Shared Flashcard Set

Details

Internal Medicine
Oncology
276
Veterinary Medicine
Graduate
09/29/2011

Additional Veterinary Medicine Flashcards

 


 

Cards

Term
How are regional lymph nodes assessed for metastasis?
Definition

Fine Needle Aspirate - histological exam 

the physical exam does NOT decide whether to aspirate the lymph node (size, consistancy) 

 

Term
What are the goals of cancer therapy?
Definition

Removal of all tumor cells - surgery 

complete remission - no gross evidence of disease 

palliation - improved quality of life 

 

Term
What is the only type of cancer that has been sucessfully cured without surgical interference?
Definition
Transmissible veneral of cats and dogs
Term
How often is response to cancer therapy assessed?
Definition
1, 2, 3, 5, 7, 9, 12 months post op
Term
What is the most common cell found in lymphoma cytology?
Definition
lymphoblasts
Term
What is an easy way to confirm a suspecious case of lymphoma in a dog?
Definition

PCR testing 

sensitivity 85% sensitive and 99% specific 

(less specific in a cat) 

Term
Why would you make sure to examine the
Definition
Term
Which type of cancer is best treated with chemotherapy?
Definition
Lymphoma
Term
Which is safe for cats: Cisplatin or carboplatin?
Definition
Carboplatin?????
Term
What are the 4 R's of radiation therapy?
Definition

Repair

Redistribution 

Reoxygenation 

Repopulation 

Term
What is plesiotherapy?
Definition
This is where radioactive materials are applied directly to the tumor. They are applied via wand - doesnt penetrate very far (superficial)
Term
How do you work up a cancer patient?
Definition

- confirm histologically 

- clinical staging

- assess for concurrent diseases 

- select therapeutic options

Term
What is the cellular effect of cancer?
Definition

it is an imbalance between proliferation and death rate.

Since it is a defect in cell physiology, cancer progresses from bad to worse.

Cancer arises from a faulty differentiation of stem cells  

Term
What is the stem cell theory?
Definition

There is a stem cell that undergoes genetic derangement and maintains replicative potential. 

This cell replicates and causes cancer

Term

Most tumors are (clonal or polyclonal) and

(homogenous or heterogenous)?

Definition

Most tumors are clonal and heterogenous 

So they are some a single cell type but because they are heterogenous there is a challenge in controlling the tumors

Term
What happens to cancer cells over time?
Definition
cancer cells become more anaplastic which makes them more resistant to apoptosis and then will have more rapid cycling.
Term
What are the 6 strategies cancer cells must acquireto overcome evolutionary anticancer techniques of the cell?
Definition

1. Evasion of apoptosis 

2. self-sufficiency in growth signals 

3. Insensitivity to anti-growth signals 

4. tissue invasions and metastasis 

5. Limitless replicative potential 

6. Sustained angiogenesis (need vascular support)

*inhibiting this is the foundation of anti-cancer therapy*

Term

Non-metastatic, non-invasive and slow to moderate growth rate are characterisitics of:

Benign or Malignant tumors?

Definition
Benign
Term

Metatstatic, invasive, destructive and variable to rapid growth rate are characteristics of:

Benign or Metastatic tumors?

Definition
Metastatic tumors
Term

Which of the following is not a characteristic of benign tumors?

A) Abundant Stroma 

B) Hyperchromatic 

C) N:C ratio of 1:4-6

D) Encapsulation 

E) Adequate blood supply 

Definition

B) hyperchromatic - 

there is typically only normal amounts of chromatin in benign tumors 

Term

Which of the following is not a characteristic of malignant tumors?

A) Unrestricted growth 

B) Scant stroma 

C) N:C ratio of 1:1

D) Encapsulation

E) Pleomorphic cell size and shape 

Definition

Answer: D) encapsulation 

malignant tumors are often unrestricted 

Term
What are the 3 classesof malignant neoplasms?
Definition

SARCOMA (mesenchymal tumors) 

CARCINOMA (epithelial tumors) 

Round cell tumor 

Term
What are tumors originating from connective tissue or stroma referred to as?
Definition
SARCOMA
Term
What is a tumor of epithelial origin referred to as?
Definition

CARCINOMA 

 

Term
What is a tumor originating from gladular epithelium referred to as?
Definition
Adenocarcinoma
Term

Which malignant tumor exfoliate the best?

A) Carcinomas

B) Sarcomas

C) Round Cell tumors

Definition
C) round cell tumors
Term

You preform a fine needle aspirate on a tumor, but it exfoliates poorly. Which type of tumor is most likely?

A) Carcinoma

B) Sarcoma 

C) Round cell tumor 

Definition

B) sarcoma 

they exfoliate poorly and can only be diagnosed by biopsy

Term
Where do Round cell tumors originate from?
Definition

IMMUNE SYSTEM 

lymphocytes, APCs, plasma cells, mast cells 

 

Term
What are the 5 major types of round cell tumors?
Definition

Plasma cell tumors 

transmissible venereal tumor 

Histiocytoma 

mast cell tumor 

lymphoma 

Term
At what size do tumors require their own vascular supply?
Definition
Angiogenesis occurs if the mass is greater than 0.5mm
Term
A 1 cm tumor is approximately how many cells?
Definition
1X109
Term
When tumors metastasize hematogenously where do they most often end up?
Definition

Lungs, liver, spleen 

areas of tissues with high-density capillary beds 

Term
When tumors invade the lymphatic system, where do they often metastasize?
Definition

Aside from regional lymph nodes and vessels :

Spleen 

bone marrow 

(aites of high lymphatic activity) 

Term
What are the different routes of metastasis?
Definition

hematogenous 

lymphatic invasion 

Exfoliation 

Seeding 

Implantation 

Term
Where do mammary tumors commonly metastasize?
Definition

Regional lymph nodes 

lungs 

 

Term

Where do perineal or genitourinary tumors commonly metastasize?

Definition

sublumbar nodes

pelvic and caudal lumbar bones 

lung 

 

Term

Where do solid intestinal tumors commonly metastasize?

Definition

regional lymph nodes 

peritoeal cavity 

liver 

Term

Where do appendicular osteosarcomas commonly metastasize?

Definition

lung 

regional lymph node

secondary osseous sites 

Term

Where do hemangiosarcomas of the spleen or subcutis commonly metastasize?

Definition

lung 

heart (auricle) 

liver 

mesentery

Term

Where do primary lung tumors commonly metastasize?

Definition

Tracheobronchial lymph nodes 

secondary pulmonary sites 

Term

Where do insulinomas commonly metastasize?

Definition

liver

regional lymph nodes 

Term
What is taken into consideration when clinically staging tumors?
Definition

size of tumor 

depth of penetration 

invasion of adjacent organs 

lymph node metastasis

distant organ spread 

 

Term
What are the methods for staging?
Definition

Blood tests 

histopathology 

imaging

Term

"Screening tests" are available for some cancers that are presented with no obvious mass.

Which is the best example of this?

Definition

Bladder tumor antigen test 

*only useful when negative*

Term

Clinical staging involves determining TNM.

What does this stand for?

Definition

T - measured tumor size 

N - Lymph node status (aspiration) 

M - Distant metastasis 

Term
If a tumor is assessed as a squamous cell carcinoma T1aN0M0, what would this indicate?
Definition

T1a - tumor less than 2cm, no bone involvement 

N0- no node involvement 

M0 - no distant metastasis 

Term
What is the gold standard of assessing lymph node metastasis?
Definition
Histopathologic examination of the entire lymph node
Term

Lymph node metastasis can be diagnosed by palpation.

True or False?

Definition
FALSE
Term
What are the goals of cancer therapy?
Definition

Remove all tumor cells 

remission with no gross evidence of disease 

Prolonged remission 

Palliation - improved quality of life 

 

Term
What factors determine a tumors overall response to therapy?
Definition

Tumor type 

histological pattern (grade) 

location 

Extent of disease 

 

Term
When do post-operative or post-radiation therapy patients need to be re-evaluated?
Definition
1, 2, 3, 5, 7, 9, and 12 months
Term
What are the most commonly available therapeutic options for cancer?
Definition

Surgical incision 

radiation therapy 

Cryotherapy 

laser 

photodynamic 

chemotherapy 

immunotherapy-gene therapy 

small molecule therapy 

Term
What is the definitive treatment for solid, solidary, low grade tumors?
Definition
Surgical removal
Term
When removing cancerous tumor surgically, what can lead to surgical failure?
Definition

Incomplete resection 

contamination of the site (from instruments or drains)

surgically induced tumor seeding 

Metastatic disease (incomplete staging, agressive tumors)

 

 

Term
What are the chances of remission for cases of properly treated lymphoma?
Definition
80% complete resmission
Term
What is the difference between a lymphoma and a lymphsarcoma?
Definition
Nothing, the terms can beused interchangably
Term
What are the differential diagnoses for lymphadenomegaly?
Definition

Lymphoma 

histiocytic sarcoma 

metastatic neoplasia 

lymphadentitis 

(fungal, bacterial, parasitic, rickettsial infections) 

immune mediated diseases 

Term
Which breeds of dog are at higher risk of lymphoma?
Definition

Boxers 

St. bernard

scottish terrirt 

rottweillers 

retrievers 

basset hounds 

bulldogs 

bullmastiffs

airedales

Term
Which breeds of dogs are at the lower risk for lymphoma?
Definition

Dachshunds

pomeranians 

pekingese 

Min poodle 

Term

Exposure to 2,4-Dichlorophenoxyacetic acid can increase the risk of what type of tumor in dogs? And what is 2,4 D?

 

 

 

 

Definition

It can increase the risk of lymphoma in dogs 

it is a lawn treatment that is applied 4X a year 

Term
What are some common extranodal locations of lymphoma in dogs?
Definition

CNS 

Skin 

Liver 

EYE - ocular involvement 40%

Term
What cell type is predominant in cytology of lymphomas?
Definition
Lymphoblasts
Term
Which lymph nodes should be avoided in diagnosing lymphoma?
Definition
submandibular (superficial cervical)
Term
Which lymph nodes should be avoided in diagnosing lymphoma?
Definition
submandibular (superficial cervical)
Term
How can lymphoma be diagnosed?
Definition
LN aspirate cytology
LN excision and histopathology
PCR
Term
PCR for lymphoma is more sensitive or more specific in dogs ??
Definition
More specific
PCR for lymphoma is 85% sensitive, but 99% specific
Term
How sensitive and specific are feline lymphoma PCR tests? How does this relate to the Canine PCR testing?
Definition
Feline PCR is less sensitive (60%), but more specific (100%)
Dogs are 85% sensitive and 99% sensitive
Term
When collecting a sample for lymphoma PCR, which is better to collect: Effusions or Whole blood?
Definition
Effusions
Term
Elevated Ca2+ levels are associated with what type of lymphoma?
Definition
mediastinal form of lymphoma
Term
Lymphoma is a systemic disease.
True or false?
Definition
TRUE
Term
What are important aspects to remember when preforming a physical exam on a lymphoma dog?
Definition
Palpate lymph nodes
examine eyes (for retinitis, anterior uveitis)
Palpate abdomen (for liver/spleen enlargement)
Thoracic ausculatation (rate/dyspnea)
Term
What clinical signs are most likely seen in the CBC of a lymphoma dog?
Definition
Nonregenerative anemia of chronic dz
Non clinical thombocytopenia
circulating lymphoblasts
leukemia
elevated calcium
Term
When staging cancers, what is the difference between a substage a and a substage b?
Definition
Substage a = well
Substage b = presenting sick
Term
What is the most common stage of canine lymphoma?
Definition
Stage III
This is the generalized lymph node involvement
Term
If the liver is involved, but there is no generalized lymph node involvement, which stage of lymphoma is most likely?
Definition
Stage IV
Term
What are the 2 basic phenotypes of lymphoma? What are the difference between the two?
Definition
B CELL - most common, better remission rate and length, better survival rate
T CELL - less common
Term
What factors have a negative effect on prognosis of canine lymphoma?
Definition
T cell type
advanced clinical stage
subset b
hypercalcemia
younger dog
pretreatment with prednisone
anemia
multidrug resistance (p-Gp)
extranodal location
Term
What factors have a positive outcome on prognosis in canine lymphoma?
Definition
lower body weight (<15 kg)
B cell immunophenotype
response to therapy
female
low histolytic grade
deit high in n-3 fatty acids
indolent histologic subtype
Term
Survival rate would be better with a dog with Acute or Chronic lymphoblastic lymphoma?
Definition
Chronic
the acute form has a very poor survival rate
Term
What is the UW-Madison short protocol for treating canine lymphoma?
Definition
Week 1 - vincristine, pred
week 2 - cyclophosphamide, pred
Week 3 - Vincristine, less pred
week 4 - doxorubicin, even less pred
week 6 - repeat weeks 1-4
week 9 - 24 every other week
Term
What is the most common distribution of feline lymphoma?
Definition
GI
Term
What breed of cat is at an increased risk for lymphoma?
Definition
siamese
Term
Younger cats are more likely to have which subset of lymphoma?
Definition
T cell
this is the worse type as well
so there is a poor prognosis
Term
Older cats are more likely to have which subset of lymphoma?
Definition
B cell
Term
What risks increase the chances of lymphoma in a cat?
Definition
retroviral infections
living with a smoker
Term
When diagnosing a cat for lymphoma, which blood tests should be included in the work up?
Definition
CBC, Biochemistry
T4
FeLV
FIV
(also Urine analysis)
Term
Which species is more likely to have extranodal forms of lymphoma: cats or dogs?
Definition
cats
most likely GI
Term
Which species is more likely to have extranodal forms of lymphoma: cats or dogs?
Definition
cats
most likely GI (small cell)
Term
What is the best predictor of prognosis in a cat with lymphoma?
Definition
Response to initial treatment
Term
Which cat would have the worst prognosis?
A) GI lymphoma
B) Spinal Cord Lymphoma
C) Nasal lymphoma
Definition
B) spinal cord lymphoma
Term
Which species is more likely to have hypercalcemia as a paraneoplastic symptom of lymphoma : cat or dog?
Definition
DOG
Term
FeLV positive lymphoma cats have lower remission rate and shorter survival time than FeLV negative lymphoma cats.
True or False?
Definition
FALSE
Although the survival time is shorter, the remission rate is the same
Term
Which lymphoma has the best prognosis in cats:
A) Low grade , Large cell, nasal
B) High grade, small cell, nasal
C) High grade, large cell, spinal
D) Low grade, small cell, spinal
E) Low grade, small cell, GI
F) Low grade, large cell, GI
Definition
Answer:E)
low grade, small cell GI
Term
What is a differential diagnosis for GI lymphoma in a cat?
How is this differentiated?
Definition
IBD
pathologic identity of invaded muscularis and immunophenotyping
Term
Which of the following pretreatment drugs will NOT help in feline lymphoma?
A) prednisone
B) valium
C) dexdomitor
D) Mitrazapine
Definition
Answer: A) prednisone
B) & C) can be used to sedate a cat when treating for lymphoma
D)mitrazapine is a tricyclic antidepressant which can increase appetite
Term
When was the x-ray discovered and by who?
Definition
Roentgen in 1895
Term
In radiation therapy: alpha particles, beta particles and gamma rays are transferred (as energy) into target cells of the body to disrupt normal cell processes.
True or False?
Definition
TRUE
Term
What is a "hard x-ray"?
Definition
Overlapping gamma radiation in the electromagnetic spectrum
Term
Linear accelerators have xrays that are not able to penetrate deeply and can only be used to determine a small range of tumors.
True or False?
Definition
FALSE
linear accelerators produce deeply penetrating xrays that can grant accessibility to a wide variety of tumor types.
Term
What is the difference between direct and indirect cellular alterations from ionizing radiation?
Definition
Direct: alterations from ionization affects DNA and associated structures
Indirect: DNA alterations caused by ions and free radicals generated from interaction of radiation with water and oxygen within the cell.
Term
What are the alterations that radiation can cause to DNA (and associated structures)?
Definition
H2- bond breakage
Double stranded break
Pyrimidine dimer
DNA cross-linkage
Cross linkage
protein cross linkage
single strand break
Base loss
Base change
Term
What is the most difficult type of damage from radiation for cells to repair? Why?
Definition
Double strand break
this leaves the cell with no DNA template to reconstruct with
this causes the DNA to be erroneously attached in an attempt to repair it.
Term
Why are tumor cells more susceptible to radiation damage to DNA?
Definition
1)Abnormal (tumor) cells have a decreased ability to correct DNA damage = apoptosis = cell death = yay!
2) neoplastic cells typically divide more rapidly - DNA during replication is most sensitive to radiation
Term
Which of the following is most sensitive to radiation?
A) Reproductive organs
B) Skin
C) Blood-forming organs
D) Bone and teeth
E) Muscle
F) Nervous system
Definition
Answer:C) Blood forming organs are the most sensitive to radiation
Term
What are the 4 R's of radiation?
Definition
1) Repair (neoplastic cells have trouble with this)
2) Redistribution/reassortment (death of susceptible stages - movement to susceptibility over time)
3) Reoxygenation (oxygen consumed in radiation to form free radicals, needs to reperfuse)
4) Repopulation (normal tissue needs to recover)
Term
How are radiation doses measured?
Definition
GRAYS
Term
What are the methods of radiation delivery ?
Definition
1) Intra-tumor/ tissue rad
- radioisotope therapy
- brachytherapy
- plesiotherapy
2) external beam radiation
- orthovoltage
- megavoltage
Term
What is radioisotope therapy?
What is an example of its use?
Definition
Radioactive element ingested/injected and will accumulate in desired area - tissue absorption (intra-tumor/tissue radiation)
IE.I-131 in treating hyperthyoidism of cats with thyroid adenomatous hyperplasia.
Term
What is the most common radiation treatment for cats with hyperthyroidism from thyroid adenomatous hyperplasia?
Definition
I-131 radioisotope therapy
Term
What is Brachytherapy?
What is an example of its use?
Definition
direct application of radioactive material to the superficial tissue/tumors (intratumor/tissue.
Mostly in the form of metallic implants of iridium 192.
IE. cutaneous squamous cell carcinomas of cat and cattle,
prostate tumors of men
Term
What type of therapy involves the placement of a small metallic implant of iridium 192 in a tumor/skin?
Definition
Brachytherapy
Term
What radiation therapy is most commonly used to treat cutaneous squamous cell carcinomas of the cat and cattle?
Definition
Brachytherapy
iridium 192 implant
(in cats of SCC of the nasal plantum - plesiotherapy)
Term
What is plesiotherapy?
What is an example of its use?
Definition
Direct application of radioactive source to target tissue, most commonly stronium 90 probe.
IE. superficial ocular lesions of cats,
superficial squamous cell carcinoma of the nasal plantum of cats
Term
What method of radiation involves direct application of a radioactive source (strontium 90 probe) onto target tissue?
Definition
Plesiotherapy
Term
What is orthovoltage radiation therapy?
Definition
External beam radiation that is best for superficial tumors that require protection of important underlying structures (like lung, liver, brain)
Term
What is the major disadvantage of using orthovoltage?
Definition
Causes intense skin reaction because of the high amount of energy being absorbed in the first few centimeters of outer tissues
Term
What is megavoltage?
Definition
Cobalt 60 and Linear accelerators
have best tissue penetration
Term
What kind of tumors are the best candidates for radiation therapy?
Definition
SMALL masses
periphery of solidary masses
associated regional lymph nodes
Tumors of : Brain, Nasal cavity, Oral cavity, trunk/limb
Term
What locations of tumors are best candidates for radiation therapy?
Definition
Brain
Nasal Cavity
Oral Cavity
Trunk/limb
Term
Why is radiation often the most practical therapy for brain tumors?
Definition
Chemotherapy agents hampered by BBB
Surgery may be more difficult (harder to access)
Term
What are the side effects associated with radiation of brain tumors?
Definition
acute: temporary demyelination, Increased intracranial pressure
LATE side effects: (need to be differentiated from regrowth)
necrosis and fibrosis of affected tissues.
Term
What is the most common tumor of the nasal cavity? How can it be treated?
Definition
CARCINOMAS
can be treated with radiation therapy
Term
Which nasal tumors respond best to radiation therapy?
Definition
chondrosarcomas and nasal lymphomas
Term
Which oral tumors respond well to radiation?
Definition
Acanthomatous ameloblastoma
Squamous cell carcinoma
fibrosarcoma (less responsive)
Term
What trunk/extremity tumors are most responsive to radiation?
Definition
Invasion tumors: vaccine-induced sarcomas, nerve sheath tumors
Term
What are the early effects associated with radiation therapy?
Definition
Transient demyelination
Mucositis (tender mouth, diarrhea)
Hair loss
pigmentation changes in skin
desquamation (flaky skin)
Many acute eye effects, delayed healing
Term
Oral mucositis is an early side effect of radiation therapy, how can it be treated?
Definition
low salt diets, supplemental feeding, subQ fluids
Term
What are the late effects associated with radiation therapy?
Definition
Cataracts, retinal atrophy
necrosis
associated edema that is unresponsive to steroids
fibrosis
loss of function
death
Term
What is the typical presentation of lymphoma in dogs?
Definition
Non painful lymph node enlargement
(this is usually generalized, stage III)
Term
What are lymphoblasts?
Definition
Lymphocyte cells that are 4-6 times the size of a RBC
These are found on the histology of lymphomas
Term
What is a hemangiosarcoma?
Definition
highly metastatic malignancy of vascular endothelial cells
Most commonly arises from subQ tissue, spleen, liver, right atrium
Term
What is the least aggressive form of hemangiosarcoma?
Definition
The superficial (epidermal) form that is common in the pink skin of sunbathing whippets, pit bulls and dalmations.
Term
What is the most common hemangiosarcoma in dogs?
Definition
Splenic
Term
Hemangiosarcoma is most common in what breeds of dogs?
Definition
German shepards
golden retrievers
labrador retrievers
dobermans
boxers
other large breeds
Term
Hemangiosarcoma is most common in what breeds of dogs?
Definition
German shepards
golden retrievers
labrador retrievers
dobermans
boxers
other large breeds
Term
How common are metastasis of hemangiosarcomas?
Definition
VERY COMMON
80% of dogs have a metastasis with splenic hemangiosarcomas
Term
What is the most common clinical presentation of hemangiosarcoma in the dog?
Definition
Signs of a bleeding splenic mass
acute weakness, collapse, pallor, exercise intolerance, abdominal effusion/mass, hypovolemic shock
Term
What is the clinical presentation of canine cardiac hemangiosarcomas?
Definition
Signs from hemorrhage of mass
- muffled heart sounds
- vent premature contractions
- tachycardia
- hypotension
- pericardial effusion
Term
What are some differentials for splenic hemangiosarcoma?
Definition
mast cell tumor
hematoma
extramedullary hematopoeisis
nodular regeneration of the spleen
sarcoma
Term
What are the most common causes for spleen enlargement in the cat?
Definition
hepatic adenoma/adenocarcinoma
hematoma
Term
Where is the primary site for hemangiosarcoma in cats?
Definition
spleen
cutaneous/subQ tissue
Term
Which diagnostic techniques are not recommended with potential hemangiosarcomas?
Definition
Palpation - they are very friable and can rupture
Fine needle aspirate - may increase bleeding
Term
How should a splenic mass be diagnosed?
Definition
Histopath
Send the whole spleen in
Term
What is the treatment for splenic hemagiosarcoma?
Definition
Splenectomy
right atrial appendage removal
and removal of any subcutaneous masses
ALSO systemic therapy because they are almost always metastatic
Term
What are some negative prognostic factors of hemangiosarcomas?
Definition
presence of hemoabdomen
multiple splenic nodules
Term
What proteins are important in sustaining tumor growth by initiating angiogenesis?
Definition
VEGF- vascular endothelial growth factor
bFGF - basic fibroblast growth factor
Together these activate endothelial cells
Term
What type of chemotherapy treatment can be given to help inhibit angiogenesis?
Definition
LOW DOSE (1/10th) chemotherapy of cyclophosphamide
Term
Most oral tumors are: Malignant or benign?
Definition
Malignant
Term
In the cat, what can increase the risk or oral squamous cell carcinomas?
Definition
Living with smokers
eating canned tuna
eating canned cat food
Wearing flea collars
Term
In dogs, what factors may increase their risk of oral squamous cell carcinoma?
Definition
urban environment - 10X tonsillar
White dogs - lingual SCC
Papillomavirus
Term
What are the most common oral tumors of the dog?
Definition
Malignant melanoma
then acanthomatous ameloblastoma (epulus)
SCC
Fibosarcoma
Term
What are the most common oral tumors of the cat?
Definition
SCC
Term
Salivary gland tumors are most often benign, in both cat and dog.
True or False?
Definition
FALSE
They are almost always Malignant in both cats and dogs
Term
What are the clinical presentations of oral tumors?
Definition
Gingival swelling with oral ulceration most common
- inappetence
- facial mass
- lumps under jaw (dogs)
- facial swelling below eye/along jaw (cat)
- drooling (ptyalism)
- pawing at face
- bloody discharge, blood on food
- tooth loss
- bad breath (halitosis)
Term
A biopsy should be preformed of any suspicious-looking proliferations in the mouth during routine dental prophylaxis.
True or False?
Definition
TRUE
Term
What the differential diagnoses for oral tumors?
Definition
More often infectious than tumor
tooth root abscess
fingal disease
SCC
Melanoma
fibrosarcoma
acanthomatous amelblastoma
osteosarcoma
plasma cell tumor
granulomatous disease
exuberant gingival hyperplasia
Term
What are the differential diagnoses for an enlarged salivary gland in the dog?
Definition
Mucocoele
sialadentitis
adenocarinoma
Term
What are the differential diagnoses for a cat with a mass under the tongue ?
Definition
Foreign body (look for string/needle)
SCC
fungal infection
calicivirus
Term
What percentage of corticol bone loss must occur before bone lysis will be evident on radiograph?
Definition
40% of the corticol bone must be lost for it to begin to appear radiographically
Term
What is the most accurate method in determining extent of oral tumors?
Definition
CT scan
CT can also detect spread to regional lymph nodes
Term
What is the most accurate method in determining extent of oral tumors?
Definition
CT scan
CT can also detect spread to regional lymph nodes
Term
The WHO staging system is used in canine oral melanomas. If a tumor was stage II, then it would be:
a) <2cm diameter, negative lymph nodes
b) <2cm diameter, positive lymph nodes
c) 2-4cm diameter, negative lymph nodes
d) 2-4cm diameter, positive lymph nodes
Definition
Answer: C) stage II tumors =
2-4cm diameter, negative regional lymph nodes
Term
What are some factors of oral tumors that indicate a poor prognosis?
Definition
metastasis to lymph nodes or lungs
large sized tumor
incomplete surgical excision
caudal location within mouth
bone lysis underlying tumor
high histological grade
Term
When histologicaly evaluating tumors, what phase of cell cycle is most concerning because of metastatic potential?
Definition
S phase
Term
How much of a dog's tongue can be removed without inhibiting its ability to eat/drink effectively?
Definition
40-60%
Term
What are the treatments for oral lesions?
Definition
Surgical excision
radiation therapy (if non adequate closure or deep penetration)
Cyrodurgery - small, non bone invading lesion.
Term
Oral melanomas are likely cured through surgical excision alone because metastasis is uncommon.
True or False?
Definition
FALSE
oral melanomas are likely to metastasize
and because of this, surgery should be combined with additional therapy
Term
Squamous cell carcinomas are radiation responsive and will be cured if small.
True or false?
Definition
TRUE
Term
Radiation alone can be used to treat acanthomatous ambeloblastomas, and this carries a high survival rate.
True or False?
Definition
TRUE
Term
When should radiation be used on oral fibrosarcomas?
Definition
Only if surgery was first preformed leaving only microscopic disease. Fibrosarcomas are otherwise poorly responsive to radiation therapy
Term
Oral malignant melanoma is radiation sensitive, so adequate radiation therapy would leave a dog with a good prognosis.
True or False?
Definition
FALSE
melanomas are radiation sensitive
but are also highly metastatic, so animals have a guarded prognosis and most often die of metastatic disease.
Term
How wide should margins be when removing oral melanomas?
Definition
2 cm min
Term
Melanomas are highly metastatic. What can be done asides from radiation therapy and surgery to extend survival rates?
Definition
Merial melanoma vaccine
(xenogenic DNA vaccine)
Tyrosinase vaccine
(human tyrosinase which is involved in melanin synthesis and will be found in malignant melanocytes)
Term
What is the Xenogenic DNA vaccine used against malignant oral melanoma of dogs?
Definition
It is a vaccine that inject DNA from a different species that codes for a similar protein. Body produces antigens (overcoming reluctance of self-antigens) and stimulates immune response.
Term
What is the tyrosinase vaccine?
How is it used?
Definition
It is a human tyrosinase that is injected into dogs with oral malignant melanoma. It is used to target malignant melanocytes that use tyrosinase to synthesize melanin.
this amounts an immune response to the enzyme helping to destroy tumor cells.
Term
Prognosis of dogs with squamous cell carcinoma of the caudal tongue us grave.
True or False?
Definition
TRUE
Term
Low grade oral fibrosarcomas of the dog behave: less aggressively or more aggressively than high grade fibrosarcomas?
Definition
MORE aggressively
fibrosarcomas dont fit the rule!!
Low grade tumors behave more aggressively than high grade ones!
Term
What is the most common nasal tumor of the dog?
What about the cat?
Definition
Most common nasal tumor of the dog: adenocarcinoma
Cat: lymphoma (less frequently adenocarcinoma)
Term
What are some risk factors for nasal tumors in dogs?
Definition
Dolichocephalic (long nosed)
Males more frequently affected
living in urban areas
exposure to flea sprays
indoor kerosene/coal heaters
owners smoke
Term
Clinical signs of nasal tumors often relate to the respiratory tract. What other symptoms may be found?
Definition
NEUROLOGIC (primary)
like seizures, paresis
this is because it invades teh cribiform plate and get to the brain
Term
What are some paraneoplastic disorders associated with nasal tumors?
Definition
Rare
erythrocytosis
mild non regenerative anemia
immune mediate thrombocytopenia
hypercalcemia
Term
What are the differential diagnoses for nasal tumors?
Definition
inflammatory disorders
bacterial rhinitis
fungal rhinitis
parasitic rhinitis
foreign body
tooth root abscess
inflammatory polyp
Term
What differentials should be considered when presented with epistaxis?
Definition
Coagulopathy
secondary coagulopathy
vascular disorder
...then nasal tumors
Term
Evaluation of oral and nasal tumors almost always require anesthesia.
True or False?
Definition
TRUE
Term
Why should a coagulation screen be run before evaluating the nasal cavity for tumors?
Definition
1) more likely epistaxis (f presented) is caused by coagulatopathy than tumor
2) Nasal cavity = HIGHLY VASCULARIZED
hemostasis may be difficult as is, so if there is a clotting issue, it may make it worse
Term
What are the most diagnostic radiographic views for tumors of the nasal cavity?
Definition
Open-mouth (dorsoventral intraoral)
frontal sinus (rostrocaudal /"skyline" views)
Term
Flushing and evaluation of nasal exudate can be helpful in diagnosing nasal tumors.
True or False?
Definition
FALSE
there is lots of normal bacterial flora present in the nose, or there may be a secondary bacterial infection from the primary disease
Term
The nasal cavity is highly vascular. What should be done prior to collecting histologic samples of the nasal cavity to prevent aspiration pneumonia (from hemorrhage)?
Definition
Pack caudal pharynx with gauze
Inflate the ETT cuff
Term
When biopsying nasal cavity tumors: If a catheter is inserted into the medial canthus of the eye, what important structure may it perforate?
Definition
Cribiform plate
(and get into the brain, ew)
Term
Aspergillus and/or penicillum are normal findings on fungal cultures of the canine nasal cavity.
True or False?
Definition
TRUE
Term
Which is more effective when evaluating nasal cavity tumors?
A) retroflex endoscope around soft palate
B) Endoscopy through external nares
C) Fiberoptic endoscopy through external nares
Definition
Answer: A)
visualization of nasal tumors thorugh external nares are almost always unrewarding
Term
What is the best treatment option for most dogs with nasal tumors?
Definition
Radiation therapy
(chemotherapy can be the sole treatment in dogs with nasal lymphoma and transmissible veneral tumors)
Term
Retroviral testing should be part of the minimum database in cats suspected of having a nasal tumor.
True or False?
Definition
TRUE
the most common nasal tumor in the cat is lymphoma, which retrovirus infection can be a prognostic determinant
Term
What is piroxicam?
Why is used in cancer therapy?
Definition
It is an NSAID
used in cancer therapy because it decreases clinical signs and is potentially useful for anti-tumor activity.
It also doesnt require monitoring and it relatively inexpensive ($30/mon) and owners can administer at home
Term
What is the prognosis and survival rate of dogs with nasal carcinomas?
Definition
POOR
usually euthanized within 3-6 months
Term
What are some factors that will increase the prognosis of a canine nasal tumor?
Definition
minimal tumor invasion (away from the eye)
radiation treatment
sarcomas (better than carcinomas, slower growing)
metastasis
regional lymph node invasion
Term
Why do nasal tumors carry a generally poor prognosis?
Definition
They are often found late in teh course of the disease and by this point there is invasion and large tumor burden and possible metastasis
Term
What is the most common paraneoplastic disorder in veterinary medicine?
Definition
Hypercalcemia
Term
How is hypercalcemia accurately determined?
Definition
Blood measurement of ionized calcium
(this is the biologically active form)
total serum concentrations are considered elevated above 12 mg/dl
Term
Which tumors are associated with hypertrophic osteopathy as a paraneoplastic disorder?
Definition
Primary lung tumors
rhabdomyosarcoma (bladder0
esophageal sarcomas
pulmonary metastasis
carcinomas (esp renal and pulmonary)
hepatic adenocarcinoma
renal papillary adenoma (cat)
Term
Hypercalcemia is most commonly associated with what types of tumors in dogs?
Definition
LYMPHOMA
apocrine gland (anal sac) adenocarcinomas
multiple myeloma
thymoma
(but is seen with many more)
Term
Hypercalcemia is most associated with what type of tumors in cats?
Definition
Parathyroid adenoma
(lymphoma and SCC as well, but less)
Term
Decreased sensitivity to ADH is a paraneoplastic syndrome seen in cats and dogs. What are the common clinical signs of this?
Definition
CATS: Anorexia
DOGS: PU/PD
Both: less common effects - nausea, vomiting, muscle weakness, seizures, bradycardia, constipation
Term
What are the mechanisms that result in hypercalcemia of malignancy?
Definition
Tumor production of PTHrP (parathyroid hormone related protein)
TNF, interleukins, colony stimulating factors, and osteoclast activating factors = osteolysis as well
Term
How is hypercalcemia of malignancy treated?
Definition
By managing the tumor that is producing the hormone like substance that is producing the hypercalcemia
Term
Hypercalcemia of malignancy is most often treated by managing the tumor. When would direct treatment of the paraneoplastic disorder be indicated? How is it treated then?
Definition
If clinical signs exceed PU/PD
total calcium >16-18
CaXPO4 product >70
Volume expansion, correct dehydration, stimulate calciuresis (0.9% NaCl)
furosemide can be used once adequately hydrated
Term
When does soft tissue mineralization begin to occur? Which tissues are most sensitive to this?
Definition
total calcium >16-18 or CaXPO4 product >70
tissues most at risk:
kidneys
nervous system
heart
Term
What is the most common cause of paraneoplastic hypoglycemia in dogs?
Definition
insulinoma
(tumor of pancreatic islet cells secreting insulin)
Term
What are the differential diagnoses for hypoglycemia?
Definition
Lab error
liver disease
sepsis
adrenal cortical insufficiency
paraneoplastic hypoglycemia
Term
What are the clinical signs associated with hypoglycemia?
Definition
weakness
seizures
lethargy
tremorsbehavioral changes
coma
death
Term
Why may a dog with a blood glucose concentration of 40 mg/dl not have any clinical signs of hypoglycemia?
Definition
Because it could be chronic
if a tumor is present for a long time, the animal could have adapted to the increasingly lower glucose levels over time
Term
How is hypoglycemia accurately confirmed?
Definition
measuring blood insulin levels when blood glucose is less than 60 mg/dl
Term
Paraneoplastic hypoglycemia is most associated with what types of tumors?
Definition
Insulinomas
hepatocellular carcinomas
Term
How is paraneoplastic hypoglycemia treated?
Definition
(presuming the animal is stable)
Surgical Excision of the tumor
otherwise low glucose containgin fluids, 20% dextrose IV bolus
Term
Increased metastasis is directly related to decrease in prognosis.
True or False?
Definition
TRUE
Term
What is the most common cause of paraneoplastic hyperestrogenism?
Definition
Sertoli cell tumor (testicular tumor, most often of undescended testicles)
Term
What is the most common type of anemia found in patients with cancer?
Definition
Non-significant
anemia of chronic inflammatory disease
(normochromic, normocytic, and non regenerative)
Most often doesnt require a blood transfusion
Term
Clinically significant anemia is a negative prognostic factor in dogs with cancer.
True or false?
Definition
TRUE
Term
What causes Microangiopathic hemolytic anemia?
Definition
DIC
(fragmentation of RBC caused by fibrin strands within the blood vessels)
Term
Disseminate intravascular coagulopathies are common with what type of tumor in the dog?
Definition
Hemangiosarcomas
Term
Immune mediated hemolytic anemia is found most commonly with what type of tumors in dogs?
Definition
Lymphoid tumors
Term
Aplastic anemia of malignancy is caused by what mechanisms?
Definition
- estrogen effects of sertoli cell tumors or myelopthisis
- crowding of normal cell precursoes by tumor cells
- depression of production of RBC because of tumor made cytokines
Term
Paraneoplastic leukocytosis is associated with which types of tumors?
Definition
renal tubular carcinoma
hemangiosarcoma
rectal adenomatous polyp
metastatic fibrosarcoma
Term
What is the most common hematologic abnormality in dogs with lymphoma?
Definition
THROMBOCYTOPENIA
Term
What are the causes of thrombocytopenia?
Definition
Immune mediate destruction
consumed by DIC or frank hemorrhage
sequestering in spleen or vasculature of large tumors
hyperestrogenism
depressed bone marrow production
Term
DIC is most commonly seen with which types of tumors?
Definition
HEMANGIOSARCOMAS
metastatic advanced mammary gland adenocarcinoma
Term
What type of tumor is associated with hyperviscosity paraneoplastic syndrome?
What causes the increased serum viscosity?
Definition
Plasma cell tumor
- these tumors snthesize a large quantity of paraprotein
these immunoglobulin producing tumors increase serum viscosity
Term
What are the clinical signs associated with hyperviscosity syndrome?
Definition
Coagulopathies
retinal hemorrhage
dementia
depression
heart failure
nephropathies
ataxia, seizures
bleeding
renal failure
Term
What are the differential diagnoses for hyperglobulinemia?
Definition
multiple myeloma
paraneoplastic hyperviscosity syndrome
erlichiosis
lymphoma
chronic infection
cold agglutin disease
lymphoid neoplasms
Term
What are the three main mechanisms that cause paraneoplastic polcythemia?
Definition
Inappropriate secretion of erythropoietin
secretion of erythropoietin like factors by tumors
hypoxemia of tissues
Term
In dogs with paraneopplastic polycythemia, erythropoietin levels are increase, blood oxygen is decreased, and there is decreased renal function.
True or false?
Definition
FALSE
althogh erythropoietin levels are elevated, blood oxygen and renal function remain normal
Term
How do tumors produce energy?
Definition
They preferentially metabolize glucose for energy via krebs cycle. This results in a net energy loss to the patient.
protein is degraded to replace glucose, resulting in muscle wasting
Term
Why might a dog with cancer have altered amino acid profiles?
Definition
cancer cachexia - when tumors use up glucose stores they break down proteins (muscle wasting)
Term
Argininge and omega 3 fatty acid supplementation has no shown effect on survival of dogs with cancer.
True or false?
Definition
FALSE
they have been shown to improve the survival in dogs with cancer
Term
How do you treat hypertrophic osteopathy?
Definition
remove the primary disease (tumor)
this will allow the bone to resolve
Term
What causes paraneoplastic fever?
Definition
IL-1 production by tumor activated macrophages
IL1 produced by tumor
IL6
TNF alpha
Interferons
prostaglandins
Term
The most common causes of fever are infection and immune mediated diseases, not cancer.
True or False?
Definition
TRUE
Term
With cancer patients, what temperature should antipyretics be used?
Definition
only if fever reachs 106F or more
Term
Bilateral symmetrical alopecia of the ventrum and limbs is associated with what type of tumors in cats?
Definition
Pancreatic carcinoma
liver metastases
Term
Superficial neoclytic dermatitis is associated with dogs that have what type of tumor?
Definition
Pancreatic tumors
Term
Exfoliative dermatitis is associated with what type of tumor in cats?
Definition
Thymoma
Term
Myasthenia gravis is reported with what tumor types in cats and dogs?
Definition
Lymphoma
hepatic tumors
**thymoma**
Term
What are transitional cell carcinomas?
Definition
epithelial cell tumors of the bladder
Term
What signalment and breed of dog is at risk for transitional cell carcinoma?
Definition
Female dogs
scottish terriers
shetland sheep dogs
West highland white terriers
airedales
beagles
collies
Term
Transitional cell carcinomas are more common in female cats and dogs.
True or false?
Definition
FALSE
It is true that transitional cell carcinomas are more common in female dogs, but there is no gender predilection in cats. Cats rarely get these though.
Term
What are the clinical signs of transitional cell carcinomas in dogs?
Definition
blood in the urine (hematuria)
painful urination (stranguria)
overactive bladder (pollakiuria)
renal insufficiency
abdominal pain
bone pain
Term
Why are rectal exams important in all dogs suspected of having a transitional cell carcinoma?
Definition
Prostate and urethra are commonly involved
Term
What are some metastatic lesions and paraneoplastic disorders associated with transitional cell carcinomas?
Definition
thoracic metastasis (LUNG)
hypertrophic osteopathy
regional lymph node invasion
vertebral body metastasis
Term
Urine sediment alone can be diagnostic in canine cases of transitional cell carcinoma.
True or False?
Why or why not?
Definition
TRUE
Veterinary bladder tumor antigen test is available to detect TCC
Term
The veterinary bladder tumor antigen test can diagnose transitional cell carcinomas in dogs, but its can produce false negatives or false positives? why?
Definition
It can produce false postives when there is urinary tract infection and inflammation
*serves as a good screening test*
Term
How should biopsies of transitional cell carcinomas be collected?
Definition
traumatic urethral catheterization
tumor cells can be transplanted into the abdomen if a needle biopsy is preformed
Term
Transitional cell carcinomas are never completely excised, so surgical excision is not a good method of treatment.
True or false?
Definition
FALSE
surgical excision is still appropriate as long as it is it resecable.
this will decrease tumor burden, improve quality of life and decrease paraneoplastic disorder occurrence.
Term
Prognosis of transitional cell carcinomas are poor, despite use of chemotherapy, radiation and surgical excision with clean margins.
True or False?
Definition
Unfortunately true
Term
The majority of feline mammary gland tumors are malignant.
True or false?
Definition
TRUE
85-90% are malignant
this is in comparison to dogs where only about 50% are malignant
Term
Mammary tumors are a more significant disease in cats or dogs?
Why?
Definition
CATS
this is because there is a greater chance of malignancy (85-90%) and they are almost always metastatic to the lungs and regional lymph nodes.
This is in comparison to dogs, where only 50% of cases are malignant, and there is a variable range of metastasis
Term
What signalment and breed of dogs are more predisposed to mammary tumors?
Definition
UNSPAYED FEMALE
~8-10 yo
german shepard
cocker spaniels
dachshunds
poodles
yorkshire terriers
(purebred dogs)
Term
How do hormones play a role in the development of mammary tumors?
Definition
Progestins = hyperplasia and benign tumors
progesterone tx (to control estrus)= increased risk of benign and malignant mammary tumors
By spaying females = sparing effect on malignant Mammary tumors
Term
What would decrease the risk of malignant mammary tumors to nearly zero?
Definition
SPAY BEFORE FIRST ESTRUS
Term
What are differential diagnoses for mammary gland enlargement ?
Definition
Mammary gland swelling from pseudocyesis
lactation
hyperplasia
mastitis
cutaneous lymphoma
mast cell tumors
Term
What are the three main types of mammary cell tumors? How would they present histologically?
Definition
Adenocarcinomas - epithelial (this is most common form)
Inflammatory carcinomas - epithelial and mononuclear/ ploymorphic cells
sarcomas - mesenchymal (poor prognosis)
Term
Why do dogs with inflammatory mammary carcinomas respond well to piroxicam?
Definition
Piroxicam is a NSAID
It inhibits COX2 which induces conversion to prostaglandins (which would increase tumors) and COX2 supresses apoptosis and promotes angiogenesis, proliferation and tumor invasion.
Inflammatory mammary carcinomas expres more COX2, so inhibiting it would prevent that cascade.
Term
Radiation therapy is not usually helpful in treating mammary tumors.
True or False?
Definition
TRUE
Term
What are some negative prognostic factors associated with canine mammary tumors?
Definition
older dogs = more malignant
inflammatory mammary gland carcinoma =short survival
larger dogs
rapidly growing tumors
tumor ulceration
metastasis (lymph node)
6month duration of tumor
sarcomas = more aggressive
lack of lymphoid reactivity
Term
IN regards to mammary tumors: SIZE MATTERS.
True or False?
Definition
True
size = most important indicator of prognosis
Term
Which gene kinase expression in cats indicates a decreased prognosis?
Definition
F-HER2
Term
What breed of dog is more at risk for a mast cell tumor?
Definition
*BOXER*
Shar-peis (agressive and non responsive)
Bulldogs
basset hounds
Weimeraners
boston terriers, scottish terriers
beagles
pointers
Goldens
Labs
German short hair pointers
Term
All Mass cell tumors should be considered malignant.
True or false?
Definition
TRUE
Term
Mast cells are granulated. What do their granules contain?
Definition
Histamine
heparin
chondrotin sulfate
Platelet activating factor
tumor necrosis factor alpha
prostaglandin D2
leukotrine C4
acid hydrolases
IL5, IL6
cathepsin G1
carboxypeptidases
tryptase
Term
What effect does histamine have on GI motility?
Definition
increases
Term
Why are thoracic radiographs not part of a basic workup of a mast cell tumor, unless the tumor is located on the thorax?
Definition
The chance of lung metastasis is low, it is more likely that it would metastasize to the liver, spleen and lymph nodes first
Term
In which species can a fine needle aspirate be diagnostic of a mast cell tumor?
Definition
DOGS
feline mast cell tumors do not granulate as well
REGARDLESS FNA should still be preformed on all patients
Term
What is the most treatment therapy for mast cell tumors?
Definition
Surgical excision and radiation therapy
Term
What are the most important factors for assessing prognosis of mast cell tumors?
Definition
Clinical stage
**histological grade ** most important
location
Term
When is chemotherapy indicated for dogs with mast cell tumors?
Definition
Disseminated disease
grade III tumors
high mitotic index
non resectable disease
recurrent mast cell tumors
Term
What is small molecule inhibition?
Definition
It inhibits the ATP binding sites of kinases, inhibition of protein phosphorylation
thus inhibit tumor growth
Term
What are the most common cutaneous tumors found in cats?
Definition
#1 basal cell tumors
#2 Mast cell tumors
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