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50 Cards in this Set
- Front
- Back
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What are the goals of cancer therapy in pets?
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1. Cure: Diagnose & Stage
2. Obtain complete remission 3. Obtain partial remission 4. Control the cancer: "chronic dz" 5. Provide good quality of life |
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How is TCC so invasive?
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Causes urinary obstruction and metastatic disease
Very similar to humans |
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How many TCC patients are treated and go into remission & stabalize?
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75%
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What is the diagnostic plan for lumps?
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1. Preliminary cytology from fine needle aspiration
2. BIOPSY for histopath and tumor grade |
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What are the criteria for malignancy?
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Increase in nuclear/cytoplasmic ratio
Multiple nuclei Variation in nuclear size Irregularly clumped chromatin Increased mitotic figures multiple nucleoli Increased basophilia of cytoplasm |
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Why should you stage a tumor?
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Prognosis
Plan Baseline |
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What helps you stage a tumor?
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Physical exam
Biopsises other diagnostics |
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What types of local therapy are available?
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surgery!!!!
radiation photodynamic therapy hyperthermia local chemotherapy |
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Surgical margins for tumors
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1 cm for benign
3 cm for malignant |
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Systemic treatments
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Chemotherapy
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Treatment for complete remission after 4-8 weeks after chemotherapy?
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Continue treatment until at least 4-8 weeks and monitor for relapse
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Treatment for partial remission or stable after 4-8 weeks after chemotherapy?
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continue tx and stage/remeasure every 4-8 weeks; adjust Tx as needed to minimize toxicity
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Treatment for progressive after 4-8 weeks after chemotherapy?
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Switch to a different drug or consider palliative care
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What should you monitor before & after every treatment?
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Neutrophil and platelet count
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What are the guidelines for reducing chemotherapy by 10%?
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Neutrophils less than 1,000
Platelets less than 100,000 |
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What are the guidelines for reducing chemo by 20%?
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Neutrophils less than 500
Platelets less than 50,000 |
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When should you delay giving chemotherapy that day?
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Neutrophil less than 3,000
Platelets less than 150,000 |
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When should you stop giving chemotherapy?
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If remission stays for 2 checks
Progressive dz Animal won't tolerate Owners don't want to continue |
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What 2 systems are mostly affected by chemotherapy?
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GI
Bone marrow |
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When should pet owners be cautious handling an animal on chemotherapy?
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Cleaning up urine & feces (especially after 1st 24 hours)
Oral chemotherapy |
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What is the basis for Gompertzian growth kinetics?
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Initial slow phase
Rapid growth phase *most susceptible to chemo Plateau (carrying capacity) *finally detectable |
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What is the Goldie-Coldman hypothesis?
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Large heterogenous tumor cell population w/unstable genome -> high chance for mutation leading to cellular resistance to chemo
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Why do tumors display chemotherapy resistance?
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Unfavorable growth kinetics (plateau vs. rapid growth)
Goldie-Coldman Hypothesis |
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Which tumors are least likely to respond to chemotherapy?
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Sarcomas
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Which tumors respond well to chemo?
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Round cell tumors and some carcinomas
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Indications for chemotherapy?
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Adjuvant Therapy
Downstaging a tumor prior to surgery/radiation Palliation of unresectable tumor Sensitize tumors to radiation??! |
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Is myelosuppression due to chemotherapy dose-limiting?
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Yes
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Why are neutrophils targeted so much in chemotherapy?
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Neutropenia is the most common finding due to its high mitotic rate -> hours
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What other hematologic findings can occur?
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Thrombocytopenia
Anemia |
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What is a nadir?
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The low point in a blood cell count following chemotherapy is called the nadir.
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Should patients at risk for sepsis (neutropenia , GI disruption, afebrile) stay in the hospital?
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No, do what needs to be done but get them out, so they don't get a nosocomial infection
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Should a febrile, neutropenic patient be managed at home?
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No, hospitalize and support while in isolation. Remove as many variables as possible.
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What can you treat acute nausea and diarrhea with?
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Happens w/in 24 hours
Likes Cerenia |
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How should you treat delayed diarrhea and vomiting?
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Happens 3-5 days postTx, lasts for 3-5 days
Meteclopramide |
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Why do most dogs not lose their hair?
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The hair follicles are not usually dividing, catagen phase
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Types of canine lymphoma?
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Multicentric
Cutaneous Mediastinal GI Other rare forms |
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Are multi-agent chemo protocols better than single agent?
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Yes, better at circumventing chemoresistance and reducing toxicity.
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What are the multi-agent protocols for lymphoma?
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COP
CHOP "Standard of Care" |
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What are single-agent protocols for lymphoma?
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CCNU
Pred Doxorubicin |
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Six Hallmarks of Cancer
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Self sufficiency in growth signals
Unresponsiveness to anti-growth signal Resistance to apoptosis Limitless replicative potential Sustained angiogenesis Invasion and Metastasis |
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First step of carcinogenesis
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Initiation
could lead to apoptosis or cancer |
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2nd step of carcinogenesis
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Promotion: exposure to mitogenic agent causing cellular proliferation
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3rd step of carcinogenesis
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Progression: accumulation of further mutations, acquisition of invasive/metastatic potential
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What do normal cells do when they have reached maximal divisions?
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Replicative senescence
Crisis: telomeres, chromosomal erosion *Aneuploidy -> apoptosis; cancer cells love it |
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What is the major growth limiting factor for cancer cells?
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Oxygen
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How does invasion and metastasis occur?
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Metalloproteinase -> basement membrane
Down-regulate Cadherins -> cells break off from one another |
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How do cancer cells avoid the immune system?
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Suppress production of immunogenic proteins
Produce immunosuppress. cytokines Recruit immuonsupp. leukocytes Subert leukocytes to do their bidding |
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Is there are large difference b/w advance cancer and clinically evident cancer?
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No very close on the graph
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Examples of targeted therapy
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Palladia: inhibits ATP of growth factors
Canine Melanoma vaccine Anti-angiogenic |
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What is the best way to treat cancer?
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Prevent it!!!
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