Urinary Tract Tumor

Front 1

Renal tumor

Back 1

rare primary tumor, usually maglinant

Front 2

Renal tumor in cats

Back 2

most often lymphoma
6y
usually bilateral
most often systemic dz, develop CNS lymphoma
FeLV can directly cause lymphoma, FIV is indirect causeRen

Front 3

For cancer affect kidney as primary organ in cats

Back 3

carcinoma
11y
unilaterial
azotemia prognositic factor

Front 4

Renal tumor in dogs

Back 4

Lymphoma affect kidneys (often bilateral) but usually as part of multicentric dz

Front 5

Cancer affecting kidney as primary organ in dogs

Back 5

older, 8y
95% unilateral
2/3 carcinoma
1/3 sarcoma,

Front 6

PE and history of feline renal tumor

Back 6

nonspecific signs: weight loss, lethargy, anorexia
palpable mass/ renomegaly
lymphoma: bilateral renomegaly (non- painful) +/- CNS sign or rear limb paresis

Front 7

PE and history of canine renal tumor

Back 7

nonspecific sign: wt loss, inappetance, lethargy, occasional vomit, pain (if sarcoma)
20-40% palpable mass
1/4 hematuria

Front 8

Diagnostic for renal tumor:
1. min database/ FIV/ FeLV

Back 8

1. anemia in 1/4 dogs, 1/2 cats (affect erythropoietin, uncommonly bleeding into ab, anemia of chronic dz )
2. azotemia: 20% dog, 40% cats, HIGH BUN AND MILD ELEVATION OF CRE cause of GI bleeding (ulcer), high BUN and high CRE cause of azotemia
3. Urine abnormality common: proteinuria (low specific gravity), isosthenuria, pyuria and microscopic hematuria)

Front 9

Diagnostic of renal tumor (cont.):
2. thoracic rads
3. ab imaginig

Back 9

thoracic rads: dogs high mets later in dz
cats mets early on in dz
ab imaging: mass identified in rads/ ultrasound. highly locally invasive (may invade vena cava), regional mets (LN, liver and other ab organ, very mets in dog)

Front 10

Definitive ddx of renal tumor

Back 10

FNA/ cytology: blind or ultraouns guide
most sensitive for lymphoma
Biopsy: for unilateral tumor (not LSA)
surgical excisional or exploratory ideal, laproscopy also used

Front 11

Therapy and prognosis of renal tumor in cats

Back 11

Lymphoma: chemo, not nephrectomy (bilateral dz), MST 6M, renal failure not prognositic factor
Carcinoma: nephretomy, rare cats with low grade have prolonged survival

Front 12

therapy and prognosis of renal tumor in dogs

Back 12

lymphoma: chemo
Other tumors: nephrectomy,
dog do not usually get lymphoma in kidney, take biopsy
90% maglinant in dog (carcinoma, sarcoma), 90% unilateral, GFR and staging before necphrotomy, w/o surgery, dog do not do well, w/ surgery. 12-16 m

Front 13

Differential for renal tumor

Back 13

For bilateral kidney enlarged: vertebral dz, CP decifict
w/ rads, ultrasound to confirm hyperchoic kidney and guide FNA (for lymphoma and infectious dz), otherise transabdominal lymphoma
For unilateral kidney enlarged, one large, one lumpy bumpy, rule out hydronephritis, renal insufficiency

Front 14

Tumor of urinary bladder

Back 14

rare, more often than renal tumor
most common transitional cell carcinoma (TCC)
middle aged to older cats
older female cats esp. scottie
increased risk of TCC with cyclosphoshamide chemo, topircal insctisides, herbicies and decreased risk with leafy green/ orange vege

Front 15

History and PE of urinary bladder tumor in cats

Back 15

history: similar to other lower urinary tract dz (urolith, bacterial cystitis etc.). Healthy cat seldom get recurrent UTI
PE: bladder mass often palpable (easier in cats than dogs)

Front 16

History and PE of urinary bladder tumor in dogs

Back 16

clnical signs similar to other lower UT dz
further diagnostic needed for recurrent UTI (UA, urine culture, ab rads to look for stones, ab ultrasound before cysto)
stranguria, pollakiruia, hematauria, dysuria, urinary incontience )
possibly palpable bladder ass

Front 17

Diagnositcs for urinary tumor

Back 17

CBC (wnl), chem (azotemic), urinalysis (may see anaplastic epi cell on sediment, caution with concurrent infection, might just be responding to that)
urine culture: may see concurrent UTI cause bladder mucosa is compremised

Front 18

Differential for renal tumor

Back 18

For bilateral kidney enlarged: vertebral dz, CP decifict
w/ rads, ultrasound to confirm hyperchoic kidney and guide FNA (for lymphoma and infectious dz), otherise transabdominal lymphoma
For unilateral kidney enlarged, one large, one lumpy bumpy, rule out hydronephritis, renal insufficiency

Front 19

Tumor of urinary bladder

Back 19

rare, more often than renal tumor
most common transitional cell carcinoma (TCC)
middle aged to older cats
older female cats esp. scottie
increased risk of TCC with cyclosphoshamide chemo, topircal insctisides, herbicies and decreased risk with leafy green/ orange vege

Front 20

History and PE of urinary bladder tumor in cats

Back 20

history: similar to other lower urinary tract dz (urolith, bacterial cystitis etc.). Healthy cat seldom get recurrent UTI
PE: bladder mass often palpable (easier in cats than dogs)

Front 21

History and PE of urinary bladder tumor in dogs

Back 21

clnical signs similar to other lower UT dz
further diagnostic needed for recurrent UTI (UA, urine culture, ab rads to look for stones, ab ultrasound before cysto)
stranguria, pollakiruia, hematauria, dysuria, urinary incontience )
possibly palpable bladder ass

Front 22

Diagnositcs for urinary tumor

Back 22

CBC (wnl), chem (azotemic), urinalysis (may see anaplastic epi cell on sediment, caution with concurrent infection, might just be responding to that)
urine culture: may see concurrent UTI cause bladder mucosa is compremised

Front 23

diagnostics for urinary bladder tumor (cont.)

Back 23

three view thoracic rads: lung mets <40% @ ddx, multiple interstital nodules
Ad rads: rule out urolith, rarely see mass unless mineralized. may identify sublumbar lymphadenomegaly or bone invasion
ad ultrasound: most commonly used to ddx, highly sensitive to define extent of dz, most commonly trigone area

Front 24

definitive ddx for urinary bladder tumor

Back 24

urine cytology:
-fine needle aspiration NOT recommanded ( rare reports of seeding)
Biopsy (GOLD STANDARD):
traumatic catheter biopsy commonly used, female required sedation
cystoscopic also useful
ultrasound guided biopsy (e.g. tru cut NOT recommended) cause of seeding
cystotomy may also get seedling

Front 25

might not need definitive ddx

Back 25

ddx with biopsy but 90% TCC so might not need to get definitive ddx if see in trigone area and ????

Front 26

Bio behavior of urinary bladder tumor

Back 26

Cats: 50% trigone, 50% apical, mets in 20% of pt @ ddx
dogs: usually trigone, usually obstruct ureter and uretra, urethral sphincter
moderately mets (more than 40%)
EXTREMELY EXFOLIATIVE TUMOR, easily seed with tru cut biopsy tract

Front 27

Antigen test

Back 27

don't use as definitive ddx, should be use as screening e.g. for scottie. False +ve for other urinary tract dz

Front 28

Treatment and prognosis for urinary bladder tumors in cats

Back 28

localized tumor should be surgically resected (20% mets)
diffuse tumor should be treated medically
MST 8-9M
most cats die of local dz

Front 29

Treatment for urinary bladder tumors in dogs: surgical

Back 29

surgery: in trigone area so surgically not possible, 40% mets in dogs
If apical, localized dz, rare cases curable with surgery. Need excellent surgical techniques to prevent seeding

Front 30

Treatment for urinary bladder tumors in dogs: medical therapy

Back 30

TX OF CHOICE for most dogs (usually trigonal and non- resectable)
MONITOR RENAL FUNCTION cause chemo and NSAID are nephrotoxic
COMBINATION of chemotherapy and NSAID with 35% response rate, 75% clinical improvement, MST 10-12m
NSAID (piroxicam) alon 20% response rate and MST 6m

Front 31

Palliative option for dog with urinary bladder cancer

Back 31

-tube cystotomy: may allow pt to survive for months beyond when they would have euthanized for urethral obstruction
-RT w/ chemo and NSAID, improve clinical signs but not increase in MST