Chapter 20 Veterinary Oncology

Integrative medicine

Approach that makes use of complementary, holistic, and conventional treatments. Examples include I'm-Yunity, Yunnan, Baiyao, and nutritional management

Neoplasm

Characterized by unrestrained proliferation of abnormal cells

Chronic exposure to chemotherapeutic agents is of particular concern for pregnant veterinary staff. T or F

False- Any exposure is a concern

To assess cell morphology and to confirm that proper technique was used during blood collection and handling, a ____________________________should be performed.

Manual blood smear

Mast Cell Tumor

The most common malignant skin tumors in dogs

The diet recommended over the use of generic brands is an _____________diet.

AAFC

______________________therapy is treatment given in addition to primary treatment.

Adjuvant

Oral tumors

Affects primarily older animals

Non -mainstream therapies used instead of standard medical treatment are known as ___________________________

Alternative treatments

If the owner would like to feed a homemade diet, how would you respond?

Although most home cooked diets are not nutritionally balanced to meet the long-term feeding needs of pets, if home feeding is desired we can set up a consultation with a board-certified nutritionist. Most high quality commercial diets are approved by the AFCO

What are side effects of .chemotherapy drug Mitoxatrone? What is the nadir?

Anorexia, vomiting, diarrhea, lethargy. Myelosuppression, caution using live vaccines, blue green colored urine after treatment. The nadr is 10 days.

Why are radiographs always recommeded prior to taking a CT scan?

Before performing expensive, invasive or risky treatments, it is important to stage a patients cancer, particularilly if metastasis is present. Patients undergoing CT must be anesthetized or sedated which can increase risk for an unhealthy patient. CT is not widely available and is more expensive, therefore, initial survey radiography is recommended.

The standard of care for cancer patients that may undergo treatment includes

CBC, Chem panel, urinalysis, and chest radiographs

The veterinarian asks you to pepare the tests for an initial cancer eval. What tests need to be provided?

CBC, serum chemistry profile, urinalysis, three view thoracic radiographs, abdominal ultrasound.

________________is a tumor of epithelial tissue that arise from many sites

Carcinoma

Chemotherapy is not useful in treating every type of cancer, and not all chemotheraphy has negative side effects. T or F

Chemotherapy is no useful in treating every type of cancer BUT does come with side effects.

Chemotherapeutic drugs all work to target cell replication. T or F

Chemotherapy is used in different ways depending on patients condition and tumor type.

Hemangiosarcoma

Common in larger, middle-aged to older dogs;commonly found on the skin, heart, liver and spleen

The most common side effects of chemotherapy are____________________________________

Decreased appetitie, lethargy, vomiting, and diarrhea

___________________is an antibiotic antineoplastic used to treat lymphoma, carcinoma, leukemia and sarcoma.

Doxil

Are Chemotherapy drugs safe to handle?

Exposure to chemotherapeutic agents can occur from improper handling, contamined packaging and patient waste. Special care to minimize exposure should be taken by all personel. The use of PPE and strict adherence to recommended safety guidleline can significantly reduce the risk of exposure. Chronic exposure can cause health problems and many chemotherapy agents are well known teratogens, mutagens and carcingens. When chemotherapy agents are prepared, a ventilated class II or III laminar flow biological safety cabinet with HEPA filltration should be used. Syringes should be lableled and chemogherapeutic drug and saline should be drawn up in a CSTD. Full PPE should be worn during unpackaging and storing of all anticeoplastics.

Pain medicaiton is of little use in the the dog. T or F

False- Analgesia may be used to improve patients quality of life

Cat owners should be aware that anorexia for short periods is common and poses no signigicant threat to a cat's wellbeing. T or F

False- Anorexia, even for a short period of time may cause hepatic lipidosis and can significantly compromise the patients well being.

A form of radiation therapy frequently used in veteirnary medicine is the placement of radioactive seeds in the body. T or F

False- Brachytherapy is rarely used in veterinary medicine.

Canine and human cancers often exhibit remarkably different clinical presentations, pathology, treatment responses, and molecular underpinnings. T or F

False- Canine and human cancers often share common clinical presentations, pathology, treatment repsonses and molecular underpinnings.

Morphine should be used in patients with confimred or suspected mast cell tumors, because these tumors can be quite painful. T or F

False- Morphine should be avoided, morphine can cause mast cell tumor degranulation and histamine release.

The most common feline presentation of lymphoma is in the kitten T or F

False- Most common presentation of lymphome is in 12-14 year old cats

Neoplasm is another term for new blood. T or F

False- Neoplasm is abnormal growth of tissue

Elspar is used to treat thyroid adenocarcinoma and melanoma. T or F

False- Paraplatin is used to treat thyroid adenocarcinoma and melanoma. Elspar used to treat lymphoid malignancies

The primary goal of treatment in veteirnary oncology is to prolong the life of the animal. T or F

False- Primary goal is to maintain good quality of life for the patient.

Severe reactions to radiation are common. T or F

False- Severe reactions occur in less that 5 % of cases.

Leukotracia is common following radiation therapy. T or F

False- Skin reactions such as hair loss or moist dermatitis are common following radiation therapy.

Cytology slides should be fixed with formulin. T or F

False- Slides are stained for microscopic eval. samples submitted for pathology should not be fixed in formulin which can alter cell morphology.

Tumor grade is determined by diagnostic tests, such as caliper measurements, abdominal ultrasonography, thoracic radiography, computed tomography (CT) blood work, urinalysis, magnetic resonance imaging MRI, and lymph node sytologhy or biopsy. T or F

False- Tumor grade is determined by anatomic pathologist

Radiography is the best choice to guide percutaneous collection of biopsy samples and body cavity effusions. T or F

False- Ultrasound is the best choice

A tumor that grows large and causes discomfort is likely malignant. T or F

False- large tumors can be malignant or benign

Home-cooked meals provide the best balance to meet the long term feeidng needs of pets. T or F

False- most homecooked meals are not nutritionally balanced to mee the long term feeding needs of pets.

Tumor size and how far it has spread are part of the grade of the tumor. T or F

False- tumors are graded on the basis of certain factors, such as, mitotic activity, vascular or lymphatic invasion, cellular appearance and nuclear characteristics.

One of the leading causes of disease relate deaths in the small animal species is coronary artery disease. T or F

False-Cancer is a common disease seen in veterinary patients

"Watch and wait" is the best approach during early diagnosis procedures. T or F

False-Watch and wait is not advised, early detection and appropriate treatment should be provided

The term neoplasia describes only malignant tissue. T or F

False-can be benign or malignant

_________________________is one of the most common tumors in the frog of the horse's foot.

Fibromas

PPEs that should be worn when working with chemotherapeutic drugs include

Gloves, gown, mask and eye protection

A patient with ___________________________ofen presents on emergency with pale gums, poor or snappy pulses, distended abdomen and extreme lethargy

Hemongiosarcoma

Traditionally chemotherapy is given at the ________________possible dose fore relatively________________periods with intervals of recovery when no chemotheraphy is given.

Highest, short

The components of the Quality of Life (HHHHHMM) include these criteria

Hurt, hunger, hydration, hygience, happiness, mobility and more good than bad.

Assistant asks, why are we taking a blood draw from the jugular vien? You respond:

Ideally blood sample should be obtained from the jugular vein. Peripheral veins may used in future treatments and should not be comprimised.

Dogs with four white feet may carry the ___________________mutation, making them more likely to have a toxicity reaction to chemotherapeutic agents.

MDR1

Cells of a _____________________tumor are filled with vesicles containing histamine.

Mast cell

________________tumors are cutaneous tumors derived from melonocytes.

Melanocytic

______________________is typically found under the tongue in cats

Melanoma

_____________is the most common oral tumor in dogs

Melanoma

The most abundant type of WBC with a short half life and rapid turnover is the

Neutrophil

A fine needle biopsy is completed on Buffy, during which no cancer cells are noted. The cells have been sent to a pathologist for verificaiton. Is it appropriate to tell the owner, " good news, the tumor is benign"?

No, histologic examination of the primary tumor is performed by an antomic pathologist to confirm the diagnosis of cancer.

When lameness is presented, radiographs are recommended to rule out the presence of ___________________

Osteosarcoma

Osteosarcoma

Primarily affects bones on the appendicular skeleton

___________________is the most common type of skin tumor in horses, it is locally invasive but rarely metastatic

Sarcoid

____________________________tumors are associated with prolong exposure to the sun and are therefore more commonly seen in open ranged cattle.

Squamous cell carcinoma

Practically, chemotheraphy involves a diverse array of therapies that include___________, non steroidal anti-inflammatory drugs, _______________________, traditional chemotherapy,_____________________________, ______________________________ and targeted therapies.

Steroids, metronomic therapies, hormonal therapy, immunotherapy

ATLS ( acute tumor lysis syndrome) is usually fatal unless treatment is immedicate. T or F

True

Canned pumpkin is a good addition to the diet to help with loose stools. T or F

True

Patients undergoing CT must be either anesthetized or sedated T or F

True

Radiation does not specifically target cancer cells. T or F

True

Rarely is surgery recommended for a patient with metastasis. T or F

True

Sarcomas most commonly spread through the bloodstream alone. T or F

True

Staging a tumor is essential for planning appropriate and effective treatment. T or F

True

The absence of cancer cells in a cytology sample does not always rule out cancer. T or F

True

The grade of tumor can only be determined by a pathologist. T or F

True

The nadir of neutrophil count is appoximaely 5 to 7 days following the adminsitraiton of chemotherapy. T or F.

True

Tissue biopsy is the only definitive proof of hemangiosarcoma. T or F

True

Sarcoma

Tumor Classification: Mesenchymal tissue

Lipsarcoma

Tumor Classificiation: Fat cells

Vet asks that you not use cystocentesis when collecting urine from patient suspected of having bladder cancer, why?

Tumor cells may seed along the needle track, therefore cystocentesis would not be the first recommended dianostic for a confirmed of suspected bladder tumor.

Osteosarcoma

Tumor classification: Bone

Adenoma

Tumor classification: Glandular tissue

Lymphosarcoma

Tumor classification: Lymph cells

Leiomyosarcoma

Tumor classification: Smooth muscle tissue

Carcinomas

Tumors of epithelial tissues

Alternative medicine

Use of nonstandard treatments in place of standard therapy

Palliative care

Used synonymously with "comfort care" Goal of teratment is to improve the patient's quality of life with less regard for longevity.

Complementary medicine

Uses non standard treatments in combination with standard therapy

An all natural herbal supplement known to stop bleeding used by herbalists and acupuncturists, is___________________________

Yunnon Baiyo

A serious and potentially lif threatening allergic reaction is known as ____________

anaphylaxis

Lymphoma

cancer of immune system cells

most common side effects of _______________________include skin reactions, such as hair loss or most dermatitis, which occur toward the middle to end of treatment period.

chemotherpy

Two of the morst important factors for long term treatment success are ____and ______________

diagnosis and early treatment

Radiation causes damage to DNA______________ and __________________through the formation of highly charged particles called free radicals taht damage DNA

directly and indirectly

Cutaneous tumors are common in horses and are often found on ________,_______,_______,__________,_________________________ and ____________________________

eyelids, ears, lips, muzzles, perianal area and external genitalia

A dog with a _________________________most commonly present with acute history of collapse and abdominal swelling

hemangiosarcoma

Histologic examination requires a sample of tissue obtained through either _______________ or ___________________________of the mass.

incisional or excisional biopsy

The most common presentation of __________________________in dogs is multiple, non painful, enlarged lymph nodes.

lymphoma

The most common presentation of _______________in cats is a subacute to chronic history of weight loss, possible vomiting, decreased appetitie and diarrhea.

lymphoma

The patient management check list for veteirnary technicians in oncology includes six main areas:

patient check, drugs, pharmacy set up during administration and after administration.

In the scale produced by the VCOG that standardizes the reporting of adverse drug events, a grade 1 and 2 toxicity is considered to be ______________

reasonable

Cancer should be considered in patients with one or more of the following signs:

swelling that persist or grows, nonhealing wounds, weight loss, loss of appetite, bleeding or dishcarge from the orifices, reluctance to excercise or lehargy, persistentlameness or stiffness, difficulty breathing/ urinating/or defecating.

Some chemotherapy agents, called_________________cause severe tissue irritation, blistering, and sloughing of skin and tissue if they are ______________________________

vesicants, accidentally administered outside the vein

the vet has asked you to assist in post administration care for Buffy. You review the post administration portion of the patient management checklist for veterinary technicians in oncology. What are the ten questions to ask yourself from this portion of the checklist?

1. Have we reviewed side effects with the pet owner again? 2. Have we discussed post treatment concerns? 3. Have we discussed the possible nadir of the drug with the pet owner? 4. Have we discussed chemotheraphy drug exposure risks with the pet owner? 5. Does the pet owner have medications to provide supportive care at home, or do the woners need rx refills? 6. Have we discussed the future treatment plan? 7. Do we need to schedule any additional diagnostics for the next visit. 8. Did the owner receive a copy of their discharge instructions? 9. Did we answer all the owner's questions? 10. Are the owners satisfied with the care we ar eproviding thier pet?

What four aspects should be considered during the process of staging a cancer?

1. The location or type of tumor 2. Tumor size and it's borders 3. The involvement of regional lymph nodes 4. Presence or absence of metastasis and the numbe of tumors

Identify 5 of the 8 characteristics of cancer cells.

1. They stimulate their own growth 2. They are insensitive to inhibitory signals that would stop their growth. 3. The evade their own programmed cell death 4. They have the ability to multiply indefinitely 5. They invade local tissues and can spread to distant sites

Doses of chemotherapeutic drugs should be checked_______________________times to avoid overdose.

3 (triple checked)