Term
| T/F paraneoplastic syndromes are unrelated to tumor size or presence of metastasis |
|
Definition
TRUE
*** paraneoplastic syndromse are a result of release of hormones, hormone-like substances, and/or polypetites from cancer cells (can act locally, or enter circulation and exert effects on distant tissues) |
|
|
Term
| Why are paraneoplastic syndromes important to recognize? |
|
Definition
| paraneoplastic syndromes can contribute to the pathogenesis of neoplasia and can provide diagnostic tools to alert a practitioner to the presence of neoplasia |
|
|
Term
| How does cancer cachexia differ from cancer anorexia? |
|
Definition
Cancer cachexia refers to weight loss occuring despite adequate nutritional intake, primarily the result of IL-1, IL-6, TNF, and IF-gamma.
Cancer anorexia is asssociated with inadequate nutritional intake associated with taste aversions, cancer treatments, and growth/spread of inciting neoplasia in combination with increased resting energy requirements, and increased fat mobalization and gluconeogenesis. |
|
|
Term
| What is the best way to alleviate paraneoplastic syndromes? |
|
Definition
| treat the underlying tumor |
|
|
Term
| Why can you infer that oncology patients with clinical hypoprotinemia secondary to protein loosing enteropathy have had sustained protein losses? |
|
Definition
serum proteins have a very long half life so a patient with clinical hypoprotinemia must have had sustained protein lossess
*** PLE in cancer patients has been hypothesized as secondary to GI mucosal erosions/ulcerations which increase GI protein permiability |
|
|
Term
| What type of tumor is most commonly associated with paraneoplastic GI ulceration? |
|
Definition
Mast cell tumors --> mast cell degranulation and histamine release --> binds to H2 receptors --> increased production of HCL
*** gastrinoma (non-islet pancreatic tumor) has also been associated with GI ulceration |
|
|
Term
| What is the most common cause of hypercalcemia in dogs and cats? |
|
Definition
| cancer! (and of the cancers that cause hypercalcemia of malignancy, lymphoma <- esp. mediastinal, is the most common |
|
|
Term
| What is the pathogenesis of hypercalcemia of malignancy? |
|
Definition
depends upon the inciting neoplastic process -->
Multiple myeloma --> release of osteoclast-activating factor
primary bone tumors --> destruction of bone by neoplastic cells
lymphoma, apocrine gland ADCA --> secretion of PTH or PTHrp |
|
|
Term
| What is the first clinical manifestation of hypercalcemia of malignancy? |
|
Definition
impaired renal function (PU/PD, anorexia, vomiting, muscle weakness)
*** occurs secondary to vasoconstriction (acute hypercalcemia) with decreased GFR and decreased concentrating ability AND calcification of renal parenchyma (chronic hypercalcemia) --> epithelial cell necrosis and tubular obstruction |
|
|
Term
| Other than fluid therapy and rehydration (increase renal blood flow) what other medical therapies can be used to normalize hypercalcemia and minimize renal damage associated with paraneoplastic hypercalcemia? |
|
Definition
furosemide (potassium sparing diuretic -> increased calcium excretion by the kidneys)
glucocorticoids (reduce intestinal absorption of calcium <-- do not use if suspecting lymphoma until definitive dx has been made as glucocortoicds can substantially alter LN morphology)
**** if hypercalcemia is severe or refractory to other treatments can try using bisphosphonates or calcitonin |
|
|
Term
| What is the most common cause of hypoglycemia in dogs and the most common neoplasia associated with hypocalcemia in cats? |
|
Definition
insulinoma
***hypoglycemia is associated with excessive production of insulin by neoplastic cells |
|
|
Term
| What are some hypothesized mechanisms for paraneoplastic hypoglycemia associated with non-islet cell tumors (ex. hepatocellular carcionma, oral melanoma, hemangiosarcoma etc.)? |
|
Definition
ectopic insulin production
production of insulin-like substance
increased glucose utilization by the tumor
decreased hepatic glycogenolysis/gluconeogenesis
**** hypoglycemia associated with non-islet cell tumors is an UNCOMMON paraneoplastic syndrome |
|
|
Term
| How do you diagnose and treat insulinoma? |
|
Definition
Dx via serum chem --> increased serum insulin levels with concurrent hypoglycemia
surgical excision is treatment of choice *** remember, successful treatment of underlying neoplasia will resolve paraneoplastic syndrome |
|
|
Term
| What type of cancer is associated with anemia of chronic disease (normocytic, normochromic, +/- non-regenerative)? |
|
Definition
| disseminated tumors --> altered iron storage and metabolism + reduced RBC lifespan +/- diminished BM response |
|
|
Term
| What type of tumors are associated blood loss anemia (microcytic, hypochromic)? |
|
Definition
| vascular tumors (hemangiosarcoma) and ulcerated GI/cutaneous tumors |
|
|
Term
| Why are cancer patients at increased risk of thrombosis and DIC? |
|
Definition
| local circulatory disturbances + inactivity (blood stasis) + epithelial necrosis/release of thromboplastins w/ consumption of clotting factors |
|
|
Term
| What is the pathogenesis of paraneoplastic neutrophilia and what tumors are most commonly associated with this PNS? |
|
Definition
likely secondary to production of GM-CSF/G-CSF
commonly associated with lymphoma, renal carcinoma, lung tumors, rectal polyp and metastatic fibrosarcoma |
|
|
Term
| What tumors are associated with monoclonal gammopathy and hyperviscosity? |
|
Definition
multiple myeloma and lymphoma
*** increased immunoglobulins secondary to monoclonal gammopathy result in hyperviscosity of the blood (ataxia, seizures, depression, retinal detachement, tissue hypoxia) |
|
|
Term
| What is the clinical manifestation of paraneoplastic dermatologic syndrome and what tumors are most commonly implicated in the development of this PNS? |
|
Definition
erythema, crusts and ulcerations esp. at mucocutaneous junctions, alopecia
Although this paraneoplastic dermatologic syndrome is UNCOMMON it has been described in association with thymoma in cats and glucagonoma in dogs |
|
|
Term
| What is the most common cause of acquired myasthenia gravis (intermittent paresis, dysphagia and megaesophagus) in dogs? |
|
Definition
thymoma
**has also been reported in association with osteosarcoma, lymphoma, and bile duct carcinoma |
|
|
Term
| What tumor types have been associated with paraneoplastic peripheral neuropathy and what is the proposed pathophysiology? |
|
Definition
| peripheral neuropathy is associated with multiple myeloma, lymphoma, mast cell tumor, insulinoma and various carcinomas/sarcomas proposed mechanism is immune mediated destruction in response to antigens present on both tumor cells and peripheral nerves |
|
|
Term
| If you see a dog with warm, swollen, painful extremities, shifting lameness, and lacey periosteal proliferation affecting the diaphyeal region of long bones on limb rads, what diagnostic test should you do next? |
|
Definition
| Thoracic rads! The described clinical and radiographic findings are consistent with hypertrophic osteopathy with is associated with space occupying thoracic masses (primary lung tumors are most etiology of HO in dogs and cats but non-neoplastic causes are also possible) |
|
|
Term
| What is the mechanisms of paraneoplastic fevers? |
|
Definition
release of IL-1, IL-6, TNF-alpha and interferons by neoplastic cells
*** remember, these cytokines are also associated with the development of cancer cachexia |
|
|
Term
| What type of osteosarcoma is more common in large breed dogs? In small breed dogs? |
|
Definition
large breed dogs are more predisposed to appendicular OSA (away from elbow, near knee <-- usually begins at physis)
small breed dogs are more predisposed to axial osteosarcoma
*** cats are more predisposed to developing extraskeletal OSA (ex. mammary gland, spleen, liver, GI, skin) |
|
|
Term
| What are the three histological types of bone tumors? |
|
Definition
osteoblastic: neoplastic cells produce large amounts of tumor osteoid
chondroblastic: neoplastic cells produce cartilage and some amount of tumor osteoid
fibroblastic: neoplastic cells are primarily derived from fibroblasts and can produce both collagen and tumor osteoid |
|
|
Term
| How is the biologic behavior of bone tumors in cats different from that in dogs? |
|
Definition
| bone tumors in cats are less metastatic than bone tumors in dogs (up to 90% of dogs with appendicular osteosarcoma have micromets at the time of diagnosis) |
|
|
Term
| What is the diagnostic value of using nuclear scintigraphy for osteosarcoma? |
|
Definition
nuclear scintigraphy highlights regions of osteoblastic activity so can be useful for determining the extent of primary tumor involvement
*** nuclear scintigraphy is NOT specific to OSA lesions (ex. arthritis and osteophyte proliferation will also be highlighted) |
|
|
Term
| Where should you obtain core biopsies from suspected osteosarcoma lesions? |
|
Definition
biopsy from the CENTER of the lesion
*** Michelle trephine is most accurate method of collecting a biopsy but increases risk of pathologic fracture. Jamshidi needles are also pretty good for obtaining biopsies |
|
|
Term
| What are four prognostic indicators associated with osteosarcoma? |
|
Definition
Location of primary tumor (best to worst prognosis: rostral mandibular/maxillary >appendicular >rib >spine/craniaum >extraskeletal)
larger tumors have a worse prognosis than smaller tumors
young patients have a worse prognosis that older patients
preop ALP > 110 U/L have a worse prognosis |
|
|
Term
| T/F osteosarcoma is NOT curable |
|
Definition
|
|
Term
| What are the treatment options for osteosarcoma? |
|
Definition
SURGERY --> immediate pain relief
+/-
chemotherapy (ineffective without removal of primary tumor) cisplatin, carboplatin, doxorubicin (aka adriamycin)
+/-
local radiation therapy |
|
|
Term
| What medical therapies have been describe to treat metastisized osteosarcoma? |
|
Definition
immunotherapy --> L-MTP-PE, IL-2, TNF, FasL
Angiostatin --> inhibits angiogenesis and may inhibit tumor progression
Palladia (tyrosine kinase inhibitor) |
|
|
Term
| Other than osteosarcoma, what other types of tumors (4) can develop in bone? |
|
Definition
chondrosarcoma (nasal is most common, generally slow to met)
hemangionsarcoma (highly metastatic)
fibrosarcoma (hard to differentiate from fibroblastic OSA, may be cured with surgery)
multilobular osteochondrosarcoma (MLO) |
|
|
Term
| Which is a better prognosis periosteal OSA or parosteal OSA? |
|
Definition
paroseal has a better prognosis (slower growing, slower to met, can be controlled with surgery alone)
vs. periosteal (high grade, invasive, and histologically very similar to intraosseous OSA) |
|
|
Term
| What are the most common locations for other cancers to met to the bones? |
|
Definition
diaphysis of long bones (esp. humerus and femur) associated with hematogenous spread
pelvis and lumbar vertebrae are commonly implicated in metastisis of uro-genital malignancies |
|
|
Term
| What are three types of benign bone tumors? |
|
Definition
osteoma (associated with proliferation but NO lysis, surgery is currative)
multiple cartilaginous exostosis (occurs in young dogs, less frequently cats, lesions stop growing when patients reach skeletal maturity)
bone cyts (expansile lesions, sharply demarcated from normal bone with NO cortical lysis --> tx: currette and bone graft) |
|
|
Term
| All soft tissue sarcomas share what embryologic origin? |
|
Definition
|
|
Term
| What type of tumor is more common in animals than people? |
|
Definition
|
|
Term
| What is the biologic behavior of soft tissue sarcomas? |
|
Definition
slow growing pseudoencapsulated tumors that are locally invasive <-- local recurrence is common after conservative excision
**** because these tumors are slow growing and symptoms associated with small sarcomas are minimal, most have metastasized by the time they are clinically detected |
|
|
Term
| Although metastatic rate of soft tissue sarcomas vary with tumor grade, which tumors are more likely to be metastatic? |
|
Definition
| synovial cell sarcoma, hemangiosarcoma, and histiocytic sarcoma <-- usually met via hematogenous route, chemotherapy (doxorubicin) in addition to surgical excision is recommended |
|
|
Term
| What are some cytologic features characteristic of soft tissue sarcoma on cytology? What are some challenges associated with sample collection? |
|
Definition
cells appear generally appear spindlyoid
<-- sarcomas are poorly exfoliative compared to carcinomas so non-diagnostic samples are common. Additionally these tumors can be associated with significant inflammation which confounds cytologic diagnosis (ie. you just sample inflammatory cells) |
|
|
Term
| What is the gold standard for diagnosis of soft tissue sarcomas? |
|
Definition
| biopsy! Do NOT shell out the tumor, STS are generally pseudoencapsulated, this capsule is comprise of compressed tumor cells |
|
|
Term
| What is the metastatic rate associated with grade III (poorly differentiated) soft tissue sarcomas? |
|
Definition
50% metastasize
grade II -> 20%
grade I (well differentiated) -> <5% |
|
|
Term
| Complete excision of soft tissue sarcoma can be curative, what treatment is advised for tumors that are too large or in a location that prohibits complete excision? |
|
Definition
surgery + local radiation therapy
(surgical debulking increases the sensitivity of remaining tumor cells to radiation therapy) |
|
|
Term
| What biochemical factor causes mast cells to mature and proliferate? |
|
Definition
stem cell factor activates c-kit
*** although mutations in c-kit are implicated in the development of some mast cell tumors not ALL have the mutation |
|
|
Term
| What tissues have the highest concentration of mast cells? |
|
Definition
| tissues exposed to the environment (ex. skin, GI, lungs) |
|
|
Term
| exposure to what substance leads to mast cell degranulation? What do mast cell granules contain? |
|
Definition
| IgE causes mast cells to degranulate. Granules contain heparin (-> bruising), histamine ( -> anaphylaxis/hypotension, GI ulceration), and proteases (degrade local tissues -> invasion) |
|
|
Term
| What is the most common skin tumor in dogs? |
|
Definition
Mast cell tumors
*** often puritic, and wax and wane in size, and can become ulcerated if traumatized |
|
|
Term
| What is the most important aspect of staging mast cell tumors? |
|
Definition
LN aspirate
**** remember, even palpably normal LN may have mets, >6 mast cells per LN aspirate slide is indicative of metastasis |
|
|
Term
| What drug should be give to a patient prior to surgical excision of a mast cell tumor? |
|
Definition
| diphenhydramine (histamine release is expected as a result of handling the tumor during the surgical procedure) |
|
|
Term
| If complete surgical excision of a mast cell tumor is not possible, what adjunctive therapies are available? |
|
Definition
radiation therapy
*** can also be used as sole therapy, pre-treat with diphenhydramine and steroids
**** also palliative chemo for non-resectable tumors (palladia, vinblastine) |
|
|
Term
| What feature of malignancy has the greatest prognostic impact for mast cell tumors? |
|
Definition
| mitotic index (>5 is a negative prognostic indicator) |
|
|
Term
| What is the most common form of mast cell tumor in a cat? |
|
Definition
mastocytic (histologically similar to canine mast cell tumors) most commonly on the head and neck
*** siamese develop histiocytic form of mast cell tumors (characterized by marked esosinophilic and lymphocytic infiltrate, these tumors can spontaneously regress) |
|
|
Term
| T/F histologic grading of mast cell tumors is subjective and is NOT prognostic in feline mast cell tumors |
|
Definition
|
|
Term
| What is the difference between surgical management of mast cell tumors in dogs and cats? |
|
Definition
in dogs requires wide surgical excision (2-3 cm margins, 1 fascial plane deep)
in cats conservative surgical management is adequate and prognosis is excellent |
|
|
Term
| T/F some patients with miliary cutanous mast cell tumors have long term survival without therapy |
|
Definition
TRUE
**** can also tx with chemo (CCNU, vinblastine, prednisone) |
|
|
Term
| Splenic mast cell tumors are more common in which species? |
|
Definition
cats
**** chemotherapy is recommended following surgical excision |
|
|
Term
| What is the biologic behavior of anal sac adenocarcinoma? |
|
Definition
early mets to regional lymph nodes
*** generally looks benign on cytology but acts malignant |
|
|
Term
| What clinical signs are associated with anal sac adenocarcinoma? |
|
Definition
| hypercalcemia +/- tenesmus (sublumbar LN metastasis externally compressing the colon) +/- lumbar pain (secondary to vertebral/sacral lysis) |
|
|
Term
| What are negative prognostic factors associated with anal sac adenocarcinoma? |
|
Definition
presence of distant mets
tumor size (early detection offers best hope for a cure) |
|
|
Term
| What treatments are used for anal sac adenocarcinoma? |
|
Definition
surgical excision can be curative (esp. if tumor is small with no mets)
adjunctive radiation therapy if incomplete margins or nodal mets
*** chemotherapy is not super effective due to the slow growing nature of anal sac adenocarcinoma |
|
|
Term
| What is the most common primary liver tumors in dogs? in cats? |
|
Definition
in dogs --> high grade hepatocellular carcinoma
in cats --> biliary adenoma |
|
|
Term
| Why is chemotherapy rarely an effective treatment for hepatobiliary tumors? |
|
Definition
most of these cancer cells contain p-glycoprotein membrane efflux pump
*** surgery is treatment of choice for hepatobiliary tumors |
|
|
Term
| T/F primary lung tumors are much more common than metastatic disease in the thoracic cavity |
|
Definition
|
|
Term
| What is the most common type of primary lung tumor in dogs? |
|
Definition
| poorly differentiated carcinomas |
|
|
Term
| What is the best diagnostic test for assessing resectability of a primary lung tumor? |
|
Definition
| CT (more sensitive than survey rads, can also assess lymph nodes for metastasis and collect FNA under CT guidance) |
|
|
Term
| What disease can sometimes be mistaken for a primary lung tumor on rads but can be distinguished from neoplasia using FNA cytology? |
|
Definition
| lymphoid granulomatosis (responds to medical treatment) |
|
|
Term
| What is the ideal treatment for a primary lung tumor? |
|
Definition
lung lobectomy (+ assessment/biopsy of regional lymph nodes)
radiation therapy can be used adjunctively or as sole treatment for incompletely excised or non-resectable tumors <-- pulmonary fibrosis is a complication |
|
|
Term
| What chemo agent is most affective against primary lung tumors? |
|
Definition
vinblastine (however, these tumors tend to have resistance proteins <-- so do hepatobiliary tumors, which make tx with chemo less effective)
*** if malignant pleural effusion is present intracavitary chemo can be palliative |
|
|
Term
| What is the most important prognostic factor for primary lung tumors? |
|
Definition
histologic grade (Can only be obtained from lung lobectomy)
smaller sized tumors and solitary tumors without lymph node involvement are associated with a better prognosis |
|
|
Term
| What is a common location of metastasis of primary lung tumor in a cat? |
|
Definition
| digits (the presence of digital mets is a negative prognostic indicator; however, biopsy samples can be collected from this location with minimal patient morbidity (vs. thoracotomy for lung lobectomy) |
|
|
Term
| T/F invasiveness associated with thymoma is determined based on severity of clinical signs rather than histology |
|
Definition
TRUE
***distant mets are rare, however local invasion is quite common --> dyspnea, precaval syndrome (obstruction to lymphatic and venous drainage past the thoracic inlet --> facial edema) and PNS (myasthenia gravis) |
|
|
Term
| What inflammatory cell is often found infiltrating thymoma lesions in dogs? |
|
Definition
|
|
Term
| What clinical signs are assocaited with thymoma? |
|
Definition
dyspnea/coughing
precaval syndrome (lymphatic and venous obstruction at thoracic inlet --> facial edema)
caudally displaced heart sounds |
|
|
Term
| How can you differentiate thymic lymphoma from a lymphocyte infiltrated thymoma on FNA cytology? |
|
Definition
| primary lymphoBLASTS associated with thymic lymphoma while mature lymphocytes associated with thymoma |
|
|
Term
| What is the treatment of choice for thymoma? |
|
Definition
| surgical resection --> good prognosis if completely resectable |
|
|
Term
| What is the treatment for mesothelioma? |
|
Definition
| palliative thoracocentesis <-- chemotherapy has not been very effective |
|
|
Term
| Why might brachycephalic dogs be predisposed to developing chemodectomas? |
|
Definition
there is an association between chronic hypoxemia and development of the tumor
**** usually benign, clinical signs associated with local effect of the tumor on sensitive nearby structures (ie. the heart) |
|
|
Term
| What anatomic location is associated with metastasis of hemangiosarcoma? |
|
Definition
|
|
Term
| T/F primary renal tumors are more common than metastatic |
|
Definition
|
|
Term
| What is the most common neoplasia of the bladder and urethra? |
|
Definition
| transitional cell carcinoma --> most commonly affects the trigone |
|
|
Term
| What clinical signs are associated with urogenital tumors? |
|
Definition
| hematuria, dysuria and polakiuria --> often clinical signs resolve with antibiotic therapy because secondary bacterial infections are common, once therapy is removed infection recur due to underlying neoplasia |
|
|
Term
| What method of sample collection is safest and associated with the highest diagnostic yield in cases of suspected urogenital tumors? |
|
Definition
mid-stream voided urinalysis
*** there is a small risk of tumor seeding along the needle tract if sample is collected via cysto |
|
|
Term
| What does a positive value on the veterinary bladder tumor antigen assay (VBTA) mean? |
|
Definition
VBTA is very sensitive but not so specific (false positives with protinuria and hematuria) so a positive result necessitates further diagnostic testing (ex. ultrasound, contrast cystography, cystoscopy)
*** negative VBTA allows bladder neoplasia to be ruled out |
|
|
Term
| Surgical resection of bladder tumors is possible if the trigone isn't affected (most common region affected), and while surgery is associated with improved survival why is curative resection unlikely even with clean margins? |
|
Definition
bladder tumors are highly exfoliative and transitional cell carcinoma is very invasive
*** can add piroxicam or mitoxatrone for improved clinical comfort |
|
|
Term
| T/F prostatic neoplasia is more common in intact male dogs |
|
Definition
| FALSE! prostatic neoplasia is NOT androgen dependent (only perianal adenoma is androgen dependent) and is more common in neutered male dogs |
|
|
Term
| What is the treatment and prognosis for prostatic neoplasia? |
|
Definition
| palliative piroxicam, prognosis is grave |
|
|
Term
| What are risk factors associated with development of mammary carcinoma? |
|
Definition
intact females are at higher risk (0.5% chance of developing mammary carcinoma if spayed before 1st estrus, 26% if spayed before 3rd estrus)
risk increases with age and obesity |
|
|
Term
| What is the 50, 50 rule in regards to canine mammary tumors? |
|
Definition
| 50% are malignant, 50% metastasize (lung, lymph nodes, liver) |
|
|
Term
| What 5 signs associated with malignant mammary tumors? |
|
Definition
rapid growth, ulceration, inflammation, poorly circumscribed, fixed to skin or muscle
*** these are important to note as it is difficult to distinguish malignant from benign mammary tumors on cytology |
|
|
Term
| When is a lumpectomy sufficient for removing a mammary tumor in a dog and when do you need to do a mammectomy (ie. remove mammary gland and fascia underneath)? |
|
Definition
<0.5 cm and not fixed --> lumpectomy
>1 cm or fixed --> mammectomy
*** because mammary tumors often have multiple primary masses use the simplest procedure to remove all the tumors |
|
|
Term
| Which factors are NOT prognostic for canine mammary tumors? |
|
Definition
| number of tumors, or (mammary) glands involved |
|
|
Term
| What type of mammary tumor is associated with a very poor prognosis even with surgery? |
|
Definition
| inflammatory mammary carcinoma (rapidly growing, multiple glands affected, painful and erythematous with mononuclear and PMN inflammatory cell infiltrates) |
|
|
Term
| T/F feline mammary tumors are more likely to be malignant than canine mammary tumors |
|
Definition
TRUE (85% of feline mammary tumors are malignant <-- remember 50,50 rule for dogs (50% malignant, 50% metastasize))
*** ALWAYS do radical mastectomy for cats |
|
|
Term
| What is the main differential for feline mammary tumor? How is this disease treated? |
|
Definition
fibroepithelial hyperplasia (massive swelling, ulceration and edema affecting multiple glands <-- secondary to hormonal stimulation)
Tx is OHE via flank incision (too much edema for ventral midline) |
|
|
Term
| What are the three phases of illness? |
|
Definition
| crisis, chronic, terminal |
|
|
Term
| What are the three key questions to address with families that are caring for pets in the chronic phase of illness? |
|
Definition
What is the greatest source of strain?
What is the family doing well?
How can you [the vet] make daily life more predictable/manageable? |
|
|
Term
| What are the four key questions to address with families that are caring for pets in the crisis phase of illness? |
|
Definition
Who makes up the family?
Who is the key decision maker?
What resources are available to the family to help with understanding and coping with the disease?
What does the family need from you [the vet]? |
|
|
Term
| What are the three key questions to address with families that are caring for pets in the terminal phase of illness? |
|
Definition
What needs to happen for euthanasia to feel like the right decision?
Are there practical restrictions to the patient's care?
What, if anything, is unacceptable for your animal to experience as they die? |
|
|
Term
| What two qualities have been identified as components of a positive euthanasia experience in veterinary medicine? |
|
Definition
supportive and non-judgmental veterinary team
Some sense of control over how death unfolds for the animal
*** always keep a list of end-of-life and crisis response resources available |
|
|
Term
| What are the three most common cutaneous tumors in horses? In cattle? |
|
Definition
horses --> sarcoids> squamous cell carcinoma> melanoma
cattle --> papillomatosis> squamous cell carcinoma> lymphoma |
|
|
Term
| list the five types of sarcoids in order from most benign to most malignant |
|
Definition
occult - verrucous - nodular - fibroblastic - malevolent
***mixtures of various forms on one horse is very common |
|
|
Term
| Describe the clinical appearance and biological behavior of occult sarcoids? |
|
Definition
occur in hairless or thinly haired areas (face, medial thigh), localized area of alopecia (hard to appreciated given location) which develops a superficial gray keratin crust
can remain static or spontaneously resolve, if traumatized can develop into a more aggressive form |
|
|
Term
| Describe the clinical appearance and biological behavior of verrucous sarcoids? |
|
Definition
crusty wart-like lesions often associated with paralesional invasion (thickening of surrounding skin)
May remain static, if traumatized can develop into a more aggressive form |
|
|
Term
| Describe the clinical appearance and biological behavior of nodular sarcoids? |
|
Definition
discrete solid nodules, single or multiple, that vary in size. Most commonly occur at eyelid, axilla, and medial thigh. Subtype A: no cutaneous involvement, skin moves freely over the lesion vs. Subtype B: poorly defined margins, overlying skin cannot be moved independently of the nodule
extremely prone to malignant transformation if traumatized |
|
|
Term
| Describe the clinical appearance and biological behavior of fibroblastic sarcoids? |
|
Definition
fleshy, ulcerated, and highly vascular, secondary bacterial infection is common (because fibroblastic sarcoids commonly develop at the site of a wound can be mistaken for exuberant granulation tissue)
quite locally invasive |
|
|
Term
| Describe the clinical appearance and biological behavior of malevolent sarcoids? |
|
Definition
rare, multiple lesions with extensive spread through skin and SQ tissues
highly aggressive and invasive, complete cure is unlikely |
|
|
Term
| What sites of sarcoid development are associated with a poorer prognosis? |
|
Definition
periocular and distal limbs
*** complete excision may not be possible for sarcoids that develop in these regions |
|
|
Term
| What two principles must be followed for successful sarcoid treatment? |
|
Definition
| Treat early and desisively (trauma associated with biopsy/FNA often incite malignant transformation in the more benign forms) |
|
|
Term
| T/F surgical excision is the least successful sarcoid treatment when used alone |
|
Definition
|
|
Term
| What is the leading cause of death associated with cancer? |
|
Definition
| malignancy, so, strive for EARLY DETECTION (decreases patient morbidity and cost of treatment, increases positive outcomes associated with treatment) |
|
|
Term
| What is the treatment of choice for pituitary tumors? |
|
Definition
| radiation therapy (alone MST 1-3 years) |
|
|
Term
| What is the mechanism of prednisone for the treatment of brain tumors? |
|
Definition
decrease CSF volume, parenchymal inflammation and edema --> decrease intracranial pressure
**** neurons are VERY susceptible to pressure necrosis |
|
|
Term
| Which type of brain tumor is most ammenable to surgery? |
|
Definition
|
|
Term
| What is the inciting cause of actinic squamous cell carcinoma? |
|
Definition
solar radiation
*** actinic SCC affects lightly pigmented areas of skin with poor hair coverage ex. nasal planum, ears, periocular |
|
|
Term
| What is the potential etiology of multicentric (bowen's) SCC? |
|
Definition
|
|
Term
| What are the best treatment options for superficial squamous cell carcinoma lesions? for invasive lesions? |
|
Definition
superficial: surgical excision, cryotherapy, strontium pleiotherapy (single tx for lesions <2mm deep)
invasive: nosectomy
*** surgery is WAY more effective than radiation therapy for SCC |
|
|
Term
| Why should you run a coagulation panel in patients that require a nasal biopsy for characterization of a tumor? |
|
Definition
| nose is very vascular and biopsy requires a large piece of tissue (lots of bleeding even in patients with normal coag capabilities) |
|
|
Term
| What is the most common nasal tumor in dogs? In cats? |
|
Definition
dogs --> carcinoma
cats -> lymphoma |
|
|
Term
| What is the landmark for measuring catheters for use in biopsy collection of suspected nasal tumors? |
|
Definition
| medial canthus of the eye |
|
|
Term
| What diagnostic test should be done prior to nasal hydropulsion (collect biopsy specimine and relieve nasal congestion)? |
|
Definition
| CT or MRI to assess integrity of cribiform plate --> in not intact water will be flushed into the cranium during the procedure resulting in elevated intracranial pressure --> pressure necrosis of neurons |
|
|
Term
| What is the best treatment for nasal tumors? |
|
Definition
radiation therapy!
*** surgery is NOT reccommended (unless it's squamous cell carcinoma) |
|
|
Term
| What side effects associated with radiation therapy generally resolve? |
|
Definition
mucositis and moist desquamation (these are acute side effects of radiation therapy)
VS. delayed effects (alopecia, keratoconjunctivitis sicca, and cataracts) do not resolve |
|
|
Term
| How should you work up a suspected salivary gland tumor? |
|
Definition
FNA of mass and regional nodes, chest rads, and REFER!
**** surgery is VERY complicated |
|
|
Term
| T/F most thyroid tumors in dogs are functional |
|
Definition
FALSE <- most thyroid tumors in dogs are carcinomas
**** most thyroid tumors in CATS are FUNCTIONAL adenomas -> hyperthyroidism |
|
|
Term
| What is the histological appearance and biological behavior associated with thyroid carcinomas in dogs? |
|
Definition
| appear histologically benign but behavior aggressively biologically |
|
|
Term
| Due to the vascular nature of thyroid tumors what FNA technique provides the most diagnostic samples? |
|
Definition
| rapid single pass, non-aspiration technique |
|
|
Term
| What is the treatment of choice for a freely movable thyroid tumor? fixed? |
|
Definition
freely movable --> surgical excision +/- radiation therapy (incomplete margins)
fixed --> curative intent radiation therapy or radioactive iodine |
|
|
Term
| What are three negative prognostic indicators associated with thyroid tumors? |
|
Definition
| size (>20cm), fixed (ie. invasive), mets (tend to be associated with larger tumors >4.7 cm) |
|
|
Term
| What is the most common oral tumor affecting dogs? cats? |
|
Definition
dogs -> malignant melanoma
cats -> squamous cell carcinoma |
|
|
Term
| What are the most common sites of primary malignant melanoma tumors in dogs? |
|
Definition
| oral and digital ** dermal lesions are usually benign |
|
|
Term
| What should always be a differential diagnosis for any anaplastic oral tumor? |
|
Definition
| amelanotic malignant melanoma |
|
|
Term
| Other than surgery and radiation therapy, what other treatments are available for management of malignant melanoma in dogs? |
|
Definition
| immunotherapy (plasmid DNA human tyrosinase) |
|
|
Term
| Although surgery and radiation therapy have the greatest impact against oral squamous cell carcinoma in dogs, what chemotherapy protocol can also be used? |
|
Definition
|
|
Term
| How does the location of a primary oral squamous cell carcinoma affect prognosis? |
|
Definition
| rostral lesions have a better prognosis than caudal; mandibular lesions have a better prognosis than maxillary; gingival>lingual>tonsilar |
|
|
Term
| What is the histologic and biologic appearance of canine oral fibrosarcoma? |
|
Definition
| appear histologically benign, but behave biologically aggressively |
|
|
Term
| What type of epulis is locally invasive? |
|
Definition
acanthomatous ameloblastoma
vs. fibromatous and ossifying epulides which are benign |
|
|
Term
| What tissues are epulides derived from? |
|
Definition
| periodontal ligament fibrometous and ossifying -> benign acanthometous ameloblastoma -> locally invasive |
|
|
Term
| What clinical signs are associated with esophageal tumors? What is the prognosis? |
|
Definition
regurgitation is most common clinical sign
prognosis is poor |
|
|
Term
| What is the most common gastric tumor in dogs? |
|
Definition
adenocarcinoma
*** high met rate, poor prognosis even if resectable |
|
|
Term
| what is the most common gastric tumor in a cat? |
|
Definition
gastric lymphoma
*** tx w/ chemo |
|
|
Term
| What is the most common intestinal tumor? |
|
Definition
lymphoma
**** cats have high incidences of intestinal mast cell tumors as well |
|
|
Term
| T/F intestinal carcinomas rarely metastasize |
|
Definition
FALSE
*** mets are common at time of diagnosis |
|
|
Term
| What is the primary treatment for intestinal tumors? |
|
Definition
| surgery (even if mets are present) |
|
|
Term
| What palliative therapy is available for patients with carcinomatosis? |
|
Definition
| abdominocentisis, intracavitary chemo (vs. malignant pleural effusions don't respond well to intravacitary chemo), carboplatin and mitoxantrone |
|
|
Term
| Place the three types of rectal carcinoma in order from worst to best prognosis |
|
Definition
| annular - nodular/cobblestone - pedunculated |
|
|
Term
| What is the most common perianal tumor in dogs? |
|
Definition
perianal adenoma
** androgen dependent, common in intact male dogs, slow growing - do not met |
|
|
Term
| What is the cytologic appearance of perianal adenoma? What is the tx? |
|
Definition
appears hepatoid on cytology
tx via surgical resection and castration |
|
|
Term
| What is the difference in biological behavior of perianal sebacious gland adenocarcinoma vs. perianal adenoma? |
|
Definition
sebacious gland adenocarcionma is NOT androgen dependent, it's faster growing and commonly mets to regional nodes
vs. perianal adeoma is androgen dependent and biologically benign |
|
|
Term
| What three factors likely contribute to the development of sarcoids in horses? |
|
Definition
host genetics
viral infection (bovine papillomavirus)
environmental factors (fly vectors etc.) |
|
|
Term
| Which sarcoid treatment option works pretty well for small periorbital sarcoids of the fibroblastic or nodular type but is associated with anaphylactic shock after repeated injections? |
|
Definition
| bacille calmette-guerin TB vaccine (BCG) *** do not use for sarcoids on the limb! |
|
|
Term
| What are the general treatment recommendations for equine sarcoids? |
|
Definition
MULTI-MODAL!!!
CO2 laser excision/ablation + cisplatin bead +/- aldara (imiquimod) |
|
|
Term
| What risk factors are associated with development of squamous cell carcinoma in horses? |
|
Definition
breed (drafts, paints, appaloosas)
poorly pigmented/haired areas of skin (common at mucucutaneous junctions)
exposure to UV light |
|
|
Term
| What are the sites of predilection for equine squamous cell carcinoma? |
|
Definition
| eyes and external genetalia |
|
|
Term
| What signalment is most commonly associated with equine melanoma? |
|
Definition
gray horses
*** malignant melanoma is rare |
|
|
Term
| What is the difference between equine dermal melanomas and dermal melanomatosis? |
|
Definition
melanoma -> smaller single or multiple nodules that originate deeper in the dermis and appear benign histologically
melanomatosis = multiple large melanomas <-- associated with increased risk of metastasis |
|
|
Term
| What are the predilection sites for equine melanoma in gray horses? |
|
Definition
| perineum/base of tail and head (lips, eyes, parotid region) |
|
|
Term
| What is the main treatment for melanoma in horses? |
|
Definition
benign neglect
*** surgical excision is usually curative but new tumors will likely develop, melanomas rarely cause significant disease in affected horses |
|
|
Term
| What is the treatment for bovine papillomatosis? |
|
Definition
| surgical excision or cryotherapy are often curative; however, most lesions that develop in young animals will spontaneously regress |
|
|
Term
| T/F cutaneous lymphoma in cattle is associated with BLV infection |
|
Definition
FALSE
**** occurs sporadically in young animals |
|
|
Term
| What type of tumor can occur in young bulls and interfere with breeding? |
|
Definition
| penile/prepucial fibropapillomas |
|
|
Term
| T/F incidence of neoplasia is greater in small animals than in large animals |
|
Definition
|
|
Term
| Although neoplasia is generally uncommon in cattle, which two types to occur with some frequency? |
|
Definition
lymphosarcoma (enzootic (BLV) and sporatic)
squamous cell carcinoma (occular, aka cancer eye) |
|
|
Term
| Which form of lymphosarcoma in cattle is ALWAYS derived from B-cell lineage? |
|
Definition
enzootic (BLV)
vs. sporatic may be derived from B or T cell lineages |
|
|
Term
| What is the most common form of lymphosarcoma in cattle? |
|
Definition
enzootic (BLV)
*** infected cattle are seropositive for life, <5% of infected cattle develop lymphosarcoma (but that's still more frequent than sporatic forms) |
|
|
Term
| What are the predilection sites for enzootic lymphosarcoma in cattle (BLV)? |
|
Definition
heart (right atrium), abomasum, retrobulbar, epidural, uterus
+/- generalized lymphadenopathy |
|
|
Term
| Which form of lymphosarcoma in cattle is most frequently associated with generalized lymphadenopathy? |
|
Definition
sporatic juvenile generalized form
**** calves 3-6 months of age, anemia is also common (secondary to neoplastic BM infiltration) |
|
|
Term
| T/F BLV can only infect cattle |
|
Definition
FALSE
**** goats and (esp.) sheep are susceptible -> percentage that go on to develop LSA is unclear |
|
|
Term
| What is the most common neoplasia of cammelids? |
|
Definition
lymphosarcoma
**** poor prognosis |
|
|
Term
| What neoplasia is responsible for 'cancer eye' in cattle? |
|
Definition
squamous cell carcinoma
** most common in animals with white faces |
|
|
Term
| What is the most common neoplasia in horses? |
|
Definition
lymphosarcoma
*** B,T, and mixed. No evidence of viral oncogenesis |
|
|
Term
| What are the four most common forms of equine lymphosarcoma? |
|
Definition
alimentary (malabsorption syndrome)
thymic
multicentric (lymphadenopathy)
cutaneous (spontaneous regression in some horses) |
|
|
Term
| In large animals, what is the most reliable way to diagnose lymphosarcoma? |
|
Definition
| wedge biopsy of affected tissue or LN (FNA doesn't provide the most diagnostic samples) |
|
|
Term
| What is the treatment for cutaneous lymphosarcoma in horses? What is the expected outcome of treatment? |
|
Definition
palliative corticosteroids +/- asparaginase --> animals may be cured, remission with recurrence once tx is stopped, or animals may not respond to tx
*** additionally spontaneous remission of cutaneous LSA has been reported in some horses |
|
|
Term
| What is the most common neoplasia that occurs in equine salivary glands? |
|
Definition
|
|
Term
| What is the most common neoplasia that occurs in equine esophagus? |
|
Definition
| squamous cell carcinoma (metastasis is common with GI SCC) |
|
|
Term
| What is the most common primary hepatic neoplasia in young horses? in old horses? |
|
Definition
young --> hepatoblastoma
old -> cholangiocarcinoma |
|
|
Term
| What is the most common neoplasia affecting the bladder in horses? |
|
Definition
squamous cell carcinoma
*** transitional cell carcinoma is most common bladder tumor in small animals |
|
|
Term
| What is the most common ovarian tumor in horses? |
|
Definition
granulosa cell tumor --> stallion like behavior
tx w/ OHA |
|
|
Term
| What is the most common testicular tumor in stallions? |
|
Definition
|
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