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Congress on Demand 2021: Oncology
We are pleased to present a selection of lectures from BSAVA virtual Congress 2021 that cover oncology. This collection can be purchased as a standalone item, with a discount for BSAVA members. Visit our Congress on Demand information page for information about how to access the rest of our 2021 congress lectures.
Collection Contents
10 results
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Are all feline abdominal masses lymphomas?
BSAVA Congress Proceedings 2021Author Sarah MasonAbdominal masses are a common presentation in feline patients, and clinical signs commonly include weight loss, inappetence, vomiting and diarrhoea. The first step in investigation is to consider the likely differential diagnoses and obtain base line haematology and biochemistry to assess for red or white blood cell changes. Investigation of the mass should include abdominal ultrasound to confirm organ of origin, and needle aspirates or trucut biopsy. Ultrasound may give a good indication of the likelihood of successful resection and guide the decision to proceed with additional staging or surgery. The most common abdominal mass in cats is intestinal lymphoma, staging should include testing for FIV/FeLV, and thoracic radiographs if the budget permits. As lymphoma is a systemic disease, chemotherapy is indicated, regardless of staging and surgical intervention. In some patients, however, it is of benefit to excise the mass prior to chemotherapy, in the case of obstruction for example. Other intestinal tumours in felines include carcinoma, mast cell tumour and sarcoma. Abdominal masses may also arise from mesenteric lymph nodes and other organs such as liver, spleen pancreas, bladder or adrenal gland. This session uses a case-based approach to discuss differentials for and investigation of feline abdominal masses.
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Chemotherapy: common myths debunked
BSAVA Congress Proceedings 2021Authors: Owen Davies and Sarah MasonGiving chemotherapy is too dangerous to the cat: Many clients are very unnerved when the prospect of chemotherapy for their cat is discussed, fearing that their pet will endure the level of adverse effects (AEs) that many human chemotherapy patients do. While this preconception is perfectly understandable, it is a highly inaccurate. The majority of cats receiving chemotherapy either experience no AEs, or mild, self-limiting AEs. This difference arises from compassionate dosing of our feline friends. Since most of the AEs of chemotherapy are dose-dependent, rather than idiosyncratic, it is perfectly possible to control the risk by altering the doses of chemotherapy the cat receives. Although this approach also compromises cancer control, it still produces an acceptable outcome since cats have a much shorter life-expectancy than people; a remission of 2-3 years is often very acceptable for a cat whereas a cancer-free interval of decades (at least) would be the goal for people. This lecture discusses avoiding and managing some of the common chemotherapy-associated AEs in cats, giving tips on how best to educate cat owners that chemotherapy is a safe and ethical treatment for their feline companion.
Giving chemotherapy is too dangerous to the dog: Chemotherapy is becoming more widely available and advocated as a treatment for many neoplastic conditions and is a generally well tolerated treatment which affords excellent quality of life in most patients. Some clients, however, are reluctant to pursue chemotherapy treatment for their dog due to concerns related to possible toxicity, often extrapolated from human medicine. This presentation outlines the risks, possible side effects and approximate frequency with which these are reported with the cytotoxic chemotherapy drugs commonly used in canine patients. The session discusses toxicities associated to vinka alkaloids, anthracyclines and alkylating agents commonly used in the treatment of canine neoplasia, and give practical tips on how to avoid these, and to manage them should they occur. The aim is to demonstrate that quality of life in veterinary oncology patients is paramount and to give practitioners the tools to recommend chemotherapy with confidence and to discuss the risk of chemotherapy toxicities in canine patients with clients.
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Client communication – it’s a two-way street!
BSAVA Congress Proceedings 2021Authors: Linda Ryan and Michael MacfarlaneTop tips for getting the message across without losing the patient – part 1: The diagnosis of a pet’s cancer can be an emotional one for caregivers. Additionally, along with shock and grief, it can be the start of a long journey of decision-making, large financial and time commitments, home nursing, and more. Caregivers’ wishes for their pet may vary, from wanting to do everything possible, to not proceeding. Client’s concerns may be diverse – from whether they can cope with caring for a pet with cancer, to whether their pet can cope with cancer treatment. No matter what decisions are made, or a treatment paths are followed, the veterinary oncology team must work with caregivers to build a strong and trusting working relationship. In this way, we can guide them through the reality of cancer treatment, prognoses and realistic expectations, ethical and welfare-centred outcome objectives, and treatment options. This session focuses on some of the potential barriers perceived by clients, and how the oncology team – working collaboratively and in a multi-disciplinary way – can support the caregiver empathetically, considering their and the pet’s perspective, to facilitate optimal and ongoing patient care. Getting this right from the start is crucial, and can make all the difference to successful interventions, and to how the pet and client proceed through care plans.
Top tips for getting the message across without losing the patient – part 2: We are all very different! Some owners want to know every detail of their pet’s condition, some want to put the care completely into our hands, some owners will know that their dog drinks an average of 714mls of water a day, some will not have any idea their dog is drinking more than normal. Neither is right or wrong or even good or bad but all owners want their pet to feel well and stay well for as long as possible. For these different owners, the way to reach the best treatment decision for their pet may be very different. This lecture uses the author’s experience of working in a multi-disciplinary team and with nurses who have been a big part of owner communication. I will let you know what I feel has worked well and what hasn’t and my top tips for stress-free communication.
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Giving chemotherapy in practice is not too difficult!
BSAVA Congress Proceedings 2021Author Sarah MasonAs more people pursue cancer treatment for their pets there is growing demand for chemotherapy treatment which many clients would like to pursue within their local practice. Chemotherapy can be safely delivered in general practice and can result in a satisfying relationship for the veterinarian, client and pet. The main risks associated with chemotherapy are exposure of personnel and risk of side effects to patients. The practice should ensure appropriate protective equipment, cytotoxic delivery systems and disposal systems are in place. Many practices will have their own guidelines and standard operating practices, and resources are available such as the ACVIM guidelines on chemotherapy administration. The risk to patients is managed by the veterinarian developing a robust knowledge of potential side effects and ensuring that clients are provided with information on actions to take in the event of suspected chemotherapy toxicity. This lecture provides a practical guide to giving chemotherapy in practice.
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How to deal with the incidental mass
BSAVA Congress Proceedings 2021Authors: Michael Macfarlane and Sarah MasonCan we ever assume a mass is a lipoma? This lecture covers the approach to the incidentally found cutaneous and subcutaneous mass. This can be a very broad spectrum from a pinpoint mass to a football-sized tumour which wasn’t there yesterday! Topics addressed include: is it OK to remove a tumour without knowing what it is?; which masses are deserving of some additional testing or staging before surgery?; a brief discussion on surgical margins; that I do sometimes assume a mass is a lipoma!
Incidental abdominal masses in dogs: As more animals undergo imaging evaluations in veterinary practice, and as these assessments increase in sensitivity, the possibility of finding an ‘incidentaloma’ (incidentally found mass) increases. These are occasionally found in canine patients, often when staging is performed for more obvious external conditions. In the limited veterinary literature on abdominal incidentalomas, 4% of dogs undergoing abdominal ultrasonography in one study were found to have adrenal masses, and 9% in another study on CT. Splenic masses are a relatively common incidental finding and one report documented that 30% of incidentally found splenic nodules were malignant. These findings are challenging for vets and clients in attributing relevance, especially in patients with other neoplastic diseases. This presentation focuses on common presentations of abdominal incidentalomas and uses case studies to demonstrate decision making for these patients. The aim is to develop awareness of the significance of incidentalomas and skills in how to manage them.
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Improving your practice’s skills in cytology
BSAVA Congress Proceedings 2021Authors: Paola Monti and Elizabeth VilliersCommon mistakes in sampling: Optimal cytology smears, correct sample handling and contextualisation of the findings with the clinical history are all essential steps for achieving an accurate cytological diagnosis. Good quality cytology smears provide excellent morphologic details of cells and infectious agents, often allowing to differentiate between inflammatory and neoplastic processes, identify the tumour type and its behaviour (benign or malignant). When performing a fine-needle aspirate (FNA), the aim is to produce a monolayer of cells with minimal cell rupture. An incorrect technique can produce unsuitable samples precluding adequate evaluation and identification of the cells. Another common pre-analytical mistake in cytology is to collect a single aspirate, especially from larger masses. A single mass may contain areas of necrosis, inflammation, neoplasia or normal tissue cells and a single slide is unlikely to be representative of the entire lesion. If a mass is fluid-filled, collection of fluid and adjacent solid areas would be recommended, as fluid cytology alone rarely reveals the nature of the surrounding mass. Labelling of the slides with patient name and origin of the FNAs is another crucial step. The importance of sample handling before processing and staining should not be underestimated. Fluid samples should be collected in the correct tubes and adequately stored; unstained cytology slides should not be exposed to formalin fumes. Finally, adequate staining procedures are essential to guarantee and highlight the cellular details that are required for the diagnosis. Taking care of all these simple steps will prevent the most common sampling mistakes, increasing the diagnostic power of cytology.
Common mistakes in interpreting: When interpreting cytology, it is vital to consider the clinical history and appearance of the lesion as well as the cytological appearance and to have likely differential diagnoses in mind. Organisms may not be visible in infected lesions if antibiotics are given before sampling. Bacteria are rarely seen in septic arthritis. Fungi and mycobacteria can be difficult to see with routine stains. The lesion may have mixed pathology such as focal areas of necrosis or inflammation within a tumour and sometimes the fine needle aspirate may harvest only some of these components and not be wholly representative. Hence if neoplasia is suspected but only inflammation is seen, resampling different areas would be recommended. We are familiar with looking for criteria of malignancy to make a diagnosis of neoplasia. However, hyperplastic or dysplastic cells can sometimes be impossible to distinguish from neoplastic cells, since all three can show criteria of malignancy. This is a particular problem of mesenchymal cells because the fibroblasts in granulation tissue or in inflammatory lesions can resemble the neoplastic cells seen in soft tissue sarcomas. The history and appearance may help distinguish these although biopsy will often be required. Just as non-neoplastic cells can look malignant, the converse is also true. Some malignant tumours consist of cells which do not display marked criteria of malignancy. Examples include haemophagocytic histiocytic sarcoma, some malignant melanomas and thyroid carcinoma. Knowledge of the clinical presentation and expected pathology will help minimise errors in interpretation. Cytology should never be performed in isolation.
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Interactive cytology
BSAVA Congress Proceedings 2021Authors: Paola Monti and Elizabeth VilliersThis case-based session explores and discusses common but still challenging cytology cases using live cytology slide examination, enabling you to see the step by step process of how we examine a slide and how the findings lead us to a diagnosis or differential diagnoses.
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Is it cancer?
BSAVA Congress Proceedings 2021Authors: Elizabeth Villiers and Laura BlackwoodHow does the cytologist do it? Although there are some exceptions, benign tumours consist of a uniform population of cells that resemble their normal non-neoplastic counterpart whilst malignant tumours generally show variability. In benign tumours cells are small and uniform, with small nuclei and a low nuclear:cytoplasmic (N:C) ratio. Nucleoli may be absent or nuclei may contain 1-2 small nucleoli. When in aggregates the cell arrangement is orderly and neat. Malignant tumours are recognised by identifying cellular, nuclear and cytoplasmic criteria of malignancy: Abnormal location for that cell type e.g. metastatic carcinoma cells should not be present in a lymph node; macrocytosis and karyomegaly with anisocytosis and anisokaryosis; cell clusters may be chaotic and disordered with cell or nuclear moulding; increased N:C ratio; large nucleus and sparse; bi- and multinucleation – anisokaryosis within one cell is especially significant; multiple nucleoli or a single large nucleolus; coarsely stippled to clumped nuclear chromatin; frequent/ abnormal mitoses; increased cytoplasmic basophilia and/or abnormal cytoplasmic vacuolation or granulation, or excessive secretory product. The shape and arrangement of cells will help identify the ‘family’ of cells: Epithelial cells are columnar, cuboidal, roundish or polygonal and in cohesive clusters. Mesenchymal cells are oval to spindle shaped and seen individually or in loose aggregates, sometimes with a swirling pattern, with poorly defined cell borders. Round cells are discrete. The quantity and appearance of the cytoplasm distinguishes lymphoid cells, plasma cells, histiocytic cells and mast cells.
What else does the oncologist need to know (TNM)? Staging determines the extent of disease in cancer patients, to inform treatment decisions. Recommended staging is strongly influenced by the diagnosis and likely behaviour of the tumour: a diagnosis is essential. Full staging is most appropriate for high grade tumours, and in older patients (identifying comorbidities) or before invasive/expensive treatments. Cytology is particularly useful for superficial masses and those accessible by ultrasound guidance. Carcinomas and round cell tumours tend to exfoliate well, sarcomas not. Primary tumour extent is assessed clinically and by imaging. Carcinomas, mast cell tumours, and malignant melanomas tend to metastasise by the lymphatic route, requiring assessment of locoregional lymph nodes. The closest node (moving from peripheral to central) is often likely to be the draining node, but lymphangiography can identify unexpected draining nodes in high grade tumours. Identifying and sampling these nodes leads to better staging. Imaging of retropharyngeal, axillary, medial iliac and inguinal nodes by ultrasound or CT is useful: CT allows imaging of sacral nodes e.g. in anal sac adenocarcinoma patients. FNA has a variable rate of false negatives in different tumours: in particular, FNA may be insensitive to oral melanoma metastases. For distant metastases, cytology is especially useful for assessing splenic and hepatic nodules.
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Mast cell tumours: what to do when
BSAVA Congress Proceedings 2021Author Michael MacfarlaneMast cell tumours are the subject of many research articles and CPD talks. That is partly because they are common, but also because they do not have a set of clear diagnostic and treatment paths like other tumours do. They present in so many different ways and there are an overwhelming number of treatment and diagnostic options which can also be used in any number of combinations. Whilst making a treatment algorithm which applies to every mast cell tumour is impossible (after many failed attempts!), this lecture presents clear information on what the options are and when to use them. It covers: do I need to stage?; do I need to follow my surgery with chemotherapy or tyrosine kinase inhibitors?; multiple mast cell tumours; a focus on new and less common therapies – radiotherapy, Stelfonta®, electrochemotherapy and more.
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The miracle cures – how to deal with Dr Google
BSAVA Congress Proceedings 2021Authors: Owen Davies and Sarah MasonWill changing my pet’s diet help to cure the cancer? It is common for pet owners to seek advice on nutrition, herbs and dietary supplements when their best friends are diagnosed with cancer. A growing industry has developed to serve this need, and there are many, sometimes very compelling, sources of advice to be found online. Evidence to support such nutritional interventions in veterinary patients is sparse, however. Many ‘cancer’ diets stem from the alteration of cellular energetics seen in some cancers (the ‘Warburg’ effect), however the importance of this effect, and clinical benefit of diets with different carbohydrate levels, has not been demonstrated in veterinary cancer patients. Currently the recommendation is to feed a balanced, cooked diet which is palatable to the animal, seeking to maintain a stable bodyweight. If cachexia develops, dietary alteration to support lean body mass and supplementation to minimise the associated inflammatory state (e.g. with omega 3 fatty acids) may be appropriate. A number of nutraceutical compounds are also widely touted as beneficial to veterinary cancer patients; since there is often no evidence, or weak evidence to support use of these compounds, it may be more pragmatic to consider their risk of adverse effects or interactions with other drugs before supporting or opposing their use.
I have read on the internet about… Using EBM to combat miracle cures: Evidence based medicine (EBM) is the conscientious, explicit, judicious and reasonable use of modern best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information. This presentation and discussion includes a summary of evidence-based medicine, the quality and relevance of this in veterinary oncology decision making and how to use this to assist in empowering and including owners in the treatment decisions for their pet. The concept of goal driven care is also discussed. The common situations in which owners present questions around their own research, motivations and questions about their pet’s care are outlined. We discuss how to navigate this and how to guide clients to useful and appropriate sources of information. The session offers practical tips on how to answer queries from owners regarding ‘miracle cures’ using real life experiences to illustrate this. The aim is to develop tools to assist in supporting clients need to be involved in their pets care and treatment decisions.
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