Sa Med - Oncology - Bracha P1

Front 1

Initiation, Promotion, or Progression of cancer cells...
...interaction of the carcinogen with cellular DNA

Back 1

Initiation

Front 2

Initiation, Promotion, or Progression of cancer cells...
...cells cloning themselves containing the mutated gene allowing them a selective growth advantage

Back 2

Promotion

Front 3

Initiation, Promotion, or Progression of cancer cells...
...the phase when the tumor is able to invade tissues and metastasize to other locations

Back 3

Progression

Front 4

T/F: An initiated cell is considered to be a cancerous cell.

Back 4

False! It is NOT a cancer cell yet bc it lacks autonomal growth ability

Front 5

What is the hallmark of the progression stage of carcinogenesis?

Back 5

Alterations in the DNA and it's increasing instability

Front 6

How does sustaining proliferative signaling benefit a cancer cell?

Back 6

Autocrine proliferation! They can produce their own growth promoting ligands and induce expression of the necessary/corresponding receptors

Front 7

What is the term for induction of apoptosis due to inadequate cell to cell contact?

Back 7

Anoikis

Front 8

Apoptosis or Necrosis...
...no loss of membrane integrity (membrane bleeding)

Back 8

Apoptosis

Front 9

Apoptosis or Necrosis...
...loss of membrane integrity

Back 9

necrosis

Front 10

Apoptosis or Necrosis...
...shrinking of cytoplasm and condensation of nucleus

Back 10

apoptosis

Front 11

Apoptosis or Necrosis...
...smear formation after gel electrophoresis

Back 11

necrosis - due to random digestion of DNA

Front 12

Apoptosis or Necrosis...
...ends with fragmentation of the cell into smaller bodies and mono/oligonucleosomal length of nuclear DNA fragmentation

Back 12

apoptosis

Front 13

Apoptosis or Necrosis...
...ends with total cell lysis and is energy independent

Back 13

necrosis

Front 14

Apoptosis or Necrosis...
...involves at least 2 independent pathways and is energy dependent

Back 14

apoptosis

Front 15

T/F: angiogenesis is usually not a constantly used process.

Back 15

True - it's usually still with a few exceptions: female cycle, inflammation, & wound healing

Front 16

How far away from a vessel does a cancer cell have to be for it to become hypoxic and releases its factors?

Back 16

2 mm

Front 17

What causes the shift in balance between angiogenic and anti-angiogenic factors?

Back 17

Hypoxic factors inducing the formation of new vessels

Front 18

What are the anti-angiogenic factors? the angiogenic factors?

Back 18

Anti-angiogenic: endostatin, TSP, angiostatin

Angiogenic: VEGF, HIF, PDGF, FGF

Front 19

What's the tyrosine kinase inhibitor used in veterinary medicine that may have anti-angiogenic characteristics?

Back 19

Palladia - used as a VEGF inhibitor

Front 20

What's metronomic chemotherapy?

Back 20

Administration of low dose chemotherapy (10%) and anti-inflammatory drugs (COX2 inhibitors) on a daily or every other day dose

Front 21

Metronomic chemotherapy is effective against circulating ______ & ______ cells.

Back 21

Progenitor & endothelial cells

Front 22

Why does metronomic therapy work against cancer cells that are resistant to chemotherapy?

Back 22

Because it doesn't target the cancer cells directly

Front 23

How do cancer cells enable replicative immortality?

Back 23

By having high levels of telomerase - adds telomere repeat segments to the ends of DNA which enable continued replication of the cell

Front 24

T/F: The majority of deaths of cancer patients are due to metastasis and NOT due to the primary tumor.

Back 24

TRUE

Front 25

What are the 2 theories of metastasis?

Back 25

Seed & Soil - tumor/organ hosting; specific cells having matching receptors to a site in the specific organ

Hemodynamic consideration cells getting lodged in capillary bed rich organs (ie: liver & lungs)

Front 26

Who is the guardian of the genome? how does it manage this?

Back 26

P53! recognizes damaged DNA, induces cell arrest at G1, preventing replication, and either repairs the damage or signals for apoptosis

Front 27

Where do hemangiosarcomas arise from?

Back 27

Endothelial layer of the vessels

Front 28

Which breeds are more susceptible to the cutaneous form of HSA?

Back 28

The lightly pigmented breeds: beagles, white bulldog, whippets

Front 29

Etiology of HSA?

Back 29

UV light - cutaneous
Radiation
Vinyl chloride
Thorium dioxide
Arsenicals
Viral agent?

Front 30

What percentage of patients with splenic masses will have a right atrial mass?

Back 30

25%

Front 31

How would you expect a patient to present who has a chronic HSA?

Back 31

Anorexic, lethargic, indolent history - will bleed off & on and reabsorb it

Front 32

How would you expect a HSA patient to present acutely?

Back 32

Abdominal distention
Hypovolemic shock signs (pale mucous membranes, inc CRT, dyspnea)
DIC - very common
Cardiac murmur, muffled heart sounds, dyspnea

Front 33

Of all splenic masses how many of those are malignant? and of those how many are HSA?

Back 33

2/3 of splenic masses are malignant and 2/3 of those are HSA

Front 34

T/F: The smaller the splenic mass, the more likely it is to be malignant.

Back 34

True - the benign ones are usually bigger

Front 35

Hemoabdomen will be more common in a hemangiosarcoma disease or a hemangioma disease?

Back 35

Hemangiosarcoma - but can happen with either

Front 36

How can you tell if abdominal fluid is of neoplastic origin?

Back 36

If its neoplastic effusion, it should have a lower glucose concentration and a higher lactate concentration compared to a non-neoplastic effusion

Front 37

How is DIC characterized?

Back 37

Activation of the coagulation cascade resulting in formation and deposition of fibrin ultimately leading to formation of thrombin in various organs -> organ failure

Front 38

Increased or decreased with DIC..
...PT
...PTT
...FDP
...BMBT
...PLT

Back 38

Increased PT/PTT, FDP, & BMBT
Decreased platelets (bc theyre being consumed)

Front 39

What kind of laboratory findings would you expect to see with DIC?

Back 39

Anemia, neutrophilia (stress leukogram), thrombocytopenia
Nucleated RBCs, polychromasia, schistocytes, acanthocytes

Front 40

Which is the better option to diagnose a splenic mass...
...ultrasound guided FNA or biopsy

Back 40

Neither! Too high a risk of bleeding and not getting anything usable
Just take out the mass!

Front 41

Which of the following are appropriate treatments for hemoabdomen/HSA:

A. Total splenectomy
B. Fluids
C. Fresh frozen plasma
D. Splenectomy, doxirubicin, L-MTP-LE

Back 41

All of them! Greatest MST doing total splenectomy + doxorubicin + L-MTP-LE

Front 42

Who is at greatest risk for having cardiac HSA?

Back 42

Neutered females - x5 greater!

Front 43

How does cardiac HSA most commonly present?

Back 43

Cardiac tamponade

Front 44

How do you diagnose a cardiac HSA?

Back 44

Thoracic rads, cardiac echogram
Can also send in pericardial effusion but won't generally find any malignant cells in it; Troponin I will be higher with HSA vs idiopathic effusion

Front 45

Most common site of cardiac HSA metastasis?

Back 45

LUNGS
followed by spleen, liver, and kidneys

Front 46

Of the following treatments for cardiac HSA, which is done as a palliative treatment?

A. Chemotherapy - doxirubicin
B. Pericardiocentesis
C. Right atrial appendage resection
D. Pericardioectomy

Back 46

Pericardioectomy - less than 20 days survival
- do pericardiocentesis for immediate resolution of cardiac tamponade

Front 47

Where on the dog are you going to poke for a pericardiocentesis?

Back 47

Right side, 4-6 ICS
Elbow to mid-thorax -> will always find the heart there

Front 48

Cutaneous form is more commonly associated with a hemangiosarcoma or hemangioma?

Back 48

Hemangioma

Front 49

When doing IHC, what are the markers to look for to confirm a hemangiosarcoma?

Back 49

Factor VIII (von Willebrand factor) & CD31

Front 50

Cutaneous HSA stage 1, 2, or 3...
...dermal
How do you treat it?

Back 50

Stage 1
Wide surgical margins

Front 51

Cutaneous HSA stage 1, 2, or 3...
...hypodermal
How do you treat it?

Back 51

Stage 2
Surgical resection followed with chemotherapy

Front 52

Cutaneous HSA stage 1, 2, or 3...
...muscle
How do you treat it?

Back 52

Stage 3
Surgical resection followed with chemotherapy - doxirubicin/metronomic?

Front 53

A stage III HSA has a ___% metastatic rate and a MST of ___.

Back 53

60% metastatic rate
MST of 307 days

Front 54

MST times for...
...Stage I?
...Stage II?

Back 54

Stage I MST 780 days
Stage II MST 170 days

Front 55

Which of the following are FALSE?

A. Don't obtain needle aspirates or biopsies from a spleen with a cavitated mass
B. Stabilize a patient with hemoabdomen before taking them to surgery
C. Never throw away a mass that was removed
D. Resect a cutaneous HSA then submit for staging

Back 55

B. Don't wait on a hemoabdomen or cardiac tamponade! Take them to surgery!
D. Don't perform resection of cutaneous HSA BEFORE a complete staging has been performed

Front 56

What are histiocytes? Where do they arise from? Which MHC do they express?

Back 56

Leukocytes in tissues playing an active part in the immune system and can different into monocytes/macrophages/dendritic cells
Arise in bone marrow from CD34+ stem cells
Express MHCII

Front 57

What is the common signalment for a patient with cutaneous histiocytoma?

Back 57

<2 years, brachiocephalic dogs (or cocker spaniels, great danes)

Front 58

What is the typical history for a patient with cutaneous histiocytoma?

Back 58

Rapid growth on the skin - on the head (pinna), extremities, & neck; usually occurring within 1-4 weeks

Front 59

What is the appropriate treatment for cutaneous histiocytoma? prognosis?

Back 59

Spontaneous remission is common or can do surgery or cryosurgery
prognosis = excellent

Front 60

What is the common signalment for an animal with histiocytic sarcoma?

Back 60

Middle aged (~4 yrs), Bernese mountain dog, flat coated retriever, Rottweiler, golden/labs

Front 61

How do you go about diagnosing histiocytic sarcoma?

Back 61

Bloodwork - CBC/Chem; CYTOLOGY +/- BONE MARROW, ultrasound/rads, IHC for CD1/CD11/CD18

Front 62

Localized, Disseminated, or Hemophagocytic histiocytic sarcoma...
...macrophages

Back 62

Hemophagocytic histiocytic sarcoma

Front 63

Localized, Disseminated, or Hemophagocytic histiocytic sarcoma...
...interstitial dendritic cells

Back 63

Localized AND disseminated histiocytic sarcoma

Front 64

Localized, Disseminated, or Hemophagocytic histiocytic sarcoma...
...skin & SQ, joint spaces

Back 64

Localized histiocytic sarcoma

Front 65

Localized, Disseminated, or Hemophagocytic histiocytic sarcoma...
...multi-organ involvement

Back 65

Disseminated: lnn, lung, liver
Hemophagocytic: sleen, +/- liver, bone marrow, lung, lnn

Front 66

Localized, Disseminated, or Hemophagocytic histiocytic sarcoma...
...anemia, thrombocytopenia, hypoalbumin, hypocholesterolemia

Back 66

Hemophagocytic histiocytic sarcoma

Front 67

Localized, Disseminated, or Hemophagocytic histiocytic sarcoma...
...poor response to chemo

Back 67

Hemophagocytic histiocytic sarcoma

Front 68

Where do all tumors that make up soft tissue sarcomas arise from? Are they mostly local or disseminated tumors?

Back 68

Originate in connective tissue - mostly localized

Front 69

What tumors make up the soft tissue sarcomas?

Back 69

Fibrosarcoma
Peripheral nerve sheath tumor
Myxosarcoma
Undifferentiated sarcoma
Liposarcoma
Histiocytic sarcoma
Rhabdomyosarcoma

Front 70

T/F: Soft tissue sarcomas tend to be encapsulated tumors that are locally invasive.

Back 70

False - pseudoencapsulated tumors with poor margins that are locally invasive = local recurrence after conservative surgical excision is common

Front 71

Common signalment for an animal with a soft tissue sarcoma?

Back 71

Large breed dogs - flat coated retriever & Bernese mountain dog

Front 72

Soft tissue sarcoma or hemophagocytic histiocytic sarcoma...
...hypoglycemia

Back 72

Soft tissue sarcoma - paraneoplastic syndrome of leiomyoma & leiomyosarcoma

Front 73

Diagnosing a soft tissue sarcoma...
...FNA or biopsy?

Back 73

Biopsy for definite diagnosis
FNA usu not rewarding bc of poor exfoliation and necrosis

Front 74

Diagnostic methods to diagnose a soft tissue sarcoma?

Back 74

Chest rads - pulmonary metastasis
Abdominal ultrasound - visceral metastasis
CT - surgical planning

Front 75

Appropriate treatment for soft tissue sarcomas?

Back 75

SURGERY! Followed by radiation for incompletely resected tumors

Front 76

What are the margins you should try to get when resecting any tumor?

Back 76

Minimum of 3 cm margins and 1-2 facial planes deep

Front 77

Most appropriate treatment for a 6 cm soft tissue sarcoma?

A. Radiation
B. Chemotherapy
C. Neither

Back 77

Neither - >5cm usually won't respond to either
- chemo won't increase survival time
- 30% response rate but 50% local recurrence with radiation

Front 78

What is the most important prognostic factor for soft tissue sarcomas?

Back 78

Surgical margins - 35-50% local recurrence if incomplete
Tumor size & location also indicators: MST if non-oral > oral (2270 > 540); <5 cm better prognosis with sx or sx & radiation

Front 79

Which of the following statements regarding soft tissue sarcomas is correct:

A. After recurrence, soft tissue sarcomas are more difficult to control locally and may have an increased metastatic rate.
B. The histologic grade does not correlate with completeness of margins.
C. The mitotic index correlates with survival time.
D. Grade 3 tumors have a metastatic rate of up to 10%.

Back 79

A & C
(the histologic grade DOES correlate with completeness of margins; grade 3 tumors have a metastatic rate up to 50% - grade 1 tumors are 10%)

Front 80

Which of the following statements are false with regards to soft tissue sarcoma prognosis:

A. Mutation in P53 is a poor prognostic factor
B. Fibrosarcomas have the least response to radiation
C. Peripheral nerve sheath tumors have a high recurrence rate while DFI are location dependent

Back 80

All True!

Front 81

What is a low-high soft tissue sarcoma?

Back 81

Tumors with a low grade (benign histological appearance) but are VERY aggressive biologically

Front 82

Who is at greatest risk for low-high soft tissue sarcomas and where are the tumors typically found anatomically?

Back 82

More common in golden retrievers & usually located in the oral cavity (maxilla)

Front 83

T/F: The appropriate treatment for low-high soft tissue sarcomas is to surgically excise and follow with chemotherapy.

Back 83

FALSE - no effective chemotherapy treatment and surgery is unrewarding