Caesarean, Mammary and Other Reproductive Surgery Flashcards
What kind of ovarian tumours occur in the cat and dog? Which individuals are most likely to be affected?
- Rare, in both dogs and cats
- Infrequency might be because many individuals undergo neutering at a young age
- Affected individuals are most frequently older, nulliparous individuals, although teratoma will often occur in younger individuals
What clinical signs are associated to tumours of the ovary? How are they diagnosed? How are they treated?
Clinical signs
* Pyometra
* Abnormal oestrus
* Vaginal discharge
* Secondary sex organ change
* Lumbar pain
* Presence of an abdominal mass
* Enlarged abdomen (presence of effusion and/or mass)
* Lethargy
* Weight gain or weight loss
Diagnosis
* Physical examination
* Blood samples
* Imaging techniques
* radiography
* ultrasonography
* computed tomography
* Cytology
* Biopsy
* Often, an incidental finding at the time of OE or OHE
Treatment
* Surgery
* OE or OHE
* +/- chemotherapy
What kind of tumours occur in the uterus and cervix? Which individuals are most likely to be affected? How are they diagnosed and treated?
- Rare, in both dogs and cats
- Infrequency might be because many individuals undergo neutering at a young age
- In the bitch, benign tumours occur with greatest frequency
- In the queen, although very uncommon, malignant tumours are more frequent
Diagnosis
- same as ovarian tumours
Treatment
- surgical OHE or hysterectomy in neutered individuals
What kind of vaginal and vulval tumours occur in the cat and dog? WHich individuals are most likely to be affected? How are they treated?
- Excluding mammary tumours, vaginal, vestibular and vulval tumours are the most common tumours of the reproductive tract in the bitch
- Tumours of these sites are seen in queens
- Benign mesenchymal tumours, such as leiomyoma, affect entire, aged bitches
- Majority of tumours are seen in nulliparous individuals
- Benign smooth muscle tumours account for approximately 80-90% of vaginal and vulval tumours reported in bitches
- The growth of many of these benign smooth muscle tumours is associated with the ovarian secretion of oestrogen
- The most common malignant tumour of the vagina and vulva is the leiomyosarcoma
- Transmissible venereal tumour (TVT) is seen more commonly in females than in males
- Tumours of the vulval labia can be associated with any form of cutaneous tumour, particularly squamous cell carcinoma (SCC) and mast cell tumours (MCT)
Treatment
Often need to do an episiotomy to open vagina
Will do OHE or ovarioectomy at the same time
What tumour types are possible in the testicle? What individuals are more likely to be affected? How are they treated?
- Common in the male dog
- Usually seen in dogs older than 10-years-old
- Earlier in cryptorchid animals (20-fold increased risk)
- Three common types seen are; interstitial cell tumour, seminoma and Sertoli cell tumour
- Rarely seen in the tom cat (related to elective castration)
Treatment
* Treatment consists primarily of orchiectomy (castration)
* Closed rather than open (for clean margin of excision)
* Cryptorchid cases might prove more difficult dependant on where the testicle is situated
* Often, will prove curative
* Feminisation signs might take 6-weeks or more to resolve
What signs are associated to sertoli cell tumours and sometimes seminomas?
Will often produce excess oestrogen, causing the development of feminization syndrome
* Bilaterally symmetrical alopecia
* Attractiveness to male dogs
* Pendulous prepuce
* Gynaecomastia (mammary enlargement, nipple enlargement)
* Atrophy of affected testicle
* Myelosuppresion (anaemia, neutropenia and thrombocytopenia)
What tumour types affect the penis? What individuals are most likley to be affected?
- Tumours of the penis are, in general, rare in both the dog and cat
- However, TVT is recognised as a relatively common condition in certain parts of the world
- Apart from TVT, the majority of penile tumours occur in the older dog
- Where TVT is not endemic, squamous cell carcinoma (SCC) is the most common tumour of the penis in the dog
- The prepuce may be affected by any type of skin tumour
- Tumours commonly associated with this structure include MCTs, melanomas, etc.
What clinical signs are associated to penile tumours? How are they treated?
Related to local tissue irritation, infection and bleeding:
* Licking of prepuce and penis
* Haemorrhagic and/or purulent discharge from the prepuce
* Haematuria (may be frank blood at the beginning or end of micturition)
* Dysuria
* Increased frequency of urination
* Phimosis
* Paraphimosis (occasionally)
The presence of the tumour will often become apparent only when the penis is extruded from the prepuce
Treatment
Penile amputation - scrotal urethrostomy
* TVT (histiocytic tumour) can be treated using either chemotherapy or radiotherapy
* Metastasis, although reported, is considered unusual
* Prognosis is excellent in the majority of individuals
Which individuals are most effected by mammary tumours? How are they treated? What is the prognosis?
- Common in female dogs, but rare in male dogs and cats
- Of dogs, poodles, dachshunds, and spaniels are most affected
- In cats, Siamese or other Oriental breeds and domestic short hairs are most often affected
- In dogs, obesity at a young age is a risk factor
Risk
* Mammary tumours are morecommon in female dogs that are either not neutered or were neutered after 2 years of age
* Risk of a dog developing a mammary tumour is 0.05% if neutered before their first heat (approximately 6 months of age), 8% after their 1st heat, and 26% after their 2nd heat, no effect if neutered after 3rd season
* Cats spayed before 6 months of age have a 7-times reduced risk of developing mammary cancer
* Neutering before 1st oestrus reduces lifetime risk by 91% in cats
* Neutering at any age reduces the risk of mammary tumoursby 40% to 60% in cats
Treatment
* Surgical excision recommended for most cases (chemotherapy may be required following surgery in some cases)
* The type of surgery depends on the size, location, and number of mammary tumours and species
* In general, surgery is more conservative for dogs with mammary tumours and involves removal of either the mass alone or the affected mammary gland
* However, in cats, more aggressive surgery is recommended with removal of one or preferably both sets of mammary glands
* Surgery to remove both sets of mammary glands from a cat is often performed in two surgical procedures 2–3 weeks apart
* The local lymph node should also be removed in cats, if possible, to assess for evidence of spread of the cancer
* The role of neutering female dogs with mammary tumours is controversial. Most studies have shown no beneficial effect of neutering at the time of tumour removal in preventing the development of new mammary tumours, or influencing the aggressiveness or metastatic potential of existing mammary tumours
* The role of chemotherapy in cats and dogs with malignant mammary tumours has not been clearly defined for all tumour types
* For most mammary tumours in cats and dogs, hormonal therapy, immunotherapy, and radiation therapy have either not been investigated or are not beneficial
Prognosis
* Prognosis often very good following surgery in bitches, but prognosis worse for certain types of tumour in dogs and all mammary tumours in cats
What clinical signs are associated with mammary tumours? How are they diagnosed?
Clinical signs
* A palpable mass underneath the skin of the abdomen or near a nipple is the most common findings in dogs and cats with mammary tumours
* However, other signs and symptoms include discharge from a mammary gland, ulceration of the skin over a gland, painful, swollen breasts, loss of appetite, weight loss, and generalised weakness
Diagnosis
* A good general physical exam is needed to find the location, size, and character of all the mammary masses and assess local lymph node enlargement
* Other procedures are performed to stage the cancer (determine what type it is and where it is located in the body):
* Full haematology and biochemistries, urinalysis, +/- clotting profile
* Abdominal ultrasound, chest radiographs / CT scans - used to check for metastatic cancer
* FNA and cytology - Lymph nodes may also be assessed to look for a spread of cancer cell
* Biopsy may be indicated to rule out an inflammatory mammary carcinoma (surgery is generally not indicated for this tumour type)
What mammary tumour type is not treated through removal?
- Surgery is not recommended for dogs with inflammatory mammary carcinomabecause it does not improve survival rate
- Unfortunately, an effective treatment has not been discovered
- Radiation therapy in combination with a non-steroidal anti-inflammatory drug has been shown to provide the most effective pain relief in dogs, but the prognosis remains poor
Where should you open for a caesarian and perform the surgery? How should you close a hysterotomy?
Incision and procedure
* Make the incision at the bifurcation of the horns. Not too deep so as to not nick the foetus.
* Cut into the amniotic sac or take amniotic sac out in full
- clamp and cut cord
- take out placenta
- revive puppy
Closure
* 3/0 or 4/0 monofilament absorbable
* Taperpoint or tapercut needle
* Single-layer continuous pattern
or
* Double-layer continuous pattern (simple continuous appositional inner layer and continuous inverting outer layer (Cushing, Lembert or Utrecht pattern)
* Suture should engage submucous but not penetrate the lumen
