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Labrador cross with mass on antebrachium (view source)
Revision as of 18:09, 4 October 2012
, 18:09, 4 October 2012no edit summary
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<center><WikiQuiz
<center><WikiQuiz
questionnumber="1"
questionnumber="1"
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<center><WikiQuiz
questionnumber="13"
questionnumber="13"
question=""
question="What next step do you propose?"
choice1=""
choice1="Adjuvant doxorubicin chemotherapy to reduce the chance of development of pulmonary metastatic disease, followed by frequent checks for local recurrence (every 3 months for a year) and repeat radiographs at 6 and 12 months postoperatively. "
choice2=""
choice2="Frequent checks for local recurrence (every 3 months for a year) and repeat radiographs at 6 and 12 months postoperatively. "
choice3="Long-term piroxicam chemotherapy as an antiangiogenic treatment to reduce the development of pulmonary metastatic disease, as well as frequent checks for local recurrence (every 3 months for a year) and repeat radiographs at 6 and 12 months postoperatively."
choice4="Adjuvant carboplatin chemotherapy to reduce the chance of development of pulmonary metastatic disease, followed by frequent checks for local recurrence (every 3 months for a year) and repeat radiographs at 6 and 12 months postoperatively."
choice5=""
correctchoice="2"
feedback1="'''Incorrect'''. Adjuvant chemotherapy for grade 2 STS is not indicated, as there is no proven benefit, nor is it proven to be of benefit for grade 3 STS in dogs. Chemotherapy may have some value for highly anaplastic sarcomas, where immunohistochemistry is required to determine histiogenesis; however, even this is unproven. Choose again."
feedback2="'''Correct'''. Adjuvant chemotherapy is of no benefit for grade 2 STS, so should not be offered."
feedback3="'''Incorrect'''. Adjuvant chemotherapy for grade 2 STS is not indicated, and is likely to be of little benefit for grade 3 STS. It may have some value for highly anaplastic sarcomas, where immunohistochemistry is required to determine histiogenesis; however, even this is unproven. The chemotherapeutic agent with the most expected benefit is doxorubicin or similar, so this would be inappropriate therapy. Choose again."
feedback4="'''Incorrect'''. Adjuvant chemotherapy for grade 2 STS is not indicated, and is likely to be of little benefit for grade 3 STS. It may have some value for highly anaplastic sarcomas, where immunohistochemistry is required to determine histiogenesis; however, even this is unproven. The chemotherapeutic agent with the most expected benefit is doxorubicin or similar, so this would be inappropriate therapy. Choose again."
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questionnumber="14"
question="You recheck your patient frequently and after 12 months there is evidence of a 5 × 3-cm wide, fixed soft-tissue swelling along one area of the surgical suture line at the proximal lateral antebrachium and overlying the ventrolateral chest wall. You biopsy this swelling as a small wedge biopsy and this confirms local recurrence of tumour, this time as a grade 3 STS. You had warned the clients that amputation was your preferred treatment option due to the difficulty in attaining margins because of tumour size and location, and so they are disappointed but not unprepared. It was also explained to them that recurrent disease has a poorer prognosis than optimally treated first-time, curative intent surgery. What would you do next?"
choice1="Thoracic radiographs + abdominal ultrasound (as now grade 3) before amputation if staging is negative."
choice2="Thoracic radiographs + abdominal ultrasound (as now grade 3) + contrast-enhanced advanced imaging (e.g. CT, magnetic resonance imaging (MRI)) of local disease to ensure recurrent disease is resectable before wide surgical resection (most likely amputation)."
choice3="Thoracic radiographs + abdominal ultrasound (as now grade 3) + contrast-enhanced advanced imaging (e.g. CT, MRI) of local disease followed by marginal resection of local recurrence and adjuvant radiation therapy."
choice4=""
choice5=""
correctchoice="2"
feedback1="'''Incorrect'''. It is best to have advanced imaging of local tumour before surgery, as this may help you plan your surgery. Choose again."
feedback2="'''Correct'''."
feedback3="'''Incorrect''', because you are irradiating over the chest wall and may incur long-term complications of fibrosis of irradiated lung. Therefore this is not your preferred option, as long as the dog has no intercurrent orthopaedic or neurological disease which precludes amputation. Choose again."
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<center><WikiQuiz
questionnumber="15"
question="Luckily, your thoracic radiographs are negative for pulmonary metastatic disease, and there is still no palpably enlarged regional lymph node. You have optimized this patient’s outcome by ensuring frequent rechecks. However, you need to treat the primary tumour. What is the commonest cause of death for dogs with subcutaneous STS?"
choice1="Metastatic disease"
choice2="Uncontrolled or inadequately treated local disease"
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choice3=""
choice4=""
choice4=""
choice5=""
choice5=""
correctchoice="4"
correctchoice="2"
feedback1=""
feedback1="'''Incorrect'''. Review STS before retrying.]]>"
feedback2=""
feedback2="Correct."
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questionnumber="16"
question="The clients are prepared for amputation, which your advanced imaging shows is most appropriate, as you will not be able to attain wide margins without it. You perform the amputation and succeed in attaining 3-cm margins around gross tumour, confirmed by the pathologist. You continue your frequent rechecks. Unfortunately, after 6 months there is evidence of two nodules in the caudal lung fields.Now it is optimal for you offer the clients doxorubicin chemotherapy. True or false?"
choice1="True"
choice2="False"
choice3=""
choice4=""
choice5=""
correctchoice="2"
feedback1="'''Incorrect'''. This treatment is of no proven benefit."
feedback2="'''Correct'''. There is no proven benefit of giving adjuvant doxorubicin in this setting. You have done all you can do for this dog. It is a shame that the clients would not agree to amputation initially, as a surgical cure was likely at the first adequate surgical attempt at resection with wide clean margins. A marginal excision and adjuvant radiation therapy would have also given a good prognosis.]"
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{{Elsevier
|url = http://www.elsevierhealth.co.uk/product.jsp?isbn=9780702042508
|book = North and Banks, Small Animal Oncology
|image = North and Banks SA Oncology.jpg
}}
[[Category:Case-based Quizzes]]