1. Tumors of the GI Tract Flashcards
What is the 4th most common site of neoplasia in dogs and cats?
ORAL TUMORS
Oral tumors occur ____x more likely in dogs than cats and males ____x more likely than females
dogs- 2.6 males- 2.4
Oral tumors arise from these areas?
gingiva buccal mucosa labial mucosa tongue tonsils dental elements mandible/maxilla
What is the age/breed signalment for oral tumors
Middle-aged to older Boxers, GSD, Goldens, Cockers, Min. Poodles, German SHP, Gordon Setter, Chows & Weimaraner
What are the main clinical signs of oral tumors? When do we often notice these?
Visible mass w/ oral bleeding, difficulty eating, or halitosis most common Anorexia, weight loss, loose or displaced teeth, ptyalism, facial deformity, and/or nasal discharge may also be noted Not uncommon to have hx of recent tooth extraction. Precedes rapid growth of a mass at the extraction site
*****Oral tumors masses are often _____ at presentation especially with _____ locations
large; caudal
What are the top 3 oral tumors for dogs?
1• Melanoma 2• SCC 3• Fibrosarcoma
What are the top oral tumors for cats? What tumor do they not get (that dogs do) in their mouth
1• SCC • Fibrosarcoma (they don’t get melanoma in their mouth that we’ve seen)
What other malignancy in dogs is often noted originally from the skull (maxilla/mandible)?
OSA
What is a benign variant of a oral tumor often seen with dogs?
*****Odontogenic tumors (aka Epulides)
What is a benign variant of a oral tumor often seen with cats?
• Eosinophilic granuloma complex • Odontogenic tumors – Feline Inductive Odontogenic Tumor
When working up and staging oral tumors, cytology is likely not effective bc its hard to get a good sample so instead state what you do a for a proliferative or non proliferative?
IF PROLIFERATIVE: Incisional (big wedge) biopsy for tissue diagnosis (shave biopsy preferred, blade 1 cm piece then tamponade, no suture) perform under heavy sedation If NOT proliferative: incisional biopsy (DO NOT COMPROMISE 2nd SX with biopsy) and don’t attempt under sedation (will bleed and cause it to be reactive)
True or False: When biopsying an oral mass that is protruding through the external lip it’s okay to take a biopsy through the lip?
FALSEEEEE BITCHES NEVER EVER FUCKING EVER do a biopsy through the lip.
Take ______ when performing an excisional biopsy
caution
What is the downfall for using rads for radiographic evidence of bone lysis? What is the preferred imaging modality
Radiographic bone lysis is not evident until 40% cortical destruction so we prefer using CT
What type of radiographs are indicated for oral tumors
DENTAL RADS not skull theres a fucking difference okay!?!?!!?
Say we want to take rads and we haven’t decided about doing a biopsy just yet…..can we anesthetize the patient for taking just the rads?
NO ya moppheaded nimwitt You can just do rads under sedation when performing the biopsy but you aren’t just going to anesthetize to take rads……cmon man use your effing head
What’s significant to note about sentinel lymph nodes and oral tumors
Sentinel LN with oral tumors are unpredictable and often (like in 42% in one study) the LN draining the tumor was not the locally regional lymph node in 42%
With oral tumors with regional LN mets, only ___% go to _____
55%; mandibular
What other radiographs do you need to take with an oral tumor?
3 view thoracic metastasis for all patients
Is malignant melanoma always black? What do you do if not?
It’s a classically pigmented black but there a non pigmented variant known as Amelanotic melanoma so you have todo a special stain for Melan A (do a IHC)
Oral melanoma is commonly ______ most melanoma of the skin in dogs is often _____
oral-malignant skin-benign
Oral melanoma is highly malignant at ___%
80 (rate is site/ size/stage dependent)
When you have malignant melanoma thorough staging is required and state what is recommended?
Abdominal US Full body CT for locoregional assessment for sx planning
With oral malignant melanoma surgery results in local control ____% of cases but the biggest point of failure is ____ ____
75%; systemic mets
SCC is # _____ in dogs for commonality and #_____ in cats
dogs- #2 cats- #1
SCC happens in both cats and dogs and is ______ _____ with a ____ rate of metastasis
locally invasive; low rate of metastasis (<20%)
In cats there are inherent risk factors for SCC which are? (3)
Flea collar usage (3.5x) Smoke exposure (2x) Excessive canned food (esp. tuna)
In cats particularly SCC of the mouth tend to secrete this?
Increase in tumor expression of parathyroid hormone related protein (PTHrp) which causes bone reabsorption and hypercalcemia tumor driven protein and signal body to start releasing calcium and body in order todo that destroys bone
In cats, where do we often find SCC
sublingually (under the tongue) 99%
What is the common signalment with Fibrosarcoma
think puppies are Friendly with Fibrosarcoma Large breeds most common (Golden and Labs = friendly breeds) younger like 7-8 months (puppies are always Friendly)
Fibrosarcoma is ______ very _____ but often looks _____. because why? What does this cause us todo
- locally
- invasive;
- looks benign
- bc it is histologically low grade but biologically high grade variant
- (in young dogs like golden’s less than 2 years old)
- So it causes us to state to the pathologist that tells us its benign that its not!!! If the biopsy comes back as a fibroma instead of a fibrosarcoma don’t believe it!
What is so surprising about Fibrosarcomas because it’s very locally aggresively invasive?
It has a relatively low metastatic rate <30% so check the lungs and LN’s only
What is our biggest point of failure when treating Fibrosarcomas?
Recurrent disease after surgery (we didn’t get it all)
Odontogenic tumors are also called _____ and arise from this area and look like this mistakenly?
AKA Epulides
Arise from the periodontal ligament and often appear similar o gingival hyperplasia
State the benign Odontogenic tumor that needs special consideration and why we need special consideration..(even though we think it would be okay due to its benign classification)?
Acanthomatous ameloblastoma
(be careful becasue very locally invassive and beign but needs to be treated with aggressive local surgery)
Do Acanthomatous ameloblastoma metastesize?
NOOOOO (it’s benign and very locally invasive but doesnt metastesize)
What breeds do we often see with Acanthomatous ameloblastomas and where is it commonly located on the animal? Who is it rare in?
Shetland
Old English Sheep
rare in cats
rostral mandible is the most common site
When you see Lacey we think of????
Acanthomatous ameloblastoma
This benign odontogenic tumor is slow growing, and cmmon in dogs (uncommon in cats) and can often be treated by sometimes taking a wait and watch approach?
Peripheral Odontogenic Fibroma
Describe the indications for wait and watch approach, or a surgical approach to peripheral odontogenic fibroma? State some of the indications for certain treatments
If not really infitrative and coming from portion of Periodontal ligament that is not disrupting the tooth you can do the wait and watch approach, if a young animal and disrupting the tooth or area around it do a local surgery.
Surgical EXCISION is ideal but can watch and wait if AND ONLY IF the biopsy is confirmed
Cryotherapy works very effectively too if less than <1cm!
What is the cat version of ameloblastoma that is benign and very aggreisively invasive locally (no metastasis) and how do we treat
Feline Inductive Odontogenic Tumor (tx like ameloblastoma)
Feline Inductive Odontogenic Tumor is commonly seen in this age bracket of cats and where is it commonly located (compare with Acant. Amelo.)
Unique to young cats (usually 8 to 18 months) = Raised, submucosal soft tissue
masses most commonly located on the rostral maxilla. AA is rostral mandible
What is the gold standard for treatment of oral tumors what is the exception, describe the margins?
Aggressive surgical excision = Gold standard
– Almost always have bone involvement
– Peripheral odotogenic fibroma’s are the exception
Margin procurement = 2cm for malignancies (*Tall order in the mouth*)
– 1cm for acanthomatous ameloblastoma (rim excision acceptable)
For Oral tumors, The more rostral the mass= _____ to excise, _____prognosis
easier; better
Describe the tolerance of dogs and cats that have mandibulenctomies, maxillectomies, orbitoectomies performed?
– Well tolerated w/ good cosmesis & functional results
• Most animals eats w/in 24 hours
– Exception = cats w/ mandibulectomies, Need feeding tube just in case (some will not eat)
- Does radiation work for oral tumors and if so which ones, what if it’s systemic?
- Which does not work for melanoma?
- What is shown to double the survival time in cats?
- What is more common RT or CT
RT can be effective for oral tumor mgt. (radiation for local control not systemic radiation does nothing for metastases)
- Responding tumor types for RT:
– SCC (dogs), melanoma, Acanthomatous ameloblastoma & FSA (+/-)
- Primary treatment considerations for RT
– if used as Curative intent – you would use it as Adjunctive post op to a incompletely excised FSA
– used as Palliative –to Down stage oral melanoma
- (melanoma most responsive t0 RT)
Chemotherapy not commonly employed RT more common
– Should be considered w/ highly metastatic variants
• Melanoma fits this bill but is not chemo responsive…
• Piroxicam for sublingual SCC in cats (shown to double ST)
What are some positive prognostic indictors with oral tumors?
• Smaller tumors
– Recurrence 3x more likely in T2 (2-4cm) vs. T1 (<2cm) and 8x more likely in T3 (>4cm)
• Rostral location
– Tumor related death 5x more likely w/ tumor caudal to K9 teeth
• Histologically complete resection
– Tumor related death 2-4x more likely w/ positive margins
– Local recurrence: Complete (15-22%) & Incomplete (62-65%)
• No evidence of preoperative metastasis
What cancer is viewed as a rare cancer in dogs and cats and typically happens with older animals with no gender or breed predilection?
Esophageal tumors
With esophageal tumors in indigenous areas, _________ ____ infection and causes _______
Spirocerca Lupi; sarcomas
Secribe the life cyles spirocerca lupi?
life cycle of S. lupi, coprophagous beetle that dog eats (or transport host
dog subsequently eats), granulomas in esophagus around larvae
What are the chief complaints with esophageal tumors
Chief complaint = Weight loss, regurgitation, vomiting, dysphagia
Signs of esophageal partial obstruction/stricture
– secondary aspiration pneumonia
What is the most common esophageal tumor and where is it commonly located?
*SCC most common*
– Cats = Females & located in middle 1/3rd of
esophagus just caudal to thoracic inlet
What is your top DDX with esophageal tumors?
Leiomyosarcoma **TOP DDX**
FSA, OSA & rarely benign (leiomyoma, polyp)
How do we work up and stage esophageal tumors?
• Imaging
– Survey radiographs – Dilation proximal to tumor (not best its onsensitive)
– Positive contrast esophagram – Stricture/mass effect
_**GOLD STANDARD **• Esophagoscopy = Ideal b/c biopsies can be procured_
– Smooth mm. based tumors = Mucosa looks normal!
• Fecal testing for S. Lupi if indicated
What is the gold standard treatment for esophageal tumors? Is there any complications, best curative chance for which tumor?
Generally Surgical excision but very challenging exposure and poor healing compicated resection
Best chance for low grade leiolyosarcoma (can treat with marginal excision)
How is the prognosis with esophageal tumors? What can we do if the mass is secondary to S. Lupi? What can improve quality of life?
Generally very poor prognosis
Palliation w/ feeding tube or stent can improve quality of life
• Benign lesions, LSA (medical tx) & low grade leiomyosarcomas can do well w/ treatment
If mass is secondary S. Lupi granuloma – Tx w/ doramectin will resolve lesion
Name one of hte most uncommon tumors affecting <1 % of all cancers
GASTRIC tumors (think like GANDALF from Lord of the rings….he’s rare to see)
What 2 breeds have a genetic predispositon for gastric tumors and do females or males more commonly get this.
- Belgian shepherd and chows / more commonly males
What genetic predisposition commonly gets Benign gastric tumors (leimyomas)
Beagles
With chronic gastritis, _____ infection MAY play a role in development
Helicobacter
What is the number one clinical sign seen with gastric tumors?
1. Anorexia
(Hematemesis second)
With gastric tumors they are mostly _____ until tumor becomes large enough to effect _____
aymptomatic; outflow
What are the BIG 2 gastric tumors for dogs and then anme number 3 and and name the common benign variant and other considerations that could cause these (6 things to list)
1. Adenocarcinoma (70-80%)
2. Leiomyosarcoma
- LSA
- GIST
Benign variant: Leimyoma (2nd most common tumor)
Other considerations (Pythium insidiosum -fungal can cause severe inflammatory infiltrative lesions se and gulf cloast)
What is the number one cause of gastric tumors in cats? Most are negative for _______. _______ = rare. Benign tumors = rare in cats
#1. Lymphoma
FeLV (neg)
Adenocarcinoma rare
Gastric adenocarcinoma likes to set up shop in the GI tract in what specifc location?
Pyloric antrum/ lesser curvature
What does gastric adenocarcioma often look like grossly and what do the lesions do?
Often scirrhous (firm/white on serosal surface) Linitis Plastica (leather bottle)
The lesions are often diffusely expansile, infiltrative with deep ulcerations in the center
True or False:
Gastric adenocarcicoma is a low metastatic rate in dogs
FALSE ya dumba**
High metastatic rate (74%) can spread anywhere LITERALLY ANYWHERE there have been dogs with testicular mets seen from this tumor
What are some of the nonspecific lab findings with gastric adenocarcinoma (not that rewarding for minimum database)
- Anemia if ulcerated/bleeding
- sometimes based on location so infltrative mass effect in common bile duct so elevated T BILI -EHBO due to CBD obstruction (bad)
What is the gold standard for diagnosing gastric adenocarcinoma?? What should this be paired with
Abdominal U/S
See mural thickening with loss of normal wall and diminised to absent local motility (mass effect can be seen)
Should be paired with U/S guided FNA cytology to rule out (treatment is based on what it is)
(LSA because it may not be surgical if it’s that)
What is the gold standard techniue to work up and stage gastric adenocarcinoma? Good for assessing?
Endoscopy (endoscopic evaluation) allows for biopsy procurement and can assess resectability
Leiomyoma and Leiomyosarcoma are _____ muscle tumors that are usually WELL CIRCUMSCRIBED submucosal masses and have +/- ulcers (not leather bottle appearance like with ACA). Leimyoma’s like the _____ are their main location.
Adenocarcinoma in comparison are extensive and ulcerated (eroding the mucosa) and usualy like the _____ for their location
smooth; Cardia
ACA: pylorus
What is the main treatment for gastric tumors, what is the exception to this? What won’t really work? What should be removed for staging and can this be curative
Surgery (except lymphoma) (chemo and radiation doesn’t really work, radiation needs to be static (still cant tll stomach to stop moving)
Enlarged perigastric LN should be removed for staging (curative resction is feasible if no metastasis)
Wht are the names of the surgeries we do when removing gastric tumors? What one has high morbidity associated?
Partial Gastrectomy or gastroduodenostomy/jejunostomy (Billroth I or II)
Billroth II or complete gastrectomy with biliary by pass are very extensive surgeries with high morbidity and minimal survival advantage
Describe the prognosis of ACA?
- Prognosis = poor with majority dead within 6 monthd due to either recurrent or metastatic disease
- (BUT if NO METS and RESECTABLE than longer survival is possible)
Describe the prognosis of LSA in dogs/cats?
Does not respond well to conventional chemo so resect if solitary and adjunctive chemo may not be required but you really won’t know how thy will do till you start treatment and see how they do with chemo so sometimes a hard sell
Leimyoma is cured with _____
surgery
Describe the prognosis of Leimyosarcoma?
GOOD!!!!! (but a head scratcher)
MST 1 year to 21 months (little less than 2 years)
- 1 year survival rate 75%
- 2 year survival rate 66%
54% metastatic rate ut not a poor prgonostic factor with a MST = 22 moths (high metastatic but not always poor prognisus and can live well)
Name the Uncommon GI tumor location that accounts for 3% of all tumors and has a breed predilection for COLLIES and GSD :-(. Which aspect is more common?) (Male or female) (young or old?)
Intestinal tumors
(large intestinal tumors are more common than small intestine)
70% MALE predilection
Older dogs with 80% greater than or equal to 7 years old
It CATS intestinal tumors are also uncommon (4%-9%) accounting or 68-94% of all non oral GI tumors, ______ intestine is more common than _______ intestine
small int more common than large
Intestinal tumors are typically _____ animals and very similar symptoms as gastric tumors such as _____, _____, _____
older; A+ V+ D+
With intestinal tumors in contrast with gastric tumors _______ will ___ allow for access to jejunum and proximal ileum) (can get to distal ileum with ______)
ENDOSCOPY; NOT; colonoscopy
Can we use endoscopic biopsy to interpret LSA?
BE CAREFUL****
Careful with endoscopic biopsy interpreation in Cats, LSA is misdiagnosed as IBD in 70% of cases in one study
SO instead it’s recommended todo FULL THICKNESS biopsy of multiple areas of GI tract
What area is lymphoma commonly in small intestine in cats?
ileum (and most likely missed with a biopsy)
With intestinal tumors for work up and staging it’s very benficial to perform this because there’s over a 70% accuracy and should be attempted in ALL cases
U/S guided FNA with cytology to assess LN carefully and to stage the intestinal tumor
With U/S guided FNA with cytology our main goal is to rule out _____ which would generally not be surgical in dogs and cats. What would be the exception to performing surgery?
LSA
Exception would be if large solitary mass is resent that is causing mechanical obstruction (V+ and sick) and it would take too long for the chemo to relieve the obstruciton so you need to excise it surgically
What are the top 3 intestinal tumors in Dogs?
- LSA
- ACA
- Leiomyosarcoma
What are the top 3 intestinal tumors in Cats
- LSA
- ACA
- MCT
What are other intestinal malignancys/benign variants involved in dogs? What is the 4th most common?
- MCT
- GIST (4th most common)
Benign variant
- Leiomyoma
What are other intestinal benign variants involved in cats?
Duodenal ademoatous polyp
In intestinal tumors the T for WHO tumor staging =
depth of invasion
What is th gold standard treatment with intestinal tumors? What is the exception? State the margin procurement and which regional LN should be assesed?
- Surgery!!! (Exploratory laparotomy with surgical excision via intestinal resection and anasthemosis)
- Exception: LSA
- Margin procurement: 4-8 cm
- Mesenteric and regional LN should be assesed resected or aspirated if not amenable to excision
LSA tumor specific considerations for dogs. The majority ___ cell origin and _____ in distribution. Overall remission rate is ___% which is poor.
Overal MST is _____ days (with resection _-___days)
Negative prognostic indicators are?
- Majority T-cell origin & multifocal in distribution
- Overall remission rate = 56% 👎
- Overall MST = 77 d (R= 6 – 700d) 👎
- Negative prognostic indicators =
- Dogs that failed to achieve a remission or had diarrhea at initial presentation
Do dogs or cats respond and live longer with intestinal LSA (describe the according prognostics)
CATS!!! 1 year of good quality life with chemo
MST = 201-280 days w/ a variety of different chemotherapy protocols
Prognostic indicator = Must wait to Respond to tx to prognosticate
Stage at presentation:
– II (32%) = Single resectable site ± mesenteric lymph node involvement
– III (43%) = Single non-resectable site or extra-nodal secondary site
Intestinal adenocarcinoma in dogs?
• 44% metastatic rate
– Sites - regional LN, mesentery & liver
• MST = 272-300 days
Intestinal adenocarcinoma in Cats?
Do better than dogs
- Majority of feline intestinal ADC are advanced w/ 72% metastatic rate at diagnosis– Regional LN & peritoneum (carcinomatosis)
- 50% local tumor recurrence rate in long-term survivors
- MST = 5-15 months for surgery alone
- Negative prognostic factors = Histologic subtype & metastasis
– Tubular ACA (11m) vs. Undifferentiated/mucinous (4m)
– LN mets = 12m vs. 15m if not
– Omental mets – 4.5m vs. 28 m if not
Carcinomatosis with feline intestinal adeocarcinoma indicates…..?
poor poor poor prognosis = euthanasia
When you see MCT in small intestine it’s what kind of news??
- Bad news BAD DISEASE
- Dogs- 100% metastatic rate,
- MST = 16 days w/ 100% tumor related mortality w/in 2 months of diagnosis
In cats every so often fortunate enough to get a solitary tumor that hasn’t spread and in those cases with surgical excision those cats do really well!!
Is Leiomyosarcoma more commin in dgs or cats, discuss the MST
More common in dogs, cats it’s uncommon and survival data for cats is not avaiable. Dogs MST is 8 months after surgical resection.
Advent of ____ staining allowed realization that not all leiomyosarcomas could be categorized as such so instead we call them?
IHC; gastrointestinal stromal tumor (GIST)
GIST’s – Not composed only of _____muscle. Primarily originate from ___________ = which are known as the _____ cells of the GI tract. They express _____ on (___) and have a predilection for _____(name anatomical organ)
smooth;
interstitial cells of Cajal = Pacemaker cells of the GI tract
Express c-kit (CD-117) on IHC which is how you differentiate them from Leiyomyosarcoma because they do not
****Predilection for CECUM (often get large & rupture)
What is the most common tumor of the cecum or appendix in the dog? Describe prognosis?
****GIST**** Indicated test question
They are dying of septic peritonitis PO b/c masses ruptured before diagnosis (if caught before they rupture they do great!!)
• MST = 11.6 m – If survive PO = 37.4 m
– If only dogs surviving PO considered, MST = 37.4 m
