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68 Cards in this Set
- Front
- Back
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What is the common signalment for an animal with osteosarcoma?
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Middle aged to older large/giant breed dogs
OR Young (~1 yr), spayed female Rottweiler - the worser disease |
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Most common places for osteosarcomas to occur?
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2x more likely to be on a front limb than hindlimb
DISTAL RADIUS & PROXIMAL HUMERUS (away from the elbow, close to the knee), Metaphysis |
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OSA can be associated with which of the following?
A. Chronic osteomyelitis and bone infarcts B. Internal fixation of fractures and total hip arthroplasty C. Chemotherapy D. Fractures, bone cysts, and OCD lesions |
C - not associated with chemotherapy but IS associated with radiation therapy
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85% of fracture associated OSA develop at the _____.
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Diaphysis
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What are survey radiographic signs indicating OSA?
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Lytic changes
Soft tissue extension with new bone formation Codman's triangle |
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In cases of OSA, only _____% have detectable masses via thoracic rads, _____% have micro metastasis, and ____% will eventually develop metastatic disease.
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10-15% have detectable metastasis
99% (almost all) have micro metastasis 75-90% will eventually develop |
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T/F: Nuclear scintigraphy cannot differentiate benign from malignant or detect pulmonary metasasis.
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True - its very sensitive but not specific
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What are potential complications of taking a biopsy of an OSA lesion?
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Induced fractures
Needle track Infection |
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Which biopsy technique is more accurate...
...Jamshidi or Michele trephine open technique |
Michele trephine open technique
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What is the gold standard for OSA local disease control? Who is it contraindicated in?
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Limb amputation
Contraindicated in neuro animals |
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What are possible complications when doing a limb amputation for an OSA case?
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Hemorrhage, infection, air embolism
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Which treatment method for OSA provides the longest MST? the shortest?
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Shortest: amputation or radiation therapy alone (119/125 days)
Longest: amputation + carboplatin (321 days); amputation + cisplatin + doxorubicin (30 days) |
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T/F: When treating OSA with chemotherapy, there was no significant difference when chemotherapy was started - whether pre-op, intra-op, or up to 21 days post-op.
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True - however high toxicity is more common when chemo was given 2 days post vs 10 days post-op
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Is radiation therapy more of a curative or palliative intent when treating OSA?
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Can be either! Requries a really really really high dose of radiation to be curative - very resistant
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What drug can be given to OSA patients to reduce osteoclastic activity, bone resorption, & increase bone mineral density?
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Bisphosphonate
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What are side effects of bisphosphonate?
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Renal failure
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What are good prognostic indicators of OSA?
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ALKP (good: bone alkp <23 U/L, total alkp <110 U/L)
Tumor necrosis (>90% inc tumor necrosis = poor prognosis) |
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What allows doxorubicin to remain in the body longer allowing a greater amount to be delivered to the cancer cells?
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Liposome
(liposomal DNA complex encoding IL-2, then pegylated to pretoect from mononuclear phagocytes) |
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What are 2 benefits to liposomal DNA complexes?
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Improved survival time by 3x in dogs with metastatic dz
Results in less cardiotoxicity in dogs |
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What are the 4 different types of epuli? Where is the most common location?
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Fibromatous
Ossifying Acanthomatous Giant cell Most common location: maxillary premolar teeth |
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T/F: Acanthomatous epuli are extremely quick to metastasize though do not cause a lot of local damage.
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False - locally invasive but low rate of metastasis
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What is appropriate treatment for acanthomatous epuli?
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Surgery - mandiblectomy/maxillectomy
Radiation (95% cure rate) Intralesional bleomycin (100% cure rate for 1yr) |
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What is the most common oral cancer in cats? dogs?
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Cats: SCC
Dogs: oral malignant melanoma |
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When looking to treat oral SCC in cats with surgery, what is needed for planning?
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Needle aspirates/tissue biopsy & CT
(FNA sentinel lnn, chest rads, & CBC/chem are also helpful for staging) |
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What treatment gives the best result for feline SCC? Prognosis?
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Aggressive surgery
(radiation in combo with surgery/chemo only) Poor prognosis <10% for 1yr survival |
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Which type of SCC has a low risk of metastasis but is very invasive?
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Young dog SCC = Papillary SCC
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What is the best treatment for canine SCC?
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Surgery (resection of rostral SCC is curative)
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Which is more responsive to radiation...
...canine SCC or feline SCC |
Canine SCC - piroxicam & cisplatin (nephrotoxic!)
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Which canine SCC treatment has the best prognosis?
A. Radiation alone B. Mandiblectomy C. Piroxicam & cisplatin D. Maxillectomy |
Mandiblectomy - 91% alive in 12 months w/ 10% local recurrence rate
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What is the most common signalment for dogs presenting with oral malignant melanoma?
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Older (~12 yrs), male dogs (no breed disposition)
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What is the common clinical behavior of oral malignant melanoma? Where is this tumor most likely to metastasize to?
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Common location at the gingiva, commonly have radiographic evidence of bone involvement, and metastasis is common
70% metastasize to regional lnn, 67% to tonsils, 15-70% to the lungs |
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30% of OMMs are _____ and thus makes diagnosis difficult.
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Amelanotic - melanoma cells can look like any other malignancy (ie: carcinoma or sarcoma)
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What are appropriate diagnostics for a case of OMM?
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**FNA of sentinel lnn - 40% of normal size lnn will have mets**
CT (surgical or radiation planning) 3 view chest rads CBC/Chem |
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Clinical staging of OMM...
...<2 cm without regional nodes or distant mets |
Stage I
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Clinical staging of OMM...
...2-4 cm without regional or distant mets |
Stage II
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Clinical staging of OMM...
...>4 cm or any size tumor with regional nodes or distant mets |
Stage III
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Which has a greater risk of local recurrence...
...mandiblectomy or maxillectomy? |
Maxillectomy: MST 5-10 month, 50% local recurrence
(mandiblectomy MST 9-11 month, 22% local recurrence; thus better prognosis) |
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Which OMM treatment is meant for a curative intent?
a. Radiation b. Chemotherapy c. Immunotherapy vaccine |
Radiation - high dose once a week, include regional lymph nodes
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Which neoplasia is the only one that may be treated with a vaccine?
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Oral malignant melanoma
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How does the immunotherapy vaccine work?
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Injected into patient post surgery &/or radiation to stimulate dendritic cells causing a stimulus to the immune system
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What is the prognosis for a dog with oral melanoma? What are prognostic indicators?
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Very poor (metastatic rate >90%)
Indicators: size of tumor, location, & local tumor recurrence |
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What is the MST for dog with a 1 cm malignant melanoma mass? a 5 cm mass?
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Mass <2 cm - MST 500 days
Mass >2 cm - MST 160 days |
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Which of the following are good prognostic indicators for OMM?
a. Mass >2 cm b. Benign neglect c. Stage III d. Low mitotic figure on histology e. Mass on the mandible |
d. Low mitotic figure on histology
e. Mass on the mandible |
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What is the most common gastric cancer in dogs?
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Gastric adenocarcinoma
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What is the common signalment for an animal with gastric adenocarcinoma?
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Older, male (2.5:1) dogs; Belgian shepherd & rough coated collies overrepresented
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Where do gastric adenocarcinomas commonly occur?
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Lesser curvature of the stomach and pyloric antrum
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Where do gastric adenocarcinomas commonly metastasize to?
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Gastric lnn., peritoneum, liver, & lungs
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How would you expect a gastric adenocarcinoma patient to present clinically?
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Decreased motility, outflow obstruction, anemic, wt. loss, vomiting post-prandial, vomit with digested/fresh blood
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You suspect your patient has a gastric adenocarcinoma. How will you go about confirming this diagnosis?
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Radiographs (look for mass effect)
Ultrasound (thickening & loss of layering of gastric wall) Endoscopy (visualize mass) CT (surgical planning) Blood chemistry (look for elevated liver enzymes - biliary duct obstruction) |
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T/F: Surgery followed by chemotherapy is the recommended course of treatment regardless if metastasis has occurred or not.
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False! Surgery is recommended tx - can be curative IF confined to stomach.
(there is NO known effective chemotherapy) |
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Aside from surgery, a patient with a gastric adenocarcinoma may also benefit from what other treatment(s)?
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NSAIDs - piroxicam
(adenocarcinomas express COX2) |
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What is the prognosis for a patient diagnosed with gastric adenocarcinoma? What does the prognosis for a gastric adenocarcinoma depend on?
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Poor (MST <6 months - most suffer from local recurrence or metastatic dz)
Depends on: • location of mass • +/- complete surgical resection • metastatic status on presentation |
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What is the common signalment for an animal presenting with anal sac adenocarcinoma?
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Older dog; German shepherd, cocker spaniel, Alaskan malamute are predisposed
- equal distribution bw males & females |
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T/F: Castration is an imperative treatment for anal sac adenocarcinomas.
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False - NO hormonal dependency!
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What clinical signs would you expect to see in a patient presenting with anal sac adenocarcinoma?
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PU/PD (hypercalcemia)
Obstruction of pelvic canal from 1º dz or 2º to sublumbar lnn metastasis Pain & lameness (bone mets) Neuro dz (mets to the spinal cord) |
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How would you confirm diagnosis of anal sac adenocarcinoma?
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RECTAL EXAM!!
Blood chemistry - renal values Blood serology - ionized calcium, PTH, PTHrp Abdominal ultrasound 3 view chest rads FNAs |
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What are treatment options for an anal sac adenocarcinoma?
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Surgery
Radiation Chemotherapy |
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What is involved with surgery if that is the treatment chosen for an anal sac adenocarcinoma?
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Intensive diuresis if hypercalcemic prior to
Resection of up to 5-% of rectum (results in intemittent fecal incontinence) Sublumbar lnn resected if involved |
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What is the chemotherapy protocol for anal sac carcinoma? Whats the prognosis for this treatment plan?
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Carboplatin or cisplatin - 30%
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What is the expected prognosis for a dog with anal sac carcinoma if an owner chose to do surgery, radiation and chemotherapy? What if they chose just surgery?
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Surgery, radiation, chemo: 740-950 days
Surgery: 500 days (Radiation: 650 days) |
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What are poor prognostic indicators in a case with anal sac adenocarcinoma?
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Metastasis (lnn or lungs)
Hypercalcemia Tumor size |
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What is the most common reason for hypercalcemia?
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Lymphoma (T & B cell)
more than 25% of dogs w/ anal sac adenocarcinoma present with hypercalcemia |
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What is the fetal peptide that is upregulated in cancer that increases blood ionized calcium levels?
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PTH-related peptide (PTHrp)
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Hypercalcemia results in a decreased responsiveness to ____ in the distal rubles and ____ renal blood flow and glomerular filtration rate.
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ADH; decreased renal blood flow & GFR
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What is the appropriate treatment for hypercalcemia due to neoplastic causes?
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Bisphosphonate
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Who is most at risk for perianal adenomas?
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Intact males (androgen dependent) & spayed females (low estrogen levels)
Can also be associated with Cushing's or adrenal tumors (testosterone producing cancers) |
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Where are perianal adenomas generally found?
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Around the perineum! But can also be seen around the scrotum & prepuce
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What is the recommended treatment & prognosis for perianal adenomas?
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Castration!! Also surgical removal of tumor/cryosurgery, estrogen (will shrink tumor but can result in bone marrow suppression)
Prognosis: EXCELLENT! <10% recurrence |
