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69 Cards in this Set
- Front
- Back
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What are common clinical signs seen associated with nasal tumors?
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Violent sneezing
Nasal discharge Epistaxis Facial deformity/exophthalmos |
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What kind of imaging is preferred for identifying nasal tumors?
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CT & MRI
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How can you tell if the palatine bone has been invaded by a nasal tumor just by opening the mouth?
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A ventral deviation of the hard palate
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What should be done prior to taking a nasal biopsy?
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Check clotting - will be bloody!
(coagulation profile to check intrinsic & extrinsic pathways & BMBT to check platelets) |
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What are the two types of traumatic nasal biopsies?
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Catheter biopsy ("ram & jam")
Cup forceps ("clam shell") |
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What are the most common nasal tumors found in dogs? cats?
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Dogs: 2/3: adenocarcinoma 1/3: sarcomas (fibro-, chondro-, & osteo-)
Cats: lymphoma |
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T/F: A dog can sneeze under anesthesia.
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True! And if it happens just after a nasal biopsy - it will be bloody!
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Heparin & antithrombin III inactivate which part(s) of the coagulation cascade?
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Factors IX, X, XI, XII and (prothrombin to) thrombin
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What is the general biological behavior of most nasal tumors?
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Slow to metastasize
Eats their way through the head like a hot coal on ice |
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What is the treatment of choice for nasal tumors?
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"local disease → local treatment"
Surgery + radiation therapy |
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What is the difference in radiation therapy protocols between hypofractionation, conventional, and palliative?
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Hypofractionation: 10 treatments
Conventional: 18-20 treatments Palliative: 4-6 lg treatments |
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What is the average survival time for animals undergoing radiation therapy as a treatment for nasal tumor?
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1-2 years median survival
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Name 5 things you should expect as a result of radiation therapy.
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Decreased epistaxis
Improved movement of air Acute side effects: conjunctivitis, dry eye, ulcers Chronic side effects: cataracts, blindness, bone necrosis |
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What are common clinical signs seen associated with lung tumors?
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COUGH, COUGH, COUGH (unproductive & paroxysmal)
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How do you work up a lung tumor case?
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Good quality rads
FNA - ultrasound guided Differentiate 1º vs metastatic Differentiate from fungal lesions |
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How can you usually differentiate between 1º and metastatic lung tumors?
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Lung carcinomas: often solitary & larger
Mets: often peripheral |
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What is the best way to differentiate fungal lesions in the lung from neoplasia?
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FNA (may even be better than doing a CT)
May be multiple lesions - then again so could carcinomas & mets... |
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What is the preferred imaging technique for lung tumors?
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CT (better detail & visualization of traceobronchial nodes)
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T/F: Enlarged trachobronchial nodes have no correlation with metastasis.
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False - its a high positive correlation
(prognosis is dismal with TB node mets - 2 month survival) |
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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?
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Paraneoplastic syndrome → Hypertrophic osteopathy
(dont confuse with OSA!!) |
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What are 2 odd lung tumor metastases that have been seen to occur in cats?
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Mets to the distal phalanges (lysis of bone, extremely painful, & can aspirate ciliated respiratory cells from the feet!)
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The majority of neoplasia found in the lungs are what kinds of tumors?
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Carcinomas (adenocarcinoma, bronchogenic carcinoma, +/- squamous differentiation)
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What is the prognosis for lung tumors?
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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) |
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What is now the standard of care post-op for lung tumors?
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Vinorelbine chemotherapy
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Canine lymphoma is synonymous with ___.
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Lymphosarcoma (LSA - no benign counterpart)
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Which breed is most predisposed to canine lymphoma?
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Golden retrievers - 8x more
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T/F: lymphoma is incurable.
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True for the most part
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What changes might an owner notice in their dog or cat with lymphoma?
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**generalized lymphadenopathy**
lethargy, weakness inappetitant, wt loss vomiting, diarrhea PU/PD, dyspnea cutaneous masses, bleeding |
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What physical abnormalities can be seen in dogs & cats with lymphoma?
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hepatosplenomegaly, emaciation
pallor, pleural/abdominal effusions intrathoracic masses cutaneous plaques/ulcers |
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Which form of lymphoma is more common in dogs? in cats?
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Dogs: multicentric form
Cats: alimentary |
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How does the multicentric form of lymphoma commonly present?
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**generalized lymphadenopathy**, hepatomegaly, splenomegaly, tonsillar enlargement, occasional extranodal involvement
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How does the alimentary form of lymphoma commonly present?
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affects Gi lymphoid tissue in intestines & mesenteric nodes, +/- liver, spleen
palpable abdominal masses, wt. loss, dehydration |
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What are the different forms of lymphoma?
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Multicentric
Alimentary Mediastinal Extranodal |
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How is lymphoma staged? What are the stages?
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From the results of diagnostic procedures. Stages I-V
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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 |
b. Mild anemia
c. Immature lymphs in blood (will see thrombocytoPENIA) |
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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 |
a. Increased liver enzymes
b. Azotemia d. Increased protein (or decreased!) expect to see HYPERcalcemia |
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What are some clinical signs of hypercalcemia?
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PU/PD, anorexia, depression, vomiting
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What effects does hypercalcemia have on the kidney?
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High serum calcium -> decreased ADH activity on tubules (reversible)
prolonged calcium -> nephrocalcinosis (irreversible) |
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How do you work up a lymphoma case?
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CBC/Chem
Urinalysis Thoracic rads Abdominal radiographs/ultrasound |
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What procedure done for lymphoma is diagnostic most of the time?
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Lnn aspiration for cytological exam
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How does normal lymph node cytology compare to a reactive lymph node?
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Normal: 90-95% mature lymphocytes, 5-10% lymphoblasts
Reactive: 20% lymphoblasts, 10-20% prolymphocytes, 30% mature lymphocytes, 20% plasma cells, 10% neutrophils/eosinophils |
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How does a normal lymph node cytology compare to a lymph node infiltrated with lymphoma?
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Normal: 90-95% mature lymphocytes, 5-10% lymphoblasts
Lymphoma: 60-100% "tumor cells" |
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What is immunophenotyping and why is it recommended?
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Identifying the lymphoid lineage - T cell vs B cell
Recommended bc its prognostic - **Most T cell lymphomas are aggressive!!** |
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If your dog had to have lymphoma - which type would you rather it be - T cell or B cell?
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dogs with B-cell LSA >/= twice as long as T-cell
MST 160 days vs 1 yr (T is terrible, B is better) |
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What is the exception to the saying: Most T cell lymphomas are aggressive?
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Dogs with T-zone lymphomas have a 2 yr survival
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As a generalized rule which breeds more often have T cell lymphoma? B cell lymphoma?
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T cell: "old world" breeds - Arctic circle breeds, Irish wolfhound, Yorkie
B cell: "young" breeds - bassett hound, cocker spaniel, Scottie, border collie |
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What are prognostic indicators of canine lymphoma?
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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 |
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Looking at a PCV tube - what about it might make you suspicious of potential leukemia?
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A large buffy coat
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How is leukemia classified?
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Acute vs Chronic
Myeloid vs Lymphatic |
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What characteristic is common among ALL leukemia patients?
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Splenomegaly
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What is the difference between acute & chronic leukemia?
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Acute: predominance of blasts in peripherial blood and bone marrow - AGGRESSIVE
Chronic: predominance of mature cells in PB & BM - LESS AGGRESSIVE |
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What are common physical findings associated with acute leukemia?
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Splenomegaly - ALL
Hepatomegaly Lymphadenopathy Pallor Fever Emaciation |
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What clinical tests are essential to diagnosing leukemia?
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Hemogram (aka CBC)
Bone marrow evaluation (also clinical signs & physical findings) |
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What are general morphologic bone marrow changes in acute leukemia?
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Increase in monomorphic blasts
Lack of cell differentiation - left shifted Reduced/absent normal precursors - RBCs often affected |
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What are general morphologic bone marrow changes in chronic leukemia?
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Granulocytic cells
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What are general hematologic findings in acute leukemia?
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Leukemia - most!
Pancytopenia Bicytopenia Thrombocytopenia |
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What are general hematologic findings in chronic leukemia?
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High counts of mature (or nearly) leukocytes
- segmented neutrophils, well differentiated lymphocytes |
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What treatment protocol is used for acute leukemia? Prognosis?
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CHOP
(cyclophosphamide, doxorubicin, vincristine, prednisone) Poor/guarded; 3-4 months - goal is to make p more comfortable, not cure |
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What must you be sure to differentiate a suspected chronic myelogenous leukemia from?
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Inflammation! - segmented neutrophils
**CML mimics a normal physiological response** |
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In general, are chronic leukemias more or less severe compared to acute leukemias?
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Not as severe
may or may not be sick (fever, vomit, diarrhea) |
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What treatment protocol is used for chronic leukemia? Prognosis?
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Goal: slow production of cancer cells - hydroxyurea, chlormabucil + pred (non-responders tx w/ CHOP)
Prognosis: improve for months to years w/ chemo! |
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What is multiple myeloma?
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Excess of one Ig type or deficiency of normal Ig
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What are some clinical signs of multiple myeloma and what are they attributed to?
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Plasma cells destroying bone: bone pain, fractures, paralysis
high Ig blood levels: sludging, renal, ocular, CNS |
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How does MM show on serum protein electrophoresis?
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Monoclonal spike - USUALLY
do radial immunodiffusion to termine idiotype & concentration |
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What are diagnostic criteria of MM?
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Radiographic bone lesions
Excessive plasmacytosis in bone marrow Presence of paraprotein in blood Same idiotype (Ig) in urine |
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What other disease can present similar to MM - plasmacytosis & gammopathy?
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Ehrlichia
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What is the standard of care for treating multiple myeloma?
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Alkylating agent + Pred (mephalan + pred)
if refractory use doxorubicin |
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Why use prednisone in neoplastic cases?
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Lyses lymphoid cells
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What is the prognosis for treating MM with chemotherapy in dogs & cats?
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Dogs: 540 day survival
Cats: <1 yr (closer to 6 months) |
