Anal sac tumors Flashcards
What are most anal tumors (round cell, sarcoma, carcinoma)?
- Most are carcinomas
- Epithelial tissues
Where do anal tumors tend to spread?
- Lymph nodes more, less via blood
- Sub-lumbar lymph nodes most often
How would an anal sac apocrine gland adenocarcinoma tend to behave locally?
- Tend to stick together and are well circumscribed
- The bigger it is, the less obvious
What are the three main anal tumors?
- Perianal adenoma
- Perianal gland carcinomas
- Anal sac carcinomas
Perianal adenoma - who gets?
Malignant/benign?
- Benign
- Intact male dogs
Perianal gland carcinomas - who gets?
Malignant/benign?
- Malignant (often more diffuse than perianal adenoma)
- Possible male predominance
Anal sac carcinomas - who gets?
Malignant/benign?
- Malignant!
- Older dogs
- Lots of chondrodystrophic breeds (e.g. Springer spaniel, dachshund, malamute, cocker spaniel German Shepherd)
How do anal sac carcinomas tend to present?
- Anal sac mass
- HYPERCALCEMIA!
Staging for anal sac carcinomas
- CBC/Chem/UA
- Hypercalcemia due to PTHrp in 25-50%)
- Chest rads
- Image the abdomen (>50% have metastasized to lymph nodes at diagnosis)
- Image tumor
Anal sac carcinoma hypercalcemia vs lymphoma
- Often NOT as sick as lymphomas, which change very acutely
Surgery for anal sac carcinomas
- Remove mass and nodes
Radiation therapy for anal sac carcinomas
- Seems to be the best for mass and nodes
Chemotherapy for anal sac carcinomas
- Carboplatin/cisplatin
- TKI
- May not work as well
Survival times for anal sac carcinomas
- Can be long
Other perianal tumor possibilities
- Soft tissue sarcoma
- LSA
- Mast cell tumor
- Melanoma
- Squamous cell carcinoma
Tumors on the inside presentation in general
- Could present with very vague signs
Therapy options for tumor on the inside in general
- Surgery
- Radiation
- Chemotherapy
- Anti-angiogenic
Surgery for internal tumors
- Works if tissue is expendable
Radiation for internal tumors
- Tumor tissue has to sit still and surrounding tissues must tolerate radiation
Chemotherapy for internal tumors
- Often poorly response
- Often the gut, kidney, and respiratory system are pretty resistant to toxic things already (MDR genes high there)
Anti-angiogenic therapy for internal tumors
- In human med for GI carcinomas and lung
What type of tumors do most organs give rise to?
- Carcinomas!
- GI tract including pancreas and liver
- Kidney/bladder
- Ovaries/uterus
- Testicles/prostate
- Adrenal glands
Round cell or sarcomas in the abdominal organs - where do they arise?
- Spleen/lymph nodes
Signalment for GIT tumors
- Usually middle aged or older
GIT presentation
- Depends on where in the GIT the tumor is
Gastric tumor presentation
- Weight loss, vomiting, melena
Small intestinal tumor presentation
- Melena, diarrhea, weight loss
Colon tumor presentation
- Diarrhea, weight loss, hematochezia
Hepatobiliary tumor presentation
- Weight loss
- Inappetance
- Vomiting
- PU/PD
Staging for GIT tumors
- NECESSARY!
- Abdominal imaging (ultrasound is best)
- Chest rads
- +/- cytology of mass and all other masses found
- Exploratory
Treatment for lymphoma in GIT
- Chemotherapy
Prognosis for adenocarcinoma of intestines
- Depends on surgical margins
Metastasis of GI adenocarcinoma
- > 44% met but can be late
Chemo for GIT adenocarcinoma
- Often ineffective
- Doxorubicin, carboplatin
- Gemcitabine
- Metronomic chemotherapy
- TKI
Leiomyoma/leiomyosarcoma - where do you see theses?
- Often cecum
Leiomyoma/leiomyosarcoma prognosis
- Depends on surgical margins (in general, small intestine is better than large intestine)
Metastatic potential of leiomyoma/leiomyosarcoma
- Moderate
Chemo for leiomyoma/leiomyosarcoma
- May help
- Doxorubicin
Gastrointestinal stromal tumors (GIST) metastatic potential
- Low metastatic potential
Treatment of GI stromal tumors
- Traditional chemotherapy not helpful but TKI can be effective even with gross disease present
Hepatic tumors - how to diagnose?
- BE WARY OF MAKING A DIAGNOSIS WITH ULTRASOUND
- NEED A SAMPLE
Feline hepatic tumors - benign or malignant more common?
- Benign tumors more common
Canine hepatic tumors - benign or malignant more common?
- Malignant tumors more common but can be quite low grade
- Surgical removal if possible
- Chemo ineffective
What are the most common bladder tumors?
- Transitional cell carcinoma
Signalment for TCC
- Usually small breed older dog
- Scottish terriers and shelties are over-represented
- female tendency maybe?
Presentation for TCC
- Pollakiuria, stranguria, dysuria, urinary obstruction (if you treat like a UTI and doesn’t get better, you need to look again)
Biologic behavior of TCC
- Unusual metastasis; it’s possible (30-60%) but generally NOT detected initially and often not the cause of death
- Generally cause signs locally and can cause the death or euthanasia of the animal
Staging TCC
- Thoracic rads
- Abdominal imaging (ultrasound more common these days than contrast cystogram)
- CT (only for radiation)
- Biopsy or cytology
Surgical biopsy or cytology for TCC before treating?
- Ideally, yes!
- Biopsy is great, but often do a urinary catheter and drain or poke
Prognosis for TCC surgery alone (complete resection)
- 12-13 months
- Often can’t do this
Prognosis for TCC: Surgery plus RT intraoperatively
15 months
Prognosis for TCC: NSAID alone
6 months
Prognosis for TCC: variety of chemo drugs possible
Carboplatin, vinblastine, metronomic chemo
- Mitoxantrone
Prognosis for TCC: Chemo PLUS NSAID
12 months
Palliative radiation for TCC
- Effective, but commonly used as a rescue or to un-obstruct
Which thoracic structures can give rise to a tumor?
- Heart and greater vessels
- Trachea and lungs
- Esophagus
- Lymph nodes
- Mesothelium
- Thymus
Most like history for tumors in the thorax
- Labored breathing or cough/dyspnea, tachypnea
- Difficulty swallowing/regurgitation
- Poor blood circulation (low BP, sudden collapse)
- Paraneoplastic association of hypertrophic osteopathy
Signalment for tumors in the thorax
- various, usually older animal
- May be from a smoking household
Diagnosis and staging of tumors in the thorax
- Most thoracic problems would be difficult without at least a thoracic radiograph
- Thoracic CT, or cardiac ultrasound, or trans-esophageal ultrasound often needed as well
- Biopsy can be difficult without surgical approach
- Needle aspirates as well can be difficult and ill-advised
Staging for primary lung tumors
- Thoracic rads
- Thoracic CT is very helpful to identify presence of metastasis to other lung lobes or LN
Treatment of primary lung tumors
- Depends on size, type of tumor, and presence or absence of metastasis
- Surgery is usually treatment
- Chemo is minimally effective but Vinorelbine may be better than most drugs
Good prognostic indicators for primary lung tumors
- Adenocarcinoma or papillary carcinoma, low grade tumors
- <5 cm diameter
- Peripheral location
- Negative node, no clinical signs
- Survival ~1-2 years
Bad prognostic indicators for primary lung tumors
- SCC, poorly differentiated tumors, high grade tumors
- > 5cm diameter
- Pleural effusion
- Presence of clinical signs
- Positive nodes
- Evidence of metastasis
