59 General Therapeutic Approach to the Cancer Patient

Staging

What is the name for the initial tests are the performed on a tumor to determine a patient's general health, extension of tumor growth, metastatic spread, and concurrent disease status to potentiate outcome?

Takes lymphatic route --> regional lymph nodes and lungs

What is the typical rule of thumb for carcinoma spread?

Hematogenous route --> liver, lungs. RARE lymph nodes

What is the typical rule of thumb for sarcoma spread?

Lymph nodes --> abdominal viscera (liver, spleen) --> bone marrow

BUT NOT THE THORAX

What is the typical spread of mast cell tumors?

Minimum database, lymphnode evaluation, abdominal ultrasound, determine local tumor extent

What are the appropriate staging diagnostics for canine mast cell tumors?

Minimum database, lymph node evaluation, thoracic radiographs

What are the appropriate staging diagnostics for canine soft tissue sarcomas?

Calcium

What bloodwork finding will be elevated with anal sac adenocarcinomas?

1. TMN (tumor node metastasis staging) for solid tumors

2. WHO I-V (for canine lymphoma ONLY)

What are the two common guidelines for staging tumors?

WHO, stages I-V

What is the tumor staging system for canine lymphoma ONLY?

T = tumor size/extent

N = nodal status (noted as 0 or 1)

M = metastatic or "distant" status (noted as 0 or 1)

What does the TNM staging system for solid tumors evaluate?

Carcinomas, sarcomas, melanomas

What types of cancers are often staged using the TNM system?

0, 1, 2, 3, 4

How many TNM system stages are there?

Stage correlated with prognosis

What do stages, such as in the TNM system, correlate with?

Stage 4

If there is any kind of metastasis in the TNM staging system, what stage does this automatically put the tumor at?

The lymphnodes you evaluated are clear

If I tell you that in the TNM system, that N=0, what does this mean?

T1 = 1-3 cm

T2 = 3-5 cm

T3 = 7-8 cm

If T0 indicates no gross disease and T4 indicates tumors growing into nearby structures in the TNM system, tell me what T1, T2, and T3 mean? What is the tumor size?

I = single lymph node

II = regional lymph nodes/mediastinum/same side of diaphragm

III = generalized lymph nodes

IV = liver, spleen

V = anywhere else (bone marrow, skin, etc)

What are the different stages of the WHO canine lymphoma staging system?

Chemosensitive

Lymphoma is sensitive to what treatment modality?

Surgery first

NOT SENSITIVE TO RADIATION

Bone tumors are generally treated with what modality?

That they do not have overlapping toxicities (like both cardiotoxic)

What do you need to be careful of when using two modalities at the same time?

You can use surgery to get rid of any macroscopic disease, but then use radiation to treat "residual disease" or "sterilize it" = which works because you know mast cell tumors are sensitive to surgery AND radiation

Why would you use radiation therapy for something like an appendicular macroscopic canine cutaneous mast cell tumors when you can surgically remove it?

Osteosarcomas are highly locally aggressive, so surgery is typically the only option. You know bone tumors are not susceptible to radiation, but using chemotherapy helps to improve outcome because osteosarcomas have a high metastatic rate normally and this can help to decrease the risk

Why would you use chemotherapy for something like a canine appendicular osteosarcoma when you can surgically remove it?