solid tumours 2 - sarcomas

Bio behaviour of soft tissue sarcoma

Locally invasive

Tissues sarcoma can originate from

Bone, CT, n, BV, m, fat, cartilage, lymphatic + Haematopoietic cells

Stage vs grade

S- clinical assessment of current dz burden

G- histo behaviour

How to assess cases

CE

Dx

Stage

Co morbidities

Dx options

FNA

Biopsy - trucut, incisional

Histo

IHC

CT

MRI

Staging dx options

LN aspiration

Imaging

Common metastasis route

Haematogenous

Common distant metastasis location + how to check

Lungs

Infl thoracic rx (lat x2, DV) / CT

Limitations of dx + imaging

Rx - lower sensitivity than CT

Lungs cant be sampled

Cost

Soft tissue sarcoma - common animasl

Middle/ large breed dogs

8-11yrs

Soft tissue sarcoma - Fibrosarcoma common in what breed

Retriever

Soft tissue sarcoma - Tx

Wide sx resection

Adjuvant radiotherapy

Soft tissue sarcoma - Tumour growth to accomodate for in sx

Grow along path of least resistance

Soft tissue sarcoma - Sx margins

3cm lat, 1 fascial plane

Include FNA tracts + biopsy scars

Soft tissue sarcoma - How to ensure got good margins

Histo - cardinal, bread loafing, shaved margins

Soft tissue sarcoma - Outcomes of sx determined by histo

Complete excision

Incomplete excision

Excision with narrow margins (<3mm)

Soft tissue sarcoma - Narrow margins meaning + what to do

Tumour cells <3mm from tissue edge → monthly monitoring, sx again, adjuvant radiotherapy, metronomic chemo

Soft tissue sarcoma - Metronomic chemo def + when to do + drugs

Continuous low dose chemo

Microscopic residual dz

Cyclophosphamide + piroxicam/meloxicam

Soft tissue sarcoma - When to do active monthly monitoring for 1yr

Low change of recurrence in microscopic residual dz (low grade, tiny questionable margins)

Soft tissue sarcoma - Survival time with successful sx + radiotherapy

>4yrs

Soft tissue sarcoma - Prognostic factors

Grade, mitotic rate, size, location, local control

Soft tissue sarcoma - What to do with non resectable tumours

Refer

Reduce to microscopic dz through sx → radiotherapy, metronomic therapy

Primary radiotherapy

Soft tissue sarcoma - When to do anti metastatic tx

High grade

Non resectable dz

Soft tissue sarcoma - Which tx has highest chance of cure if non metastatic

Wide Sx excision

Feline inj site sarcoma - common vaccine causes

Rabies, FeLV

Feline inj site sarcoma - Histo

Malignant fibroblasts, lymphocytic infl, macrophages

Feline inj site sarcoma - Primary tumour assessment + when to assess

CE

>3mon mass, >2cm, continues to inc in size 1mon later

Feline inj site sarcoma - Primary tumour dx

>3mon mass, >2cm, continues to inc in size 1mon later

FNA, incisional biopsy

Feline inj site sarcoma - which dx to avoid + why

Excisional biopsy - tx fail

Feline inj site sarcoma - Staging dx

Imaging

Feline inj site sarcoma - metastasis route

Haematogenous

Feline inj site sarcoma - Tx

Sx

Feline inj site sarcoma - Sx margins

>5cm

2 fascial planes

Excisional Biopsy?

No

Feline inj site sarcoma - Adjuvant tx when to do

Non resectable / incomplete resection tumours

Feline inj site sarcoma - Chemo drug + common side effect

Doxorubicin - nephrotoxicity

Feline inj site sarcoma - Prevention

Inj given in sides that can have wide excision - limb, tail

Dec infl at sites

No over vaccination

Feline inj site sarcoma - Which approach

Pathologist shaved Margins

Bone tumours - most commo type

Osteosarcoma

Bone tumours - Common animal

Middle aged/ older dog

Large breeds

Bone tumours - CS

Pain

Lame

Swelling

Bone tumours - Rx appearance

Bone lysis

Soft tissue swell

Periosteal elevation

Long zone of transition

Doesn’t cross joint

Sunburst

Bone tumours - Dx

Cytology, histo

Bone tumours - Ddx

Fungal osteomyelitis, Chondrosarcoma, histiocytic sarcoma

Bone tumours - Tx

Amputate

Analgesia, de sensation (radiotherapy)

Slow bone destruction (Bisphosphonates)

Bone stabilisation+fixation

Bone tumours - How to slow metasistasis (microscopic)

Chemo - carboplatin, anthracyclines

Toceranib

Bone tumours - Osteosarcoma prognostic factors

Humerus worst > rib, vertebra, pelvis

Maxilla > skull

Metastasis

Total alkaline phosphatase levels

Bone tumours - Pain Control

Amputation

Bone tumours - Amputation breeds

Yes

Bone tumours - Feline osteosarcoma tx

Amputation

Haemangiosarcoma - common locations

Spleen, liver, R auricular appendage, m, skin

Haemangiosarcoma - Malignancy

Highly invasive + metastatic

Haemangiosarcoma - CS

Bleeding → shock, collapse, haemoabd, pericardial effusion, bruise

Anaemia, schistocytosis

Dec TP

Low platelets

Prolonged coagulation

Haemangiosarcoma - Dx

Histo

Haemangiosarcoma - Staging + when to do

Before splenectomy, determine if hyperplasia

Imaging

Haemangiosarcoma - Tx primary lesions

Sx - splenectomy

Radiotherapy

Haemangiosarcoma - Common issue with splenectomy

V arrhythmias

Haemangiosarcoma - Metasitsi tx

Chemo - anthracycline

Metronomic chemo

Haemangiosarcoma - Which have poor prognosis (<6mon)

Splenic, m, sc, RA appendage

Haemangiosarcoma - Which have good prognosis

Dermal

Histiocytic sarcoma - common locations

Lung, spleen, liver, bone, brain, joints

Histiocytic sarcoma - Tx

Multimodal - sx, radiotherapy, chemo (Lomustine, anthracycline)

Histiocytic sarcoma - Prognosis

Solitary >900d

Gross metasitsis 4-5mon