AGASACA

Question 1

T/F: plain radiographs can both under- and over-estimate lymph node disease.

Answer 1

True

Question 2

T/F: cytology is a reliable way to differentiate perianal adenomas versus adenocarcinomas in male dogs.

Answer 2

False; usually requires biopsy

Question 3

What is the most important histologic criteria to support a diagnosis of peri-anal sebaceous gland adenocarcinoma (as opposed to benign tumor)?

Answer 3

Invasiveness of tumor cells into surrounding tissue. Also, disorderly cellular arrangement, nuclear pleomorphism, and increased numbers of mitotic figures.

Question 4

Which of the following can be used on ultrasound to distinguish neoplastic from benign nodes?
Contour/shape
Cavitation
Parenchymal uniformity
Size

Answer 4

Size only

Question 5

T/F: For peri-anal tumors that require aggressive unilateral resection, incontinence is fairly common post-operatively.

Answer 5

False: “very rare” per Withrow text

Question 6

Which anti-cytokeratin antibody was found to react positively in cats with anal sac adenocarcinoma?

Answer 6

CAM 5.2

Question 7

What % of intact male dogs will be cured of their perianal adenomas by castration and removal of the mass?

Answer 7

> 90%

Question 8

What is the ORR and CR for perianal adenomas treated with electrochemotherapy? What was a prognostic factor affecting response?

Answer 8

ORR >90%
CR 65%
Tumors <5 cm more likely to respond
Larger tumors more likely to develop necrosis, erythema, inflammation

Question 9

What immunosuppressive (non-chemo) drug gave a measurable reduction in tumor size in a dog with multiple perianal adenomas?

Answer 9

Cyclosporine

Question 10

T/F: perianal sebaceous adenocarcinomas are typically cured with the first surgical removal.

Answer 10

False; requires planned aggressive removal with adequate margins (usually not done the first time).

Question 11

What are negative prognostic factors for perianal sebaceous adenocarcinomas?

Answer 11

Stage/size

Metastasis

Question 12

What is the 2 year control rate for a perianal sebaceous adenocarcinoma <5 cm removed with surgery?

Answer 12

> 60%

Question 13

What % of dogs with perianal sebaceous adenocarcinomas have mets at diagnosis? What is the MST for these dogs?

Answer 13

15%

MST with mets: 7 months (but 5/6 were not treated aggressively)

Question 14

What % of dogs with AGASACA have mets at diagnosis?

Answer 14

50-80%

Question 15

What are negative prognostic indicators for dogs with AGASACA?

Answer 15

increased primary tumor size
lymph node mets
distant mets
advanced stage
lack of surgery
treatment with chemo alone
lack of any treatment
\+/- E-cadherin

Question 16

T/F: For dogs without distant metastasis, removal of metastatic nodes improves survival for dogs with AGASACA relative to surgical removal of only the primary tumor

Answer 16

True

Question 17

What was the median duration of response for dogs with relapsed/resistant AGASACA treated with Palladia?

Answer 17

19-25 weeks (4.75-6.25 months)

Question 18

Through what receptor is AGASACA thought to respond to Palladia?

Answer 18

PDGFR-a.
In one study, 19.5% of tumors were positive for it (Brown 2012). In another, PDGFR-a was found in all tumors, and the stroma of all was positive for PDGFR-b. (Urie 2012)

Question 19

What is the MST for AGASACA treated with surgery and melphalan?

Answer 19

20 months (1.7 years)

Question 20

What is the event-free survival and MST for AGASACA treated with surgery (tumor +/- metastatic nodes), definitive RT (3.2Gy x 15), and mitoxantrone?

Answer 20

EFS 9 months

MST 31 months

Question 21

What can be done to minimize the risk of acute RT effects during treatment of the perineal and pelvic regions?

Answer 21

<3 Gy per fraction

Question 22

Is hypercalcemia a negative prognostic indicator for dogs with AGASACA?

Answer 22

Controversial. One study says yes; others have not supported it.

Question 23

What are the best and worst MST reported for cats with AGASACA treated with surgery +/- multimodal therapy?

Answer 23

One study: 3 months (included some with incisional bx).

Another more recent study: >300 days