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198 Cards in this Set

  • Front
  • Back

Name 9 features of malignancy

Degree of differentiation


Mitosis index


Degree of cellular or nuclear polymorphism


Amount of necrosis


Invasive ness


Stromal reaction


Nucleolar size and number


Overall cellularity


Lymphoid response

What is immunohistochemistry?

Staining procedure using antibodies to identify specific intracellular or extracellular molecules eg KI67

What is lung digit syndrome?

A condition in cats where metastatic lesions of the digits appear secondary to primary lung tumours

Cats can appear with paraneoplastic disease such as? 2

Alopecia in pancreatic, hepatic or bile duct carcinoma


Exfoliative dermatitis with thymoma

3 ancillary tests which may aid diagnosis is lymphoma?

Immunocytochemistry


PARR


Flow cytometry

In what tissue are tru cut biopsies not recommended?

Lymph nodes as they are no more sensitive than fine needle aspirates for detection of metastatic disease

4 neoplasia that can cause hypercalcemia

Anal sac adenocarcinoma


Lymphoma


Multiple myeloma


Squamous cell carcinoma

Which tumour can cause GI ulceration?

MCT

Which lymph nodes drain


- head? 2


- pinnae? 2


- distal forelimb?


- proximal forelimb?


- distal hindlimb?


- perianal, anogenital, rectal? 3

- Submandibular, retropharyngeal


- submandibular and prescapular


- pre scapular


- axillary


- popliteal


- inguinal, sublumbar, sacral

How sensitive is CT compared to rads for picking up metastasis?

Can pick up as small as 2mm compared to 5mm

What is a target lesion?

On ultrasound, hypoechoic rim with a hyperechoic or isoechoic centre

What is skin sparing effect?

Mega voltage radiotherapy deposits maximum radiation dose 0.5cm below the skin

Difference of photons and electron beams where they treat

Photons are used to treat deeper tumours


Electron beams are used to treat superficial lesions

explain indirectly ionising?

X rays (photons) collide with other atoms and transfer energy to other electrons to initiate the chain of events that causes biological damage

Why do some tumours shrink faster than others following radiotherapy?

Cells die when they try to divide at the next mitosis so slow growing tumours will take longer

Why is presence of oxygen helpful in radiotherapy?

Oxygen reacts with free radicals which damage DNA. In absence of oxygen cells have time to repair themselves

2 Benefits of more frequent fractions?

Less time for tumour cells to repair and repopulate


Less side effects

Why is radiation a gradual process?

During the process tumour cells enter different phases of the cell cycle, aka redistributing. They also may become re-oxygenated which allows greater kill

Palliative radiotherapy regieme

Fewer treatments but larger doses per fraction

Curative intent radiotherapy

Smaller doses frequently eg daily for 4 weeks

Which tissues are typically affected by acute radiation side effects?

Rapidly proliferating cells such as oral mucosa, skin, small intestines and bladder mucosa

What types of tissues undergo late radiation side effects? Treatment?

Nerves and bones


Not always treatable hence hypofractionated protocols only chosen in patients with a short term prognosis

Give an example of an anti tumour antibiotic

Doxorubicin

Example of vinca alkaloid

Vincristine

Example of an alkylating agent

Cyclophosphamide


Chlorambucil

How do corticosteroids work as a chemotherapy drug?

Apoptosis of lymphoid, round, mast cell and plasma cell tumours

Actions to take if IV chemo drug extravasates?

Stop infusion, aspirate, give dex IV in another vein

If vincristine extravasates what can you give?

Hyaluronidase SC


Warm compress


Anti inflammatory ointment

If doxorubicin extravasates what can you do? 4

Cold compress to minimise spread


Administer dexrazoxane IV at 10x dose within 3 hours. Repeat at 24 and 48 hours


Apply DSMO topically every 2 hours


Apply anti inflammatory ointment

What genetic defect can affect chemo tolerability?

MDR gene multi drug resistance in certain breeds

When does neutrophil nadir occur? 1 exception

8 days


Carboplatin 10-14 days

What should you do if nadir falls below 1000/ microlitre 2

If no other symptoms then administer broad spectrum oral antibiotics do several days and monitor until next blood count. Doesn’t usually last longer than 72 hours


Reduce the dose of the drug by 15-20% at next administration

3 possible late side effects of radiation

Cataracts


Bone necrosis


Internal Strictures

If neutrophil count is below 2000 u/l what could you so?

If patient clinically well then could give treatment but if drug very immunosuppressive eg doxorubicin then Delay treatment by 2-4 days

Neutrophil count less than 500 u/l action?

Risk of sepsis, if fever or GI signs, hospitalisation and IV fluids and antibiotics and symptomatic

If patient presents for chemo with anorexia, diarrhoea, vomiting, fever action?

Regardless of neutrophil count, treatment not given and symptomatic tx

3 drugs to treat diarrhoea induced by chemo

Sulphasalazine


Metronidazole


Loperamide (not with mdr1 mutation)

What gut side effect can vincristine cause? What species more affected? Tx?


2 more toxicities?

Ileus paralyticus more frequent in cats


Self limiting, metoclopramide or cisapride can help


Peripheral neuropathies and skin sloughing

Antiemetic prophylaxis is helpful with treatment with which drug?

Doxorubicin

High dose cyclophosphamide in cats can cause what?

Anorexia

Which drug can cause cardio toxicity? Chronic administration can lead to what?

Doxorubicin


DCM

2 organs that can be affected with doxorubicin? 1 tumour can react? Local reaction?

Cardio toxicity


Mast cell degranulation


Nephrotoxicity reported in cats


Vesicant

Cyclophosphamide specific toxicity in dogs and treatment?

Sterile haemorrhage cystitis


Discontinue. Rule out infection. Analgesia. Oxybutin (anti spasmodic) intracranial dsmo

What are the 4 stages of the cell cycle?

G1- enzymes synthesised


S- dna is synthesised


G2- proteins are synthesised


M- mitosis

What side effect can be seen with lomustine in 7% of dogs? What supportive medication could be given?

Hepatotoxic in 7% of dogs. Consider same

2 side effects of cisplatin (GI sign and one organ toxicity) and what does it cause in cats?

Neprotoxic and vomiting


Fatal pulmonary oedema in cats

4 side effects of receptor tyrosine kinase inhibitors?

GI


Myelosuppression


Renal and hepatic toxicity


Depigmentation

2 drugs not to be given to cats

Cisplatin- pulmonary oedema


Fluoracil- neurotoxicity

Mdr mutation can be sensitive to what 2 drugs? What breed are sensitive?

Doxorubicin


Vinca alkaloids


Herding breeds

What is oncept?

Canine melanoma vaccine

Mutations in kit gene are associated with what?

Development or progression of some mast cell tumours

How can tyrosine kinase inhibitors work?

Receptors present on Mcts. Inhibitors have anti cancer activity and anti angiotenic.

What type of tumour are veterinary TKIs best for? Names? What form?

Canine cutaneous non respectable grade 2 and 3 mast cell tumours


Toceranib (Palladia) and masitinib (masivet)


Oral

3 main side effects of TKIs and when can they develop?

GI


Haematological


Musculoskeletal


Few days to weeks or months after starting tx

Define mitosis index

Percentage of cells undergoing mitosis in a tissue

Why do you need to be cautious and proactive in particular with TKI side effects?

As effects are cumulative, even if stopping the medication and imitating sympmatic tx the symptoms can continue for weeks

How do Feline cutaneous mcts compare to canine?

Benign and surgery is curative

Response rates to TKIs?

Often not durable and typically only last a short number of weeks to months

Define metronomic chemotherapy

Administer chemo on a more continuous basis

How common is osteosarcoma of the bone tumours?

85% of malignancies

What breeds are predisposed to osa? Link to neutering? Age?

Large breeds


Early neutering in Rottweilers linked to osa


2 peaks- small at 18-24 months and bigger at 7-9 years

How common is metastasis in osa? And locations 3

90% by diagnosis


Lungs, bone and soft tissue

2 most common localisations for osa

Away from the elbow (think vowels)


Towards the knee

What biochemical abnormality is associated with poorer prognosis in osa

Alp

Diagnosis of osa

Location, x rays and fna or biopsy


Fna agrees with biopsy 71% of the time

Name 3 tumours where chemotherapy would be beneficial as adjuvant therapy following surgical excision

Osteosarcoma


Haemangiosarcoma


Grade 2 or 3 mast cell tumour with a mitotic index of >7

Pain management in osa

NSAIDs, opioids, gabapentin, amantadine, paracetamol


Radiation - very effective


Bisphosphanates? Poor evidence basis

Use of bisphosphonates in osa and example

Osteoclasts inhibitors


Palliative treatment to increase bone density and maybe pain relief


Pamidronate- IV once monthly


Oral bisphosphonates have poor bioavailability alendronate

How can chemo be used in osa? 2 drugs

Adjuvant treatment of canine appendicular osa


Carboplatin and doxorubicin

Why is persistent hypercalcemia a problem?

Underlying problem


But will result in renal failure and gastritis

Treatment for hypercalcemia

Identify the underlying cause


Saline IV


Once rehydrated furosemide


Presnisolone helps with lymphoid tumours


Bisphosphonates help with multiple myeloma and solid tumours


Calcitonin in acute setting

What is tumour lysis syndrome?

Rare but usually due to acute leukaemia or late stage lymphoma within 48 hours of induction chemo


Characterises by acute renal failure and metabolic acidosis


Aggressive fluid therapy

Optimal dose intensity when administering myelosupressive drugs?


Neutrophil nadir?

Neutrophil nadir between 1-1.5 x 10^9

Limitations of body surface area dosing?

Smaller pets may need smaller doses. Individual drugs may require a lower dose eg doxorubicin

Name 2-3 tumours that are intrinsically resistant to chemo

Malignant melanoma


Pancreatic and renal carcinomas

Define adjuvant chemotherapy


- 3 examples of tumours (2 dogs, 1 cat)

Used following resection of a primary tumour with a significant risk of recurrence or metastasis eg osteosarcoma and haemangiosarcoma in dogs and mammary tumours in cats

Define neoadjuvant chemotherapy?

Used prior to surgery or radiation to reduce tumour size

What types of tissues undergo late radiation side effects? Treatment?

Nerves and bones


Not always treatable hence hypofractionated protocols only chosen in patients with a short term prognosis

Give an example of an anti tumour antibiotic

Doxorubicin

Example of vinca alkaloid

Vincristine

Example of an alkylating agent

Cyclophosphamide


Chlorambucil

How do corticosteroids work as a chemotherapy drug?

Apoptosis of lymphoid, round, mast cell and plasma cell tumours

Actions to take if IV chemo drug extravasates?

Stop infusion, aspirate, give dex IV in another vein

If vincristine extravasates what can you give?

Hyaluronidase SC


Warm compress


Anti inflammatory ointment

If doxorubicin extravasates what can you do? 4

Cold compress to minimise spread


Administer dexrazoxane IV at 10x dose within 3 hours. Repeat at 24 and 48 hours


Apply DSMO topically every 2 hours


Apply anti inflammatory ointment

What genetic defect can affect chemo tolerability?

MDR gene multi drug resistance in certain breeds

When does neutrophil nadir occur? 1 exception

8 days


Carboplatin 10-14 days

What should you do if nadir falls below 1000/ microlitre 2

If no other symptoms then administer broad spectrum oral antibiotics do several days and monitor until next blood count. Doesn’t usually last longer than 72 hours


Reduce the dose of the drug by 15-20% at next administration

3 possible late side effects of radiation

Cataracts


Bone necrosis


Internal Strictures

If neutrophil count is below 2000 u/l what could you so?

If patient clinically well then could give treatment but if drug very immunosuppressive eg doxorubicin then Delay treatment by 2-4 days

Neutrophil count less than 500 u/l action?

Risk of sepsis, if fever or GI signs, hospitalisation and IV fluids and antibiotics and symptomatic

If patient presents for chemo with anorexia, diarrhoea, vomiting, fever action?

Regardless of neutrophil count, treatment not given and symptomatic tx

3 drugs to treat diarrhoea induced by chemo

Sulphasalazine


Metronidazole


Loperamide (not with mdr1 mutation)

What gut side effect can vincristine cause? What species more affected? Tx?


2 more toxicities?

Ileus paralyticus more frequent in cats


Self limiting, metoclopramide or cisapride can help


Peripheral neuropathies and skin sloughing

Antiemetic prophylaxis is helpful with treatment with which drug?

Doxorubicin

High dose cyclophosphamide in cats can cause what?

Anorexia

Which drug can cause cardio toxicity? Chronic administration can lead to what?

Doxorubicin


DCM

4 toxicity’s seen with doxorubicin?

Cardio toxicity


Mast cell degranulation


Nephrotoxicity reported in cats


Vesicant

Cyclophosphamide specific toxicity in dogs and treatment?

Sterile haemorrhage cystitis


Discontinue. Rule out infection. Analgesia. Oxybutin (anti spasmodic) intracranial dsmo

What are the 4 stages of the cell cycle?

G1- enzymes synthesised


S- dna is synthesised


G2- proteins are synthesised


M- mitosis

What can lomustine cause?

Hepatotoxic it’s in 7% of dogs. Consider same

2 side effects of cisplatin and what does it cause in cats?

Neprotoxic and vomiting


Fatal pulmonary oedema in cats

4 side effects of receptor tyrosine kinase inhibitors?

GI


Myelosuppression


Renal and hepatic toxicity


Depigmentation

2 drugs not to be given to cats

Cisplatin- pulmonary oedema


Fluoracil- neurotoxicity

Mdr mutation can be sensitive to what 2 drugs? What breed are sensitive?

Doxorubicin


Vinca alkaloids


Herding breeds

What is oncept?

Canine melanoma vaccine

Mutations in kit gene are associated with what?

Development or progression of some mast cell tumours

How can tyrosine kinase inhibitors work?

Receptors present on Mcts. Inhibitors have anti cancer activity and anti angiotenic.

2 veterinary TKIs are available for use in what type of tumour? Names? What form?

Canine cutaneous non respectable grade 2 and 3 mast cell tumours


Toceranib (Palladia) and masitinib (masivet)


Oral

3 main side effects of TKIs and when can they develop?

GI


Haematological


Musculoskeletal


Few days to weeks or months after starting tx

Define mitosis index

Percentage of cells undergoing mitosis in a tissue

Why do you need to be cautious and proactive in particular with TKI side effects?

As effects are cumulative, even if stopping the medication and imitating sympmatic tx the symptoms can continue for weeks

How do Feline cutaneous mcts compare to canine?

Benign and surgery is curative

Response rates to TKIs?

Often not durable and typically only last a short number of weeks to months

Define metronomic chemotherapy

Administer chemo on a more continuous basis

How common is osteosarcoma of the bone tumours?

85% of malignancies

What breeds are predisposed to osa? Link to neutering? Age?

Large breeds


Early neutering in Rottweilers linked to osa


2 peaks- small at 18-24 months and bigger at 7-9 years

How common is metastasis in osa? And locations 3

90% by diagnosis


Lungs, bone and soft tissue

2 most common localisations for osa

Away from the elbow (think vowels)


Towards the knee

What biochemical abnormality is associated with poorer prognosis in osa

Alp

Diagnosis of osa

Location, x rays and fna or biopsy


Fna agrees with biopsy 71% of the time

Name 3 tumours where chemotherapy would be beneficial as adjuvant therapy following surgical excision

Osteosarcoma


Haemangiosarcoma


Grade 2 or 3 mast cell tumour with a mitotic index of >7

Pain management in osa

NSAIDs, opioids, gabapentin, amantadine, paracetamol


Radiation - very effective


Bisphosphanates? Poor evidence basis

Use of bisphosphonates in osa and example

Osteoclasts inhibitors


Palliative treatment to increase bone density and maybe pain relief


Pamidronate- IV once monthly


Oral bisphosphonates have poor bioavailability alendronate

How can chemo be used in osa? 2 drugs

Adjuvant treatment of canine appendicular osa


Carboplatin and doxorubicin

Why is persistent hypercalcemia a problem?

Underlying problem


But will result in renal failure and gastritis

Treatment for hypercalcemia

Identify the underlying cause


Saline IV


Once rehydrated furosemide


Presnisolone helps with lymphoid tumours


Bisphosphonates help with multiple myeloma and solid tumours


Calcitonin in acute setting

What is tumour lysis syndrome?

Rare but usually due to acute leukaemia or late stage lymphoma within 48 hours of induction chemo


Characterises by acute renal failure and metabolic acidosis


Aggressive fluid therapy

3 cell types of lymphoma?

B


T


Natural killer cell

Optimal dose intensity when administering myelosupressive drugs?

Neutrophil nadir between 1-1.5 x 10^9

Limitations of body surface area dosing?

Smaller pets may need smaller doses. Individual drugs may require a lower dose eg doxorubicin

Name 2-3 tumours that are intrinsically resistant to chemo

Malignant melanoma


Pancreatic and renal carcinomas

Define adjuvant chemotherapy


- 3 examples of tumours (2 dogs, 1 cat)

Used following resection of a primary tumour with a significant risk of recurrence or metastasis eg osteosarcoma and haemangiosarcoma in dogs and mammary tumours in cats

Define neoadjuvant chemotherapy?

Used prior to surgery or radiation to reduce tumour size

What do we need to know about the lymphoma? How do we get this?

Cell type


Grade


Immunophenotype


Biopsy- immunohistochemistey


Fna- immunocytochemistry and flow cytometry, PARR also available (70% reliable)

High grade LSA responds best to which protocols? Resistant to which drug in which common protocol?

MOPP or LOPP


Doxorubicin in CHOP

Treatment for low grade multi centric T cell?

Use of chemo doesn’t affect prognosis so tx only necessary if clinical signs present


Steroids and chlorambucil

Most common type of multi centric LSA? And treatment

Diffuse large B cell LSA


CHOP or COP

Most common type of multi centric LSA? And treatment

Diffuse large B cell LSA


CHOP or COP

Most common grade and cell type of lymphomas


General prognosis with an without tx

Medium to high


B cell


Prognosis- quickly progress without therapy. Quickly respond to tx and go into remission. Also develop resistance rapidly

How common are low grade lymphomas? What cell typically? How do they respond?

5-29%


T cell


Respond slower to chemo and can take several weeks of remission is achieved

Most common 80% form of canine lymphoma

Multicentric which presents as peripheral lymphadenopathy

5 stages of lymphoma

1 single lymph node enlarged


2. Regional lymph node


3. Generalised lns


4. Liver spleen


5. Bone marrow and blood involved


Substages a- no signs b/ clinically unwell

Differences in prognosis with the stages of canine lymphoma

1 has best prognosis but stages 2-4 no difference


Sub stage b worse prognosis

Canine Alimentary lymphoma


- protocols, prognosis


- challenges


- large bowel differences

- Chop unsatisfactory prognosis of 6 months


- overlapping GI side effects and symptoms


- cop as good as chop -and cheaper, fewer adverse reactions, great response

Cutaneous lymphoma protocol?

Single agent Oral lomustine and preds

In CNS lymphoma what drugs have good blood brain barrier penetration? Remission times?

Steroids, cytosine arabinoside or lomustine


Shorter periods of remission

Presence of blood cytopenia at time of dx of lymphoma should consider what? 2

Bone marrow aspiration is useful to determine the percentage of bm infiltration and to rule out an IM process secondary to neoplasia as the cause


Is it going to change there tx plan?

Risks with focal intestinal or gastric masses lymphoma. What should be avoided?

Perforation when starting chemo. Fast acting drugs should be avoided such as L-asparaginase

Presence of cytopenias +/- circulating neoplastic cells


- prognosis?


- treatment considerations


- suggested beneficial infusion?

Worse


Avoid particularly immunosuppressive drugs but also need to be aggressive as cell lines won’t be restored until cancer is removed from bone marrow


Cytosine arabinoside as been advocated as part of an induction protocol on stage 5

How do you test for MDR gene? If they are heterozygous or homozygous then how do you address this?

Blood or saliva


Reduce dose by 25% of certain drugs and take extra precautions regarding GI toxicity

What % of dogs with high grade multicentric lymphoma will induce remission for how long?

60-90%


50% survive 1 year, 20% 2 years

Authors treatment of choice for


- high grade B cell canine lymphoma


- high grade T cell lymphoma


- when finances or other factors are a barrier to above?


- low grade T cell

Madison Wisconsin


LOPP


COP


No treatment, if symptomatic then steroids and chlorambucil

When remission ends?

Reinduction using same protocol. rates are lower and shorter


Rescue protocol

Presence of cytopenias +/- circulating neoplastic cells


- prognosis?


- treatment considerations


- suggested beneficial infusion?

Worse


Avoid particularly immunosuppressive drugs but also need to be aggressive as cell lines won’t be restored until cancer is removed from bone marrow


Cytosine arabinoside as been advocated as part of an induction protocol on stage 5

How do you test for MDR gene? If they are heterozygous or homozygous then how do you assess this?

Blood or saliva


Reduce dose by 25% of certain drugs and take extra precautions regarding GI toxicity

What % of dogs with high grade multicentric lymphoma will induce remission for how long?

60-90%


50% survive 1 year, 20% 2 years

Authors treatment of choice for


- high grade B cell canine lymphoma


- high grade T cell lymphoma


- when finances or other factors are a barrier to above?


- low grade T cell

Madison Wisconsin


LOPP


COP


No treatment, if symptomatic then steroids and chlorambucil

When remission ends?

Reinduction using same protocol. rates are lower and shorter


Rescue protocol

Prognosis of feline lymphoma with a positive retro viral disease? Progression and response 2

Rapidly progressive


Transient response to therapy

Nasal lymphoma in cats treatment and prognosis?

Radiation +/- chemo


Very good response- 945 days in one study

Systemic LSA in cats therapy response?

70% of cats having a median of 8 months

Young cats with mediastinal lymphoma?

Respond well to COP

Important ddx for mediastinal tumour in older cat?

Thymoma (won’t respond to cop)


Lymphoma

Feline renal lymphoma behaviour and response to treatment? Name 3 factors indicate a worse prognosis?

Variable.


Bilateral disease, severe azotaemia, other abdominal involvement

How does spinal lymphoma often present? Treatment?


What infectious disease should be considered testing for?

Posterior paresis


Severe pain often


Felv positive with concurrent bone marrow involvement


Chemo with focal radiation therapy

Most common anatomical form of lymphoma in the cat? Grades? Which 2 grades are very similar and approaches the same? Which grade is least common?

Alimentary


Low, intermediate and high grade AL


Sub classification large granular lymphocyte lymphoma


IGAL and HGAL


LGAL

LSA phenotype and location within the GI tract has a strong association


- B cell predominates where? 2 grade?


- T cell predominates in which location? grade?

B- stomach, large intestine and high grade LSA


T- small intestine and low grade LSA

T and B cell lymphomas arise from where in the intestines?

MALT of the small intestine


Peyers patches and mucosal lymphoid nodules in the distal


Small intestine, caecum and colon

Felv- risk of developing lymphoma. Organs preference? T or B cell?


FIV? Chances of developing

Increased 60 fold


Varies with anatomical type, lowest with AL


Usually T cell


FIV increase chance 5 fold

What condition has been documented to histolgically progress to AL?

Lymphoplasmacytic enteritis

Ddx for LGAL

Lymphoplasmacytix enteritis aka IBD

Ddx for LGAL

Lymphoplasmacytix enteritis aka IBD

2 Ddx for HGAL and intramural mass lesions

Adenocarcinoma


Mast cell

Cobalamin and folate results when investigating AL?

80% hypocobalaminemia


Folate can be low (reduced absorption proximal), normal or high ( proliferation of intestinal microflora)

Usefulness of FNA cytology for diagnosis of LGAL compared to I/HGAL and LGLl?

LGAL often non diagnostic, consider fna of mesenteric lymph node. Biopsy often required


Can often make diagnosis with fna of intestinal wall mass. Preferable to ex lap as may delay treatment and increase in morbidity

Usefulness of FNA cytology for diagnosis of LGAL compared to I/HGAL and LGLl?

LGAL often non diagnostic, consider fna of mesenteric lymph node. Biopsy often required


Can often make diagnosis with fna of intestinal wall mass. Preferable to ex lap as may delay treatment and increase in morbidity

Diagnosis of LGAL

Fna often inconclusive, consider fna of mesenteric Ln


Biopsy via ex lap often requires, may need IHC and clonality testing to confirm as histo logically very similar to IBD (LPE)


Histologically- Neoplastic small lymphocytes, monomorphic sheet



Sample all sections of SI

Treatment for LGAL? And I/HGAL?

Oral alkylating agents eg lomustine and preds


COP or CHOP

Treatment for LGAL? And I/HGAL?

Oral alkylating agents and preds


COP or CHOP

Should surgery be performed on an intestinal mass prior to chemo?

No improvement on survival time

Treatment for LGLL?

Poor response to cop or chop


Other agents indicated

Local aspiration of what is indicated in presence of a MCT?

Fna of local lymph node

When is staging indicated in MCT? 7

Some clinicicians would advise every time however majority are locally invasive..


Grade 3 or 2 with a high mitotic index are more likely to be behave aggressively


Rapid growth or ulceration


Lymph node metastasis


Location: mucocutaneous, oral, nail bed, preputial/ scrotal tumours


Recurrent


Systemic signs

What does complete MCT staging involve?

Fna of the drainage lymph node


Abdominal ultrasound


Thoracic rads or Ct although rarely spread to lungs

How should you treat multiple MCTs?

As individual lumps unless there is very large amounts or metastasis present

How should you treat multiple MCTs?

As individual lumps unless there is very large amounts or metastasis present

Treatment requires for Metastatic lymph nodes of mcts?

Remove m.

Treatment for MCT


- grade 1 and 2 completely excised


-Grade 2 high mitotic index


- grade 1 and 2, low mitotic index, incomplete margins


- High grade 3 with complete margins

No further therapy, risk of recurrence low, monitor


Consider systemic therapy


Revision surgery or radiation ideally. If declines, chemo.


Moderate risk of regrowth and high risk of metastasis so chemo indicated

What can help gauge prognosis of grade 2 MCT? 4

Mitotic index > 5


Ki-67 (increased worse, sensitive but not so specific)


AgNOR counts (increased bad)


Kit gene mutations poorer prognosis

Why is identifying kit mutations on MCT useful?

If present can use TKIs to treat although some tumours with no mutation can also respond

Is radiation helpful for MCT? 2 situations. What type of protocol?

Sensitive


Primary where surgery isn’t possible


Most commonly following incomplete resection


Hyperfractionated preferred

What percentage of MCTs have mutated KIT gene?

20-40%

Cutaneous changes seen with hypothyroid?

Hair loss affecting the bridge of the nose/ and or trunk with mixoedema

What is alopecia areata? And what causes it?

Focal/ multi focal type of progressive hair loss in dogs


Autoantibody production attacking the hair follicles

What does parr stand for? What does it do?

PCR for antigen receptor rearrangement


Used to detect clonality within a population of cells where monoclonal represents lymphoma and polyclonal represents reactive lymphocytosis

What sample so you require for flow cytometry?

Bloods


Lymph node aspirate


Effusion


Csf

Flow cytometry tests what

Immunophenotypic analysis in canine lymphoma