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Oncology Boards > AGASACA + Perianal Tumors > Flashcards

AGASACA + Perianal Tumors Flashcards

1
Q

True or false - cats can develop perianal adenoma/perianal adenocarcinoma

A

False - don’t have perianal sebaceous glands

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2
Q

Development and progression of perianal adenomas is _____ with growth stimulated by ______ and suppressed by _____

A

Sex hormone-dependent androgens estrogens

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3
Q

Perianal adenomas in female dogs occur almost exclusively in ______

A

spayed animals - have low estrogen = no tumor suppression

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4
Q

T/F: Perianal adenocarcinomas are hormonally dependent?

A

False

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5
Q

Rate of metastasis for perianal adenocarcinomas

A

Low, <15%

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6
Q

Most frequent sites of mets from perianal adenocarcinomas? Less frequent?

A

Regional LN and lungs; liver, kidney, bone

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7
Q

What five things are increased histologically/molecularly in perianal adenocarcinomas compared to adenomas?

A

Increased proliferating cell nuclear antigen (PNCA), apoptotic corpuscles, Ki67, VEGF, serum magnesium levels

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8
Q

What is needed to definitively tell perianal adenoma from adenocarcinoma?

A

Incisional bx

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9
Q

What IHC can help differentiate perianal adenoma from adenocarcinoma?

A

Monoclonal Ab against carcinoma-associated Ags 4A9, 1A10; PCNA, Ki67

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10
Q

What can help differentiate a perianal adenocarcinoma from AGASACA?

A

cytokeratin expression patterns

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11
Q

What margins can perianal adenomas be removed with?

A

Minimal margins, <1cm

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12
Q

Other than surgical removal of the primary tumor, what else is recommended for treatment in dogs with perianal adenomas?

A

Castration

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13
Q

What if a perianal adenoma is diffuse or too large to be removed? Treatment?

A

Surgical staging - castration first, may shrink tumor Cryosurgery CO2 laser ablation Hyperthermia RT ECT

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14
Q

What is the repoarted response rate for perianal adenomas treated with ECT

A

>90%, 65% CR

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15
Q

Do perianal adenocarcinomas respond to castration?

A

Nope

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16
Q

What has a significant influence of DFI and OSTs for dogs with perianal adenocarcinoma?

A

Stage of tumor - T2 tumors (<5cm) do better

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17
Q

2-year control rate for T2 perianal adenocarcinoma treated with surgery? Also, what is a T2 tumor?

A

<5cm >60%

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18
Q

MST for dogs with LN or distant mets from perianal adenocarcinoma

A

7mo (but aggressive therapy not pursed for most dogs)

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19
Q

What breeds have an increased risk of AGASACA?

A

Spaniels (particularly English cocker spaniels) German Shepherds Alaskan malamutes Dachshunds

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20
Q

Gender/neuter status assoc. with risk of AGASACA?

A

Neutering may be associated with increased risk for males

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21
Q

What are the three histologic patterns of AGASACA?

A

Solid Tubules/Rosettes/Pseudorosettes Papillary

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22
Q

Which are the most common histologic patterns of AGASACA

A

solid and tubules/rosettes/pseeudorosettes in 95%

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23
Q

What is the rate of bilateral AGASACA (simultaneously or temporally separated)

A

up to 14%

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24
Q

Rate of paraneoplastic hypercalcemia in dogs with AGASACA?

A

16-53%

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25
Q

Mediator of hypercalcemia in canine AGASACA?

A

PTHrp from neoplastic tissue

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26
Q

Overall rate of mets for dogs with AGASACA? LN? Distant?

A

Overall: 26-96% LN 26-89% Distant 0-42%

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27
Q

What are the less common sites of AGASACA mets?

A

heart, omentum, stomach, adrenal glands, panc, kindeys, Ubladder, mediastinum

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28
Q

What has been associated histologically with risk of metastasis at diagnosis for canine AGASACA?

A

Marked peripheral infiltration into surrounding tissue, LV invasion, solid pattern

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29
Q

Does high or low levels of E-cadherin expression in AGASACA correlate with a better survival time?

A

Higher

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30
Q

Rate of mets from AG melanoma in dogs?

A

4/8 sublumbar LN, 1/11 pulmonary

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31
Q

Rate of mets from regional LN for feline AGASACA?

A

20%

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32
Q

Have bilateral AGASACA been reported in cats?

A

Nope

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33
Q

What percentage of dogs have an AGASACA be an incidental finding?

A

up to 47%

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34
Q

What is the most common clinical sign for cats with AGASACA?

A

Perineal ulceration or discharge

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35
Q

What IHC staining can confirm AGASACA dx if needed?

A

Cytokeratin pattern CK7+/CK14-

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36
Q

What was shown to be the only consistently abnormal feature of abdominal malignant LNs?

A

Size

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37
Q

What three LN centers can be involved in AGASACA

A

medial and internal iliac, sacral

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38
Q

What is the complication rate after local surgery for AGASACA and what is the most common complication?

A

5-24% wound dehisence, rectal perforation, rectocutaneous fistulation, incisional infection, transient fecal incontinence

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39
Q

What can help limit the complications of surgical removal of AGASACA

A

Smaller anoplasty - previous studies showed 40-60% rate of fecal incontinence when 120-270 degree anoplasties performed

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40
Q

Complication rate of LN extirpation for dogs with AGASACA?

A

0-12% - hemorrhage, uncresectable LN, LN rupture and abdominal wall dehisence

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41
Q

T/F: treatment of recurrent AGASACA or progressive nodal mets is not recommended for dogs as it does not improved survival

A

False

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42
Q

When can you pursue splenectomy for AGASACA?

A

If confirmed mets to spleen + context of slowly progressive dz and no other mets

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43
Q

What drugs have demonstrated antitumor activity in gross disease setting for AGASACA in dogs

A

carbo, cisplat, actinomycin D

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44
Q

Measurable response rates for dogs with AGASACA with bulky disease treated with RT (hypofx or fx protocols)?

A

38-75%

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45
Q

Over what radiation dose per fraction to the colon are late radiation side effects more likely to occur?

A

3Gy

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46
Q

Palliative RT protocols result in an improvement in clinical signs in up to ______, including resolution of____

A

up to 63% Obstipation

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47
Q

Palliative RT protocols can resolve ____% of hypercalcemic dogs with AGASACA. What improves this %?

A

RT alone 31% RT + Pred + bisphosphonate = 46% additional

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48
Q

Reported PFIs and MSTs for dogs treated with palliative RT for AGASACA?

A

PFI 10-11 mo MST 8-15mo

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49
Q

Is rate of local recurrence for dogs treated with AGASACA related to the completeness of excision?

A

Nope

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50
Q

What is associated with a shorter median DFI for dogs with AGASACA treated with surgery (across multiple studies)

A

LN mets: 134-197d vs. 529-760d if not

51
Q

Est. 1 and 2 yr survival rates for dogs with AGASACA

A

65%, 29%

52
Q

Poor prognostic factors for AGASACA in dogs (10)

A

Primary tumor size, presence of clinical signs, presence of LN mets, size of LN mets, distant mets, no surgery, tx with chemo alone, E-cadherin expression, solid histo type; hypercal in some.

53
Q

PFI and OST for dogs treated for AG melanoma with a variety of treatments?

A

3mo, 3.5mo

54
Q

MST for cats with AGASACA treated with surgically +/- chemo and/or RT?

A

260d

55
Q

Poor prognostic factors for survival in cats with AGASACA

A

local tumor recurrence Increased nuclear pleomorphic score (2 or 3)

56
Q

What was the agreement for intra- and peri-mural Tc99 injected for sentinel LN mapping of AGs? (Linden VRU 2019)

A

50% agreement

57
Q

Which method of Tc99 injection was uptake faster for, perimural or intramural? (Linden, VRU 2019)

A

Intramural

58
Q

What was the MST for dogs treated with surgery, RT and mitoxantrone chemotherapy (Turek VCO 2003)? What was the RT protocol?

A

MST 956d.

RT 3.2Gy x 15 = 48 Gy

59
Q

Late RT effects developed in what percent of dogs treated for AGASACA with RT, Mito and surgery? (Turek VCO 2003)

A

50% of dogs - nonconformal RT used

Protocol 3.2Gyx15=48 Gy

60
Q

Curative-intent RT protocols should limit pelvic radiation to ____Gy/fraction

A

< 3Gy/fraction

61
Q

Median OST/TTP for dogs treated with adjuvant carboplatin and surgery compared to treated with surgery alone? (Wouda VCO 2016)

A

Carbo group: OST 703d, TTP 384d

Surgery alone: OST 581d, TTP 402 (no significant difference)

n=74 dogs, 44 carbo, 30 surgery alone

62
Q

What was found to significantly affect OST/TTP in dogs with AGASACA treated with surgery +/-chemo (Wouda VCO 2016)

A

Primary tumor size

LN mets

63
Q

What significantly prolonged survival in dogs treated with surgery +/- carbo for AGASACA? (Wouda VCO 2016)

A

Treatment

64
Q

In 130 dogs with AGASACA, what were found to be prognostic factors? (Polton JVIM 2007)

A

Lack of treatment

Presence of distant mets

LN mets

Primary tumor size (2.5cm)

65
Q

What algorithm for treatment for dogs with AGASACA was developed in the 2007 Polton paper (130 dogs with AGASACA)

A

Treat with neoadjuvant chemotherapy if local LN >4.5cm or if primary >2.5cm

66
Q

Prognostic factors for dogs with AGASACA based on Williams, JAVMA 2003

A

Tumors >10cm2

hypercalcemia

pulmonary metastasis

67
Q

Response rate to Palladia for dogs with stage IV AGASACA? (Elliot JAVMA 2019)

A

13/15 (87%) SD, no CR or PR

68
Q

What percentage of dogs with stage IV AGASACA treated with Palladia had improvement in clinical signs? (Elliot JAVMA 2019)

A

5/13 dogs with SD = 38% of dogs with SD or 5/15=33% for all dogs included

69
Q

mPFI and MST for dogs treated with Palladia for stage IV AGASACA (Elliot JAVMA 2019)

A

mPFI 354d, MST 356d

Longer compared to historic data

70
Q

PFI and MST for dogs with stage 3b AGASACA treated with surgery or hypofx RT? (Meier VCO 2017)

A

Surgery: PFI 159d, MST 182d

RT (8x3.8Gy = 30.4Gy): PFI 347d, MST 447d

71
Q

Percent resolution for hypercalcemia in dogs with AGASACA treated with hypofractionated RT? (McQuown, VCO 2016)

A

31% resolution

72
Q

PR rate to hypofractionated RT for dogs with advanced AGASACA? What about improvement in clincal signs? (McQuown, VCO 2016)

A

38% PR (n=77 dogs total)

63% improvement in signs

73
Q

MST and PFS for dogs with advanced stage AGASACA treated with hypofractionated RT (McQuown VCO 2016)

A

MST 329d.

PFS 289d.

74
Q

MST for dogs with early-stage AGASACA (no mets) treated with surgery alone? Size cutoff? Skorupski JAVMA 2018

A

MST 1,237d (<3.2cm)

75
Q

Tumor recurrence and median time to recurrence for dogs with early-stage AGASACA treated with surgery alone? (Skorupski JAVMA 2018)

A

7/34 (20%) had recurrence

median time to recurrence = 354d

76
Q

Rate of and time to metastasis for dogs with early stage AGASACA treated with surgery alone? (Skorupski JAVMA 2018)

A

9/34 (25%)

Time to mets = 589d

77
Q

What was positively associated with development of metastasis in dogs with early stage AGASACA treated with surgery alone? (Skorupski JAVMA 2018)

A

Cellular pleiomorphism positively associated with developing mets

78
Q

What was the rate of complications for dogs treated with surgery for AGASACA (Barnes JSAP 2017)

A

12% rate for perineal surgery

79
Q

What was associated with decreased survival time in 42 dogs treated with surgical excision +/- chemo for AGASACA (Potanas JAVMA 2015)

A

Sublumbar LN mets, surgical LN extirpation (not consistent throughout rest of literature)

80
Q

Was there a difference in survival or DFI for dogs treated with surgery +/- chemo for AGASACA (Potanas JAVMA 2015)

A

Nope, no difference for complete, marginal or incomplete

81
Q

What histo features were not associated with nodal mets at presentation in dogs with AGASACA? (Pradel VCO 2018)

A

mitotic counts, necrosis

82
Q

What histo features were associated with decreasd PFI and OST for AGASACA? (Pradel VCO 2018)

A

Solid tumor pattern

increased peripheral infiltration into surrounding tissue

presence of necrosis

lymphovascular invasion

83
Q

What IHC markers do AGASACA express? (Suzuki Vet Path 2013)

A

Chromogranin A (40.6%)

Neuron-specific enolase (46.4%)

Synaptophysin (15.9%)

84
Q

What molecular factors are expressed in canine AGASACA? (Urie and London BMC 2012)

A

PDGFRa/b

VEGFR2

KIT

Ret - posphorylated in 54%

85
Q

What LNs were identified for dogs with AGASACA using CT lymphography (Majesk VRU 2017)

A

Sacral, internal iliac and medial iliac

Ipsilateral in 8/12, contralateral in 4/12

86
Q

What LNs were identified for dogs with AGASACA using CT lymphography (Majesk VRU 2017)

A

Sacral, internal iliac and medial iliac

Ipsilateral in 8/12, contralateral in 4/12

87
Q

What molecular factors are expressed in canine AGASACA? (Urie and London BMC 2012)

A

PDGFRa/b

VEGFR2

KIT

Ret - posphorylated in 54%

88
Q

What IHC markers do AGASACA express? (Suzuki Vet Path 2013)

A

Chromogranin A (40.6%)

Neuron-specific enolase (46.4%)

Synaptophysin (15.9%)

89
Q

What histo features were associated with decreasd PFI and OST for AGASACA? (Pradel VCO 2018)

A

Solid tumor pattern

increased peripheral infiltration into surrounding tissue

presence of necrosis

lymphovascular invasion

90
Q

What histo features were not associated with nodal mets at presentation in dogs with AGASACA? (Pradel VCO 2018)

A

mitotic counts, necrosis

91
Q

Was there a difference in survival or DFI for dogs treated with surgery +/- chemo for AGASACA (Potanas JAVMA 2015)

A

Nope, no difference for complete, marginal or incomplete

92
Q

What was associated with decreased survival time in 42 dogs treated with surgical excision +/- chemo for AGASACA (Potanas JAVMA 2015)

A

Sublumbar LN mets, surgical LN extirpation (not consistent throughout rest of literature)

93
Q

What was the rate of complications for dogs treated with surgery for AGASACA (Barnes JSAP 2017)

A

12% rate for perineal surgery

94
Q

What was positively associated with development of metastasis in dogs with early stage AGASACA treated with surgery alone? (Skorupski JAVMA 2018)

A

Cellular pleiomorphism positively associated with developing mets

95
Q

Rate of and time to metastasis for dogs with early stage AGASACA treated with surgery alone? (Skorupski JAVMA 2018)

A

9/34 (25%)

Time to mets = 589d

96
Q

Tumor recurrence and median time to recurrence for dogs with early-stage AGASACA treated with surgery alone? (Skorupski JAVMA 2018)

A

7/34 (20%) had recurrence

median time to recurrence = 354d

97
Q

MST for dogs with early-stage AGASACA (no mets) treated with surgery alone? Size cutoff? Skorupski JAVMA 2018

A

MST 1,237d (<3.2cm)

98
Q

MST and PFS for dogs with advanced stage AGASACA treated with hypofractionated RT (McQuown VCO 2016)

A

MST 329d.

PFS 289d.

99
Q

PR rate to hypofractionated RT for dogs with advanced AGASACA? What about improvement in clincal signs? (McQuown, VCO 2016)

A

38% PR (n=77 dogs total)

63% improvement in signs

100
Q

Percent resolution for hypercalcemia in dogs with AGASACA treated with hypofractionated RT? (McQuown, VCO 2016)

A

31% resolution

101
Q

PFI and MST for dogs with stage 3b AGASACA treated with surgery or hypofx RT? (Meier VCO 2017)

A

Surgery: PFI 159d, MST 182d

RT (8x3.8Gy = 30.4Gy): PFI 347d, MST 447d

102
Q

mPFI and MST for dogs treated with Palladia for stage IV AGASACA (Elliot JAVMA 2019)

A

mPFI 354d, MST 356d

Longer compared to historic data

103
Q

What percentage of dogs with stage IV AGASACA treated with Palladia had improvement in clinical signs? (Elliot JAVMA 2019)

A

5/13 dogs with SD = 38% of dogs with SD or 5/15=33% for all dogs included

104
Q

Response rate to Palladia for dogs with stage IV AGASACA? (Elliot JAVMA 2019)

A

13/15 (87%) SD, no CR or PR

105
Q

Prognostic factors for dogs with AGASACA based on Williams, JAVMA 2003

A

Tumors >10cm2

hypercalcemia

pulmonary metastasis

106
Q

What algorithm for treatment for dogs with AGASACA was developed in the 2007 Polton paper (130 dogs with AGASACA)

A

Treat with neoadjuvant chemotherapy if local LN >4.5cm or if primary >2.5cm

107
Q

In 130 dogs with AGASACA, what were found to be prognostic factors? (Polton JVIM 2007)

A

Lack of treatment

Presence of distant mets

LN mets

Primary tumor size (2.5cm)

108
Q

What significantly prolonged survival in dogs treated with surgery +/- carbo for AGASACA? (Wouda VCO 2016)

A

Treatment

109
Q

What was found to significantly affect OST/TTP in dogs with AGASACA treated with surgery +/-chemo (Wouda VCO 2016)

A

Primary tumor size

LN mets

110
Q

Median OST/TTP for dogs treated with adjuvant carboplatin and surgery compared to treated with surgery alone? (Wouda VCO 2016)

A

Carbo group: OST 703d, TTP 384d

Surgery alone: OST 581d, TTP 402 (no significant difference)

n=74 dogs, 44 carbo, 30 surgery alone

111
Q

Curative-intent RT protocols should limit pelvic radiation to ____Gy/fraction

A

< 3Gy/fraction

112
Q

Late RT effects developed in what percent of dogs treated for AGASACA with RT, Mito and surgery? (Turek VCO 2003)

A

50% of dogs - nonconformal RT used

Protocol 3.2Gyx15=58 Gy

113
Q

What was the MST for dogs treated with surgery, RT and mitoxantrone chemotherapy (Turek VCO 2003)? What was the RT protocol?

A

MST 956d.

RT 3.2Gy x 15 = 48 Gy

114
Q

Which method of Tc99 injection was uptake faster for, perimural or intramural? (Linden, VRU 2019)

A

Intramural

115
Q

What was the agreement for intra- and peri-mural Tc99 injected for sentinel LN mapping of AGs? (Linden VRU 2019)

A

50% agreement

116
Q

What was the difference in AUS vs. CT for staging of dogs with AGASACA? (Palladino JVIM 2016)

A

AUS only detected correct number of enlarged LN in 30% but did identify at least 1 enlarged LN in 100% of affected dogs

117
Q

Did AUS or CT identify more abnormal iliosacral LN for dogs with AGASACA? (Pollard VCO 2015)

A

Ultrasound

118
Q

MST for cats treated with surgery for AGASACA, 1- and 2-yr survival rates? (Shoieb VetPath 2009)

A

MST 3mo, 1yr 19%, 2yr 0%

119
Q

What is the MST for tumors expressing high vs. low E-cadherin in AGASACA? (Polton VCO 2017)

A

>75% of cells expressing e-cadherin: 1168d

<75% of cells: 448d

120
Q

Response to stage 4 AGASACA dogs to palladia? (Elliot JAVMA 2019)

A

13/15 SD, no PR or CR 5/13 had improvement of clinical signs

121
Q

mPFI and MST for dogs with stage 4 AGASACA treated with Palladia? (Elliot JAVMA 2019)

A

mPFI 354d, MST 356

122
Q

Most common clinical sign for cats with AGASACA? (Amsellem JAVMA 2019)

A

perianal ulceration or discharge (85%)

123
Q

Time to local recurrence in cats with AGASACA treated with surgery +/- chemo and/or RT; risk factors for local recurrence?(Amsellem JAVMA 2019)

A

96d; incomplete margins and higher nuclear pleomorphic score

124
Q

DFI and MST for cats with AGASACA treated with surgery +/- chemo and/or RT; Anything associated with DFI or MST? (Amsellem JAVMA 2019)

A

DFI 234d, MST 260d. nuclear pleomorphic score associated with both

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