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47 Cards in this Set
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physical exam finding of oral tumor
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facial swelling, visible/ palpable mass. oral pain, lymphadenomegaly, loose teeth
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Oral tumor patient history
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haliotosis (bad breath), ptyalism (excessive salivation), dysphagia (difficulty swallowing), inappetance, blood in mouth/ bowel, weight loss, difficulty opening jaw, not chewing bones, not picking up toys
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differential ddx for oral tumor
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1. malignant oral tumor: Melanoma>SCC> fibrosarcoma
2. benign oral tumor e.g. epilus 3. other: dental dz, tooth abcess, gingivital hyperplasia, infection, stomatitis (inflammation of the mouth), eosinophil granuloma complex, nasopharyngeal polyp (cats), foreign body |
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definitive diagnosis of primary tumor
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1. Fine needle aspirate with cytology: cheapest and simplest but cannot grade
2. biopsy: use intra- oral approach so won't contaminate skin, don't seed tumor, more definitive but more invasive (may require anesthesia). Wedge biopsy, tru cut biopsy (hard to get angle getting into mouth) |
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Staging
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assess extent of local, regional and distant mets
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Local evaluation of staging
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1. CT scan BEST (best for bone and LN, great for surgical/ RT planning)
2. dental rads (excellent detail compare to skull rads)- if don't see bone invasion, doesn't mean not there, need 45% bone lysis to show on rads 3. skull rads (difficult to interpret and need sedation) |
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Regional evaluation of staging: Ctology or biopsy of regional LN
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MANDIBULAR (retropharyngeal and parotid difficult to assess)
ipsilateral and contralateral LN size not reliable assesment |
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Staging: systemic assesment
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minimal database (CBC, chem, UA)
chest rads 3 views +/- ab ultrasound (useful for systemic dz) |
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oral tumor
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5% benign- lots of bone damage but no mets, no staging but almost always have bone invasion
local= ln, distant= lung invasion melanoma and SCC most common oral tumor |
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signalment of oral tumor: breed
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melanoma: small breed but lingual site more common in large breed, higher risk in heavily pigmented mucosa e.g. chow chow
SCC and FSA (fibrosarcoma)- large breed |
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signalment of oral tumor: age
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older animal
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Biological behavior of melanoma
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commonly mucosa, can be anywhere
locally aggressive (ln) high mets rate (lung) early in dz course -ve prognostic factor |
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non- tonsillar/ non- lingual SSC
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often gingivital and rostral to canine teeth
locally aggressive low mets rate later in dz course |
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tonsillar SCC
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locally aggressive, very aggressive
high mets |
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lingual tumors (rare)
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50% SCC
lingual SCC intermediate met rate possible cure with surgery |
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FSA (fibrosarcoma)
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in maxilla common
locally invasive low mets, later in dz in LN |
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Epulides
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commonly benign gingivital proliferation
fibromatous and ossifying- slow growth, firm, non invasive acanthomatous- less than 5% recur, aggressive with bone invasion, non mets, most commonly rostral mandible |
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Bio behavior of Canine Oral tumor
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Melanoma= frequent bony invasion, regional and distant mets
SSC= bony invasion if mandibular or maxilla. Infrequent regional or distant mets FSA= infrequent regional or distant mets, local invasion frequent acanthomatous epilus= never mets but always local bony invasion |
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Surgery for oral tumor
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Tx of choice for localized dz
large margin (2-3cm), aggressive dog tolerate aggressive surgery, cats don't |
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RT for oral surgery
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if tumor unresectable
good for SCC and epilus bad for FSA melanoma good with coarse fraction (large dose given less often) also for post op dirty margin and palliative intent |
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chemotherapy
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30% for melanoma
some response for SCC (NT/NL) NON RESPONSIVE FOR FSA |
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Immunotherapy
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therapeutic vx for melanoma (not prophylactic)
induce immune response against Ag expressed by melanoma tumor cell MST > 1 yr (6-9m before vx was available) |
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Bio behavior of Canine Oral tumor
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Melanoma= frequent bony invasion, regional and distant mets
SSC= bony invasion if mandibular or maxilla. Infrequent regional or distant mets FSA= infrequent regional or distant mets, local invasion frequent acanthomatous epilus= never mets but always local bony invasion |
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Surgery for oral tumor
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Tx of choice for localized dz
large margin (2-3cm), aggressive dog tolerate aggressive surgery, cats don't |
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RT for oral surgery
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if tumor unresectable
good for SCC and epilus bad for FSA melanoma good with coarse fraction (large dose given less often) also for post op dirty margin and palliative intent |
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chemotherapy
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30% for melanoma
some response for SCC (NT/NL) NON RESPONSIVE FOR FSA |
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Immunotherapy
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therapeutic vx for melanoma (not prophylactic)
induce immune response against Ag expressed by melanoma tumor cell MST > 1 yr (6-9m before vx was available) |
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feline oral tumor
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SCC > FSA> other
older cats usualy die of local dz SCC: sublingual, bone (maxilla and mandible), gingival |
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Bio behavior of feline oral tumor
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SCC and FSA= bony invasion common, mets not common
SCC faster local progression than FSA epilus uncommon in cats |
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Treatment for feline oral tumor- SCC
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90% not surgical, consider palliative therapy (MST 2-4m, die/ euth due to local dz)
surgery if small rostral tumor (uncommon), difficult for wide margin given size of cat, MST 1 yr |
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Treatment for feline oral tumor- FSA
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surgery tx of choice
similar concern as SCC9 margin, poor responss to RT and chemo, die of local dz |
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salivary and esophagral tumors
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very rare, usually maglinant
salivary gland: adenocarcinoma esophageal: SCC, saroma 2nd to spiocerci lupi |
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gastric tumors
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rare, usually maglinant
older dogs, 70-80% adenocarcinoma older cats: lymphoma |
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history and PE of gastric tumor
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history non- specific: lethargym inappetance, chroinc weight loss, vomiting (coffee ground), melena
PE: thin, possible palpable mass |
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Diagnostics of gastric tumor
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Biopsy= definitive ddx, endoscopy (need deep biopsies, may get false -ve with superficial inflam), laproscopy and surgical exploratory
min. database (CBC, chem, UA, FeLV/ FIV)- microcytic hypochromic and elevated BUN ca use of GI bleeding Imaging to look for local, regional and distant dz: 1. rads: constrast series, 2. ultrasound, 3. chest rads 3 views |
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Treatment for gastric tumor
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surgery if localized dz
chemo for cats for gastric lymphoma prognosis fair to poor (most die within 6m) |
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Intestinal tumor
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rare
dog: adenocarcinoma= lymphoma(30%)> leiomyosarcoma/ GIST, older male dogs Cats: lymphoma (75%)> adenocarcinoma> MCT, older cats, siamese predisposed cats: |
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PE and history
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History:
SI: weight loss, vomiting, anorexia, melena, diarrhea LI: tenesmus, hematochezia, diarrhea PE: Thin, palpable abdominal mass large intestine: rectal exam impt |
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diagnostic for intestinal tumor
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similar to gastric tumor
minimum database ultrasound (loss of wall layering, 50X more likely tumor than enteritis, thicker wall, more likely leiomyomas or leiomyosarcoma) |
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intestinal carcinoma
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treat with surgical excision
wide margin- 5cm LI less aggressive than SI canine SI carcinoma 10-15m MST with surgery, but 50% mets |
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intestinal sarcoma
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slower to invade and mets than carcinoma
canine leiomyosarcoma 12-15m w/ surgery but many reclassified as GIST. GIST predilection for LI v. leiomyosarcoma in SI potential tx for GIST: tyrosine kinase inhibitoy, , 30% GIST mets |
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intestinal lymphoma
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chemo recommended
feline small cell LSA reponse to tx have >1yr ST canine GI LSA has MST 3-4m immunophenotype (B vs. T) not prognostic may be systemic dz |
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Canine perianal tumor
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perianal adenoma- tenesmus, slow growing
perianal adenocarcinoma- lethargy, inappetance, tenesmus, pain, mass, larger and qicker growing than adenoma AGASACA- METS and HYPERCALCEMIC, PU/PD (w/ hypercalcemic), inappetance, lethargy, tenesmus, may see external mass, peri- anal pain |
not in cat, no perianl gland
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signalment and incidence
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older animal
adenoma most likely, almost always intact male, most likely go away with neuter, if female, almost always spayed anal sac adenocarcinoma uncommon perianal adenocarcinoma rare |
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PE of canine perianal tumor
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firm mass, may be alopecia, may be ulcerated
Rectal exam imperative, should be part of PE |
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Diagnostic evulation of canine perianal tumor
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1. PE impt
2. biopsy for definitive ddx 3. FNA/ cytology definitive for AGASACA, but cannot differenitate between perianl adenoma vs. perianl adenocarcinoma 4. Incisional/ excisional biopsy 5. minimal database (hypercalcemia with AGASACA, can cause renal damage) 6. Imaging- 3 thoracic rads (infrequent distant mets), ab rads +/- ultrasound, evaluate LNS, cytology of LNS but regional mets do not affact tx |
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Tx and prognosis of canine perianal tumor
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perianal adenoma- testosterone dependent, may regress with neutering, 90% cured with neuter
perianal adenocarcinoma- treat primarily with surgery, 15% mets AGASACA- multi- modality tx- surgery, RT, chemo, high mets to regional LN, MST 1-1.5y |
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