Podcast
Questions and Answers
What diagnosis was suggested for the enlarged peripheral lymph nodes and cranial organomegaly?
What diagnosis was suggested for the enlarged peripheral lymph nodes and cranial organomegaly?
What is the significance of the term 'RD' as used in the context of the treatment protocols?
What is the significance of the term 'RD' as used in the context of the treatment protocols?
What was the initial chemotherapy protocol administered on October 19, 2017, for the dog 'Fynnigan'?
What was the initial chemotherapy protocol administered on October 19, 2017, for the dog 'Fynnigan'?
Which symptom was noted in Fynnigan that may indicate underlying health issues?
Which symptom was noted in Fynnigan that may indicate underlying health issues?
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What change occurred in Fynnigan's treatment after the relapse on March 19, 2019?
What change occurred in Fynnigan's treatment after the relapse on March 19, 2019?
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What percentage of lymphoblasts is present in lymphoma according to lymph node cytology?
What percentage of lymphoblasts is present in lymphoma according to lymph node cytology?
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What is the median survival time (MST) for lymphoma treatment?
What is the median survival time (MST) for lymphoma treatment?
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Which staging indicates involvement of liver and/or spleen in lymphoma?
Which staging indicates involvement of liver and/or spleen in lymphoma?
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Which test is NOT typically performed for clinical staging of lymphoma?
Which test is NOT typically performed for clinical staging of lymphoma?
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What type of staining is used for immunophenotyping T cells?
What type of staining is used for immunophenotyping T cells?
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What is a common laboratory finding in lymphoma patients?
What is a common laboratory finding in lymphoma patients?
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Which breed is notably more prone to developing lymphoma?
Which breed is notably more prone to developing lymphoma?
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Which clinical sign differentiates substage a from substage b in lymphoma staging?
Which clinical sign differentiates substage a from substage b in lymphoma staging?
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What percentage of all hematopoietic tumors in dogs is comprised of lymphoma?
What percentage of all hematopoietic tumors in dogs is comprised of lymphoma?
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Which lymph node is considered to be always palpable in healthy dogs?
Which lymph node is considered to be always palpable in healthy dogs?
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What is the most common form of canine lymphoma?
What is the most common form of canine lymphoma?
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How is the histologic grade of lymphoma determined?
How is the histologic grade of lymphoma determined?
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Which clinical signs are NOT typically associated with canine lymphoma?
Which clinical signs are NOT typically associated with canine lymphoma?
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What is the most common immunophenotype in canine lymphoma?
What is the most common immunophenotype in canine lymphoma?
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When performing fine needle aspiration (FNA), what is a key factor for obtaining a diagnostic slide?
When performing fine needle aspiration (FNA), what is a key factor for obtaining a diagnostic slide?
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Which form of canine lymphoma is associated with stages 3-5 being most common?
Which form of canine lymphoma is associated with stages 3-5 being most common?
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What is the primary goal of chemotherapy treatment in dogs with lymphoma?
What is the primary goal of chemotherapy treatment in dogs with lymphoma?
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What is the median survival time (MST) for dogs with multicentric lymphoma receiving combination chemotherapy including Adriamycin®?
What is the median survival time (MST) for dogs with multicentric lymphoma receiving combination chemotherapy including Adriamycin®?
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Which side effect is commonly associated with CCNU (lomustine) chemotherapy?
Which side effect is commonly associated with CCNU (lomustine) chemotherapy?
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At what point may a veterinarian conclude that chemotherapy is not working?
At what point may a veterinarian conclude that chemotherapy is not working?
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What percentage of dogs with lymphoma typically achieve remission with CHOP chemotherapy?
What percentage of dogs with lymphoma typically achieve remission with CHOP chemotherapy?
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Which of the following indicates a worse prognosis in dogs with lymphoma?
Which of the following indicates a worse prognosis in dogs with lymphoma?
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What should be done if lymph nodes are enlarging during the chemotherapy protocol?
What should be done if lymph nodes are enlarging during the chemotherapy protocol?
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Which drug is administered in the first week of the 15 week CHOP chemotherapy protocol?
Which drug is administered in the first week of the 15 week CHOP chemotherapy protocol?
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Study Notes
Canine Lymphoma
- Lymphoma is a common cancer in dogs, comprising 83% of all hematopoietic tumors.
- It's a round cell tumor, stemming from lymphoreticular cells.
- Common locations include lymph nodes, spleen, bone marrow, gastrointestinal tract (GALT), skin, and other organs.
- Lymphoma is a systemic disease.
Lymphoma Classification
-
Histologic Grade: Classified based on the number of malignant cells per high-power field (hpf) at 400x magnification.
- Low: 0-5/hpf
- Intermediate: 6-10/hpf
- High: >10/hpf (most common)
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Immunophenotype: Differentiates between B-cell and T-cell lymphoma.
- Diffuse large cell B-cell lymphoma (DLCBL) is the most common type.
- Anatomic Form: The multicentric form is most common.
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Stage/Substage:
- Stage 3-5 is the most common staging.
History Taking
- Crucial questions include:
- When were the lumps first noticed?
- Has there been any change in their size?
- Are the lumps causing discomfort to the dog?
- Relevant information like vomiting, diarrhea, cough, past medical history (meds, travel history).
Physical Examination
- Palpable Lymph Nodes: Always palpable - mandibular, prescapular. Others are only assessed if abnormal (inguinal, axillary, popliteal)
- Important physical findings: Lumps, hepatosplenomegaly (enlarged liver/spleen), poor appetite, discharge, breathing issues, weight loss, etc.
Clinical Signs
- "Happy dog with lumps" - common presentation
- Possible presence of hepatosplenomegaly, PU/PD (polyuria/polydipsia), uveitis (inflammation of the eye), GI signs, respiratory signs.
Diagnostic Procedures
-
Fine Needle Aspiration (FNA): Essential for diagnostic cytology.
- Ensure the slide is diagnostic (not just broken cells).
- Make sure the lymph node is targeted correctly.
- Distinguish between normal vs. abnormal lymph node cells under a microscope.
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Cytology: Essential for diagnosis.
- Analyze for normal (90-95% mature lymphocytes) vs. abnormal (50-90% lymphoblasts)
- Use neutrophil size as a measurement tool.
Clinical Staging
- Cytology/excisional biopsy of affected lymph node.
- CBC, Chemistry panel, urinalysis.
- Thoracic and abdominal radiographs or imaging.
- Bone marrow aspirate.
- Immunophenotyping.
- Stages: I- single node, II- multiple nodes on one side of diaphragm, III- generalized lymph node involvement, IV- Liver or spleen involvement, V- Blood or bone marrow or extranodal sites.
CBC & Serum Chemistry
- Reasoning: Identify potential systemic issues.
- Common findings:
- Often normal
- Anemia
- Leukocytosis/stress leukogram
- Thrombocytopenia
- Pancytopenia
- Hypercalcemia
- Increased liver enzymes
- Monoclonal gammopathy
Imaging
- Thoracic Radiographs: Detect lymphadenopathy (swollen lymph nodes), interstitial, or nodular patterns.
- Abdominal Radiographs.
- Abdominal Ultrasound.
Bone Marrow Aspirate
- Assessment of cell morphology for diagnosis.
Immunophenotyping
- Technique: Identify lymphoid lineage (B or T cells), typically assessing tissue/air-dried/cytology slides.
-
Markers:
- T-cells: CD3, CD4, CD8
- B-cells: CD79a, CD20, CD21
- Flow cytometry is often employed.
Treatment
- Chemotherapy: Multiple drug protocols, Prednisone alone.
- Treatment Goal: Clinical remission
- Reasons for treatment failure: Multi-drug resistance
- Prognostic Factors: T-cell immunophenotype; substage; Stage 5; pretreatment with prednisone, GI, hepatic, or mediastinal location.
Prognosis
-
Median Survival Time (MST):
- Combination chemotherapy (e.g. CHOP), including Adriamycin®: ~ 1 year (B-cell lymphoma better prognosis than T-Cell).
- Prednisone alone: 2-3 months
- No treatment: 4-6 weeks
15-week CHOP Protocol
- 12 treatments over 15 weeks.
- Drugs are rotated sequentially, and Prednisone is tapered
- Includes vincristine, prednisone, +/-L-asparaginase, cyclophosphamide, doxorubicin.
- Hold treatment in remission, monitor q 30 days.
Additional Information
- Lymphoma is typically more effectively treated with combination chemotherapy protocols (e.g. CHOP).
- Relapse is noted if the tumor comes back or the dog gets worse.
- Rescue chemotherapy (such as lomustine) might be required if treatment stops responding.
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Description
Test your knowledge on the diagnosis and treatment protocols for canine lymphoma as illustrated in the case of Fynnigan. This quiz covers key symptoms, treatment changes, and significant terminology associated with veterinary oncology. Challenge yourself with specific questions about the case details!
