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198 Cards in this Set
- Front
- Back
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Name 9 features of malignancy |
Degree of differentiation Mitosis index Degree of cellular or nuclear polymorphism Amount of necrosis Invasive ness Stromal reaction Nucleolar size and number Overall cellularity Lymphoid response |
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What is immunohistochemistry? |
Staining procedure using antibodies to identify specific intracellular or extracellular molecules eg KI67 |
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What is lung digit syndrome? |
A condition in cats where metastatic lesions of the digits appear secondary to primary lung tumours |
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Cats can appear with paraneoplastic disease such as? 2 |
Alopecia in pancreatic, hepatic or bile duct carcinoma Exfoliative dermatitis with thymoma |
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3 ancillary tests which may aid diagnosis is lymphoma? |
Immunocytochemistry PARR Flow cytometry |
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In what tissue are tru cut biopsies not recommended? |
Lymph nodes as they are no more sensitive than fine needle aspirates for detection of metastatic disease |
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4 neoplasia that can cause hypercalcemia |
Anal sac adenocarcinoma Lymphoma Multiple myeloma Squamous cell carcinoma |
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Which tumour can cause GI ulceration? |
MCT |
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Which lymph nodes drain - head? 2 - pinnae? 2 - distal forelimb? - proximal forelimb? - distal hindlimb? - perianal, anogenital, rectal? 3 |
- Submandibular, retropharyngeal - submandibular and prescapular - pre scapular - axillary - popliteal - inguinal, sublumbar, sacral |
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How sensitive is CT compared to rads for picking up metastasis? |
Can pick up as small as 2mm compared to 5mm |
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What is a target lesion? |
On ultrasound, hypoechoic rim with a hyperechoic or isoechoic centre |
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What is skin sparing effect? |
Mega voltage radiotherapy deposits maximum radiation dose 0.5cm below the skin |
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Difference of photons and electron beams where they treat |
Photons are used to treat deeper tumours Electron beams are used to treat superficial lesions |
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explain indirectly ionising? |
X rays (photons) collide with other atoms and transfer energy to other electrons to initiate the chain of events that causes biological damage |
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Why do some tumours shrink faster than others following radiotherapy? |
Cells die when they try to divide at the next mitosis so slow growing tumours will take longer |
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Why is presence of oxygen helpful in radiotherapy? |
Oxygen reacts with free radicals which damage DNA. In absence of oxygen cells have time to repair themselves |
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2 Benefits of more frequent fractions? |
Less time for tumour cells to repair and repopulate Less side effects |
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Why is radiation a gradual process? |
During the process tumour cells enter different phases of the cell cycle, aka redistributing. They also may become re-oxygenated which allows greater kill |
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Palliative radiotherapy regieme |
Fewer treatments but larger doses per fraction |
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Curative intent radiotherapy |
Smaller doses frequently eg daily for 4 weeks |
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Which tissues are typically affected by acute radiation side effects? |
Rapidly proliferating cells such as oral mucosa, skin, small intestines and bladder mucosa |
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What types of tissues undergo late radiation side effects? Treatment? |
Nerves and bones Not always treatable hence hypofractionated protocols only chosen in patients with a short term prognosis |
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Give an example of an anti tumour antibiotic |
Doxorubicin |
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Example of vinca alkaloid |
Vincristine |
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Example of an alkylating agent |
Cyclophosphamide Chlorambucil |
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How do corticosteroids work as a chemotherapy drug? |
Apoptosis of lymphoid, round, mast cell and plasma cell tumours |
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Actions to take if IV chemo drug extravasates? |
Stop infusion, aspirate, give dex IV in another vein |
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If vincristine extravasates what can you give? |
Hyaluronidase SC Warm compress Anti inflammatory ointment |
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If doxorubicin extravasates what can you do? 4 |
Cold compress to minimise spread Administer dexrazoxane IV at 10x dose within 3 hours. Repeat at 24 and 48 hours Apply DSMO topically every 2 hours Apply anti inflammatory ointment |
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What genetic defect can affect chemo tolerability? |
MDR gene multi drug resistance in certain breeds |
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When does neutrophil nadir occur? 1 exception |
8 days Carboplatin 10-14 days |
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What should you do if nadir falls below 1000/ microlitre 2 |
If no other symptoms then administer broad spectrum oral antibiotics do several days and monitor until next blood count. Doesn’t usually last longer than 72 hours Reduce the dose of the drug by 15-20% at next administration |
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3 possible late side effects of radiation |
Cataracts Bone necrosis Internal Strictures |
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If neutrophil count is below 2000 u/l what could you so? |
If patient clinically well then could give treatment but if drug very immunosuppressive eg doxorubicin then Delay treatment by 2-4 days |
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Neutrophil count less than 500 u/l action? |
Risk of sepsis, if fever or GI signs, hospitalisation and IV fluids and antibiotics and symptomatic |
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If patient presents for chemo with anorexia, diarrhoea, vomiting, fever action? |
Regardless of neutrophil count, treatment not given and symptomatic tx |
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3 drugs to treat diarrhoea induced by chemo |
Sulphasalazine Metronidazole Loperamide (not with mdr1 mutation) |
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What gut side effect can vincristine cause? What species more affected? Tx? 2 more toxicities? |
Ileus paralyticus more frequent in cats Self limiting, metoclopramide or cisapride can help Peripheral neuropathies and skin sloughing |
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Antiemetic prophylaxis is helpful with treatment with which drug? |
Doxorubicin |
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High dose cyclophosphamide in cats can cause what? |
Anorexia |
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Which drug can cause cardio toxicity? Chronic administration can lead to what? |
Doxorubicin DCM |
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2 organs that can be affected with doxorubicin? 1 tumour can react? Local reaction? |
Cardio toxicity Mast cell degranulation Nephrotoxicity reported in cats Vesicant |
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Cyclophosphamide specific toxicity in dogs and treatment? |
Sterile haemorrhage cystitis Discontinue. Rule out infection. Analgesia. Oxybutin (anti spasmodic) intracranial dsmo |
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What are the 4 stages of the cell cycle? |
G1- enzymes synthesised S- dna is synthesised G2- proteins are synthesised M- mitosis |
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What side effect can be seen with lomustine in 7% of dogs? What supportive medication could be given? |
Hepatotoxic in 7% of dogs. Consider same |
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2 side effects of cisplatin (GI sign and one organ toxicity) and what does it cause in cats? |
Neprotoxic and vomiting Fatal pulmonary oedema in cats |
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4 side effects of receptor tyrosine kinase inhibitors? |
GI Myelosuppression Renal and hepatic toxicity Depigmentation |
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2 drugs not to be given to cats |
Cisplatin- pulmonary oedema Fluoracil- neurotoxicity |
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Mdr mutation can be sensitive to what 2 drugs? What breed are sensitive? |
Doxorubicin Vinca alkaloids Herding breeds |
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What is oncept? |
Canine melanoma vaccine |
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Mutations in kit gene are associated with what? |
Development or progression of some mast cell tumours |
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How can tyrosine kinase inhibitors work? |
Receptors present on Mcts. Inhibitors have anti cancer activity and anti angiotenic. |
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What type of tumour are veterinary TKIs best for? Names? What form? |
Canine cutaneous non respectable grade 2 and 3 mast cell tumours Toceranib (Palladia) and masitinib (masivet) Oral |
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3 main side effects of TKIs and when can they develop? |
GI Haematological Musculoskeletal Few days to weeks or months after starting tx |
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Define mitosis index |
Percentage of cells undergoing mitosis in a tissue |
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Why do you need to be cautious and proactive in particular with TKI side effects? |
As effects are cumulative, even if stopping the medication and imitating sympmatic tx the symptoms can continue for weeks |
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How do Feline cutaneous mcts compare to canine? |
Benign and surgery is curative |
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Response rates to TKIs? |
Often not durable and typically only last a short number of weeks to months |
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Define metronomic chemotherapy |
Administer chemo on a more continuous basis |
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How common is osteosarcoma of the bone tumours? |
85% of malignancies |
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What breeds are predisposed to osa? Link to neutering? Age? |
Large breeds Early neutering in Rottweilers linked to osa 2 peaks- small at 18-24 months and bigger at 7-9 years |
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How common is metastasis in osa? And locations 3 |
90% by diagnosis Lungs, bone and soft tissue |
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2 most common localisations for osa |
Away from the elbow (think vowels) Towards the knee |
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What biochemical abnormality is associated with poorer prognosis in osa |
Alp |
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Diagnosis of osa |
Location, x rays and fna or biopsy Fna agrees with biopsy 71% of the time |
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Name 3 tumours where chemotherapy would be beneficial as adjuvant therapy following surgical excision |
Osteosarcoma Haemangiosarcoma Grade 2 or 3 mast cell tumour with a mitotic index of >7 |
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Pain management in osa |
NSAIDs, opioids, gabapentin, amantadine, paracetamol Radiation - very effective Bisphosphanates? Poor evidence basis |
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Use of bisphosphonates in osa and example |
Osteoclasts inhibitors Palliative treatment to increase bone density and maybe pain relief Pamidronate- IV once monthly Oral bisphosphonates have poor bioavailability alendronate |
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How can chemo be used in osa? 2 drugs |
Adjuvant treatment of canine appendicular osa Carboplatin and doxorubicin |
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Why is persistent hypercalcemia a problem? |
Underlying problem But will result in renal failure and gastritis |
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Treatment for hypercalcemia |
Identify the underlying cause Saline IV Once rehydrated furosemide Presnisolone helps with lymphoid tumours Bisphosphonates help with multiple myeloma and solid tumours Calcitonin in acute setting |
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What is tumour lysis syndrome? |
Rare but usually due to acute leukaemia or late stage lymphoma within 48 hours of induction chemo Characterises by acute renal failure and metabolic acidosis Aggressive fluid therapy |
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Optimal dose intensity when administering myelosupressive drugs? Neutrophil nadir? |
Neutrophil nadir between 1-1.5 x 10^9 |
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Limitations of body surface area dosing? |
Smaller pets may need smaller doses. Individual drugs may require a lower dose eg doxorubicin |
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Name 2-3 tumours that are intrinsically resistant to chemo |
Malignant melanoma Pancreatic and renal carcinomas |
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Define adjuvant chemotherapy - 3 examples of tumours (2 dogs, 1 cat) |
Used following resection of a primary tumour with a significant risk of recurrence or metastasis eg osteosarcoma and haemangiosarcoma in dogs and mammary tumours in cats |
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Define neoadjuvant chemotherapy? |
Used prior to surgery or radiation to reduce tumour size |
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What types of tissues undergo late radiation side effects? Treatment? |
Nerves and bones Not always treatable hence hypofractionated protocols only chosen in patients with a short term prognosis |
|
|
Give an example of an anti tumour antibiotic |
Doxorubicin |
|
|
Example of vinca alkaloid |
Vincristine |
|
|
Example of an alkylating agent |
Cyclophosphamide Chlorambucil |
|
|
How do corticosteroids work as a chemotherapy drug? |
Apoptosis of lymphoid, round, mast cell and plasma cell tumours |
|
|
Actions to take if IV chemo drug extravasates? |
Stop infusion, aspirate, give dex IV in another vein |
|
|
If vincristine extravasates what can you give? |
Hyaluronidase SC Warm compress Anti inflammatory ointment |
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If doxorubicin extravasates what can you do? 4 |
Cold compress to minimise spread Administer dexrazoxane IV at 10x dose within 3 hours. Repeat at 24 and 48 hours Apply DSMO topically every 2 hours Apply anti inflammatory ointment |
|
|
What genetic defect can affect chemo tolerability? |
MDR gene multi drug resistance in certain breeds |
|
|
When does neutrophil nadir occur? 1 exception |
8 days Carboplatin 10-14 days |
|
|
What should you do if nadir falls below 1000/ microlitre 2 |
If no other symptoms then administer broad spectrum oral antibiotics do several days and monitor until next blood count. Doesn’t usually last longer than 72 hours Reduce the dose of the drug by 15-20% at next administration |
|
|
3 possible late side effects of radiation |
Cataracts Bone necrosis Internal Strictures |
|
|
If neutrophil count is below 2000 u/l what could you so? |
If patient clinically well then could give treatment but if drug very immunosuppressive eg doxorubicin then Delay treatment by 2-4 days |
|
|
Neutrophil count less than 500 u/l action? |
Risk of sepsis, if fever or GI signs, hospitalisation and IV fluids and antibiotics and symptomatic |
|
|
If patient presents for chemo with anorexia, diarrhoea, vomiting, fever action? |
Regardless of neutrophil count, treatment not given and symptomatic tx |
|
|
3 drugs to treat diarrhoea induced by chemo |
Sulphasalazine Metronidazole Loperamide (not with mdr1 mutation) |
|
|
What gut side effect can vincristine cause? What species more affected? Tx? 2 more toxicities? |
Ileus paralyticus more frequent in cats Self limiting, metoclopramide or cisapride can help Peripheral neuropathies and skin sloughing |
|
|
Antiemetic prophylaxis is helpful with treatment with which drug? |
Doxorubicin |
|
|
High dose cyclophosphamide in cats can cause what? |
Anorexia |
|
|
Which drug can cause cardio toxicity? Chronic administration can lead to what? |
Doxorubicin DCM |
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4 toxicity’s seen with doxorubicin? |
Cardio toxicity Mast cell degranulation Nephrotoxicity reported in cats Vesicant |
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|
Cyclophosphamide specific toxicity in dogs and treatment? |
Sterile haemorrhage cystitis Discontinue. Rule out infection. Analgesia. Oxybutin (anti spasmodic) intracranial dsmo |
|
|
What are the 4 stages of the cell cycle? |
G1- enzymes synthesised S- dna is synthesised G2- proteins are synthesised M- mitosis |
|
|
What can lomustine cause? |
Hepatotoxic it’s in 7% of dogs. Consider same |
|
|
2 side effects of cisplatin and what does it cause in cats? |
Neprotoxic and vomiting Fatal pulmonary oedema in cats |
|
|
4 side effects of receptor tyrosine kinase inhibitors? |
GI Myelosuppression Renal and hepatic toxicity Depigmentation |
|
|
2 drugs not to be given to cats |
Cisplatin- pulmonary oedema Fluoracil- neurotoxicity |
|
|
Mdr mutation can be sensitive to what 2 drugs? What breed are sensitive? |
Doxorubicin Vinca alkaloids Herding breeds |
|
|
What is oncept? |
Canine melanoma vaccine |
|
|
Mutations in kit gene are associated with what? |
Development or progression of some mast cell tumours |
|
|
How can tyrosine kinase inhibitors work? |
Receptors present on Mcts. Inhibitors have anti cancer activity and anti angiotenic. |
|
|
2 veterinary TKIs are available for use in what type of tumour? Names? What form? |
Canine cutaneous non respectable grade 2 and 3 mast cell tumours Toceranib (Palladia) and masitinib (masivet) Oral |
|
|
3 main side effects of TKIs and when can they develop? |
GI Haematological Musculoskeletal Few days to weeks or months after starting tx |
|
|
Define mitosis index |
Percentage of cells undergoing mitosis in a tissue |
|
|
Why do you need to be cautious and proactive in particular with TKI side effects? |
As effects are cumulative, even if stopping the medication and imitating sympmatic tx the symptoms can continue for weeks |
|
|
How do Feline cutaneous mcts compare to canine? |
Benign and surgery is curative |
|
|
Response rates to TKIs? |
Often not durable and typically only last a short number of weeks to months |
|
|
Define metronomic chemotherapy |
Administer chemo on a more continuous basis |
|
|
How common is osteosarcoma of the bone tumours? |
85% of malignancies |
|
|
What breeds are predisposed to osa? Link to neutering? Age? |
Large breeds Early neutering in Rottweilers linked to osa 2 peaks- small at 18-24 months and bigger at 7-9 years |
|
|
How common is metastasis in osa? And locations 3 |
90% by diagnosis Lungs, bone and soft tissue |
|
|
2 most common localisations for osa |
Away from the elbow (think vowels) Towards the knee |
|
|
What biochemical abnormality is associated with poorer prognosis in osa |
Alp |
|
|
Diagnosis of osa |
Location, x rays and fna or biopsy Fna agrees with biopsy 71% of the time |
|
|
Name 3 tumours where chemotherapy would be beneficial as adjuvant therapy following surgical excision |
Osteosarcoma Haemangiosarcoma Grade 2 or 3 mast cell tumour with a mitotic index of >7 |
|
|
Pain management in osa |
NSAIDs, opioids, gabapentin, amantadine, paracetamol Radiation - very effective Bisphosphanates? Poor evidence basis |
|
|
Use of bisphosphonates in osa and example |
Osteoclasts inhibitors Palliative treatment to increase bone density and maybe pain relief Pamidronate- IV once monthly Oral bisphosphonates have poor bioavailability alendronate |
|
|
How can chemo be used in osa? 2 drugs |
Adjuvant treatment of canine appendicular osa Carboplatin and doxorubicin |
|
|
Why is persistent hypercalcemia a problem? |
Underlying problem But will result in renal failure and gastritis |
|
|
Treatment for hypercalcemia |
Identify the underlying cause Saline IV Once rehydrated furosemide Presnisolone helps with lymphoid tumours Bisphosphonates help with multiple myeloma and solid tumours Calcitonin in acute setting |
|
|
What is tumour lysis syndrome? |
Rare but usually due to acute leukaemia or late stage lymphoma within 48 hours of induction chemo Characterises by acute renal failure and metabolic acidosis Aggressive fluid therapy |
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3 cell types of lymphoma? |
B T Natural killer cell |
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Optimal dose intensity when administering myelosupressive drugs? |
Neutrophil nadir between 1-1.5 x 10^9 |
|
|
Limitations of body surface area dosing? |
Smaller pets may need smaller doses. Individual drugs may require a lower dose eg doxorubicin |
|
|
Name 2-3 tumours that are intrinsically resistant to chemo |
Malignant melanoma Pancreatic and renal carcinomas |
|
|
Define adjuvant chemotherapy - 3 examples of tumours (2 dogs, 1 cat) |
Used following resection of a primary tumour with a significant risk of recurrence or metastasis eg osteosarcoma and haemangiosarcoma in dogs and mammary tumours in cats |
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Define neoadjuvant chemotherapy? |
Used prior to surgery or radiation to reduce tumour size |
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What do we need to know about the lymphoma? How do we get this? |
Cell type Grade Immunophenotype Biopsy- immunohistochemistey Fna- immunocytochemistry and flow cytometry, PARR also available (70% reliable) |
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High grade LSA responds best to which protocols? Resistant to which drug in which common protocol? |
MOPP or LOPP Doxorubicin in CHOP |
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Treatment for low grade multi centric T cell? |
Use of chemo doesn’t affect prognosis so tx only necessary if clinical signs present Steroids and chlorambucil |
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Most common type of multi centric LSA? And treatment |
Diffuse large B cell LSA CHOP or COP |
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Most common type of multi centric LSA? And treatment |
Diffuse large B cell LSA CHOP or COP |
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Most common grade and cell type of lymphomas General prognosis with an without tx |
Medium to high B cell Prognosis- quickly progress without therapy. Quickly respond to tx and go into remission. Also develop resistance rapidly |
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How common are low grade lymphomas? What cell typically? How do they respond? |
5-29% T cell Respond slower to chemo and can take several weeks of remission is achieved |
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Most common 80% form of canine lymphoma |
Multicentric which presents as peripheral lymphadenopathy |
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5 stages of lymphoma |
1 single lymph node enlarged 2. Regional lymph node 3. Generalised lns 4. Liver spleen 5. Bone marrow and blood involved Substages a- no signs b/ clinically unwell |
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Differences in prognosis with the stages of canine lymphoma |
1 has best prognosis but stages 2-4 no difference Sub stage b worse prognosis |
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Canine Alimentary lymphoma - protocols, prognosis - challenges - large bowel differences |
- Chop unsatisfactory prognosis of 6 months - overlapping GI side effects and symptoms - cop as good as chop -and cheaper, fewer adverse reactions, great response |
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Cutaneous lymphoma protocol? |
Single agent Oral lomustine and preds |
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In CNS lymphoma what drugs have good blood brain barrier penetration? Remission times? |
Steroids, cytosine arabinoside or lomustine Shorter periods of remission |
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Presence of blood cytopenia at time of dx of lymphoma should consider what? 2 |
Bone marrow aspiration is useful to determine the percentage of bm infiltration and to rule out an IM process secondary to neoplasia as the cause Is it going to change there tx plan? |
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Risks with focal intestinal or gastric masses lymphoma. What should be avoided? |
Perforation when starting chemo. Fast acting drugs should be avoided such as L-asparaginase |
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Presence of cytopenias +/- circulating neoplastic cells - prognosis? - treatment considerations - suggested beneficial infusion? |
Worse Avoid particularly immunosuppressive drugs but also need to be aggressive as cell lines won’t be restored until cancer is removed from bone marrow Cytosine arabinoside as been advocated as part of an induction protocol on stage 5 |
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How do you test for MDR gene? If they are heterozygous or homozygous then how do you address this? |
Blood or saliva Reduce dose by 25% of certain drugs and take extra precautions regarding GI toxicity |
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What % of dogs with high grade multicentric lymphoma will induce remission for how long? |
60-90% 50% survive 1 year, 20% 2 years |
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Authors treatment of choice for - high grade B cell canine lymphoma - high grade T cell lymphoma - when finances or other factors are a barrier to above? - low grade T cell |
Madison Wisconsin LOPP COP No treatment, if symptomatic then steroids and chlorambucil |
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When remission ends? |
Reinduction using same protocol. rates are lower and shorter Rescue protocol |
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Presence of cytopenias +/- circulating neoplastic cells - prognosis? - treatment considerations - suggested beneficial infusion? |
Worse Avoid particularly immunosuppressive drugs but also need to be aggressive as cell lines won’t be restored until cancer is removed from bone marrow Cytosine arabinoside as been advocated as part of an induction protocol on stage 5 |
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How do you test for MDR gene? If they are heterozygous or homozygous then how do you assess this? |
Blood or saliva Reduce dose by 25% of certain drugs and take extra precautions regarding GI toxicity |
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What % of dogs with high grade multicentric lymphoma will induce remission for how long? |
60-90% 50% survive 1 year, 20% 2 years |
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Authors treatment of choice for - high grade B cell canine lymphoma - high grade T cell lymphoma - when finances or other factors are a barrier to above? - low grade T cell |
Madison Wisconsin LOPP COP No treatment, if symptomatic then steroids and chlorambucil |
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When remission ends? |
Reinduction using same protocol. rates are lower and shorter Rescue protocol |
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Prognosis of feline lymphoma with a positive retro viral disease? Progression and response 2 |
Rapidly progressive Transient response to therapy |
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Nasal lymphoma in cats treatment and prognosis? |
Radiation +/- chemo Very good response- 945 days in one study |
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Systemic LSA in cats therapy response? |
70% of cats having a median of 8 months |
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Young cats with mediastinal lymphoma? |
Respond well to COP |
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Important ddx for mediastinal tumour in older cat? |
Thymoma (won’t respond to cop) Lymphoma |
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Feline renal lymphoma behaviour and response to treatment? Name 3 factors indicate a worse prognosis? |
Variable. Bilateral disease, severe azotaemia, other abdominal involvement |
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How does spinal lymphoma often present? Treatment? What infectious disease should be considered testing for? |
Posterior paresis Severe pain often Felv positive with concurrent bone marrow involvement Chemo with focal radiation therapy |
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Most common anatomical form of lymphoma in the cat? Grades? Which 2 grades are very similar and approaches the same? Which grade is least common? |
Alimentary Low, intermediate and high grade AL Sub classification large granular lymphocyte lymphoma IGAL and HGAL LGAL |
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LSA phenotype and location within the GI tract has a strong association - B cell predominates where? 2 grade? - T cell predominates in which location? grade? |
B- stomach, large intestine and high grade LSA T- small intestine and low grade LSA |
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T and B cell lymphomas arise from where in the intestines? |
MALT of the small intestine Peyers patches and mucosal lymphoid nodules in the distal Small intestine, caecum and colon |
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Felv- risk of developing lymphoma. Organs preference? T or B cell? FIV? Chances of developing |
Increased 60 fold Varies with anatomical type, lowest with AL Usually T cell FIV increase chance 5 fold |
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What condition has been documented to histolgically progress to AL? |
Lymphoplasmacytic enteritis |
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Ddx for LGAL |
Lymphoplasmacytix enteritis aka IBD |
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Ddx for LGAL |
Lymphoplasmacytix enteritis aka IBD |
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2 Ddx for HGAL and intramural mass lesions |
Adenocarcinoma Mast cell |
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Cobalamin and folate results when investigating AL? |
80% hypocobalaminemia Folate can be low (reduced absorption proximal), normal or high ( proliferation of intestinal microflora) |
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Usefulness of FNA cytology for diagnosis of LGAL compared to I/HGAL and LGLl? |
LGAL often non diagnostic, consider fna of mesenteric lymph node. Biopsy often required Can often make diagnosis with fna of intestinal wall mass. Preferable to ex lap as may delay treatment and increase in morbidity |
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Usefulness of FNA cytology for diagnosis of LGAL compared to I/HGAL and LGLl? |
LGAL often non diagnostic, consider fna of mesenteric lymph node. Biopsy often required Can often make diagnosis with fna of intestinal wall mass. Preferable to ex lap as may delay treatment and increase in morbidity |
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Diagnosis of LGAL |
Fna often inconclusive, consider fna of mesenteric Ln Biopsy via ex lap often requires, may need IHC and clonality testing to confirm as histo logically very similar to IBD (LPE) Histologically- Neoplastic small lymphocytes, monomorphic sheet
Sample all sections of SI |
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Treatment for LGAL? And I/HGAL? |
Oral alkylating agents eg lomustine and preds COP or CHOP |
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Treatment for LGAL? And I/HGAL? |
Oral alkylating agents and preds COP or CHOP |
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Should surgery be performed on an intestinal mass prior to chemo? |
No improvement on survival time |
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Treatment for LGLL? |
Poor response to cop or chop Other agents indicated |
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Local aspiration of what is indicated in presence of a MCT? |
Fna of local lymph node |
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When is staging indicated in MCT? 7 |
Some clinicicians would advise every time however majority are locally invasive.. Grade 3 or 2 with a high mitotic index are more likely to be behave aggressively Rapid growth or ulceration Lymph node metastasis Location: mucocutaneous, oral, nail bed, preputial/ scrotal tumours Recurrent Systemic signs |
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What does complete MCT staging involve? |
Fna of the drainage lymph node Abdominal ultrasound Thoracic rads or Ct although rarely spread to lungs |
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How should you treat multiple MCTs? |
As individual lumps unless there is very large amounts or metastasis present |
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How should you treat multiple MCTs? |
As individual lumps unless there is very large amounts or metastasis present |
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Treatment requires for Metastatic lymph nodes of mcts? |
Remove m. |
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Treatment for MCT - grade 1 and 2 completely excised -Grade 2 high mitotic index - grade 1 and 2, low mitotic index, incomplete margins - High grade 3 with complete margins |
No further therapy, risk of recurrence low, monitor Consider systemic therapy Revision surgery or radiation ideally. If declines, chemo. Moderate risk of regrowth and high risk of metastasis so chemo indicated |
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What can help gauge prognosis of grade 2 MCT? 4 |
Mitotic index > 5 Ki-67 (increased worse, sensitive but not so specific) AgNOR counts (increased bad) Kit gene mutations poorer prognosis |
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Why is identifying kit mutations on MCT useful? |
If present can use TKIs to treat although some tumours with no mutation can also respond |
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Is radiation helpful for MCT? 2 situations. What type of protocol? |
Sensitive Primary where surgery isn’t possible Most commonly following incomplete resection Hyperfractionated preferred |
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What percentage of MCTs have mutated KIT gene? |
20-40% |
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Cutaneous changes seen with hypothyroid? |
Hair loss affecting the bridge of the nose/ and or trunk with mixoedema |
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What is alopecia areata? And what causes it? |
Focal/ multi focal type of progressive hair loss in dogs Autoantibody production attacking the hair follicles |
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What does parr stand for? What does it do? |
PCR for antigen receptor rearrangement Used to detect clonality within a population of cells where monoclonal represents lymphoma and polyclonal represents reactive lymphocytosis |
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What sample so you require for flow cytometry? |
Bloods Lymph node aspirate Effusion Csf |
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Flow cytometry tests what |
Immunophenotypic analysis in canine lymphoma |
