SAM II Final Exam - Oncology Flashcards Preview

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Flashcards in SAM II Final Exam - Oncology Deck (112)
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1

T/F: Use of Doxorubicin is a prognosticator in cats with lymphoma

True

Better outcome in cats with doxorubicin use

2

If the standard of care is recommended to treat an osteosarcoma (curative intent), what is the expected cure rate (2 year survival)?

  • 0-5%
  • 5-10%
  • 15-25%
  • 30-40%

15-25%​

3

________ is a neoplastic proliferation of hematopoietic stem cells in the bone marrow

leukemia

4

What chemotherapeutic drugs are affected by multidrug resistance?

vinca alkyloids, anthracyclines, actinomycin D

5

What lymph nodes typically experience the most dramatic enlargement in a case of multicentric lymphoma?

mandibular and superficial cervical

Diagnosis in these patients is usually very easy (fine needle aspirate), but it is important to immunophentype!

6

CD79a-positive stain. Is this a B cell or T cell lymphoma in this dog?

B cell lymphoma

B cells have a fair response to chemotherapy. Once these patients reach remission, it is usually a very durable remission and these patients have a much higher chance (than T cell) of being cured

7

What type of chemotherapeutic drug is Toceranib?

Tyrosine kinase inhibitor

8

After treatment with Doxorubricin, how many days should you wait to look for myelosupression?

7 days

9

What is a side effect of cyclophosphamide therapy caused by acrolein?

  • Vesicant
  • Sterile hemorrhagic cystitis
  • Gastrointestinal toxicity
  • Neurotoxicity

Sterile hemorrhagic cystitis​

10

‘Petal’, the 12 year old FN Siamese presents with a mammary mass. What is the first thing you recommend?

  • FNA
  • Biopsy
  • Radical bilateral, staged mastectomy
  • Three thoracic radiographs
  • Coagulation profile

Three thoracic radiographs​

11

Some side-effects are specific to a particular chemotherapeutic agent or group of agents. Renal damage is most associated with what chemotherapeutic drug?

Cisplatin

12

Joey (who is a dog) has peripheral lymphadenopathy with a T-cell lymphoma but is otherwise healthy. Lymphoma cells are found in his spleen and liver with FNA but not in the bone marrow. The lymphoma is classified as a Multicentric, T cell, stage IV, substage A. You decide to treat Joey with a 19 week protocol.

He went into remission 1 month after starting CHOP, completed his 19 week protocol. 6 months later he relapsed. What rescue protocol would you use, and what is the expected RR and remission time?

  • Doxorubicin, 70-90% RR, remission of 7-9 months
  • Cyclophosphamide and Prednisolone combo, 60% RR, 3 months remission
  • CCNU (Lomustine) or LOPP, 40% RR, 5 months remission time

CCNU (Lomustine) or LOPP, 40% RR, 5 months remission time​

13

Some side-effects are specific to a particular chemotherapeutic agent or group of agents. Cardiomyopathy is most associated with what chemotherapeutic drug?

Doxorubicin

14

What drug may be used as a single agent protocol for multicentric lymphoma?

Doxorubicin

50-75% complete remission

Median survival of 6-8 months

15

When staging an oral tumor, what would it mean to say a tumor is a T2a?

The tumor is 2-4 cm in diameter, without bone invasion

  • T1: Tumor
  • T2: Tumor 2-4 cm diameter
  • T3: Tumor >4 cm diameter
  • A: without bone invasion
  • B: with bone invasion

16

T/F: Paraneoplastic syndromes often precede the onset of the primary cancer by weeks to months

True

17

T/F: This presentation is consistent with lymphadenitis

False

This presentation is consistent with lymphoma. Note the homogenous population of lymphoblasts (~3-5x the size of RBCs) occupying more than 50% of the cell population

Lymphadenitis would be characterized by a large population of neutrophils

18

Joey (who is a dog) has peripheral lymphadenopathy with a T-cell lymphoma but is otherwise healthy. Lymphoma cells are found in his spleen and liver with FNA but not in the bone marrow. The lymphoma is classified as a Multicentric, T cell, stage IV, substage A.

When we consider Joey’s lymphoma, which is a negative prognosticator?

  • Stage
  • Location (multicentric)
  • Immunophenotype (T cell)
  • Grade

Immunophenotype (T cell)​

19

T/F: Mediastinal lymphoma is most common in younger FIV-positive cats

False

Mediastinal lymphoma is most common in younger FeLV-positive cats

20

The most commonly used chemotherapeutic drug associated with thrombocytopenia is:

lomustine (CCNU®)

If this toxicity occurs, you MUST stop using the drug

21

T/F: Oral melanoma may be treated by vaccination

True

  • Canine melanoma vaccine - fully licensed for Stage II and III oral melanoma
  • Sensitize the dog to Tumor Associated Antigen (TAA) – unique or a mutation
  • Xenogeneic DNA vaccine - tyrosinase
  • Dosage
    • 0.4 mL dose administered with the Canine Transdermal Device
    • Injection site: muscles of the medial thigh just caudal to the femur
    • Initial treatment: 4 doses of vaccine at two week intervals
    • Booster dose at six month intervals

22

Refer to the images below. What is the correct criticism for this chemotherapy administration protocol?

  • No mask, eye shield, double gloving (nitrile) gloves used
  • A catheter does not necessarily need to be placed for Vincristine
  • The vet should not be smiling, cancer is serious business
  • I don’t see a Phaseal system in place

No mask, eye shield, double gloving (nitrile) gloves used​

23

In dogs, Stage ___ lymphoma is characterized by generalized lymph node involvement

In dogs, Stage III lymphoma is characterized by generalized lymph node involvement

24

It is important to check hematology prior to chemotherapy and  7 days post-chemotherapy, except when using __________ or __________, which both have a severe delay in the myelosuppressive effect (so we'll check them 2-3 weeks post-chemo).

It is important to check hematology prior to chemotherapy and  7 days post-chemotherapy, except when using carboplatin or lomustine, which both have a severe delay in the myelosuppressive effect (so we'll check them 2-3 weeks post-chemo).

25

Refer to the diagram and indicate at what point CT/MR would be able to detect cancer:

B

26

Joey (who is a dog) has peripheral lymphadenopathy with a T-cell lymphoma but is otherwise healthy. Lymphoma cells are found in his spleen and liver with FNA but not in the bone marrow. The lymphoma is classified as a Multicentric, T cell, stage IV, substage A.

What treatment would you recommend for Joey if the owner elects curative intent?

  • Prednisolone
  • Single agent CCNU
  • Single agent Doxorubicin
  • Multi-agent COP
  • Current CHOP (19 week protocol)

Current CHOP (19 week protocol)​

27

T/F: The majority of mammary gland tumors in cats are malignant

True

In cats, MGTs have a tendency to move into the lungs and are associated with high prevalence of developing pleural effusion. We don't really even biopsy mammary tumors in cats... we just cut them out.

28

T/F: The use of TMS for 14 days post-doxorubicin markedly reduces the likelihood of needing gastrointestinal antibiotics

True

29

T/F: Alopecia is the most common side effect associated with chemotherapeutic agents

False

Gastrointestinal effects account for the majority of the side effects

  • Anorexia, vomiting, diarrhea, colitis
    • Direct effect on gut lining
    • Pancreatitis (L-asparaginase)
    • Central effect (CTZ) (Cisplatin)

30

In cats, presentation can be similar for inflammatory bowel disease (IBD) and alimentary lymphoma. Because veterinarians have racked up some sort of good karma throughout the years, the treatment for both of these conditions is essentially the same! Woo!

What is the treatment?

Chlorambucil and prednisolone