do gastrointestinal signs occur in response to chemotherapy? |
|
Definition
-direct damage to epithelial cells: takes 3-5 days to see signs
-stimulation of chemoreceptor trigger zone (CRTZ)/ vomiting center: direct, GI vagal afferent, acute vomiting |
|
|
Term
| Describe multi-drug resistance via p-glycoprotein. Which breeds are predisposed? |
|
Definition
-Collie breeds
-transmembrane pump that removes toxins that is increased drug export out of cells |
|
|
Term
| How do you determine response to chemotherapy? |
|
Definition
-repeat exams +/- staging diagnostics approximately every other treatment (6-8w)
-compare tumor measurements: remission status influences treatment decisions |
|
|
Term
| What is the mechanism of action of alkylating agents? Which cell cycle are they specific to? |
|
Definition
-insert alkyl groups: caused DNA fragments as it is repaired and prevents RNA transcription & cross-linking of DNA
-cell cycle non-specific |
|
|
Term
| What type of drug is cyclophosphamide? How is it administered? What are its toxicities? Indications? |
|
Definition
-alkylating agents
-administered orally or via IV
-toxicities: myelosuppression, GI, STERILE HEMORRHAGIC CYSTITIS
-indications: lymphoma, carcinomas, sarcomas |
|
|
Term
| If ________ occurs while a patient is on cyclophosphamide (alkylating agent) they can never be put on it again. |
|
Definition
| -sterile hemorrhagic cystitis |
|
|
Term
| What type of drug is Lumustine? How is it administered and what makes it unique? |
|
Definition
-alkylating agent
-oral administration
-penetrates an intact BBB |
|
|
Term
| What are the toxicities associated with Lomustine? What precautions do we take to avoid them? |
|
Definition
-myelosuppression (delayed and severe), hepatotoxicity, nephrotoxicity
-evaluate liver panel prior to each dose |
|
|
Term
| What are the indicatiosn for Lomustine use? |
|
Definition
| -refractory lymphoma, mast cell tumors, brain tumors, histiocytic tumors |
|
|
Term
| What are the indications for Melphalan (Alkeran)? What kind of drug is it? |
|
Definition
-multiple myeloma, refractory lymphoma
-alkylating agent |
|
|
Term
| What are the indications for Chlorambucil (Leukeran)? What kind of drug is it? |
|
Definition
-substitute for cyclophosphamide, leukemia, small cell GI lymphoma in cats
-alkylating agent |
|
|
Term
| Heavy metal compounds are derived from ______. What is their MOA? Which cell cycle are they specific for? |
|
Definition
-platinum
-insert alkyl groups into DNA (similar to alkylating agents)
-cell cycle non-specific |
|
|
Term
| What type of drug is Cisplatin (Platinol)? How is it administered? What are its indications? |
|
Definition
-heavy metal compound
-IV admin
-osteosarcoma, carcinomas |
|
|
Term
| What are the toxicities associated with cisplatin (Platinol)? |
|
Definition
| -nephrotoxicity (acute tubular necrosis), otottoxicity, acute emesis |
|
|
Term
| What type of drug is Carboplatin? How is it administered? What are its indications? |
|
Definition
-heavy metal compounds
-IV administration
-osteosarcoma carcinomas |
|
|
Term
| What toxicities are associated with Carboplatin? |
|
Definition
-myelosuppression (may be delayed), less nephrotoxic than cisplatin
-FATAL PULMONARY EDEMA IN CATS |
|
|
Term
| What makes Carboplatin special from other heavy metal compounds? |
|
Definition
-saline diuresis is not required
-it is safe for cats |
|
|
Term
| What is the mechanism of action of antimetabolites? |
|
Definition
| -inhibit DNA synthesis: purine or pyrimidine analogues (inhibit normal nucleotide formation) and enzyme inhibition (DNAP, dihydrofolate reductase, thymidylate synthase) |
|
|
Term
| Which cell cycle phase are antimetabolites specific for? |
|
Definition
|
|
Term
| What kind of drug is Cytosine arabinoside? How is it administered? |
|
Definition
-antimetaboliite
-IV or SQ administration (CRI or SQ over 2-4d for CNS penetration) |
|
|
Term
| How does Cytosine arabinoside work? |
|
Definition
|
|
Term
| What toxicities are associated with Cytosine arabinoside? Indications? |
|
Definition
-myelosuppression
-lymphoma, granulomatous meningoencephalitis (GME) |
|
|
Term
| What kind of drug is 5-flurouracil? How is it administered? |
|
Definition
-antimetabolite
-intravacavitary, IV, topical administration |
|
|
Term
| What toxicities are associated with 5-fluorouracil? Indications? |
|
Definition
-neurotoxicity that is FATAL IN CATS, GI upset, myelosuppression
-carcinomas |
|
|
Term
| What are the mechanisms of action of antitumor antibiotics? Which phase of the cell cycle are they specific for? |
|
Definition
-formation of oxygen free radicals
-interference with topoisomerase enzymes
-intercalation into DNA
-stimulation of apoptosis
-cell cycle non-specific |
|
|
Term
| What compound is Doxorubicon derived from? |
|
Definition
|
|
Term
| How is Doxorubicon administered? |
|
Definition
-indwelling catheter, dilute drug, administer over 30 minutes
-MONNITOR PATIENTS AT ALL TIMES |
|
|
Term
| What toxicities are associated with Doxorubicon? |
|
Definition
-SEVERE vesicant (combated by Zinecard)
-nephrotoxicity in cats
-arrhythmias
-cumulative cardiotoxicity in dogs
-mast cell degranulation/hypersensitivity |
|
|
Term
| What are the indications for Doxorubicon? |
|
Definition
| -lymphona, carcinomas, sarcomas |
|
|
Term
| What kind of drug is Mitoxantrone? How is it administered? |
|
Definition
-antitumor antibiotic
-IV admin |
|
|
Term
| What toxicities are associated with Mitoxantrone? |
|
Definition
| -less cardiotoxic, less severe tissue reaction, more myelosupppression |
|
|
Term
| What are the indications for Mitoxantrone? |
|
Definition
| -transitional cell carcinoma, substitute for doxorubicin, squamous cell carcinoma, lymphoma |
|
|
Term
| If Mitoxantrone has less severe side effects than Doxorubicon, why is it not more often used? |
|
Definition
| -It is huuugely expensive |
|
|
Term
| What is the mechanism of action of plant aklaloids? Which cell cycle phase are they specific for? |
|
Definition
-inhibit microtubule formation (affects mitotoic spindle formation)
-M-phase specific |
|
|
Term
| What type of drug is Vincristine? How is it administered? |
|
Definition
-plant alkaloids
-IV admin |
|
|
Term
| What toxicities are associated with Vincristine? |
|
Definition
| -vesicant, peripheral neurotoicity |
|
|
Term
| What are the indications for Vincristine? |
|
Definition
-cure for TVT
-lymphoma/lymphoproliferative disorders, immune mediated thrombocytopenia |
|
|
Term
| What type of drug is Vinblastine? How is it administered? |
|
Definition
|
|
Term
| What toxicities are associated with VInblastine? |
|
Definition
| -myelosuppression, vesicant |
|
|
Term
| What are the indications for Vinblasitne? |
|
Definition
| -mast cell tumor, substitute ofr vincristine |
|
|
Term
| What toxicites are associated with Glucocorticoids? Indications? |
|
Definition
-PU/PD, appetitie, and panting
-lymphoma, plasma cell tumors, mast cell tumors, intracranial neoplasms, insulinoma |
|
|
Term
| What are some examples of NSAIDS? Toxicities? INdications? |
|
Definition
-Piroxicam, carprofen, deracoxib, etc
-GI, renal
-TCC, SCC, metronomic protocols (anti-angiogenesis) |
|
|
Term
| What type of drug is L-asparaginase? From what is it derived? |
|
Definition
-enzyme
-derived from E. coli |
|
|
Term
| How is L-asparaginase administered? How does it work? |
|
Definition
-IM or SQ admin
-cleaves asparagine: normal cells make more, lymphoma cells cannot |
|
|
Term
| Which phase of the cell cycle is L-asparaginase specific for? |
|
Definition
| -G1 cell cycle phase specific |
|
|
Term
| What is metronomic chemotherapy? |
|
Definition
| -continual, low dose anti-neoplastic drug combined with an NSAID |
|
|
Term
| What is the target of metronomic chemotherapy? The goal? |
|
Definition
-target = angiogenesis
-goal = slow progression and metastasis |
|
|
Term
| What toxocities are associated with metronomic chemotherapy? |
|
Definition
| -less severe and fewer vs traditional chemo |
|
|
Term
| What are the indications for metronomic chemotherapy? Give a drug combo as an example of this regimen. |
|
Definition
-incompletely resected soft tissue sarcoma, hemangiosarcoma, etc
-ex: cyclophosphamide + piroxicam |
|
|
Term
| Roughly how many dogs in the US have cancer? What about cats? |
|
Definition
-75 million dogs
-90 million cats |
|
|
Term
| What is the leading cause of death in companion ani als? |
|
Definition
|
|
Term
| What are proto-oncogenes? |
|
Definition
| -genes in normal cells that become oncogenes when mutatued |
|
|
Term
| What are tumor suppressor genes? |
|
Definition
| -induce apoptosis in damages |
|
|
Term
| What are telomeres? Why are they important in regards to cancer cells? |
|
Definition
-ens of the chromosome
-cancer cells use telomerase to become "immortal" and avoid cell death via loss of telomeres |
|
|
Term
|
Definition
| -creation of new blood vessels |
|
|
Term
| How does angiogenesis relate to tumors? How is it induced? |
|
Definition
-it is required for tumor growth and metastasis
-induced by hypoxia
(balance of angiogeneic (VEGF, FGF) and antiangiogenic (angiostatin, endostatin) factors) |
|
|
Term
| Give a brief outline of metastasis. |
|
Definition
| -primary tumor formation => local invasion => intravasation => survival in the circulation => arrest at a distant organ site => extravasation => micrometastasis formation => metastatic colonization => clinically detectable macroscopic metastases |
|
|
Term
| Which cancer(s) is/are heritable in dogs? |
|
Definition
| -renal cstadenocarcinoma and nodular dermatofibrosis (RCND) of Germand sheperd |
|
|
Term
| Which breeds of dogs are more susceptible to cancer? |
|
Definition
| -boxers and golden retrievers |
|
|
Term
| Which type of cancer is associated with environmental tobacco smoke? |
|
Definition
-feline lymphoma
-possibly associated with: oral squamous cell carcinoma in cats, lung cancer |
|
|
Term
| Which types of cancers are pesticides, herbicides, and insecticides (2,4-D) associated with? |
|
Definition
-Lymphoma
-Transitional cell carcinoma in Scottish Terriers
-oral SCC in cats (flea collars) |
|
|
Term
| Which types of cancers are associated with pets in industrial areas? |
|
Definition
| -canine lymphoma, tonisllar SCC, nasal carcinoma |
|
|
Term
| Why chemotherapy agent is associated with urinary bladder cancer in vet emd? |
|
Definition
|
|
Term
| Which type of cancer is associated with ultraviolet radiation/ sunlight? Where on the body? |
|
Definition
-Squamous cell carcinoma
-facial, aural, nasal planum in white cats
-cutaneous SCC and hemangiosarcoma in dogs |
|
|
Term
| What types of cancer are associated with ionizing radiation? |
|
Definition
-second, unrelated tumors at sites of prior radiation
-dogs and oral acanthomatous epulis, sarcomas |
|
|
Term
| What types of cancers are assocaited with trauma/ chromic inflammation? |
|
Definition
-eye lesions: corneal tumors in dogs (keratitis) and intraocular sarcoma in cats
-injection site sarcomas in cats |
|
|
Term
| Which type of cancer is associated with surgery and implanted devices? |
|
Definition
|
|
Term
| Which type of cancer is associated with estrogen and progesterone? Which type of animal is at higher risk? How can it be avoided? |
|
Definition
-mammary tumors
-intact older females at much higher risk
-early spay significantly reduces risk |
|
|
Term
| Which type of cancer is associated with androgens/testosterone? |
|
Definition
-perianal adenoma: intact males & resolve after castration
-can occur in females due to adrenal gland |
|
|
Term
| Which type of cancer is associated with a canine virus? How does it present in cats, dogs, and horses? |
|
Definition
-papillomavirus = benign papillomas
-mucocutaneous in dogs, dermal in cats, sarcoids in horses |
|
|
Term
| Which type of cancer is associated with Feline Leukemia Virus (FeLV)? |
|
Definition
| -virtually any hematopoietic neoplasm: lymphomas especially |
|
|
Term
| What type of cancer is associated with Feline Sarcoma Virus (FeSV)? |
|
Definition
| -fibrosarcomas in young cats (multicentric, rapid growth, superficial uceration) = poor prognosis |
|
|
Term
| What kind of virus is Feline Sarcoma Virus? |
|
Definition
| -hybrid virus: FeLV DNA provirus combined with cat protooncogenesis (acute transforming retrovirus) that always show FeLV positive |
|
|
Term
| What type of virus is Feline Immunodeficiency Virus? |
|
Definition
|
|
Term
| What type of cancer is associated with FIV? |
|
Definition
| -lymphomas especially, myeloid tumors, carcinomas or sarcomas |
|
|
Term
| 4 main cancer cell types? |
|
Definition
-epithelial
-round cells
-mesenchymal
-endocrine |
|
|
Term
| What are the benigh epithelial tumors? Malignant? |
|
Definition
-Benign: papilloma, adenoma
-Malignant: carcinoma, adenocarcinoma |
|
|
Term
| What doe epithelial tumors look like? Do they exfoliate well? |
|
Definition
-cells with round nuclei with moderate cytoplasm in clusters
-they exfoliate well |
|
|
Term
| What are the benign mesenchymal tumors? Malignant? |
|
Definition
-Benign: fibroma, lipoma
-Malignant: fibrosarcoma, liposarcoma |
|
|
Term
| What do mesenchymal tumrs look like? Do they exfoliate well? |
|
Definition
-singular, elongate cells in aggregates wit cytoplasmic tails
-may not exfoliate well |
|
|
Term
| What do round cell tumors look like? Do they exfoliate well? |
|
Definition
-descreet, small to medium sized cells
-exfoliate well b/c they are fragile |
|
|
Term
| What are the types of round cell tumors? |
|
Definition
| -plasma cell tumor,lymphoma, mast cell tumor, transmissible venereal tumor, histiocytoma, +/- melanoma |
|
|
Term
| What are the benign endocrine/neuroendocrine tumors? Malignant? |
|
Definition
-Benign: pituitary adenoma, thyroid adenoma
-Malignant: thyroid carcinoma, insulinoma |
|
|
Term
| What do endocrine/neuroendocrine tumors look like? |
|
Definition
| -free/naked nuclei in a sea of cytoplasm |
|
|
Term
| What are the common clinical signs of cancer? |
|
Definition
-mass/tumor
-bleeding/discharge from an orifice
-unexplained weight loss
-difficulty breathing, urinating, defecating
-anorexia, lethargy, diarrhea
-change in hevior
-PU/PD
-non-healing wounds |
|
|
Term
| What are the steps to diagnosis when presented with a mass? |
|
Definition
1. Diagnosis
2. staging
3. Treatment |
|
|
Term
| What are the two methods we use to diagnose a mass? What are the advantages of each? |
|
Definition
-Cytology: inexpensive, quick and easy, fast, performed on FNA/impression smear/fluid
-Histopath: GOLD STANDARD= ONLY WAY TO OBTAIN GRADE |
|
|
Term
| If histopathology is the gold standard of diagnosing a mass, why would anyone use cytology instead? |
|
Definition
| -histopath is more expensive, takes more time, requires more skill, takes longer, and can only e performed onbiopsy tissue |
|
|
Term
| What doe sthe TNM system incur? |
|
Definition
-T = tumor
-N = node
-M = metastasis |
|
|
Term
| What diagnostic methods do we employ for staging? |
|
Definition
-blood work and UA
-thoracic rads
-abdominal rads +- ultrasound
-bone marrow sample
-LN aspirate |
|
|
Term
| What are three primary ways to treat a mass? |
|
Definition
-Cut (1st line of defense)
-Poison: cemotherapy
-Radiation: if surgery is unseccessful (primary for nasal and brian tumors) |
|
|
Term
| Prognosis and survival time depend on what htree factors? |
|
Definition
| -what it is, where it is, and hte treatment used |
|
|
Term
| What is lymphoma's signalment? |
|
Definition
-middle aged to older dogs
-any breed or sex: golden retriever, Boxer, Basset hound, St Bernard, Scottish Terrier, Airedale, bulldogs = inc risk
-Dachshund, Pomeranian, Toy Poodle, Chihuahua = dec risk |
|
|
Term
| How does lymphoma present? |
|
Definition
-owner feels "lumphs" = +/- clinical signs (lethargy, GI upset, anorexia) +/- PU/PD
-history can be indolent or aggressive |
|
|
Term
| Which form of lymphoma is most common in dogs? |
|
Definition
-multi-centric
+/- organomegaly |
|
|
Term
| What are the 4 forms of lymphoma? |
|
Definition
-Cutaneous (5% of cases): aka mycosis fungoides
-Alimentary (7%): solitary or diffuse
-Mediastinal (2%): nodal or thymic dz
-Extranodal (2%): ocular, neural, renal, cardiac |
|
|
Term
| What are the differentials for solitary or regional lymphadenopathy? |
|
Definition
| -local infection or inflammation, metastatic disease |
|
|
Term
| What are the differentials for generalized lymphadenopathy? |
|
Definition
| -systemic infection/inflammation: immune mediated disease, infectious disease (Rickettsial, fungal, protozoal, bacterial, viral, parasitic), Diffuse skin dz, Neoplasia |
|
|
Term
| Which lymph nodes should we avoid when trying to diagnose lymphoma? Why? |
|
Definition
-mandibular lymph nodes
-oral inflammation/ infection |
|
|
Term
| What are the three methods by which we diagnose lymphoma? |
|
Definition
-Cytology
-Biopsy: grade, architecture, immunophenotype
-PCR: blood, aspirate, bone marrow, etc |
|
|
Term
Whilst doing the staging of lymphoma, explain the results of each of the following tests:
a) CBC
b) Chemistry
c) Urinalysis
d) Thoracic
e) Abdominal
f) Bone Marrow
g) immuniphenotype |
|
Definition
a) CBC: anemia & thrombocytopenia
b) Chemistry: hypercalcemia & hypoalbuminemia
c) Urinalysis: UTI & kidney function
d) Thracic rads: look at lungs, mediastinal mass, pleural effusion, heart diseease
e) abdominal rads: organomegaly, lymphadenomegaly, swiss cheese organs
f) aspirate or core biopsy, determine if stage V dz
g) ID cell marers via flow cytometry/immunohistochem/PCR |
|
|
Term
| What special staging technique is used for lymphoma cases involving doxorubicon? |
|
Definition
|
|
Term
| Describe 6 stages of lymphoma. |
|
Definition
-Substage: either type a: asymptomatic or type b: symptomatic
-Stage I: one nodes is involved
-Stage II: multiple nodes on one side of the diaphragm (regional lymphadenopathy)
-Stage III: multiple nodes on both sides of the diaphragm (generalized lymphadenopathy)
-Stage IV: liver and/or spleen involvement
-Stage V: involvment of any non-lymphoid tissue |
|
|
Term
| Does B-cell or T-cell lymphoma tend to respond better to treatment? |
|
Definition
|
|
Term
| Which stages are good prognostically? |
|
Definition
|
|
Term
| Which stages are prognostically negative? |
|
Definition
|
|
Term
| What are the negative prognostically factors for lymphoma? |
|
Definition
| -substage b, Immunophenotype T-cell or Non-B/Non-T, Hypercacemia, Anemia, Hypoalbuminemia, Prior prednisone, Extranodal location, Mediastinal involvement, poor response to treatment |
|
|
Term
| What is the treatment of choice for lymphoma? |
|
Definition
|
|
Term
| What are the components of CHOP protocol for treating lymphoma? |
|
Definition
-C: cyclophophamide
-H: hydroxydaunorubicin (doxorubicon)
-O: Oncovin (vincristing)
-P: prednisone |
|
|
Term
| What is the remission rate with a CHOP protocol for lymphoma? Median Survival Time? |
|
Definition
|
|
Term
| What is the most effective drug for lymphoma? How is it administered? |
|
Definition
-Doxorubicon
-admin IV every 2-3w |
|
|
Term
| What is the remission rate for Doxorubicon treatment of lymphoma? MST? |
|
Definition
-Remission rate = 85-90%
-MST = 6-8m |
|
|
Term
| What are the advantages of Doxorubicon alone to treat Lymphoma over a CHOP protocol? |
|
Definition
| -shorter protocol and less $ |
|
|
Term
| What is the remission rate of lymphoma treated with Prednisone? MST? |
|
Definition
-50% remission rate
-MST = 3-4m |
|
|
Term
| What is the one concern when considering Prednisone to treat lymphoma? |
|
Definition
| -Can mask dz if given without diagnosis and decreases chemo remission rates by 50% |
|
|
Term
| What is the MST of lymphoma without treatment? |
|
Definition
|
|
Term
| For canine lymphoma: out of remission off therapy has a ___% chance of re-induction with same protocol and a ___% out of remission on therapy. |
|
Definition
|
|
Term
| Feline lymphoma makes up ___-___% of all feline cancers. Which form is most prevelant? |
|
Definition
|
|
Term
| Which breeds of cat have an inc risk of developing lymphoma? |
|
Definition
|
|
Term
| What other medical state can inc chance of lymphoma? |
|
Definition
-FeLV
-spinal, mediastinal, ocular, and renal = usually young with FeLV
-nasal, alimentary = usually older without FeLV |
|
|
Term
| Which is the suggested method of diagnosis of feline lymphoma? |
|
Definition
| -biopsy with FeLV/FIV testing |
|
|
Term
| Most cats with lymphoma are stage V. Why? |
|
Definition
| -b/c most cases are the extranodal form |
|
|
Term
| What are the categories used to classify lymphomas by histologic type? |
|
Definition
-small cell
-large cell
-high grade
-low grade |
|
|
Term
| True or False: As with dogs, feline lymphoma prognosis is affected by T-cell vs B-cell classification with B-cell being the better of the two. |
|
Definition
| -FALSE, while this is true with dogs, feline lymphoma is prognostically unchanged by B-cell vs T-cell classification |
|
|
Term
| What are the negative prognostic factors for feline lymphoma? |
|
Definition
|
|
Term
| What are the positive prognostic factors involving feline lymphoma? |
|
Definition
-complete response to therapy
-treatment with doxorubicin
-small cell alimentary location |
|
|
Term
| How does one treat feline alimentary small cell lymphoma? MST? |
|
Definition
-very good prognosis with chlorambucil and prednisone (do surgery if obstructed)
-MST > 18m |
|
|
Term
| How does one treat feline nasal lymphoma? MST? |
|
Definition
-very good prognosis with radiation therapy +/- multi-agent chemotherapy (CHOP)
-MST > 18m |
|
|
Term
| How does one treat feline renal lymphoma? MST? |
|
Definition
-multi-agent chemotherapy including drugs to penetrate CNS (Cytosar, lomustine)
-MST = 3-6m |
|
|
Term
| How does one treat feline multi-centric lymphoma? Remission rate? MST? |
|
Definition
-multi-agent chemotherapy
-remission in 50-70%
-MST = 6-8m |
|
|
Term
| How does one diagnose feline mediastinal lymphoma? Treatment? MST? |
|
Definition
-thoracocentesis
-radiation and chemo
-MST = 2-3m |
|
|
Term
| What are the two classifications of leukemia? |
|
Definition
-Lymphoproliferative: affects lymphocytes
-Myeloproliferative: myeloproliferative: affects granulocytes and monocytes |
|
|
Term
| What are the cancers within the lymphoproliferative classification of leukemia? |
|
Definition
-Chronic lymphocytic leukemia (CLL)
-Acute lymphoblastic leukemia (ALL) |
|
|
Term
| What types of leukemias are classified as myeloproliferative? |
|
Definition
-chronic myelogenous leukemia (CML)
-acute myeloblastic leukemia (AML)
-acute granulocytic leukemia (AGL)
-polycythemia vera |
|
|
Term
| Do lymphoid leukemias occur more often in cats or dogs? |
|
Definition
|
|
Term
| Do leukemic cats that are FeLV+ tend be young or old? |
|
Definition
|
|
Term
| Do dogs with acute leukemia tend to be young or old? What about chronic? |
|
Definition
|
|
Term
| What will you find on physicial exam in leukemic dogs? |
|
Definition
| -+/- lymphadenomegaly or organomegaly |
|
|
Term
| Chronic lymphocytic leukemia (CLL) presents how? |
|
Definition
| -high WBC and lymphocyte couts with little to no clinical signs but might be anemic with thrombocytopenia |
|
|
Term
| Acute lymphoblastic leukemia presents how? |
|
Definition
| -weight loss, anorexia, PU/PD, ADR, hemorrhages, lymphadenomegaly, organomegaly, low nucleated cell counts (anemia, neutropenia, thrombocytopenia) |
|
|
Term
| How do you diagnose ALL and CLL? |
|
Definition
| -ID cells in circulation or bone marrow: flow cytometry best, immunohistochemistry, PCT |
|
|
Term
| How do you stage ALL or CLL? |
|
Definition
-CBC, chemistry, retrovirus testing (cats), thoracic rads, abdominal ultrasound
-BONE MARROW EXAM IS ESSENTIAL |
|
|
Term
| HOw does one treat chronic leukemias? Remission rate? MST? |
|
Definition
-if tratment needed:
-Induction = COP
-maintenance = chlorambucil and prednisone
-RR = 70%
-MST = 12-30m |
|
|
Term
| How does one treat acute leukemias? Remission rate? MST? |
|
Definition
-multi-agent protocols + supportive care
-RR = 30%
-MST = 4m |
|
|
Term
| What histological type of tumor is multiple myeloma? |
|
Definition
| -tumor of plasma cells: monoclonal population of B cells |
|
|
Term
| Does multiple myeloma occur more frequently in dogs or cats? |
|
Definition
|
|
Term
| What is multiple myeloma's major clinical characteristic? |
|
Definition
| -hyperproteinemia (hyperglobulinemia) |
|
|
Term
| A definitive diagnosis of multiple myeloma requires 2 of 4 presentations. What are they? |
|
Definition
-monoclonal gammopathy
-lytic bone lesions
-bone marrow plasmacytosis (30% or greater)
-Bence Jones proteinuria |
|
|
Term
| How does one treat multiple myeloma? MST? |
|
Definition
-surgical removal of solitary plasma cell tumors
-chemo: Melphalan and prednisone with 80% CR
-MST = 540d |
|
|
Term
| Do soft tissue sarcomas have any age preference? What about site? |
|
Definition
-middle aged to older pets
-arise from any site but skin and SQ most often |
|
|
Term
| What is significant about the capsule of soft tissue sarcomas? |
|
Definition
| -it it important to remove the capsule when removing the tumor |
|
|
Term
| Is hematogenous metastasis common in the case of soft tissue sarcomas? |
|
Definition
|
|
Term
| Give me some examples of soft tissue sarcomas. Which is markedly more aggressive? |
|
Definition
-Markedly more aggressive = histiocytic sarcoma
-aka Spindle Cell Tumor
-Fibrosarcoma
-liposarcoma
-myxosarcoma
-rhabdomyosarcoma
-maignant fibrous histiocytoma
-peripheral nerve sheath tumors |
|
|
Term
| Are soft tissue sarcomas fast-growing or slow-growing? Firm or soft? |
|
Definition
-slow-growing
-can be firm or soft |
|
|
Term
| What clinical signs are common with soft tissue sarcomas? What about PNST? |
|
Definition
-clinical signs related to location and invasion
-PNST = lameness, muscle atrophy, paralysis |
|
|
Term
| Describe the results of a fine needle aspirate of a soft tissue sarcoma. |
|
Definition
-tend to exfoliate poorly
-reactive fibrous tissue can look malignant
-necrosis happens |
|
|
Term
| What is the basis of grading soft tissue sarcomas? Why is this signficant? |
|
Definition
-differentiation, mitotic figures, % necrosis
***very important for prognosis |
|
|
Term
| How do we stage soft tissue sarcomas? |
|
Definition
-CBC/Chem/UA
-3-wiew rads
-imaging of tumor
-abdominal ultrasound
-LN eval |
|
|
Term
| What is the most common site of soft tissue sarcoma metastasis? |
|
Definition
|
|
Term
| Describe how to surgically approach a soft tissue sarcoma. |
|
Definition
-three cm margins and one fascial plane deep
-remove biopsy tracts |
|
|
Term
| Why do we have such wide margins when removing a soft tissue sarcoma? |
|
Definition
| -incomplete resection = high risk of recurrence |
|
|
Term
| How long after surgery of a soft tissue sarcoma should we wait to start radiation therapy? MST? |
|
Definition
-wait 10-14 days
-MST > 5y |
|
|
Term
| What is the rate of metastasis in grade I-II soft tissue sarcomas? |
|
Definition
|
|
Term
| In which soft tissue sarcoma cases would we use chemotherapy? What would we use to treat? |
|
Definition
-high grade tumors
-metastastic dz
-intra-abdominal location
-histiocytic sarcoma
-treat with Doxorubicin |
|
|
Term
| What is the general prognosis for most soft tissue sarcomas? |
|
Definition
|
|
Term
| What are some poor prognostic factors for recurrence of soft tissue sarcomas? |
|
Definition
| -large size, incomplete margins, high grade |
|
|
Term
| What are some poor prognostic factors for metastasis of soft tissue sarcomas? |
|
Definition
| -high grade, high mitotoic index, high % of tumor necrosis, local recurrence |
|
|
Term
| What is the MST of STS with surgery alone? What about wiht surgery an dRT? |
|
Definition
|
|
Term
| Feline injection site sarcomas can take between ___ weeks and ___ years to develop. |
|
Definition
|
|
Term
| How do genetics play a role in the development of feline injection site sarcomas? |
|
Definition
|
|
Term
| What are the most common places for cats to develop an injection site sarcoma? |
|
Definition
-interscapular
-R pelvic limb and lateral abdomen
-L PL and lateral abdomen
-lateral abdomen
-lateral thorax |
|
|
Term
| Are feline injection site sarcomas less or more aggressive that other feline soft tissue sarcomas? Why? |
|
Definition
-more
-more pleomorphism, necrosis, mitoses, inflammation, and higher grade (60% are grade III) |
|
|
Term
| How do feline injection site sarcomas appear on FNA? How do we check the extent of the tumor? |
|
Definition
-granulomas appear very aggressive
-check for tumor extent via contrast CT or MRI: tumors usually very invasive |
|
|
Term
| Describe the 3-2-1 rule of feline injection site sarcoma treatment. |
|
Definition
-treat if mass present >3m after injection
-treat if mass is >2cm in diameter
-treat if mass increases in size more than 1m after injection |
|
|
Term
| How do we treat feline injection site sarcomas if treatment is necessary? |
|
Definition
| -surgery + radiation + chemotherapy |
|
|
Term
| How do we surgically approach feline ISS? |
|
Definition
-minimum 2cm margins
-better results with 5cm and 2 fascial planes deep |
|
|
Term
| DFI and MST of feline ISS decreased with what three factors? |
|
Definition
-marginal resection
-increased number of surgeries
-surgery performed by non-specialist |
|
|
Term
| Even radiation therapy is necessary for feline ISS, what percentage recur? |
|
Definition
|
|
Term
| What is the rate of metastasis of feline ISS? What chemo drug would you use to treat? |
|
Definition
|
|
Term
| What is the MST of feline ISS with surgery alone? What about with multimodal therapy? |
|
Definition
|
|
Term
| What is the primary recommendation for avoiding feline ISS? |
|
Definition
| -go as distal as possible on the limb |
|
|
Term
| What age group of dogs is more susceptible to hemangiosarcomas? |
|
Definition
-middle-aged to oldr dogs
-Visceral HSA: German Sheperds, golden retrivers, Labrador retrievers
-Cutaneous HSA:Italian greyhound, whippet |
|
|
Term
| What is the most common primary site of hemangiosarcomas? |
|
Definition
|
|
Term
| What are the chances that a splenic mass is malignant? If it is malignant, what are the chances that it is a hemangiosarcoma? |
|
Definition
|
|
Term
| Are hemangiosarcomas usually aggressive or docile? |
|
Definition
| -very aggressive except for dermalcutaneous |
|
|
Term
| What is the most common metastatic sarcoma to the brain in dogs? |
|
Definition
|
|
Term
| Are hemangiosarcomas less or more aggressive in cats than in dogs? What can cause a high metastatic rate? |
|
Definition
|
|
Term
| What are the clinical signs of a hemangiosarcoma? |
|
Definition
-abdominal swelling
-acute weakness/ collapse
-white gums
-difficulty breathing
-sudden death
-signs may wax and wane |
|
|
Term
| What clinical signs are specific to a right atrial hemangiosarcoma? |
|
Definition
| -excercise intolerance, dyspnea, ascites |
|
|
Term
| What clinical signs are specific for a cutaneous hemangiosarcoma? |
|
Definition
| -bleeding mass, ulcerated lesions |
|
|
Term
| What will the diagnostic tests show in response to hemangiosarcoma? |
|
Definition
-CBC/Chem/UA: anemia with schistocytes, thrombocytopenia
-DIG
+/- abdominocentesis: serosanginous effusion w/out clots
-echocardiogram if odd heart on xray, golden retriever, or metastasis
-RA masses hard to find without effusion |
|
|
Term
| What is required for diagnosis of hemangiosarcoma? |
|
Definition
|
|
Term
| How do we surgically approach hemangiosarcomas? |
|
Definition
|
|
Term
| What is the primary side effect of a surgical approach to hemangiosarcomas? |
|
Definition
| -25% develop ventricular arrhythmias after surgery |
|
|
Term
| IN which hemangiosarcoma cases do we use chemo? Which drug? |
|
Definition
-cases with high rate of metastasis EXCEPT for cutaneous.dermal
-Doxorubicin |
|
|
Term
| How is the prognosis for a canine patient with hemangiosarcoma? |
|
Definition
-overall poor
-visceral with just surgery = 3m/ +chemo = 6m
-cutaneous with surgery = 2y
-RA with surgery=4m |
|
|
Term
| How is the prognosis for a feline patient with hemangiosarcoma? |
|
Definition
-nonvisceral with surgery = 12m
-visceral with surgery = 2-w |
|
|
Term
| What is the most common type of tumor in dogs? (Hint, it is the 2nd most common in cats) What are its categories? |
|
Definition
-skin tumors
-epithelial, mesenchymal, melanocytic, round cell |
|
|
Term
| Are skin tumors most likely to be malignant in the dog or cat? |
|
Definition
|
|
Term
| What are the most common types of skin tumors in dogs? |
|
Definition
-lipoma
-mast cell tumor (MCT)
-histiocytoma
-perianal adenoma |
|
|
Term
| What are the most common types of skin tumors in cats? |
|
Definition
-basal cell tumor
-mast cell tumors
-squamous carcinoma
-fibrosarcomas |
|
|
Term
| What is required for definitive diagnosis of skin tumors? |
|
Definition
|
|
Term
| What is the treatment of choice of skin tumors? |
|
Definition
|
|
Term
| While surgery is the treatment of choice of skin tumors, chemo can also be sued based on what criteria? |
|
Definition
| -diagnosis, grade, vascular/lymphatic invasion, overall patient health |
|
|
Term
| What is the one exception to the rule of surgery for skin tumors? |
|
Definition
|
|
Term
| Where do mast cell tumors occur? Where do they most commonly occur? |
|
Definition
-can occur in any tissue
-skin and subcutaneous tissue are most common |
|
|
Term
| What age of dogs are prone to mast cell tumors? Common breeds? |
|
Definition
-middle-aged dogs
-Boxers, Labs, Boston terriers, Pug, Beagle, Wimeraner |
|
|
Term
| What are the clinical signs associated with mast cell tumors? |
|
Definition
-presence of a mass
-vomiting
-anorexia
-weight loss
-organomegaly
-GI ulceration: melena, hematemesis
-Darier's sign: erythema and wheal formation
-edema
-bruising
-bleeding
-pruritis |
|
|
Term
| How do mast cell tumors appear on cytology? |
|
Definition
| -round cells with pink-dark purple granules with eosinophils |
|
|
Term
| How do we grade mast cell tumors? |
|
Definition
|
|
Term
| Name a few things that cytoplasmic granules in mast cells contain. |
|
Definition
-histamine: allergies
-heparin: blood clotting
-chemotactic factors
-platelet activation factor
-proteases
-kinins: vascular permeability |
|
|
Term
| Most mast cell tumors are what grade? |
|
Definition
| -GRade II: sometimes benign and sometimes malignant |
|
|
Term
| What new grading system has been posed for mast cell tumors rather than the three grade system? What is its basis? |
|
Definition
-Two-tier grading system
-based on: mitotic index, # of bizarre nuclei/hhpf, # of multinucleated cells/hpf, % of karyomegaly |
|
|
Term
| How do we stage mast cell tumors? |
|
Definition
-aspirate local draining LN, liver, and spleen
-thoracic rads (2 view)
-abdominal ultrasound
-bone marrow aspirate <= needed for full staging |
|
|
Term
| Describe how the mitotic index affects the prognosis of mast cell tumors. |
|
Definition
-<5 = good prognosis (MST = 70m)
->5 = poor prognosis (MST <5m) |
|
|
Term
| Which locations of mast cell tumors are worse? |
|
Definition
| -preputial, sublingual, oral, muzzle, or mucocutaneous junction |
|
|
Term
| Is the presence of multiple mast cell tumors a negative prognostic indicator. |
|
Definition
|
|
Term
| How does genes affect the prognosis of mast cell tumors? |
|
Definition
| -c-kit mutation = higher grade and more aggressive |
|
|
Term
| which type of drugs do we use to treat mast cell tumors and not other forms of cancer? |
|
Definition
| -H1 histamine blockers and H2 histamine blockers |
|
|
Term
| How do we surgically approach mast cell tumors? |
|
Definition
| -2cm margins and 1 ascial plane deep |
|
|
Term
| When do we use radiation to treat mast cell tumors? |
|
Definition
-when surgery is not an option or get incomplete margins
-radiate 3cm margin around surgical scar |
|
|
Term
| When do we use chemo to treat mast cell tumors? Which drugs are most effective? |
|
Definition
-when metastatic or incomplete surgical excision
-vinblastine and prednisone |
|
|
Term
| What type of drugs are small molecule inhibitors? How doe they work? Which kinases are important? |
|
Definition
-Kinases
-phosphorylate other proteins involved in signal transduction, growth regulation, and cell differentiation
-important ones: Kit, Met, VEGFR |
|
|
Term
| Kit dysfunction leads to the development of what? |
|
Definition
|
|
Term
| What kind of kinase inhibitors are effective for canine MCT? How doe they work? |
|
Definition
-tyrosine kinase inhibitors
-block ATP binding site of RTKs |
|
|
Term
| What are the two major veterinary tyrosine kinase inhibitors? What is the overall response rate? |
|
Definition
-Masitinib
-Toceranib
-RR = 60% |
|
|
Term
| How do we use Tyrosine Kinase Inhibitors clinically? |
|
Definition
-treat high grade, non-resectable, recurrent, multiple tumors, metastatic mast cell tumors
-concurrent gastroprotectants are needed
-discontinue before and after surgery |
|
|
Term
| What are the toxicities associated with tyrosine kinase inhibitors? |
|
Definition
-GI: diarrhea, anorexia, vomiting, ulceration
-Neutropenia: mild, non-life threatening
-Toceranib: neutropenia, muscle cramping, hepatotoxicity
-Masitinib: protein losing neephropathy, hemolytic anemia |
|
|
Term
| Which cats are more prone to mast cell tumors? Are they serious? |
|
Definition
-young, Siamese
-spntaneously regress |
|
|
Term
| Do young or old cats get mastocytic MCT? How are they diagnosed? |
|
Definition
|
|
Term
| How do we treat feline mastocytic MCT? |
|
Definition
|
|
Term
| If we diagnose mastocytic feline MCT via cytology, why is histopath needed? |
|
Definition
| -to differentiate reactive vs neoplastic |
|
|
Term
| Where do visceral feline MCTs occur? |
|
Definition
-spleen, liver, intestines, stomach
-most common splenic disease in cats |
|
|
Term
| What are the clinical signs of visceral MCT in cats? |
|
Definition
| -weight loss, anorexia, ascites, multiple skin MCTs |
|
|
Term
| How do we treat visceral MCT in cats? MST? What if GI involved? |
|
Definition
-remove spleen
->8m
-poor prognosis if GI involved |
|
|
Term
| What is the most common canine bone tumor? Which dogs are prone to them? |
|
Definition
-osteosarcoma
-<2y, >5y, large and giant breed dogs |
|
|
Term
| ___% of osteosarcomas occur in the appendicular skeleton while ___% occur in axial locations. Which location is favored by large vs small breed dogs? |
|
Definition
-75% (forelimbs > rear limbs)
-25% (mandible > maxilla > spine > cranium > ribs > nasal cavity > pelvis)
-Large = appendicular/ small = axial |
|
|
Term
| Where do extraskeletal osteosarcomas occur? |
|
Definition
| -in mesenchymal stem cells: mammry, subcutaneous, spleen, bowl, liver, kindey, testicle, vagine, eye, gastric ligament, synovium, meninges, adrenals |
|
|
Term
| Do most osteosarcomas occur at the diaphysis or metaphysis? |
|
Definition
|
|
Term
| What physical factors lead to osteosarcoma? Molecular/genetic? Any others? |
|
Definition
-Physical: multiple minor traumas, metallic implants, ionizing radiation
-Molecular/genetic: gene alterations of p53 and Rb
-Others: viruses, chemicals, etc |
|
|
Term
| What are the subtypes of mesenchymal tumors of bone? |
|
Definition
| -osteoblastic, chondroblastic, fibroblastic, poorly differentiated, telangiectatic |
|
|
Term
| What is the most common site of osteosarcoma metastasis? |
|
Definition
|
|
Term
| What are the clinical signs associated with osteosarcomas? |
|
Definition
| -lameness, swelling, dysphagia, exophthalmos, facial deformity, nasal discharge, paresis/paralysis, tenesmus, pulmonary signs |
|
|
Term
| How does an osteosarcoma appear on rads? |
|
Definition
-lysis and proliferation: Codman's triangle with Sunburst
-soft tissue swelling
+/- fracture
-lesion does not cross joint |
|
|
Term
| What are the characteristics of using an aspirate vs biopsy to diagnose an osteosarcoma? |
|
Definition
-Aspirate: quick, easy, fast results, faster treatment, cheaper
-Bipsy: slow, complicated, slow results, slow treatment, more expensive |
|
|
Term
| If biopsy gives us a more specific diagnosis of osteosarcomas, why do we usually use aspirates? |
|
Definition
| -aspirates are cheaper, faster, easier, and tells us if it indeed cancer which is all we need to know b/c all osteosarcomas are threated the same way |
|
|
Term
| Describe how we stage an osteosarcoma. |
|
Definition
-throacic metastasis check
-lymph node
-survy rads, bone scarns |
|
|
Term
| Which locations are prognostically better? |
|
Definition
| -mandible > maxilla > rib/scapula/vertebra> extraskeletal |
|
|
Term
| Which subtype of osteosarcoma is prognostically better? |
|
Definition
| -parosteal > telangiectatic |
|
|
Term
| What is the MST for amputation alone with osteosarcoma? |
|
Definition
|
|
Term
| What is the surgical alternative to amputation with osteosarcomas? |
|
Definition
-Limb spare surgery
-very expensive, will always have a gait abnormality, does not stop recurrence, failure, or infection |
|
|
Term
| What is the MST of amputation + chemo with osteosarcomas? Which drugs? |
|
Definition
-12m
-platinum agent alone, doxorubicin alone, or carboplatin + doxorubicin |
|
|
Term
| What is the MST with radioation of OSA? |
|
Definition
|
|
Term
| What are some additional options for treating OSA? |
|
Definition
-ciphosphanates: Pamidronate or Zoledranate to stabilize osteoclasts
-pain management combos: NSAIDS + opioid, Gabapentin, Amantadine |
|
|
Term
| What is the second most common bone tumor? Where do they usually occur? |
|
Definition
-chondrosarcoma
-61% occur on flat bones (nasal most comon site |
|
|
Term
| Are chondrosarcomas quick or slow to metastasize? What is the treatment of choice? |
|
Definition
-slow
-surgery: radiation for nasal and biopsy ribs |
|
|
Term
| How does location affect prognosis of chondrosarcoma? |
|
Definition
-Nasal MST = 210-580d
-Rib > 1080d |
|
|
Term
| Are hemangiosarcomas common? Are they usually aggressive or docile? |
|
Definition
-rare
-aggressive and highly metastatic |
|
|
Term
| How doe hemangiosarcomas appear on radiographs? How do we treat them |
|
Definition
-bone lysis
-treat with surgery and doxorubicin |
|
|
Term
| Are synovial cell sarcomas common or rare? What is unique about them? How do we treat them and what is MST? |
|
Definition
-rare
-often cross the joint
-Treat with surgery + chemo
-MST around 30m |
|
|
Term
| What type of cells are involved with multiple myeloma? What do you see on your chemistry? |
|
Definition
-round cells
-hyperglobulinemia |
|
|
Term
| How do we diagnose multiple myeloma? |
|
Definition
-Bnece Jones proteinuria
-monoclonal gammopathy
-lytic bone lesions
-bone marrow plasmacytosis |
|
|
Term
| How do we treat multiple myeloma? |
|
Definition
| -melphalan and prednisone |
|
|
Term
| What are the common sites of metastatic bone tumors? |
|
Definition
| -diaphysis of lumbar vertebrae, femur, humerus, rib, pelvis |
|
|
Term
| Describe hypertrophic osteopathy. |
|
Definition
-paraneoplastic syndrome of bone
-associated with pulmonary lesions
-extremely painful
-treat with pain management and remove underlying cause
-poor to grave prognosis |
|
|
Term
| Are osteosarcoas common or rare in cats? Which cats are prone to them? |
|
Definition
|
|
Term
| Where do osteosarcomas usually occur in cats? Are they less or more aggressive in cats than in dogs? |
|
Definition
-hind limbs
-less except for spinal OSA |
|
|
Term
| How do we treat cats with OSA? MST? |
|
Definition
-aputation: MST > 24m
-chemo sometimes, NOT CISPLATIN |
|
|
Term
| What is the 2nd most common primary bone tumor of cats? 3rd? How do we treat them? |
|
Definition
-2nd= fibrosarcoma
-3rd = chondrosarcoma
-amputation |
|
|
Term
| What is the most common type of tumor in older, female dogs? Which breeds are predisposed? |
|
Definition
-mammary tumors
-Spaniels, poodles, dachshunds |
|
|
Term
| How does the timing of spaying affect the chance of developing canine mammary tumors? |
|
Definition
-spayed prior to first estrus: 0.5%
-After 1st estrus: 8%
-After 2nd estrus: 26%
-After 3rd estrus: same as intact |
|
|
Term
| There are 5 pairs of mammary glands on the female dog. Which sets of glands are most likely to develop mammary tumors? |
|
Definition
|
|
Term
| Describe the clinical presentation of benign canine mammary tumors. What about malignant? |
|
Definition
-Benign: small, well-defined, firm
-Malignant: grow rapdily, ill-defined, fixed, and ulcerated |
|
|
Term
| What are the three types of malignant canine mammary tumors? |
|
Definition
-Carcinomas
-Sarcomas
-Carcinosarcoma (mixed mammary tumors) |
|
|
Term
| What are the types of benign canine mammary tumors? |
|
Definition
-adenomas
-fibroadenoma
-benign mixed tumor
-duct papilloma |
|
|
Term
| Describe the different types of malignant canine mammary carcinomas. |
|
Definition
-complex vs simple
-SCC, mucinous carcinoma, inflammatroy carcinomas are all subtypes
-in situe (the cells have not invaded the basement membrane) |
|
|
Term
| What percentage of of canine mammary tumors are benign? What about malignant? |
|
Definition
|
|
Term
| Of the malignant canine mammary tumors what percent will metastasize? Where will most of them metastasize? |
|
Definition
|
|
Term
| Most canine mammary tumors that metastasize will do so to the regional lymph node. What is the exception to this trend? What are the clinical signs? |
|
Definition
-Inflammatory Mammary Carcinoma
-rapid growth, multiple glands, firm, warm, edematous, erythematous, painful, affect many to all glands, edema of adjacent limbs, systemic signs(usually covers the entire abdomen) |
|
|
Term
| What diagnostic methods should we utilize in diagnosing inflammatory mammary carcinoma? |
|
Definition
-full physical exam
-CBC/chem
-DIC
-cranial two glands: axillary, sternal
-caudal two glands: inguinal, sublumbar
-cytology: tumor vs inflammation (NOT benign vs malignant) |
|
|
Term
| How do we stage inflammatory mammary carcinoma? |
|
Definition
-evaluate primary tumor
-evaluate LN
-evaluate for distant metastasis: lungs, liver, LN, bone |
|
|
Term
| How do we approach canine mammary tumors surgically? |
|
Definition
-remove with simplest procedure
-lumpectomy if 0.5 cm tumor
-mammectomy if 1cm or larger |
|
|
Term
| What are a few of the positive prognostic factors of canine mammary tumors? |
|
Definition
-<3 cm
-well-circumscribed
-LN negative
-estrogen or progesterone receptor +
-carcinoma (well differentiated, complex, tubular/papillary)
-low grade
-low proliferation indices |
|
|
Term
| What are a few of the poor prognostic factors for canine mammary tumors? |
|
Definition
->3 cm
-invasive, ulcerated
-LN positive
-estrogen receptor -
-carcinoma (poorly differentiated, simple, solid, anaplastic), inflammatory, sarcoma
-high grade
-high proliferation indices |
|
|
Term
| What is the MST of canine mammary tumors? |
|
Definition
-Malignant after surgery = 16m
-benign after surgery = 24m |
|
|
Term
| If you see a cat with hugely enlarged mammary glands, what should you consider in addition to neoplasia? |
|
Definition
| -Fibroadenomatous hyperplasia: common benign lesion |
|
|
Term
| What causes fibroadenomatous hyperplasia? |
|
Definition
| -progestins: rapid proliferation of ductal tissue |
|
|
Term
| Are young or old cats more prone to fibroadenomatous hyperplasia? How do we treat it? |
|
Definition
-young associated with puberty/fit estrus/pregnancy
-spay them |
|
|
Term
| What is the 3rd most common feline tumors? What are the first two? |
|
Definition
-mammary tumors
-lymphoma and skin tumors |
|
|
Term
| Are feline mammary tumros hormone dependent? |
|
Definition
-yes
-spay prior to 6m dec risk by 91%
-spay prior to 1y dec risk by 86% |
|
|
Term
| What are the common clinical signs of feline mammary tumors? |
|
Definition
-enlarged mammary glands
-pleural effusion
-up to 25% are ulcerated (tend to be more malignant) |
|
|
Term
| What percentage of feline mammary tumors are malignant? What about benign? |
|
Definition
-80% malignant
-20% benigh |
|
|
Term
| Where are feline mammary tumors likely to metastasize? Is cross communication common? |
|
Definition
-cranial glands: axillary
-caudal glands: inguinal
-cross communication is common |
|
|
Term
| How do we treat feline mammary tumors? |
|
Definition
-chain mastectomy: unilateral or bilateral
-no benefit from radiation
-Doxorubicin |
|
|
Term
| What is the prognosis of feline mammary tumors? |
|
Definition
|
|
Term
| What is the MST of feline mammary tumors? What factors affect this? |
|
Definition
-MST = 1012m
-Size: as it inc the MST dec
-extent of surgery
-histologic grade
-stage |
|
|
Term
| Describe the incidence of urinary tumors in dogs and cats. |
|
Definition
-uncommon in dogs
-extremely rare in cats |
|
|
Term
| What are the risk factors of bladder tumors? |
|
Definition
-topical pesticides
-obesity
-female
-cyclophosphamide
-breed: Scottish terriers, Sheltie, West Highland white terrier, Beagle |
|
|
Term
| What may decrease the risk of developing bladder tumors? |
|
Definition
|
|
Term
| What is the most common type of bladder tumors? What are a few other examples? |
|
Definition
-transitional cell carcinoma (TCC): at the trigone
-SCC, ACA, CA, rhabdomysarcoma, fibroma, sarcomas |
|
|
Term
| What are the clinical signs of bladder tumors? |
|
Definition
| -hematuria, pollakiuria, dysuria, ameness |
|
|
Term
| Which diagnostic methods should we use to diagnose a bladder tumor? |
|
Definition
-CBC/Chem/UA: urine culture but no cystocentesis
-bladder imaging: ultrasound and contrast cystography
-thoracic rads
-urine cytology: free catch
-catheterization
-cytoscopy
-biopsy |
|
|
Term
| How do we use veterinary bladder tumor antigen test to diagnose bladder tumors? |
|
Definition
-many false positives: anything in urine
-better for screening vs dianosis |
|
|
Term
| How do we treat bladder tumors? |
|
Definition
-we usually cannot excise it b/c of location
-obstruction can be an issue to use stents etc
-RT is difficult and has a poor response
-use COX inhibitors and chemo |
|
|
Term
| If we chose to use COX inhibitor alone to treat bladder tumors, what drug would we use and what would the MST be? |
|
Definition
|
|
Term
| If we choose to treat a bladder tumor with chemo alone, which drugs will we use and what is the MST? |
|
Definition
-Mitoxantrone and Cisplatin/carboplatin
-MST = 6m |
|
|
Term
| If we choose to use COX inhibitor + chemotherapy to treat bladder tumors, what drugs will we use? MST? |
|
Definition
-Piroxicam + mitoxantrone
-MST = 12m |
|
|
Term
| Are kidney tumors common in cats? What about in dogs? |
|
Definition
|
|
Term
| Are kidney tumors usually meetastatic or primary? |
|
Definition
|
|
Term
| Dog kidney tumors are ___% carcinomas, ___% sarcomas, ___% nephroblastoma, and the rest are lymphoa. |
|
Definition
-60% carcinomas: renal tubular cell carcinoma
-35% sarcomas: HSA
-6% nephroblastoma: young
-the rest are lymphoma: RCC and lymphoma usually bilateral |
|
|
Term
| What forms do feline kidney tumors take? |
|
Definition
|
|
Term
| What form of renal cancer is particular to German Sheperds? Is this a recessive or dominant trait? |
|
Definition
-Renal cystadenocarcinoma: paraneoplastic nodular dermatofibrosis
-females = uterine leiomyomas
-autosomal dominant |
|
|
Term
| What are the clinical signs of renal cystadenocarcinoma in German Sheperds? |
|
Definition
-anorexia
-depression
-weight loss
-abdominal distention
-hematuria
-polycythemia |
|
|
Term
| How do we treat unilateral renal tumors? Bilateral? |
|
Definition
-unilateral = nephrectomy
-bilateral = chemotherapy |
|
|
Term
| Which types of GI tumors are most common in a dog? |
|
Definition
| -oral cavity > rectoanal region > large bowel > small bowel > stomach > esophagus |
|
|
Term
| What types of GI tumors are most common in cats? |
|
Definition
| -oral cavity > small bowel > large bowel > stomach > rectoanal region > esophagus |
|
|
Term
| What types of canine oral tumors are benign? Malignant? |
|
Definition
-Benign: epulides
-Malignant: SCC, FSA, melanoma, other sarcomas |
|
|
Term
| What is the 4th most common cancer in dogs? |
|
Definition
|
|
Term
| Which dog breeds are prone to oral tumors? |
|
Definition
| -cocker spaniel, German Shepherd, German shorthaired pointer, Weimaraner, Boxer |
|
|
Term
| What are the clinical signs of oral tumors in dogs? |
|
Definition
| -dysphagia, blood in food/water bowl, drooling, halitosis, presence of mass, facial swelling, weight loss |
|
|
Term
| What are the clinical signs of oral tumors in cats? |
|
Definition
|
|
Term
| How do we diagnose an oral tumor? |
|
Definition
| -heavy sedation to do oral exam, FNA, and biopsy |
|
|
Term
| How do we tell the extent of local disease regarding oral tumors? |
|
Definition
-oral radiographs vs CT
-40% lysis to obbserve on radiographs |
|
|
Term
| How do we stage an oral tumor? |
|
Definition
-aspirate lymph nodes in ALL patients with oral cancer: size is not predictive of metastasis
-thoracic radiographs |
|
|
Term
| How do we treat oral tumors in dogs? |
|
Definition
| -surgery for local disease with 2cm margins |
|
|
Term
| Do dogs or cats handle oral surgery better? |
|
Definition
|
|
Term
| How do we use radiation to treat oral tumors? What are the side effects? |
|
Definition
-adjunct to surger or alone: acanthomatous ameloblastoma/melanoma/SCC
-SE: mois desquamation, gingivitis, mucositis, ocular changes |
|
|
Term
| Which type of oral tumor is considered chemoresistant? |
|
Definition
|
|
Term
| What is the overall prognosis of oral tumors? |
|
Definition
-acanthomatous epulis and SCC in dogs have the fewest recurrences and longest survivals
-FSA and melanoma have poorest results to treatment |
|
|
Term
| What are some good prognostic factors for oral tumors? What about poor prognostic factors? |
|
Definition
-complete resection & rostral location
-tumor caudal to canines, incomplete resection, recurrent disease, metastatic disease |
|
|
Term
| Are epulides benign or malignant oral tumors? What are the common types and why is it important to biopsy them? |
|
Definition
-benign
-fibromatous, ossifying, giant cell, acanthomatous, acanthomatous ameloblastoma
-important to biopsy b/c can look like gingival proliferation |
|
|
Term
| Epulides arose from where? Which type ivade bone? |
|
Definition
-periodontal ligament
-acanthomatous may invade bone |
|
|
Term
| How do we surgically approach epulides? What about RT? Prognosis? |
|
Definition
-wide surgical excision: resect tooth and bone to remove periodontal ligament
-can also use RT but not usually necessary
-excellent prognosis |
|
|
Term
| What are the common malignant oral canine tumors? |
|
Definition
| -melanoma > squamous cell carcinoma > fibrosarcoma > other sarcomas |
|
|
Term
| What are the common malignant feline oral tumors? |
|
Definition
| -squamous cell carcinoma > squamous cell carcinoma > squamous cell carcinoma > fibrosarcoma |
|
|
Term
| Which breeds are prone to canine oral melanomas? |
|
Definition
| -cocker spaniel, miniature poodle, golden retrievers |
|
|
Term
| How do canine melanoma cells appear? Where do they occur? |
|
Definition
-round OR spindle shaped
-anywhere in the mouth: gingiva, tongue, palate |
|
|
Term
| Are oral canine melanomas aggressive or docile? What is the overall prognosis? If they do matastasize, where to? |
|
Definition
-very aggressive
-guarded prognosis
-metastasis to LN then lungs |
|
|
Term
| What are poor prognostic factors in oral canine melanoma? |
|
Definition
-caudal to 1st premolar
-size >2cm
-metastasis
mitotic index >3
-bone lysis
-macroscopic tumor after surgery |
|
|
Term
What is the MST of canine oral melanoma with the following treatments:
a) Stage I surgery only
b) Stage II surgery only
c) Stage III surgery only
d) Palliative radiation
e)Radiation post surgery |
|
Definition
a) 18m
b) 6m
c) 3m
d) 7m
e) up to 18m |
|
|
Term
| What is Oncept? What is it used for? |
|
Definition
-canine melanoma vaccine
-used to treat dogs with stage II or III with required local control |
|
|
Term
| How is Oncept administered? |
|
Definition
| -trandermal 4 doses given biweekly |
|
|
Term
| What are the side effects of Oncept use in dogs? |
|
Definition
-pain on injection
-hematoma formation
-anaphylaxis
-loss of pigment |
|
|
Term
| Are canine oral squamous cell carcinomas locally invasive? What perfent metastasize? |
|
Definition
-yes, they are locally invasive
-20% metastatic rate but slow to metastasize |
|
|
Term
| What is the overal prognosis of canine oral squamous cell carcinomas? MST? |
|
Definition
-good prognosis
-MST up to 26m |
|
|
Term
| What is a hi-lo fibrosarcoma? Common location? |
|
Definition
-histologically low grade but biologically high grade
-common on the hard palate |
|
|
Term
| Which breeds of dogs are prone to hi-lo fibrosarcomas? |
|
Definition
| -large breed dogs: golden and labrador retrievers |
|
|
Term
| What is the overall prognosis of canine oral fibrosarcomas? Reason(s)? |
|
Definition
| -guarded b/c local control is difficult and metastasis in 30% |
|
|
Term
| What are some common etiologies of feline oral SCC? Aggressive or docile? |
|
Definition
-flea collars, environmental tobacco smoke
-VERY aggressive |
|
|
Term
| What is the overall prognosis of feline oral SCC? MST? |
|
Definition
-VERY poor prognosis
-MST = 3m |
|
|
Term
| Are tongue tumors common or uncommon? |
|
Definition
|
|
Term
| What kinds of tongue tumors are more common? |
|
Definition
|
|
Term
| How do we treat tongue tumors? Are caudal or rostral lesions better? Dog SMT? |
|
Definition
-partial glossectomies: dogs do well but cats don't
-rostral lesions better
-dog SMT 12m |
|
|
Term
| Gastric cancer makes up <___% of all malignancies. The majority are ___ in dogs that metastasizes to what three locations? |
|
Definition
-<1%
-majority are ACA in dogs
-ACA mets to LN, liver, and lung |
|
|
Term
| Which form of gastric cancer is most common in cats? |
|
Definition
|
|
Term
| What are the clinical signs of gastric cancer? |
|
Definition
| -progressive vomiting: coffee grounds/blood-tinged |
|
|
Term
| How do we diagnose gastric cancer? |
|
Definition
-contrast radiography
-ultrasound
-endoscopy: small biopsies with many false negatives
-open surgical biopsy
-microcytc, hypochromic anemia secondary to chronic bleeding |
|
|
Term
| How do we treat gastric cancer? |
|
Definition
-surgery
-poor radiation toleranc
-chemo for lymphoma + surgery if localized |
|
|
Term
| What is the overall prognosis for gastric cancer? MST? |
|
Definition
|
|
Term
| What types of intestinal tumors are most common in dogs? |
|
Definition
| -ACA > leimyosarcoma > lymphoma |
|
|
Term
| What types of intestinal tumors are common in cats? |
|
Definition
|
|
Term
| What mutation is associated with GIST? |
|
Definition
|
|
Term
| What are the clinical signs of small intestine tumors? What about large intestine tumors? |
|
Definition
-SI: wt loss, vomiting, anorexia, melena
-LI: tenesmus, hematochezia |
|
|
Term
| How do we diagnose intestinal tumors? |
|
Definition
-rare to fine metastasis
-contrast radiography
-ultrasound
-endoscopy: biopsy
-exploratory laparotomy |
|
|
Term
| How do we treat intestinal tumors? |
|
Definition
-chemo for diffuse (lymphoma, MCT)
-surgery for solitary |
|
|
Term
| What is the overall prognosis for intestinal tumors? |
|
Definition
-good for cats with small cell lymp9homa
-poor for dogs with intestinal lymphoma
-can be good for others with complete resection |
|
|
Term
| What are the types of perianal adenomas? |
|
Definition
-originating from the perianal/circumanal/hepatoid glands
-androgen-dependent
-benign |
|
|
Term
| What are the clinical signs of perianal tumors? |
|
Definition
-slow growing mass evident
-straining to defecate |
|
|
Term
| How do we treat perianal tumors? |
|
Definition
| -castration: tumors will regress (may take months), manage androgen producing syndrome in females |
|
|
Term
| What does AGASACA stand for? |
|
Definition
| -Apocrine gland of the anal sac adenocarconma |
|
|
Term
| Where are AGASACAs found? Are they bening and dociel or malignant and aggressive? |
|
Definition
-older females
-malignant and aggressive |
|
|
Term
| What is a common side effect of AGASACAs? What causes it? |
|
Definition
-paraneoplastic hypercalcemia
-PTHrp is produced by the tumor |
|
|
Term
| What are the clinical signs of AGASACA? |
|
Definition
-straining to defecate
-PU/PD (secondary to hypercalcemia)
-abdominal ultrasound and thoracic rads for staging |
|
|
