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169 Cards in this Set
- Front
- Back
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What is Cancer?
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Uncontrolled expansion of a cell population which is unrepsonsive to normal cellular signals
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How does Cancer develope?
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Requires the accumulation of several genetic mutainos
Environment and genetic predisposistions |
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Is cancer occurring more often?
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Maybe... Increased Incidence, greater awareness, or developing human-animal bond.
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How to get a definitive diagnosis.
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FNA (fenestration vs Aspiration) and Cytology
Biopsy and Histopathology |
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Why Biopsy?
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For Definitive diagnosis
- Gold Standard - Preservation of surrounding tissue - Allows for grade determination (Prognosis) - Special Stains to determine cell lineage. |
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Biopsy Methods
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Incisional:
- Needle Core Biopsy (tru-cut, Jamshidi, trephine) - Punch Biopsy -Wedge Biopsy Excisional: - En Bloc resection (conservative, aggressive) *No Penrose drains at biopsy site. *Proper biopsies do not spread cancere, careful hemostasis, avoid seromas. |
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What is staging?
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Determining the cancers location and extent.
-CBC, Chemp, U/A (usually normal or non-specific) -Regional LN evaluation (cytology is key) -Thoracic radiograpsh (3 views) -Abd Ultrasound -Advanced imaging (CT, MRI, Nuclear Med/bone scan, PET/CT) |
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What two aspects to PET/CT scanners look at?
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PET (Positron Emission Tomography) - metabolism
CT - Structural Detail |
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Some Prognostic Factors.
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Individual pt factors:
- Extent of local dx - Results of Staging - Concurrent illness (physiologic age) Dx related factors: - Biological behavior - Grading Systems |
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Cancer treatment modalities.
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Local-regional disease:
- Surgery Alone - Radiation Systemic Dx: - Chemotherapy - Small molecule inhibitors - Immunotherapy |
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Types of radiation
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daily fractionation:
- Generally for microscopic dx coarse fractionation: - Generally palliative - big, bulky, non-resectable dx |
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Radiation
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- Sterilize tumor cells (may not see tumor shrink immediately
- External beam (most common form available) - brachytherapy (Radioactive implant therapy, Injectable I131) |
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Radiation Side Effects
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Early:
- Rapidly dividing tissues (ie skin, mm's, GI, marrow) - Damage is repairable Late: - Slowly dividing tissues (ie bone, nervous, stromal) - Dose limiting and damage is irreparable |
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Cryotherapy
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- Controlled use of cold temp to induce cell death via direct cellular damage or vascular damage/collapse
- Superficial tumors only - Liquid nitrogen or nitrous oxide applied via spray or probe |
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Cytotoxic Chemotherapy
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Attacks rapidly dividing cells
- For systemic or sensitive cancers - to potentiate radiation |
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Small Molecule Inhibitors
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Smart bombs for cancer treatment
- Blocks required pathway - Should be selective - Should be necessary ~i.e. Palladia or Masitinib |
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How does Chemo damage cells?
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- Main target of toxicity is DNA or its synthesis
- Other targets may be cell membrane or protein synthesis - Damage too severe, cellular suicide - Effective repair, then cell division (normal cells) - Ineffective repair, then cell division leads to the potential for mutation |
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What are unique aspects you should consider about the patient before giving chemo?
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- Geriatric population (lesser physical constitution)
- Anatomic Involvement (key organs involved in drug metabolism and excretion) - Metabolic derangements (ie. hypercalcemia or hypo/hyperproteinemia) |
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Potential targets of the cell cycle for chemo.
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G1 (cell growth): target DNA
S (DNA synth): target synthesis building blocks G2 (Cell growth): target DNA M (separation of replicated DNA): Target spindle apparatus |
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Categorization of Chemotherapy
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Cell Cycle Specific:
- DNA synthesis Phase - Mitotic Phase Cell-Cycle Non-specific: - Affects DNA present in all cells regarless of their status in the cell cycle - Many cells affected because all cells have DNA |
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Alkylating Agents
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-Cell Cycle Non-Specific
-Form Covalent bonds with nucleotides -Directly damage DNA structure GI side effects, likely to cause toxicity |
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Antimetabolites
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-Cell cycle specific
Inhibit synthesis of nucleotides -So only affects cells that are actively undergoing synthesis -Act as decoy molecules to be incorporated into elongating DNA Strand -Less GI upset |
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Antineoplastic Antibiotics
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-Cell Cycle Non-Specific
- Damage DNA structure - Inhibition of DNA separation -Membrane Damage - More likely for toxicity |
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Mitotic Spindle Poisons
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-Cell Cycle Specific
-Inhibit polymerization or depolymerization of tubulin protein subunits -Mitotic spindle cannot be assembled or disassembled -Specifically affects the Mitotic phase of the cell cycle |
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What are two things that you need to understand about tumor growth kinetics to help guide you when to start chemo?
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1: Chemo targets rapidly growing cells (low tumor burden has quickest growth rate)
2: Chemo needs to be delivered to tumor mass (delivery of chemo requires blood) |
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When is it best to treat Cancer?
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Microscopic disease setting during the exponential growth phase
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Limitations of Chemo
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Anatomic compartment:
- Normal physiologic barriers Physiologic function: - Organs designed for detox and elimination of xenobiotics Tumor Microenvironment: - Efficient delivery of drugs to cancer cells may be afected by leaky blood vessels or poorly developed lymphatics that increase the interstitial pressure therefore not allowing the drug to leave the vessel at tumor site Spontaneous drug resistance - Inherent errors in DNA replication ALL the time. Produces random mutations which may allow for drug resistance (GOLDIE-COLEMAN hypothesis) Acquired Drug Resistance - Cells have the ability to adapt and increase transcription of key genes - Minimizes effectiveness of chemos |
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How can chemo be used most effectively?
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Dose-intensification
Combination Chemotherapy |
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Dose Intensification
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Determined by absolute dosage administered and frequency of administration.
Assumes chemosensitivity: -Large single dosage infrequently -Smaller doses frequently |
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Combination Chemotherapy
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Cancer cells have drug resistance so use drugs with different mechanisms of action to increase the likelihood of killing as many sensitive cells as possible.
Slows the development of resistance |
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Some DDx's for Oral Cancer.
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Dental dx
Gingival hyperplasia FB Nasopharyngeal polyp Infectious Inflammatory Malignant neoplasia Benign neoplasia |
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Does LN size matter with correlation to metastasis? (particularly with Oral Neoplasia)
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No.
Mets in 40% of palpably normal LNs Mets in 50% of palpably enlaged LNs |
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What is an Epulis?
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Benign oral tumor
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What are the most common oral tumors in DOGS?
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Squamous Cell Carcinoma (SCC): 41%
Oral Malignant Melanoma (OMM): 37% Fibrosarcoma (FSA): 22% |
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Behavior of OMM
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Early/ Frequent Regional Mets (60-80%)
Early/Frequent Distant Mets (50-60%) usually lung Frequent Bone invasion |
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Behavior of Tonsillar/Lingual SCC (K9)
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Frequent regional Mets to LNs (40-70%)
Frequent Distant Mets (40%) usually to lung Occasional bone invasion |
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Behavior of Non-tonsil/lingual SCC (K9)
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Infrequent Regional mets to LNs
Infrequent Distant mets Frequent bone invasion |
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Behavior of oral FSA (K9)
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Infrequent Regional mets to LNs
Infrequent Distant mets Frequent bone invasion |
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Prognostic factors of OMM (K9)
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Location - Caudal, Maxillary
Size - > 2cm diameter Invasion - Bone Lysis Metastasis - Highly metastatic early on Grade - Most are highgrade, high mitotic index |
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Severity of K9 oral SCC's
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Regular:
- locally aggressive (bone) - Low mets late in dx Lingual: - Locally aggressive - Intermediate Mets Tonsillar: - Locally aggresive - Highly metastatic early on |
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Primary form of tx for most canine oral tumors?
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Surgery
If local control can not be achieved by surgery alone, then Radiation therapy Metastatic Dx: SCC - Carboplatin/piroxicam OMM - Immunotherapy, carboplatin Radiation therapy is also very effective for local control. Coarse fraction can achieve >80% response rate in local tumors. |
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Chemotherapy for: (K9, Oral)
Dental tumors (epulides)? FSA? Melanoma? SCC? |
Epulides - no indication
FSA - minimal Melanoma - Carboplatin SCC - Tonsillar SCC: Piroxicam/Carboplatin |
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50% of lingual tumors in dogs are?
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SCC
Also OMM >50% midline or bilaterally symmetrical and are surgically complex |
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Most feline oral tumors are?
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70% SCC
20% FSA 10% other |
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Curative treatment an option for Feline oral SCC?
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Rarely
MST 2-4m Minimal respons to chemo 50% response to Rdiation best case scenario - small rostral lesions: Curative-intent sx w/ aggressive support gives MST 12m |
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Most common canine gastric tumor?
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Adenocarcinoma
*Frequent Mets! |
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Most common Feline Gastric tumor?
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Lymphoma!!!!!
Usually solitary or diffuse/multisystemic |
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Whats more common (for both canine and feline), gastric or intestinal tumors?
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Intestinal
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Most common canine intestinal tumor?
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More varied than gastric tumors, but adenocarcinomas are most common.
Lymphoma and Leio/GIST are pretty much as common |
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Most common feline intestinal tumor?
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Lymphoma!!!
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DDx's for intestinal or gastric tumors
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When there is a palpable mass in abdomen...:
Bloat FB GDV Neoplasia of liver, spleen, stomach, intestine |
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Best way to diagnose GI tumors?
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Full-thickness biopsy
Cytology is usually only 50% diagnostic Also imaging is usually necessary |
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Primary tx of focal GI tumor?
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Sx if localized (cur is rare unless it is focal/discrete
Chemo for Lymphoma/mast cell tumors |
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Prognosis for K9 GI tumors.
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Primary GI Lymphoma - MST 3-4m w/ chemo
Gastric tumors (carc/sarc) MST <6m unless focal sarcoma then it is long term survival Intestinal tumors (carc/sarc) MST 1yr w/ Sx |
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Prognosis for feline GI lymphoma.
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Do well long term:
-Small cell LSA= 50-70% response (pred/chlorambucil) (MST 18m-2yr) Lymphoblastic LSA: -May respond initially better to chemo, worse prog long term Immunophenotype not prognostic **Response to therapy biggest prog factor!! |
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What are most perianal tumors in dogs?
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Perianal adenoma (80%)
- usually intact males -non-metastatic and benign Adenocarcinoma is uncommon AGASACA is most malignant and >45% are metastatic -Likely see other PE findings and abnormal history |
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Cytology for Perianal tumors?
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Definitive diagnosis is likely for AGASACA
However, perianal tumors look similar |
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Met?/Tx/Prog for Perianal Adenoma in dogs
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no Mets
tx by Neuter +/- Sx Excellent/curative prognosis |
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Met?/tx/prog for Perianal ACA
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Uncommon mets
tx by Sx +/- RT fair-good prog |
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Met?/tx/prog for AGASACA
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Common mets (45% LNs at dx and lungs later on)
Sx, +/- RT and chemo Fair to good prog but expensive (MST 12-18m) |
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Most common type of URINARY TRACT neoplasia? (dogs and cats)
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Bladder tumors
Specifically TCC Usually in trigone, especially in dogs. Recommended tx is chemo/piroxicam |
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Prostate tumors are: uncommon, common or rare?
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Uncommon
Poor prognosis for these tumors |
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Kidney tumors are: uncommon, common or rare?
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Rare
In cats, lymphoma is the most common kidney tumor |
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If bladder tumor is suspected, should perform a cystocentesis for cytology?
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No, if tumor is suspected, cystocentesis may seed tumor to healthy tissue.
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Calf pseudohypertrophy (incr FAT, incr CT, NOT muscle, "pseudo")
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Muscular dystrophy (Duchenne's)
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Are Urine Bladder Tumor Antigen (BTA) tests useful for diagnosing bladder tumors?
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Limited used
Useful only as a screening test: 85% sens 86% spec False positives from UTI, glucosuria, proteiuria, pyuria, hematuria |
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Distant Mets from bladder tumors common?
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No, relatively rare.
16-40% LN mets at dx 14% DISTANT mets at dx (liver, lungs) Overall, 40-50% develop mets |
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Dogs prone to TCC of bladder?
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Scotties, westies, shelties, beagles
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Are canine bladder TCC's usually resectable?
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Rarely
Usually they are found at Trigone, so they are NOT surgical Prone to obstruction |
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Are feline bladder TCC's usually resectable?
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Yes, 50% of feline bladder TCC's are APICAL so these may be resected.
Still possible for metastasis since cancer cells are swimming around in the urine. Same goes for the RARE cases of Canines with APICAL TCC's |
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Are Urine Bladder Tumor Antigen (BTA) tests useful for diagnosing bladder tumors?
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Limited used
Useful only as a screening test: 85% sens 86% spec False positives from UTI, glucosuria, proteiuria, pyuria, hematuria |
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Distant Mets from bladder tumors common?
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No, relatively rare.
16-40% LN mets at dx 14% DISTANT mets at dx (liver, lungs) Overall, 40-50% develop mets |
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Dogs prone to TCC of bladder?
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Scotties, westies, shelties, beagles
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Are canine bladder TCC's usually resectable?
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Rarely
Usually they are found at Trigone, so they are NOT surgical Medical therapy should be considered the ideal Tx for these tumors Prone to obstruction |
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Are feline bladder TCC's usually resectable?
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Yes, 50% of feline bladder TCC's are APICAL so these may be resected.
Still possible for metastasis since cancer cells are swimming around in the urine. Same goes for the RARE cases of Canines with APICAL TCC's |
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Standard care for K9 bladder TCC?
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Chemo:
Mitoxantrone and piroxicam MST 10m Relatively low response rate to Chemo |
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What other supportive care should you consider for pts with bladder tumors?
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Analgesics for cystitis
- Piroxicam!! has anti-neoplastic and analgesic properties Secondary UTI's may become recurrent and resistant Home care for incontinence |
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Negative prognostic factors for K9 bladder TCC
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MST 10m
younger age incr risk of LN mets Prostatic involvement incr the risk of dist mets Urethral involvement? Spayed femals>castrated males Higher T stage |
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Feline Bladder TCC is a common tumor? T/F
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False, its rare.
Surgery if Apical (50% apical) Chemo otherwise. DONT USE CISPLATIN! kills cats |
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Clinical signs of a prostatic tumor?
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Lower UT signs
Difficulty defecating due to pressure on colon Systemic illness due to metastasis or obstruction Present similar to Bladder tumors |
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Prostatic tumors are typically what type of cancer?
Metastatic? |
Carcinomas
Uncommon, neutered males, middle to large breed Adenocarcinoma, TCC, SCC, mixed Then sarcoma More metastatic than bladder tumors: - 44% mets at Dx -80% mets at necropsy |
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How to treat Prostatic tumors.
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Medically
Resection difficult given anatomy Prostatic ACA: MST 3m Piroxicam |
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Most common feline kidney tumor?
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Lymphoma!!!
Tx w/ Chemo ** not surgical because Lymphoma is systemic and will likely spread to the other kidney... then you have nothing... MST 6m - Azotemia not a negative prognostic factor... |
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What is the most common PRIMARY feline kidney tumor?
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Carcinoma. (usually unilateral)
** lymphoma is the most common tumor affecting kidneys in the feline, it is usually part of a SYSTEMIC dx and has spread to the kidneys from another location |
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Most common K9 renal tumor?
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Adenocarcinoma (2/3)
Sarcoma (1/3-1/2) *** 90% of renal tumors in dogs are malignant All others are rare |
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How to treat primary renal tumors? K9
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Surgically
95% unilateral so Sx is ok HIGHLY malignant, locally invasive GFR imperative prior to nephrectomy!!! |
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Prognosis of primary renal tumors in dogs?
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Good w/ nephrectomy: MST 16m
W/out Sx... MST 1m Lymphoma tx'ed w/ chemo |
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Define Lymphoma.
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-Malignant cell originates from lymphoreticular cell
-Lymphocyte becomes malignant (usually lymphoblast) -Systemic dx |
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Middle-aged to older cats are mainly affected by lymphoma? t/f
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true
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There is no sex or breed predisposition in cats for Lymphoma? t/f
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true
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Young dogs are most commonly affected by lymphoma? t/f
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False, middle aged dogs are most common.
HOWEVER out of cancers affecting young dogs, LSA is common |
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There is no sex or breed predisposition in dogs for Lymphoma?
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False, there is not sex predisposition but boxers, goldens, bassets, st. bernards. scottish terriers, masstiffs are overrepresented
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Etiology for lymphoma in cats.
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FeLV is linked with most forms EXCEPT GI.
-FeLV+ LSA occurs in younger cats (2-4) and is T cell - LSA risk increases with FIV infection and increases 77x with FeLV and FIV infection FeLV directly causes malignant transformation FIV predisposes to lymphoma via immune dysfunction |
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Etiology of lymphoma in dogs.
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Nothing is as strong as the etiology in cats.
No strong associations have been found May be viral, genetic, environmental or IBS |
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Most COMMON form of lymphoma in cats?
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GI
Used to be mutlicentric and mediastinal forms, however as FeLV+ cats decreased so did these forms. Renal is the least common. |
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Most COMMON form of lymphoma in dogs?
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Multicentric form (multiple peripheral LNs)
Usually present with enlarged LN's and are asymptomatic. |
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Most common Physical Exam finding for cats and dogs w/ lymphoma.
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enlarged, firm, nonpainful LNs (most common in dogs, rare in cats)
Thickened loops of bowel is common in cats |
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Lymphoma patients with a substage 'b' generally have a better or worse prognosis?
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Worse - one of the most important prognostic factors.
a (clinically normal) does better than b (pt is ill) |
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Prognostic factors for lymphoma patients.
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Sex, age and weight are NOT prognostic factors
Hypercalcemia is neg prog factor (T cell phenotype) Immunophenotype ( T cell lymphomas are less likely to respond to chemo) Histologic subtype stage substage anatomic site (dogs with GI form do poorly) |
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Prognosis for Lymphoma depending on tx.
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Untreated: 4-6 wks
Prednisone: 11 wks Doxorubicin: 7-9m Multidrug chemo: 12m (1/2 live over 2 years) |
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FNA is an esay way to make a diagnosis if LSA?
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true.
A normal LN contains 75-95% small mature lymphocytes A reactive LN can have 50% lymphoBLASTS... However > 50% lymphoblasts is diagnostic for LSA. |
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Tissue biopsies are usually needed to make a diagnosis of LSA? t/f
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FALSE, rarely needed.
Tru-cut biopsies are nt much better than FNAs |
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Staging of Lymphoma.
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I - single LN
II - LNs in one region III - generalized LN IV - liver/spleen involvement V - marrow/peripheral blood and or other organ systems Substage::: a - clinically normal b - pt is ill |
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What is the most common bone sarcoma?
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Osteosarcoma (85%)
Others are: Chondrosarcoma, multilobular, osteochondrosarcoma, fibrosarcoma, hemangiosarcoma Soft tissue OSA is rare but possible |
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Which species has a higher incidence of OSA?
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Dog
Usually large or giant breeds Usually middle age |
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Common locations for OSA.
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"Away from the elbow, near the knee"
So: Distal femur Distal radius 75% of OSA's are appendicular |
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Clinical signs/history for patients with OSA.
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-Usually lameness (+/- acute)
-May be a palpable or visible mass -Soft tissue inflammation -Owners may claim a history of trauma -Partial response to NSAIDS -If Axial tumor: paraparesis, mass on chest wall, on head or in face Rare: initial presentation of dyspnea secondary to pulmonary mets |
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Typical radiographic appearance of OSA
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-bony lesion +/- pronounced with osteolysis, osteoproliferation and bone remodeling.
-Cortical lysis at metaphseal site, with osteoproliferation in "sunburst" -Frequent extension to soft tissues -Pathologic fracture on initial Dx DDX osteomyelitis (especially fungal) |
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How to comfirm a Dx of OSA
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Excisional biopsy
Take multiple biopsies Cytology can help (18G needle) - impression on slide |
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Mets for OSA uncommon, common or rare?
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Common (95%) (10% visible mets at Dx)
This affects Px Local and systemic therapy Typical appearance of OSA mets: soft tissue density nodules disseminated in lung parenchyma |
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Prognostic factors for OSA.
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Elevated ALP
Mets visible at Dx Patient's age (bimodal) Location Chemotherapy and % necrosis Limb spare infection |
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OSA in cats common, uncommon or rare?
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Rare
Different biologic behavior than in dogs Usually older cats Approx 2/3 appendicular More commonly in hind legs Favorable Px with amputation alone MST 2-3yrs |
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Where do mast cells originate?
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Bone marrow
From Myeloid precursors: -Mast cells -Neutrophils -Monocytes -Eosinophils -Basophils -Megakaryocytes |
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Most common malignant skin tumor in the dog?
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Mast Cell tumors
Cutaneous involvement is the most common location for MCT |
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The most common malignant skin tumor in a cat is a Mast cell tumor? t/f
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false
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Breeds over represented w/ Mast Cell tumors.
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Boxers
bulldogs Boston Terriers Weimaraners Shar-peis Labs Pugs *Note, usually short-haird dogs |
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Clinical presentation for MCT's.
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Raised, firm alopecic mass (classic presentation)
May adopt various appearances: -Can be great imposters, they can look like anything. |
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Presentation for cutaneous MCT.
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Darrier's flare = mast cell degranulation
- All the classic signs of inflammation - Change in Size and coloration via local effects of inflammatory mediators |
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Systemic signs from MCT's are common, uncommon, or rare
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Very uncommon
If there are systemic signs, it is usually a very severe Dx. -vomiting, diarrhea, melena, hypotension secondary to systemic mediator release. Remember histamine stimulates parietal cells to release gastric acid and also stimulates vascular endothelium relaxation so there is a drop in blood pressure |
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A cytology will Dx a malignant MCT?
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No, a cytology will just tell you if there are mast cells, not if it is benign or malignant.
- A cytology is fast and accurate but cannot predict biologic behavior. Need a Histologic evaluation to determine if it is benign or malignant. This is the gold standard - Histo probides prognostic info: -Histologic grade::: I, II, III (benign to aggressive) Most are grade II. Some grade II's are aggressive. A mitotic index will help you predict which grade II's are aggressive or not. |
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Histologic grading scale for MCT's
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I - usually benign and locally-confined
II - Usually locally-confined but can metastasize III - Usually metastatic in behavior |
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Clinical Stages of MCT's
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0 - incompletely excised dermal tumor
1 - solitary dermal tumor 2 - solitary dermal tumor w/ LN 3 - multiple or infiltrative tumor 4 - tumor with distant metastatic dx |
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Prognostic factors of MCTs.
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C-kit mutations and staining patterns
Microvessel density Anatomic location Recurrence Duration and speed of growth Breed Multicentric disease |
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Soft Tissue Sarcomas usually affect middle age to older animals? t/f
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True
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Typical history/physical exam findings for STS
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Insidious Onset
Common skin/subQ tumor (associated w/ trauma, parasites, RTX) -Findings typically depend on the origin of the tumor. |
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Soft tissue sarcoma is an inclusive TERM that encompasses which tumors?
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Fibrosarcoma, Hemangiopericytoma, neurofibrosarcoma, liposarcoma, fibrous histocytoma
** A number of tumor types that ALL ACT THE SAME |
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How to definitively diagnose STS
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FNA:
- May be firm -yield may be low -Mesenchymal cells BIOPSY: - DDX hemangiosarcoma -may lead to other staging tests -May change prognosis, owners decision to treat ** Recommend INCISIONAL biopsy! |
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STS metastasize readily? t/f
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False, they rarely metastasize (10-20%)
Make sure to FNA local LN 3 view rads |
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Prognostic factors for STS
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Potential for complete excision is key
- >5cm - Deep location - Invasive, fixed - Very young dogs - Histologic grade (13% grade 1, 7% grade 2, 41% grade 3) (of the three grades, usually only those that are grade 3 are the ones that metastasize) |
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Treatment for STS
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Surgery - mainstay of STS therapy
- WIDE surgical excision - do not be fooled by pseudocapsule - Chance of success is highest at first Sx - Be AGGRESSIVE |
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STS's are completely encapsulated. t/f
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FALSE.
- They appear encapsulated but really this ‘capsule’ is made up of normal host and tumor cells that have been compressed together by rapid tumor growth. - have fingers of malignant cells infiltrating through local fascial planes. These tumors are LOCALLY INVASIVE. - However, even though they are locally invasive, they are slow to metastasize. |
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Radiation therapy may be used as a sole therapeutic modality for STS. t/f
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FALSE.
- It is an excellent adjuvant to be used after Sx (or before - 'neoadjuvant') - Radiation may be curative following surgical removal with incomplete resection. |
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Chemotherapy is not an effective method for treating STS. t/f
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True.
- Chemotherapy could be considered in cases of metastatic disease, incompletely resected disease when radiation therapy is not available, incompletely resected disease in conjunction with radiation therapy (as a sensitizing agent), and in grade 3 tumors. |
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Any breed, sex, or age of cats are equally prone to VAS. t/f
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TRUE
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Likelihood of developing VAS depending on the number of vaccines at a given site.
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1 vacc/site - inc 50%
2 vacc/site - inc 127% 3-4 vacc/site - inc 175% 3 mos-1 yr to develop |
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Common physical exam findings for cats with VAS.
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Firm, irregular SubQ mass at a typical injection site
Non-painful Appearance of encapsulation can be deceiving +/- ulceration |
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How to diagnose VAS.
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FNA: reveal mesenchymal cells: large, spindloid cells that show a wide degree of pleomorphism, with high nuclear to cytoplasmic ratio
Minimum data base Thoracic Rads: Metastasis to lungs uncommon, but may be as high as 25% Biopsy: - Spindle cells, multinucleated giant cells, and variable numbers of pleomorphic polygonal to histiocytoid cells with mild to marked atypia. - May see lymphocyte infiltration - May see adjuvant/foreign material |
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Common Sacroma type found in VAS in cats.
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Fibrosarcoma is most common.
- May also be OSA, MFH, rhabdomyosacroma ** All have similar biological behavior |
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VAS is typically associated with modified live vaccines. t/f
Typically which vaccines? Where anatomic locations should these vaccines be injected? |
False.
Typically associated with killed adjuvanted vaccines. Typically Rabies and FeLV and sometimes killed FVRCP. Rabies: right rear FeLV: left rear (only give if outdoor cat at risk of FeLV) FVRCP: btwn shoulder blades |
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What are 2 theories for why VAS occur?
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- High concentration antigen deposition
- adjuvant-induced malignant transformation. (adjuvant thought to increase risk is aluminum). This is the favored theory, but both probably play a role. |
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Common transformed cell types found in feline VAS.
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Myofibroblasts - these are transitional stages of fibroblasts or macrophages.
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Biological behavior of Feline VAS.
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LOCALLY INVASIVE (just like STS, because it pretty much is a STS).
- Slow to metastasize, up to 25% of cases, usually to lungs and less commonly, to regional LNs. |
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Treatment of choice for VAS.
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SURGERY
- Chance for cure is best with first Sx - WIDE margins, don't be fooled by the pseudocapsule. They are NOT ENCAPSULATED and therefore they are not easy to remove. ** Radiation is theoretically a good option for treatment, but the true efficacy against VAS is unclear. Recurrence in and out of the RT fields are common. ** Chemotherapy may prolong survival but it is not curative. BOTTOM LINE: If the tumor is not completely excisable with WIDE margins (i.e. on a leg and able to be amputated), then usually it will be fatal. With multi-modality therapy, cats live an average of 600-700 days. |
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The vaccine manufacturer may be held liable for VAS associated with their vaccines. t/f
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FALSE, if they are USDA approved they are not liable.
HOWEVER, the veterinarian may be held liable if potential side effects of the vaccines are not made clear to client prior to vaccination of the patient. |
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What nasal tumor type is usually associated with sunlight exposure to the nasal planum in cats (and i think dogs...)?
How can it be cured? |
SCC
- Nosectomy |
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Common physical exam findings on patients with nasal tumors.
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Epistaxis
Mucopurulent nasal discharge Nasal deformity Sneezing Exophthalmos Ocular discharge Stertor |
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DDx's for patients with nasal tumor findings.
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Fungal infection
Bacterial infection Tooth root abscess Foreign body Rhinitis Coagulopathy |
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What PE findings are most indicative of nasal tumors?
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Exophthalmos
Facial deformity |
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What tests would you perform on patients with Epistaxis?
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Minimum database (PLT count)
Coag panal Blood Pressure Fundic Exam |
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What are some reasons to STAGE a patient?
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Identify metastatic Dx
Evaluate Concurrent Dx - Geriatric patients may have other problems that may be life-limiting and may affect treatment options. |
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Ideal imaging technique for patients thought to have nasal tumors.
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CT scan provides superior information
** Does not provide DEFINITIVE DIAGNOSIS - must perform blind biopsy since rhinoscopy provides little visualization. - Skull rads may be helpful - May see bony lysis and/or tumor that is of soft tissue opacity |
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Typical findings on CT scan for patients with nasal tumor
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- Bone invasion, crossing midline
- Soft Tissue Opacity - Primarily middle-caudal nasal cavity - Possible Cribiform Invasion |
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Most common signalment of patients found to have nasal tumors.
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(First of all this is a rare cancer, less than 1% of all canine neoplasia)
- Dolichocephalic breeds (ie german shephards) - Average age is 10 years - Medium and large breeds |
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Local invasion or metastasis a bigger issue for patients with nasal tumors?
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LOCAL INVASION
- Bone destruction - Brain invasion - Pain ** These tumors rarely metastasize, less than 15% at Dx. If they do it is usually to lung or regional LN. This would carry a poorer prognosis |
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Most common canine Nasal Tumors?
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Carcinomas (2/3)
- Adenocarcinoma, SCC, undifferentiated Carcinoma ** Best prognosis for ACA Sarcomas (1/3) - Fibrosarcoma, Osteosarcoma, Chondrosarcoma, undifferentiated sarcoma. |
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What supportive care should be taken into consideration for patients with Nasal tumors?
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Analgesia
Hygiene Antibiotics for secondary infections |
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What is recommended for Canine Sino-nasal tumors?
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External beam radiation therapy
MST varies with tumor type: - 12-18m for ACA - 12m for Sarcoma - 8-10m for SCC |
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Common radiation side effects during/after tx of canine sino-nasal tumors.
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Short term:
- common but heal quickly - KCS, rhinitis, mucositis, alopecia Long term: - Uncommon but usually result in chronic problem - KCS, cataracts, retinal degeneration, oro-nasal fistula, alopecia |
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Chemotherapy or Sx warranted for treatment of canine sino-nasal tumors?
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May improve clinical signs but usually do not increase MST.
- Overall MST 4m with chemo/Sx - Sx may be considered for small rostral lesions |
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Negative prognostic factors for dogs with nasal tumors.
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Epistaxis
Caudal extension (Cribiform) Neurologic Signs |
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Most common type of feline nasal tumor.
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LYMPHOMA
- Also get Carcinomas and RARELY Sarcomas. |
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Best treatment option for cats with nasal tumors.
MST's? |
Radiation! for lymphoma and Carcinomas.
*May also treat lymphoma with chemotherapy. MST for Lymphoma - 24+m MST for Carcinoma - 12m |
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Is metastatic or primary lung cancer more common?
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Metastatic
- Primary lung tumors are rare in dogs and even less common in cats - Average age is for primary lung tumors is 10yrs |
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Most common PRIMARY lung tumors.
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Carcinoma (2/3)
- Usually ACA - SCC is less common but is more metastatic than ACA. Sarcomas and Lymphomas are RARE as primary lung tumors |
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Is metastasis common with primary lung tumors?
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YES
Pathways: - Lymphatic and Hematogenous - Also through airways! and transpleural * Mets usually found in LNs and lung. * In dogs, SCC and undifferentiated Carcinomas are the most metastatic * 75% of cats usually have mets on necropsy |
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Key to diagnosis of lung cancer.
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Thoracic radiographs!:
- 3 views - Usually a single large mass in the caudal lung lobes - Hilar Lymphadenomegaly - Pleural Effusion Minimum Database Transthoracic ultrasound guided FNA Cytology of pleural effusion **** Make sure this is the primary lesion because METASTATIC tumors are more common. |
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What is the treatment of choice for lung cancer? What is needed prior to treatment?
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Surgical removal of lung lobe (Lung Lobectomy)
- CT scan is needed prior to lung lobectomy to plan surgery, evaluate small metastatic lesions, and evaluate LNs. |
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MST for dogs and cats with lung cancer.
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Dogs: MST 1 yr w/ surgery
Cats: MST <1 yr w/ surgery |
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Negative Prognostic factors for lung cancer.
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Canine:
- Metastasis - Size (>5m) - Clinical signs/symptomatic - Malignant pleural effusion - Histology::: undifferentiated carcinoma or SCC - Perihilar location Cats: - Undifferentiated or metastasis (usually only a few months in these cases) |
