Term
Name the risk factors associated with mammary gland tumors in cats |
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Definition
- likely hormonal influence
- spay early: intact/spayed late females are more likely to develop
- dont' give progesterone-like drugs
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Term
name the risk factors associated with mammary gland tumors in dogs? |
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Definition
- hormonal influence
- intact/spayed late have a higher incidence rate
- estrogen AND progesterone receptors on tumor cells (less well diff celss have less receptors)
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Term
How to prevent mammary gland tumors in dogs? |
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Definition
SPAY - spaying before 1st estrus=risk of 0.5%
- spaying after 1st estrus = risk of 8%
- spaying after second estrus = risk of 26%
- no protective effect after third estrus! (but should still spay)
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Term
Describe a diagnostic plan for cats/dogs presenting with a mammary gland tumor |
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Definition
- Thoracic rads: lungs and sternal node, cats can develop effusion/interstitial changes rather than the typical nodular mets lesions
- rectal exam: palpate for big internal iliac node
- Abd U/S: look for sublumbar or mesenteric node enlargement and metastases to the liver
- FNA: some MGT have both benign and malignant portions w/in the same tumor--makes evaluation difficult
- BX: definitive dx!
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Term
describe the biologic behavior of mammary gland tumors in cats |
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Definition
- 80% malignant, 20% benign
- usually adenocarcinomas
- mixed tumor
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Term
describe the biologic behavior of mammary gland tumors in dogs |
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Definition
- 50% malignant and 50% benign
- 50% of the malignant ones will recur or mets after first sx resection
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Term
what are the prognostic factors for dogs with mammary gland tumors? |
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Definition
- Bad
- >3cm
- invasive
- LN +
- lymphoid cellular reactivity (-)
- inflammatory carcinoma
- ulceration
- sarcomas
- ER (-)
- Good
- <3cm
- well circumscribed
- LN (-)
- Lymphoid cellular reactivity (+)
- ER or PR (+)
- Indifferent
- age
- breed
- OHE status
- Weight
- type of sx
- numbers of tumors
- glands involved
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Term
what are the prognostic factors for cats with mammary gland tumors |
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Definition
- SIZE (<2cm will live 3 yrs, >3cm will live 4-6 mo)
- histo type
- extent of sx resection
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Term
what are the appropriate treatment options for dogs with mammary gland tumors |
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Definition
- Surgery!
- conservative sx is just as good as radical
- so should remove tumor with simplest procedure possible
- NO RADIATION
- Chemo: not proven
- OHE at time of sx is controversial
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Term
what are the appropriate treatment options for cats with mammary gland tumors |
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Definition
- Surgery!!
- RADICAL MASTECTOMY is recommended (if doing bilateral, should stage)
- NO RADIATION!!
- Chemo: effectiveness controversial
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Term
What skin tumors are common in dogs and cats? |
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Definition
- Cats: cutaneous is second most common tumor type (after lymphoma)
- Basal cell
- Mast cell
- SCC
- Fibrosarcoma
- Sebaceous adenoma or hyperplasia
- Dogs: most common tumor type
- Mast cell
- Perianal adenoma
- Lipoma
- Sebaceous adenoma or hyperplasia
- Fibrosarcoma
- Melanoma
- Histiocytoma
- SCC
- Hemangiopericytoma
- Basal cell tumor
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Term
Describe in detail the biological behavior and etiology of SCC in cats (cutaneous tumors). |
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Definition
- locally invasive
- mets only LATE in the course of the dz
- local recurrence or distant mets possible (esp if actinic lesions)
- digital SCC is more aggressive (may even be a mets from the lung! eek!)
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Term
Which of the common skin tumors in dogs and cats are potentially metastatic (look at other lectures too)? |
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Definition
- SCC
- 15% of basal cell tumors
- sebaceous---a few mets
- lymphoma
- MCT:dog ones, cat diffuse mastocytic and GI visceral
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Term
List the DDX for cutaneous SCC in cats. |
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Definition
- Actinic keratitis
- erythematosus pre-malignant lesions associated with sun exposure
- ear tips, nose muzzle
- Chronic inflammation
- other tumors..
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Term
List ddx for lipoma (cutaneous tumors) (may need to look at other lectures) |
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Definition
- MCT
- liposarcoma
- the rest of the skin tumors?
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Term
What is the biologic behavior of soft tissue sarcomas in the dog? |
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Definition
- Tend to be SQ but can arise anywhere
- Variable in size and texture (usually bulky)
- pseudocapsule (capsule is normal and tumor cells are squashed together by growth
- finges of malignant cells through facial planes
- slow to mets
- locally invasive (local recurrence common)
- slow growing
- nonpainful
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Term
What diagnostic steps would you take for a dog with a subcutaneous mass? (soft tissue sarcomas) |
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Definition
- Rads: 25% mets to lungs
- FNA: don't exfoliate well
- bx: need for dx (must remove bx tract at time of sx)
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Term
What are the appropriate treatment options for STS in dogs based on biological behavior? |
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Definition
- no mets-->local options
- do sx (3-5 cm margins) with RT before and/or after (don't wait for regrowth!)
- chemo: not effective alone, but use in mets dz, incomplete resection and grade III
- DO NOT PEEL OUT
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Term
Which vaccines are associated with vaccine associated tumors in cats? |
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Definition
- killed vaccine products
- felv
- rabies
- killed FCRVP what4ever
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Term
What are the treatment options for vaccine associated sarcomas in cats ? |
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Definition
- SURGERY
- RT: not promising
- Chemo: not curative
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Term
What is the current recommendation for vaccine administration in a cat? |
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Definition
- Rabies: right rear leg (yearly--also local ordinances)
- FeLV: left rear leg (until age 2 if outdoor cat)
- FVRCP (mlv): intrascapular (q3yrs)
- warn clients of risks (maybe have them sign a waiver)
- have handouts about VAS readily available
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Term
What is the biologic behavior of HSA?(incats) |
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Definition
- primary sites: liver, spleen, mesentery, omentum, SQ tissues
- other sites: nasal cavity, bone, GI, muscles
- mets to liver, intra-abd LN, and lungs
- splenic form is highly metastatic
- SQ may have less malignant behavior than in dogs
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Term
What is the difference b/t cutaneous and subQ biologic behaviors of HSA? (indogs) |
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Definition
- cutaneous=dermal=lower mets rate
- SubQ=hypodermal=aggressive tumor, more likely to recur and mets
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Term
Describe the appropriate staging tests for dogs w/ SQ and visceral HSA |
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Definition
- Anemia (CBC)
- coag deficit
- thoracic rads for lung mets
- abd imaging for masses/organomegaly
- ECG: pericardial effusion
- FNA: not senstivie!
- bx: required for dx!
- section spleen like loaf of bread or just take it out
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Term
List the hematologic abnormalities that can occur w/ HSA. Comment on why these might occur. |
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Definition
- Anemia: secondary to intracavity hemorrhage, microangiopathic hemolysis
- nucleated RBCs d/t BM infiltration, extramedullary hematopoiesis, hypoxemia, hyposplenism, failure to clear normal nRBCs
- neutrophilic leukocytosis w/ inc bands d/t stress, tumor necrosis/rupture, nonspecific BM response
- thrombocytopenia d/t IM destruction, sequestration, severe hemorrhage, or DIC
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Term
What are the treatment options for feline and canine HSA? |
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Definition
- feline: sx with adjuvant tx
- chemo not well studied
- poor prog for non-cutaneous
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Term
What is the most common feline primary renal tumor? Describe its behavior. |
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Definition
- lymphoma
- malignant
- bilateral
- BM and CNS infiltration
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Term
What CBC changes can occur with renal tumors? |
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Definition
- usually normal
- may have anemia or polychythemia
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Term
List at least 3 ddx (only one can be neoplasia) for old dog w/ stranguria and hematuria. |
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Definition
- bacterial UTI
- urolithiasis
- neoplasia (ie TCC)
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Term
What are the treatment options for a dog w/ typical (TCC at trigone) bladder tumor? Which one should you use based on location and extent of tumor? |
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Definition
- sx: but they exfolliate so it's rarely curative and a pain since you have to switch gloves and instruments, etc
- Palliative:
- place cystotomy tube :get recurrent UTIs
- ureterocolonic anastomosis: get incontinence
- RT: localized but resectable disease
- Medical therapy: TX OF CHOICE B/C OF LOCATION
- cisplatin has 20% response rates
- (carboplatin does nothing)
- Piroxicam may or may be ok d/t immunomodulatory effects
- combo cisplatin and piroxicam is nephrotoxic!!!
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Term
Define and give an example of the TNM system for staging tumors. |
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Definition
- T: Tumor-->size and invasiveness of primary tumor
- bigger than 3cm with fixation to underlying tissues
- N: nodal involvement-
- either axillary or inguinal LN were palpable
- M: Presence or absence of distant metasis
- no clinical evidence of metastasis
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Term
Name three contraindications of doing a FNA. |
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Definition
1) Mast cell tumor (it becomes inflamed d/t degranulation and histamine release-->rarely serious and can be treated/prevented with an H1 blocker.....so not really a contraindication?) 2)Transabdominal needle aspiration/core bx of splenic and bladder masses-->risks dissemination and seeding of biopsy tracts b/c these tumors are highly exfoliative 3) If the aspiration tract of cutaneous/SQ masses can't be incorporated into the sx excision (always need to be able to cut out bx tract incase they seed) |
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Term
You shouldn't just go bx-ing everything--you need a reason to. Name two indications for biopsy-ing. |
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Definition
1) Therapy will be changed/altered based on the result -ie excision of the mass means amputation -ie more effective tx modality exists -tx is suspected to be invasive/benign and conformation is needed 2) Client requires it |
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Term
What is an excisional bx and when would you want to do it? |
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Definition
- it is where the entire tumor is removed with clean margins
- indications:
- small easily accessible tumor w/ sufficient normal tissue to allow for wide sx margins
- when presx bx will not likely alter tx/sx approach
- ie splenic, solitary lung mass, intracranial mass
- When it is a curative procedure
- When you want the entire mass presented to pathology b/c it has better tissue orientation and margin evaluation
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Term
Incisional bx: what is it when to do it advantages disadvantages examples |
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Definition
- define: multiple bxs taken from 1 incision site and need to include one tumor-normal margin
- Indications:
- large/difficult to remove tumors
- when initial tx may be altered based on result
- advantages:
- obtain a dx before sx
- establishes need for additional dx before sx (rads, etc)
- disadvantages:
- noncurative
- may provide path w/ non-representative bxs
- may complicate future sx
- hemorrhage or viscous rupture w/in a body cavity
- examples:
- FNA
- cutting neede bx
- keyes punch bx
- fiber optically procured samples
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Term
Describe the principles of proper tissue management |
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Definition
- Avoid damaging tissue by cautery, crushing dessication
- shrinkables (ie skin/muscle) should be fixed in normal configuration
- impression smears, cultures, or immunohxchemistry should be separated prior to fixing
- avoid submitting parts of excised tissue/representative sections, as you may not get margin evaluation
- margins need to be IDed in some way (ink, suture, separate containers, etc)
- proper labeling and thorough description of hx, location, tx hx, and response is needed
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Term
To "measure" therapeutic response, we use the RECIST criteria--explain |
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Definition
- CR: complete response--> disppearance of all clinically detectable dz
- PR: partial response--> >30% decrease in size (ie longest diameter) and no new tumors
- SD: stable disease--> <30% decrease in size or 20% increase in size with no new tumors
- PD: progressive disease--> >20% increase in size or appearance of new tumors
- if a static therapy is used, SD may be considered a good response
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Term
Indications for chemotherapy: |
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Definition
- Systemic neoplasia (lymphoma)
- Metastatic neoplasia (hemangiosarcoma)
- Incomplete surgical resection/nonresectable neoplasia (MCT)
- Radiation sensitization (oral SCC)
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Term
define: - Induction therapy:
- Maintenance therapy:
- Salvage protocol(rescue):
- Adjuvant therapy:
- Primary (neoadjuvant):
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Definition
- Induction therapy: intensive initial therapy (chemo is the only tx method)
- Maintenance therapy: continuation of less intense chemo to maintain a remission (duration is controversial)
- Salvage protocol(rescue): Induction for those who failed a diff chemo protocol and are switched to another (used at relapse)
- Adjuvant therapy: Chemo after sx
- Primary (neoadjuvant): chemo before sx to shrink the tumor
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Term
How does chemo work? blank and blank determine the extent of damage... |
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Definition
- damages/kills rapidly dividing and growing cells (ie inhibits mitosis/DNA synthesis, damages DNA, etc)
- DOSE and LENGTH OF EXPOSURE TO THE DRUG determine the extent of damage
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Term
Which cell populations are affected by chemo? give examples |
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Definition
- Rapidly dividing cells
- examples:
- tumor cells:genetic instability rapid growth create inherent sensitivity
- Intestinal epithelial cells: takes 3-5 d for them to grow up from the crypts
- BM: PMNs and platelets are most affected b/c they have the shortest circulating half-life
- Hair follicles
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Term
Describe in detail the potential general side effects of chemo |
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Definition
- GI Toxicity
- intestinal epith replaces every 3-5 d-->delayed signs of in appetance, nausea, vomition, diarrhea
- 2 mechanisms
- direct damage to intestial epithelial cells (after 5-7d)
- Triggering of CRTZ (onset in 24h)
- Myelosuppression:
- secondary to damage of rapidly dividing stem cells
- lowest point of myelosuppression is 5-7 d
- usually affects PMNs and platelets (not RBCs)
- Alopecia
- Perivascular slough
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Term
Why is combo chemotherapy used? |
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Definition
- maximal cell kill w/in an acceptable toxicity range
- broader range of coverage of resistant cell lines
- prevent/slow the development of new resistant cell lines
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Term
List some basic principles of combo chemo use. |
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Definition
- use only drugs known to be effective as single agents
- if several drugs are effective, choose on the basis of toxicity--don't overlap toxicities w/ other drugs
- causes a wider range of side effects, but minimizes risk of damage to one organ system
- allows maximization of dose
- use optimal dose and schedules for each drug
- give at consistent intervals
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Term
List safety precautions when handling chemo drugs |
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Definition
- chemo is excreted in urine and feces so where gloves for 48 hrs after tx and double bag waste
- if aerosol drug: prepare in a quiet, clean, draft-free room, wear dust mask or respirator and safety goggles
- topical-->wear chemo gloves (or double latex) and clean, buttoned-up lab coat
- consider chemo administration gowns
- never drink, eat, smoke in the chemo administration room
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Term
What are the three main forms of plasma cell tumors? |
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Definition
- multiple myeloma
- Extramedullary plasmacytoma
- Solitary osseous plasmacytoma
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Term
What are the sequelae of excessive Ig production in MM? |
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Definition
· Infection arises b/c excessive paraproteins inhibit production of normal Ig (àimmunocompromised individual!) · Hyperviscosity syndrome: excessive paraproteins à increased TP and hypervolumeia à o ↑ cardiac wordload, cardiomegaly, myocardial hypoxia o Poor perfusionàneuro signs (rare) o Overdistension of vasculature, messed up platelets, clotting cascade disturbed, consumption of coag factorsàhemorrhagic diathesis (bleeding disorders) o Renal failure (from high proteins in glomerular filtrate obstructing glomerulus and decreased perfusion) o Retinal lesions |
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Term
What do you need to dx mm? |
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Definition
2 out of the 4: - BM plasma cytosis
- osteolytic lesions
- monoclonal gammopathy
- Bence-jones proteinuria
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Term
What are the negative prognostic factors for MM? |
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Definition
- Bence-jones proteins
- hyper Ca
- many lytic lesions
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Term
How do you interpret a serum ectrophoresis? |
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Definition
- Normal: albumin is narrow peak, but the ones to the right are wavy, broadish and shallowish
- Polyclonal gammopathy; broad-based asymmetrical peak
- Monoclonal gammopathy: narrow spike-like peak
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Term
Describe treatments for: MM EMP SOP |
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Definition
- MM: combo chemo (won't cure, just extend life)
- EMP:
- skin-->benign-->sx plus RT-->cure
- GI-->sx plus combo chemo
- SOP: sx or RT for primary mass then chemo b/c can turn into MM
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Term
Id clinical signs associated with nasal and lung tumors. compare and contrast other nasal/lung pathologies |
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Definition
- Epistaxis:
- ddx:hypertension, coagulopathy, rhinitis, FB, tooth root abscess, trauma
- Sneezing
- respiratory stridor
- facial deformity/swelling (very advanced dz)
- exophthalmia (ditto)
- CNS signs (ditto and rare)
- apparent resolution of signs to Ab/nsaids (tumors go unnoticed)
- decreased air flow
- crusting at nares
- facial symmetry
- oral/dental exam
- retropulse eyes
- pain on opening mouth
- regional nodes
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Term
list dos and don'ts for dx of nasal and lung tumors |
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Definition
- DO open mouth VD view
- DO COAGS BEFORE BX OR ANYTHING (simple bleeding time is best)
- CT good for planning
- rhinoscopy is good
- nasal flush is good
- cytology is not dx
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Term
How do you appropriately stage nasal and lung tumors? |
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Definition
- FNA of regional nodes
- thoracic rads
- pre-anesthetic blood work
- coag studied
- BP
-
- CT scan maybe
- bx
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Term
List available tx options for resp tumors. |
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Definition
- Nasal:
- RT is tx of choice
- sxalone doesn't prolong survival
- palliative:nasal flush, Ab, nsaids,
- new: RT followed by sx (great!)
- chemo
- Lun:
- lung lobectomy tx of choice
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Term
Know the most common oral tumors in dogs (4) and cats (2) |
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Definition
- Dog
- SCC
- fibrosarc
- melanoma
- acanth epulides
- Cat
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Term
what is the biological behaviour of these oral tumors in dogs and cats |
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Definition
- dogs
- SCC: rostral mandible, rarely mets,bony invasion yes
- FSA: palate, rarely mets, bony invasion yes
- Melanoma: buccal mucosa, commonly mets, +/- bony invasion
- acanth epulid:rostral mandible, never mets, always invade bone
- Cat
- SCC: both jaws, gingiva, tongue, rarely mets, but get to mandibular LN, common bony invasion (they die before mets)
- FSA: gingiva, occmets, yes bony invasion
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Term
discuss the pros and cons of sx vs chemo for tx of oral tumors |
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Definition
Location! - SCC
- rostral mandible-->sx good! RT good!
- caudal mandible-->sx bad! RT bad cat, ok dog!
- FSA:
- melanoma:
- sx fair to good
- RT good w/ course fractions
- Acanth epuli:
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Term
most common intestinal tumor of cats |
|
Definition
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Term
biological behaviour of 3 most common perianal tumors in dogs |
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Definition
| see perianal tumor study sheet with chart on it |
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