Sa Med - Oncology - Helfand P1

Front 1

What are common clinical signs seen associated with nasal tumors?

Back 1

Violent sneezing
Nasal discharge
Epistaxis
Facial deformity/exophthalmos

Front 2

What kind of imaging is preferred for identifying nasal tumors?

Back 2

CT & MRI

Front 3

How can you tell if the palatine bone has been invaded by a nasal tumor just by opening the mouth?

Back 3

A ventral deviation of the hard palate

Front 4

What should be done prior to taking a nasal biopsy?

Back 4

Check clotting - will be bloody!
(coagulation profile to check intrinsic & extrinsic pathways & BMBT to check platelets)

Front 5

What are the two types of traumatic nasal biopsies?

Back 5

Catheter biopsy ("ram & jam")
Cup forceps ("clam shell")

Front 6

What are the most common nasal tumors found in dogs? cats?

Back 6

Dogs: 2/3: adenocarcinoma 1/3: sarcomas (fibro-, chondro-, & osteo-)
Cats: lymphoma

Front 7

T/F: A dog can sneeze under anesthesia.

Back 7

True! And if it happens just after a nasal biopsy - it will be bloody!

Front 8

Heparin & antithrombin III inactivate which part(s) of the coagulation cascade?

Back 8

Factors IX, X, XI, XII and (prothrombin to) thrombin

Front 9

What is the general biological behavior of most nasal tumors?

Back 9

Slow to metastasize
Eats their way through the head like a hot coal on ice

Front 10

What is the treatment of choice for nasal tumors?

Back 10

"local disease → local treatment"
Surgery + radiation therapy

Front 11

What is the difference in radiation therapy protocols between hypofractionation, conventional, and palliative?

Back 11

Hypofractionation: 10 treatments

Conventional: 18-20 treatments

Palliative: 4-6 lg treatments

Front 12

What is the average survival time for animals undergoing radiation therapy as a treatment for nasal tumor?

Back 12

1-2 years median survival

Front 13

Name 5 things you should expect as a result of radiation therapy.

Back 13

Decreased epistaxis
Improved movement of air
Acute side effects: conjunctivitis, dry eye, ulcers
Chronic side effects: cataracts, blindness, bone necrosis

Front 14

What are common clinical signs seen associated with lung tumors?

Back 14

COUGH, COUGH, COUGH (unproductive & paroxysmal)

Front 15

How do you work up a lung tumor case?

Back 15

Good quality rads
FNA - ultrasound guided
Differentiate 1º vs metastatic
Differentiate from fungal lesions

Front 16

How can you usually differentiate between 1º and metastatic lung tumors?

Back 16

Lung carcinomas: often solitary & larger
Mets: often peripheral

Front 17

What is the best way to differentiate fungal lesions in the lung from neoplasia?

Back 17

FNA (may even be better than doing a CT)
May be multiple lesions - then again so could carcinomas & mets...

Front 18

What is the preferred imaging technique for lung tumors?

Back 18

CT (better detail & visualization of traceobronchial nodes)

Front 19

T/F: Enlarged trachobronchial nodes have no correlation with metastasis.

Back 19

False - its a high positive correlation
(prognosis is dismal with TB node mets - 2 month survival)

Front 20

You see unusual bone formation distally in the right front forelimb. On a hunch, you then do thoracic rads only to find what appears to be mets. What are you suspicious of?

Back 20

Paraneoplastic syndrome → Hypertrophic osteopathy
(dont confuse with OSA!!)

Front 21

What are 2 odd lung tumor metastases that have been seen to occur in cats?

Back 21

Mets to the distal phalanges (lysis of bone, extremely painful, & can aspirate ciliated respiratory cells from the feet!)

Front 22

The majority of neoplasia found in the lungs are what kinds of tumors?

Back 22

Carcinomas (adenocarcinoma, bronchogenic carcinoma, +/- squamous differentiation)

Front 23

What is the prognosis for lung tumors?

Back 23

Variable:
nodal involvement = poor (2 months)
smaller = better (16 mo vs 8 mo)
peripheral = better (16 mo vs 8 mo)
if sick on presentation = poor (6mo vs 18 mo)

Front 24

What is now the standard of care post-op for lung tumors?

Back 24

Vinorelbine chemotherapy

Front 25

Canine lymphoma is synonymous with ___.

Back 25

Lymphosarcoma (LSA - no benign counterpart)

Front 26

Which breed is most predisposed to canine lymphoma?

Back 26

Golden retrievers - 8x more

Front 27

T/F: lymphoma is incurable.

Back 27

True for the most part

Front 28

What changes might an owner notice in their dog or cat with lymphoma?

Back 28

**generalized lymphadenopathy**
lethargy, weakness
inappetitant, wt loss
vomiting, diarrhea
PU/PD, dyspnea
cutaneous masses, bleeding

Front 29

What physical abnormalities can be seen in dogs & cats with lymphoma?

Back 29

hepatosplenomegaly, emaciation
pallor, pleural/abdominal effusions
intrathoracic masses
cutaneous plaques/ulcers

Front 30

Which form of lymphoma is more common in dogs? in cats?

Back 30

Dogs: multicentric form
Cats: alimentary

Front 31

How does the multicentric form of lymphoma commonly present?

Back 31

**generalized lymphadenopathy**, hepatomegaly, splenomegaly, tonsillar enlargement, occasional extranodal involvement

Front 32

How does the alimentary form of lymphoma commonly present?

Back 32

affects Gi lymphoid tissue in intestines & mesenteric nodes, +/- liver, spleen
palpable abdominal masses, wt. loss, dehydration

Front 33

What are the different forms of lymphoma?

Back 33

Multicentric
Alimentary
Mediastinal
Extranodal

Front 34

How is lymphoma staged? What are the stages?

Back 34

From the results of diagnostic procedures. Stages I-V

Front 35

Which of the following would you expect to see on a CBC in a lymphoma case?

a. Thrombocytosis
b. Mild anemia
c. Immature lymphs in blood

Back 35

b. Mild anemia
c. Immature lymphs in blood
(will see thrombocytoPENIA)

Front 36

Which of the following would you expect to see on a biochem profile in a lymphoma case?

a. Increased liver enzymes
b. Azotemia
c. Hypocalcemia
d. Increased protein

Back 36

a. Increased liver enzymes
b. Azotemia
d. Increased protein (or decreased!)

expect to see HYPERcalcemia

Front 37

What are some clinical signs of hypercalcemia?

Back 37

PU/PD, anorexia, depression, vomiting

Front 38

What effects does hypercalcemia have on the kidney?

Back 38

High serum calcium -> decreased ADH activity on tubules (reversible)
prolonged calcium -> nephrocalcinosis (irreversible)

Front 39

How do you work up a lymphoma case?

Back 39

CBC/Chem
Urinalysis
Thoracic rads
Abdominal radiographs/ultrasound

Front 40

What procedure done for lymphoma is diagnostic most of the time?

Back 40

Lnn aspiration for cytological exam

Front 41

How does normal lymph node cytology compare to a reactive lymph node?

Back 41

Normal: 90-95% mature lymphocytes, 5-10% lymphoblasts

Reactive: 20% lymphoblasts, 10-20% prolymphocytes, 30% mature lymphocytes, 20% plasma cells, 10% neutrophils/eosinophils

Front 42

How does a normal lymph node cytology compare to a lymph node infiltrated with lymphoma?

Back 42

Normal: 90-95% mature lymphocytes, 5-10% lymphoblasts

Lymphoma: 60-100% "tumor cells"

Front 43

What is immunophenotyping and why is it recommended?

Back 43

Identifying the lymphoid lineage - T cell vs B cell
Recommended bc its prognostic - **Most T cell lymphomas are aggressive!!**

Front 44

If your dog had to have lymphoma - which type would you rather it be - T cell or B cell?

Back 44

dogs with B-cell LSA >/= twice as long as T-cell
MST 160 days vs 1 yr (T is terrible, B is better)

Front 45

What is the exception to the saying: Most T cell lymphomas are aggressive?

Back 45

Dogs with T-zone lymphomas have a 2 yr survival

Front 46

As a generalized rule which breeds more often have T cell lymphoma? B cell lymphoma?

Back 46

T cell: "old world" breeds - Arctic circle breeds, Irish wolfhound, Yorkie

B cell: "young" breeds - bassett hound, cocker spaniel, Scottie, border collie

Front 47

What are prognostic indicators of canine lymphoma?

Back 47

High grade (blast cells) worse than low grade (small lymphocytes)
High grade B cell lymphoma tx'd w/ chemo live 2x as long as high grade T cell tx'd w/ chemo
Clinically ill & anemic when initially presented
Low expression of MHC class II or large size of B cell
>50% bone marrow involvement

Front 48

Looking at a PCV tube - what about it might make you suspicious of potential leukemia?

Back 48

A large buffy coat

Front 49

How is leukemia classified?

Back 49

Acute vs Chronic
Myeloid vs Lymphatic

Front 50

What characteristic is common among ALL leukemia patients?

Back 50

Splenomegaly

Front 51

What is the difference between acute & chronic leukemia?

Back 51

Acute: predominance of blasts in peripherial blood and bone marrow - AGGRESSIVE

Chronic: predominance of mature cells in PB & BM - LESS AGGRESSIVE

Front 52

What are common physical findings associated with acute leukemia?

Back 52

Splenomegaly - ALL
Hepatomegaly
Lymphadenopathy
Pallor
Fever
Emaciation

Front 53

What clinical tests are essential to diagnosing leukemia?

Back 53

Hemogram (aka CBC)
Bone marrow evaluation

(also clinical signs & physical findings)

Front 54

What are general morphologic bone marrow changes in acute leukemia?

Back 54

Increase in monomorphic blasts
Lack of cell differentiation - left shifted
Reduced/absent normal precursors - RBCs often affected

Front 55

What are general morphologic bone marrow changes in chronic leukemia?

Back 55

Granulocytic cells

Front 56

What are general hematologic findings in acute leukemia?

Back 56

Leukemia - most!
Pancytopenia
Bicytopenia
Thrombocytopenia

Front 57

What are general hematologic findings in chronic leukemia?

Back 57

High counts of mature (or nearly) leukocytes
- segmented neutrophils, well differentiated lymphocytes

Front 58

What treatment protocol is used for acute leukemia? Prognosis?

Back 58

CHOP
(cyclophosphamide, doxorubicin, vincristine, prednisone)
Poor/guarded; 3-4 months - goal is to make p more comfortable, not cure

Front 59

What must you be sure to differentiate a suspected chronic myelogenous leukemia from?

Back 59

Inflammation! - segmented neutrophils
**CML mimics a normal physiological response**

Front 60

In general, are chronic leukemias more or less severe compared to acute leukemias?

Back 60

Not as severe
may or may not be sick (fever, vomit, diarrhea)

Front 61

What treatment protocol is used for chronic leukemia? Prognosis?

Back 61

Goal: slow production of cancer cells - hydroxyurea, chlormabucil + pred (non-responders tx w/ CHOP)
Prognosis: improve for months to years w/ chemo!

Front 62

What is multiple myeloma?

Back 62

Excess of one Ig type or deficiency of normal Ig

Front 63

What are some clinical signs of multiple myeloma and what are they attributed to?

Back 63

Plasma cells destroying bone: bone pain, fractures, paralysis

high Ig blood levels: sludging, renal, ocular, CNS

Front 64

How does MM show on serum protein electrophoresis?

Back 64

Monoclonal spike - USUALLY
do radial immunodiffusion to termine idiotype & concentration

Front 65

What are diagnostic criteria of MM?

Back 65

Radiographic bone lesions
Excessive plasmacytosis in bone marrow
Presence of paraprotein in blood
Same idiotype (Ig) in urine

Front 66

What other disease can present similar to MM - plasmacytosis & gammopathy?

Back 66

Ehrlichia

Front 67

What is the standard of care for treating multiple myeloma?

Back 67

Alkylating agent + Pred (mephalan + pred)
if refractory use doxorubicin

Front 68

Why use prednisone in neoplastic cases?

Back 68

Lyses lymphoid cells

Front 69

What is the prognosis for treating MM with chemotherapy in dogs & cats?

Back 69

Dogs: 540 day survival
Cats: <1 yr (closer to 6 months)