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73 Cards in this Set
- Front
- Back
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where does lymphoma happen in the body |
anywhere that there are lymphocytes Most commonly LN, spleen, BM |
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what are all the names for lymphoma |
lymphosarcoma malignant lymphoma LSA |
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how common is lymphoma in the dog |
common 24% of all canine cancers |
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what causes lymphoma |
the etiology is poorly understood and multifactorial (they don't know) -- the does appear to be a genetic/breed specific risk for B cell vs. T cell lymphomas --potentially infectious -- environmental |
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what are the anatomic classifications for lymphoma |
multicentric - most common (84%) GI mediastrinal cutaneous primary extra nodal (ocularm CNS, bone, heart, nasal) |
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how is lymphoma staged |
based on distribution in the body - I: solitary node - II: regional involvement - III: generalized lymphodenopathy - IV: liver and/or spleen involvement - V: blood, BM, or other organ system involved |
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most dogs are at what stage at the time of prognosis |
stage III or IV (multicentric or liver/spleen involvement) |
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how would an animal be substaged |
A - clinically well B - clinical signs present |
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what is the grade based on |
histologic classification of how quickly the cancer is likely to grow and spread -- cell size and maturity |
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what is "high grade" lymphoma |
large lymphoblasts 75-80% of cases |
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what is "low grade" lymphoma |
mature/small lymphocytes "indolent lymphoma" |
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what about criteria for malignancy |
there is none for lymphoma -- it is just cell size and maturity |
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what were the 4 most common anatomical locations for lymphoma in the dog |
multicentric GI mediastinal extra nodal
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what would be the clinical presentation of an animal with multicentric lymphoma |
-- 80% will have lymphadenopathy - there are often no other clinical signs -- hepatosplenomegaly may be felt -- none-specific signs: weight loss, anorexia, fever, V, diarrhea, PU/PD if hyperCa |
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what would be the clinical presentation of a dog iwth GI lymphoma |
Proximal GI: V, melena, hematemesis, weight loss Distal GI: hematochezia, tenesmus |
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what clinical signs would be associated with mediastinal lymphoma |
--cough, respiratory compromise, exercise intolerance and distress -- PU/PD from hyperCa may be the only sign -- regurgitation due to a large mass -- precaval syndrome when the lymphatic drainage is blocked |
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mediastinal lymphoma is most likely ___ cell |
T
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__ cell is most likley to cause hyperCa |
T |
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what are the main rule outs for the thymic mass you see on rads |
lymphoma thymoma
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what FNA result would rule out lymphoma |
CD4+ and CD8+ lymphocytes |
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when lymphoma is extra nodal what site is common. why should you look for |
eye look for uveitis |
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is FNA a good way to diagnose lymphomay |
yes -- the cells exfoliate easily |
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what would you need to do to diagnose small cell lymphoma |
biopsy -- also required for grading and sub-classification |
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what is difference in disease course for high and low grade lymphoma |
high: rapid low: slowly progressive |
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how does treatment differ |
high: ideally multidrug chemo low: monitor animal until clinical signs are present and then treat w/ oral med (chlorambucil and pred) |
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what is the prognosis associated with high and low grade |
high: not great - disease will probably kill them low: very good - dogs my die w/ the disease, but not of the disease |
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what 5 things are associated with prognosis for dogs with lymphoma |
- immunophenotyping: on of the strongest (T cell worse than B cell) - clinical substage: B is worse than A - anatomic location: GI, skin, leukemic, hepatospleninc, mediastinal - histology: high grade worse survival than low |
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why would mediastinal lymphoma have a worse prognosis |
it is generally T cell |
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can clinical stage be used as a prognostic indicator |
it is not a consistent prognostic indicator, but lower stages do seem to live longer |
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what about hyperCa as a prognostic inidcator |
it is associated with T cell lymphoma which has a worse prognosis, but there is no difference in survival based on hyperCa alone |
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what might be the problem with steroid use pre-treatment |
steroids can lead to restance in the lymphocytes, but they don't know how long this takes |
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what is the treatment of choice with lymphoma |
systemic therapy with a multi drug protocol |
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what is the benefit of a multi drug protocol |
attack the cells w/ drugs that have different MOAs |
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what is the protocol generally recommended |
CHOP vincristine cyclophosphamide doxirubicin prednisone |
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which drug could be used when you are using a single drug protocol |
doxirubicin |
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what is prednisone used for |
palliation only |
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what is the goal of therapy |
induce a durable clinical remission while avoiding severe side effects.
don't make the treatment worse than the disease |
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what are two really important things that owners need to understand |
remission does not equal cure -- it will come back and most dogs will eventually die from it
some dogs experience side effects, most are mild and self limiting w/ oral med, but 1% risk of death secondary to chemo |
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what are some considerations related to patient and chemo |
- stage of disease - presence of paraneoplastic syndrome - physiologic state - temperament - how the dog will handle being in the hospital - tolerance to toxicity: MDR1 mutation breeds |
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what is the prognosis for multicentric lymphoma - w/ no therapy - w/ pred alone - w/ doxirubicin and pred - w/ multi-agent protocol |
- no tx: 4-6 weeks even when they feel good on presentation - pred: 2-3 months (palliative) - doxirubicin and pred: 6-9 months - CHOP: median remission - 8-10 months (including 6 mths of therapy). median survival - 1 yr (25% alive at 2 yrs) |
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what are some other treatment options |
- radiation w/ CHOP may improve outcome - BM transplant - monoclonal antibodies |
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___ of all feline tumors are lymphoma |
1/3 |
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prior to FeLV vaccinations what did lymphoma look like in cats |
mediastinal, multicentric and CNS lymphoma were most common
young cats 4-6 yrs
70-80% FeLV+ |
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what does lymphoma currently look like in cats |
GI is the most common site
older cats (11 yrs)
14-25% (maybe less) have FeLV |
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how does FeLV lead to lymphoma |
- insertion of the FeLV genome into the cellular genome near the oncogene myc leads to activation and uncontrolled cell proliferation
- viral incorporation of the oncogene to form a recombinant virus |
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has lymphoma in cats decreased with FeLV decrease |
no, it has increased, but changes location and signalment |
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what about genetics |
there is a genetic link in the siamese cat to mediastinal LSA |
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what environmental factor has been shown to increase risk of lymphoma 2.4 fold |
second hand smoke |
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what is the link between IBD and lymphoma |
IBD has been shown to lead to low grade GI lymphoma through chronic inflammation |
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why might FIV lead to a 5x increased relative risk of lymphoma |
immune suppression |
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what three ways can lymphoma be classificed in the cat (and dog) |
anatomic location histologic grade stage and substage
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what are the 4 most common anatomic locations for lymphoma in the cat |
alimentary mediastinal nodal/multicentric nasal |
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mesiastinal LSA is associated with what clinical signs and signalment in the cat |
young FeLV+ cats dyspnea, decreased lung sounds -- effusion hyperCa is rare although T cell is more common |
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what other anatomic location would also be associated with young FeLV+ cats |
nodal, multicentric |
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nasal is the most common extra-nodal form, does it generally spread |
no, it tends to stay in the nasal cavity |
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does staging have any prognostic value in the cat |
no |
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most cats are substage ___ |
B |
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can immunophenotype be used in the cat |
it is not prognostic |
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what should you do when a cat is hyperCa |
rule out other causes (CKD) -- hyperCa of malignancy is uncommon |
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what is the signalment associated with GI lymphoma in the cat |
older FeLV - cats |
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GI lymphoma is most likely to be in the ____ intestine |
small |
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what cell type is associated with high and low grade GI LSA |
high: lymphoblastic - often B cell low: lymphocytic - often T cell |
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what history would be consistent with high and low grade LSA |
high: rapid onset clinical signs + animal sick on presentation
low: longer clinical course + animal still happy on presentation |
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what PE finding would be consistent with high and low grade LSA |
high: palpable mass low: thickened intestines |
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you see an intestinal mass on the abdominal US -- what is the next diagnostic step |
FNA for cytology |
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you see intestinal thickening on US - what is the next diagnostic step |
endoscopic full thickness biopsy |
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how would high grade LSA be treated |
multi agent protocol chemo -- CHOP or COP |
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why might the H be dropped form the protocol |
doxirubicin is not as effective in cats and cat be nephrotoxic |
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what about tx for low grade |
chlorambucil and pred (generally for life) |
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what is the prognosis for high grade GI LSA |
response to therapy is the best prognnostic indicator - but you don't know until you try - 1/3 don't respond - 1/3 respond well w/ 6-8 months - 1/3 respond well w/ 16-18 months
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what is the prognosis for low grade GI LSA |
good 95% remission w/ a median survival of 2 yrs. |
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what is large granular lymphoma |
another variant of high grade GI LSA from the cytotoxic and T cell lineage
cytology will have large granules in the lymphocytes
signs are similar to high grade LSA, but the prognosis is really poor (57 days) |
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6 factors that don't effect the feline prognosis |
phenotype (B cell vs. T cell) age sex breed FIV status pre-tx w/ pred |
