12- Clinical Oncology
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What techniques are used to determine the “what”?
Cytology > examination of cell types from bodily fluids - obtained by fine needle aspiration (FNA) - important to rule out benign lesions (most are) Histopathology > microscopic examination of tissue - the gold standard - requires tissue biopsy - provides architecture information
What lymph nodes are usually palpable in a normal healthy dog?
• Mandibular/ Prescapular/ Popliteal
Why is FNA (fine needle aspiration) for cytology done in lymph nodes?
• drainage of tumor > often 1st site of metastasis
What are the most common cancers in vet med vs humans?
Humans- carcinomas (epithelial) Vet med- sarcomas (mesenchymal)/ hematopoietic)
What is a very common tumor in vet med (dogs)?
Mast cell tumor - C-kit is a marker for canine mast cell tumors
What are the 5 criteria of malignancy?
• Anisocytosis (cell size differences) • Anisokaryosis (nucleus size differences) • Lack of cell-cell contact (epithelial tumors) • Abundant mitotic figures • General reversion to a less mature phenotype
What are some specialized staining techniques?
ICC = Immunocytochemistry IHC = Immunohistochemistry
Why are specialized staining techniques used?
• to more definitively identify cell of origin > cancer type • to identify cell subtypes within a type of cancer (T vs B cell lymphoma)
What is done if cytology is inconclusive?
• Histology (histopathology) • Immunohistochemistry (IHC) • Flow Cytometry > test multiple markers • PCR of antigen receptor rearrangements of lymphocytes
What is the difference between grading/ staging?
Grading- classify cancer cells by appearance (how undifferentiated) Staging- classify cancer cells by extent in body/ spread
What is the WHO criteria for cancer staging?
TNM (tumor, node, metastasis)/ 0,1,2 T- depends on of mass N- (0-no LN/ 1-few regional LN/ 2-many regional LN) M- 0-no metastasis/ 1-yes metastasis
How is cancer staging obtained?
• physical examination • laboratory analysis • imaging (CT is more sensitive/ definitive than x-ray) • abdominal ultrasound
How does a PET scan work? (imaging for staging)
• glucose metabolize measured (fluorescent dye) • Warburg effect > tumor take up glucose at higher rate
What is paraneoplastic syndrome?
• cancer cells secrete substances with distant effects (symptoms) ex) mast cell degranulation > release of mast cell mediators • can lead to difficulty closing wounds/ anaphylaxis
Why are biomarkers important for clinical oncology?
• identification of potential responders to treatment • monitoring treatment response • pharmacologic biomarkers for drug optimization
What is the WHO classification for canine MCT?
Stage 1 > 1 tumor confined to dermis/ no lymph node involvement Stage 2 > 1 tumor confined to dermis/ regional lymph node involvment Stage 3 > multiple tumors or 1 large infiltrating/ lymph node Stage 4 > distant metastasis Substage > a/b > based on outlook of patient (a = good/ b = problems)
How does staging impact treatment?
• local disease > local therapy > surgery/ radiation • systemic disease > systemic therapy > chemo = Oncology Dogma
What are important considerations for surgery?
• Margins • Fascial planes (may need to remove) • separate surgical teams > surgeon removes tumor, trauma/ plastics close and repair • not all wounds are closed > heal by scarring/ second intention
What is a pre-surgery treatment?
• Neoadjuvant therapy > to ↓ surgical field • assess response of primary tumor to chemotherapy • early treatment of micrometastasis
What is adjuvant therapy?
• follow up after treatment • surgical complication (dirty margins)/ metastatic disease
What are the types of radiation therapy?
• Orthovoltage/ Megavoltage/ Brachytherapy/ Systemic
What is the mechanism of radiation therapy?
• double-stranded DNA damage • direct action > DNA damage > cell death • indirect action > free radicals > DNA damage > cell death
What is an important protocol of radiation therapy?
Fractionation- smaller doses over time - palliative, coarse-fractioned
What are the 4 R’s of radiation therapy?
Repair- allow normal cells to repair between treatments Reoxygenation- more O2 > more sensitive to radiation > target Redistribution- at any one time, cells in different stages of cell cycle (DNA damage best in G2-M phase of cell cycle) Repopulation- working against you > proliferation between cycles