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Oncology > Cancer of the Head and Neck > Flashcards

Cancer of the Head and Neck Flashcards

1
Q

Incidence of head and neck tumors

A
  • Significant part of tumors of the dog and cat
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2
Q

Lymph nodes of the head and neck (know where they are?

A
  • Lateral retropharyngeal
  • Parotid
  • Mandibular
  • Medial retropharyngeal
  • Superficial cervical or prescapular
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3
Q

History of oral tumors

A
  • Discharge or odor, lack of appetite
  • Rarely a mass
  • On PE will find an oral mass
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4
Q

Diagnostics for oral tumors

A
  • Biopsy/cytology (may go straight to biopsy if you need to anesthetize)
  • LN aspiration
  • Chest rads (always)
  • Tumor imaging (radiographic evidence of lysis requires that 40% of bone is gone)
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5
Q

Melanoma appearance

A
  • Fleshy and friable mass, often black

- MAY be amelanotic so don’t be fooled

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6
Q

What is the most common type of canine oral tumor?

A
  • Melanoma (30-40%)
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7
Q

Signalment for canine melanoma

A
  • Around 12 years
  • Male predominance possible
  • Average age 2 years
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8
Q

Behavior of canine oral melanoma

A
  • HIGH probability of metastasis
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9
Q

Staging or oral melanoma

A
  • Chest rads (>10% positive at time of diagnosis)
  • LN aspiration or biopsy (>10% positive at time of diagnosis)
  • Biopsy (tough with amelanotic melanoma)
  • Tumor imaging (for surgery and radiation it’s important)
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10
Q

Prognosis for oral melanoma with surgery

A
  • 7-9 month survival
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11
Q

Prognosis for oral melanoma with radiation

A
  • Palliative (large fractions)

- 8 months to 1 year

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12
Q

Chemotherapy for oral melanoma

A
  • Carboplatin (works in about 20% of dogs)

- Metronomic chemo/NSAIDs (may help with regulation of Treg cells)

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13
Q

Immunotherapy for oral melanoma

A
  • Best when primary disease is controlled
  • Merial melanoma vaccine
  • Cimetidine
  • Metronomic chemotherapy
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14
Q

Squamous cell carcinoma appearance

A
  • Ulcerated inflamed mass due to keratin
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15
Q

How common is SCC in dogs?

A
  • about 20-30% in dogs
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16
Q

Signalment for oral SCC in dogs?

A
  • 9-10 years (older)
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17
Q

Predilection site for oral SCC

A
  • Rostral mandible
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18
Q

Diagnosis of oral SCC

A
  • Cytology can be diagnostic, but biopsy better

- Not usually graded

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19
Q

Metastasis with canine oral SCC

A
  • UNCOMMON, unless tonsil or tongue

- MOSTLY worried about lymph nodes

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20
Q

Staging for oral SCC

A
  • Thoracic radiographs
  • MR/CT/Radiographs
  • May need imaging to ID LN as well
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21
Q

Treatment options for canine oral SCC?

A
  • Surgery

- Radiation

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22
Q

When to do surgery for canine oral SCC?

A
  • Small, superficial, rostral (mandible)
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23
Q

When to do radiation for canine oral SCC?

A
  • Small, superficial, and rostral
  • About 50/50% cured
  • Occasionally need surgery and radiation
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24
Q

SCC of the tongue metastatic rate?

A

~50% will metastasize to LN, lung, and brain

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25
Q

Prognosis for canine tongue SCC with surgery

A
  • 8 months
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26
Q

Prognosis for canine tongue SCC with radiation alone

A

4 months

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27
Q

Which chemotherapy for SCC of the tongue?

A
  • Carboplatin is best

- Toceranib + NSAID can be helpful too

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28
Q

Nail bed melanoma staging?

A
  • Aspirate local node

- Thoracic imaging

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29
Q

Nail bed melanoma treatment

A
  • Surgery

- Melanoma vaccine

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30
Q

Prognosis for nail bed melanoma

A
  • Better than oral
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31
Q

Squamous cell carcinoma imaging for nail bed tumor

A
  • Aspirate local LN
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32
Q

SCC nail bed tumor treatment

A

-Surgery

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33
Q

SCC nail bed tumor prognosis

A
  • Can be cured, but some dogs develop tumors in multiple toes
  • Black Standard poodles, Giant Schnauzers, Russian terriers
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34
Q

Canine oral fibrosarcoma appearance?

A
  • Flat boring mass to proliferative
  • Can be very boring looking
  • dfdx would be gingival hyperplasia
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35
Q

Signalment for oral fibrosarcoma

A
  • a little younger than melanoma and SCC

- M > F

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36
Q

Metastasis of canine oral fibrosarcoma

A
  • Uncommon but depends on grade and age of dog
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37
Q

What info from biopsy of a canine oral fibrosarcoma?

A
  • Grade, invasiveness, bone involvement
  • High biologic grade with low pathologic grade (look low grade but are high grade)
  • MAY come back as granulation tissue but still be horrible
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38
Q

Staging for canine oral fibrosarcoma?

A
  • Chest rads (+/- CT)

- CT/Rads (generally more bone involved than appreciated

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39
Q

Treatment for canine oral fibrosarcoma: Surgery

A
  • Must have large margins

- 3 cm in dogs and 5 cm in cats

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40
Q

Radiation for canine oral fibrosarcoma

A
  • MUST dose higher than 50 Gy or large fraction size (stereotactic radiation)
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41
Q

What is best approach for canine oral fibrosarcoma?

A
  • Surgery + Radiation
  • Still, rarely curative
  • Median survival is 18 months
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42
Q

Epulides - where do they arise?

A
  • Peridontal tissue
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43
Q

Which epulides are benign?

A
  • Fibromatous epulis

- Ossifying epulis

44
Q

Which epulides are malignant?

A
  • Acanthomatous ameloblastoma

- Aggressive locally but almost never metastasize

45
Q

Staging for acanthamotous ameloblastoma

A
  • biopsy
  • Thoracic radiographs
  • Local radiographs and CT
46
Q

Treatment for acanthomatous ameloblastoma

A
  • SURGERY OR RADIATION
47
Q

Surgery for acanthamotous ameloblastoma

A
  • 90% controlled with small margins
48
Q

Radiation for acanthamotous ameloblastoma

A
  • 85% controlled

- Slight possibility of future malignancy

49
Q

Other types of canine oral tumors

A
  • Lots
  • Osteosarcoma
  • Hemangiosarcoma
  • Plasma cell tumors
  • Lymphoma
  • Mast cell tumors
  • Transmissible Venereal Tumors
  • These will behave similarly in the oral cavity as they do elsewhere
50
Q

Feline oral SCC appearance

A
  • Inflamed proliferative mass, or ulcer, or facial distortion
51
Q

What is the most common feline oral tumor?

A
  • SCC
52
Q

Signalment for feline oral SCC?

A
  • 11-12 years
53
Q

Where can cats get oral SCC?

A
  • Anywhere

- Tongue, maxilla, mandible, tonsil, larynx

54
Q

Metastatic potential for feline oral SCC

A
  • Can metastasize beyond lymph nodes, but often late
55
Q

Treatment for feline oral SCC

A
  • Palliative
  • Surgery alone
  • Radiation alone
  • Surgery and radiation
56
Q

Prognosis for feline oral SCC: palliative

A
  • 2 months

- Feeding tubes, buprenorphine, NSAIDs

57
Q

Prognosis for feline oral SCC: surgery alone

A
  • only if small and rostral

- MAY be curative

58
Q

Prognosis for feline oral SCC: radiation alone

A
  • 3-6 months
59
Q

Prognosis for feline oral SCC: surgery and radiation

A
  • a little over a year
60
Q

Prognosis for feline oral SCC: accelerated radiation

A

~ 6 months

61
Q

Accelerated radiation treatment

A
  • 2x a day, 15 treatments in ~10 days

- +Carboplatin

62
Q

Prognosis for feline oral SCC: TKI

A
  • 2 months
63
Q

Staging feline oral SCC

A
  • Depends on treatment options

- Probably more for surgery alone

64
Q

Oral fibrosarcoma in cats appearance

A
  • Diffuse proliferative tissue

- 2nd most common in cats

65
Q

Signalment of feline oral fibrosarcoma

A
  • ~10 years
66
Q

Biologic behavior of feline oral fibrosarcoma

A
  • Bone involvement common

- Metastasis rare

67
Q

Feline oral fibrosarcoma treatment options

A
  • Surgery

- Radiation

68
Q

Surgery for feline oral fibrosarcoma

A
  • Rarely possible to achieve clean margins
69
Q

Radiation for feline oral fibrosarcoma

A
  • Curative rarely helpful

- Palliative can slow progression/shrink tumor for ~6 months

70
Q

Miscellaneous feline oral tumors

A
  • Melanoma
  • Mast cell tumors
  • LSA
  • Osteosarcoma
  • Acanthomatous epulis
71
Q

Most common tonsilar tumor in dogs?

A
  • SCC

- Then LSA and metastasis from another oral lesion (e.g. melanoma)

72
Q

Metastatic potential for dog tonsilar SCC

A
  • COMMON

- Can go intra-abdominal

73
Q

Common presentation for a dog with a tonsilar SCC?

A
  • Cervical mass (retropharygneal lymph node that went down the neck)
74
Q

Prognosis for a dog with a tonsilar SCC?

A
  • Surgery + radiation is about 3.5 months

- Chemo likely helpful (cisplatin or carboplatin)

75
Q

Cat tonsilar SCC prognosis and treatment?

A
  • CURABLE with radiation
76
Q

SIgnalment of nasal tumors in dogs

A
  • Slight male predilection

- Median age around 10 years

77
Q

History for nasal tumors in dogs

A
  • Noisy breathing, sneezing, nasal discharge, nasal bleeding
  • Reverse sneezing
  • Second hand smoke exposure is big
78
Q

Nasal tumor physical in dogs vs cats

A
  • In dogs, often can’t find anything outwardly apparent (try to retropulse eyes; rule out other options for nasal discharge and/or bleeding)
  • Cats have deformed faces
79
Q

Biologic behavior for most nasal tumors

A
  • Locally aggressive

- Metastasis as high as 50% at necropsy, but often not losing them to this specifically

80
Q

Nasal tumor types

A
  • 2/3 carcinoma (adenocarcinoma, squamous cell carcinoma, TCC)
  • Sarcomas less often (chondrosarcoma, osteosarcoma)
  • Lymphosarcoma and others (rare in dogs)
  • Anaplastic tumors (highly invasive and metastatic in general)
81
Q

Diagnostic appraoch for nasal tumors

A
  • Rule out other causes of nasal bleeding
  • Diagnosis requires histopathology
  • imaging PRIOR to biopsy (you will cause the appearance to change)
82
Q

Imaging nasal tumors

A
  • Plain films
  • CT
  • MRI
83
Q

Biopsy for nasal tumors

A
  • BE AGGRESSIVE
84
Q

What is best way to biopsy nasal tumors?

A
  • blind trans-nasal core biopsy is best (straw or catheter guard works well)
  • Nasal flushing, brushing, or aspiration cytology rarely diagnostic
  • Biopsy with visualization is tough
  • Surgical biopsy may be necessary
85
Q

Staging nasal tumors

A
  • CBC/Chem/UA
  • Chest rads
  • LN palpation and aspiration
  • Image tumor (CT/MR)
86
Q

Surgery for nasal tumors

A
  • Survival is the same as with no therapy

- Debulking MAY be helpful with sarcomas

87
Q

Chemotherapy for nasal tumors

A

Depends on the tumor

  • In general, Piroxicam or other NSAID works
  • Carboplatin and piroxicam (or other NSAID)
  • TKI
88
Q

Chemotherapy for LSA nasal tumor

A
  • standard chemo
89
Q

Chemotherapy for carcinoma nasal tumor

A
  • Cisplatin/Carboplatin will ameliorate signs but may not prolong survival
90
Q

Radiation for nasal tumors

A
  • Curative radiation therapy is the best, but side effects can be severe
  • Palliative therapy is possible (survive about 6 months)
91
Q

Which nasal tumors are best for curative radiation?

A
  1. Chondrosarcoma (best)
  2. Adenocarcinoma
  3. Squamous cell carcinoma
  4. Undifferentiated carcinomas
92
Q

Signalment for thyroid tumors

A
  • Older dogs

- Boxer, golden retrievers, beagles at increased risk

93
Q

Incidence of thyroid tumors

A
  • Low overall but seems common in the PNW
94
Q

Cause of thyroid tumors

A
  • Radiation? (ingested radiation)
  • Hypothyroidism (tumors retain TSH receptors)
  • Huskies may be predisposed
95
Q

How do thyroid tumors present?

A
  • Present for mass in neck in a variety of sites
96
Q

Biologic behavior of thyroid tumors

A
  • 30-50% are benign, but we may not be detecting them

- MOST detectable tumors are malignant tumors

97
Q

Metastatic potential of thyroid tumors

A
  • <40%

- Risk of met is higher in dogs with tumor >5 cm in diameter or with bilateral tumors

98
Q

Where would thyroid tumors met?

A
  • Usually retropharyngeal LN, cranial cervical, mandibular nodes, lungs
99
Q

Functionality of most canine thyroid carcinomas

A
  • Non-functional mostly

- 60% of dogs are euthyroid; 30% are hypothyroid

100
Q

Diagnosis or staging of thyroid tumors

A
  • FNA
  • Imaging is important (may be better or worse than we think)
  • Histopath and surgical impression are important (invasiveness, vascular invasion, pleomorphism)
101
Q

Staging for thyroid tumors

A
  • Thoracic radiographs or CT

- Image the tumor

102
Q

Gold standard treatment for thyroid tumors

A
  • SURGERY

- Median survival of mobile thyroid carcinomas with COMPLETE surgical resection is 24-36+ months

103
Q

How many thyroid tumors are removable at presentation?

A
  • Only25-50% are removable at presentation
104
Q

External beam radiation therapy for thyroid tumors

A
  • Median survival 24+
  • Palliative treatment has survival of 22 months
  • Clinically look better, but may be a bit equivocal
105
Q

Radioactive iodine for thyroid tumors

A
  • Median survival 30 months if they take it up
  • Greater likelihood of uptake when tumor is functional
  • With a large dog, this is expensive (and also not as likely to work)
106
Q

Other treatments for thyroid carcinomas?

A
  • Long term thyroid supplementation advised to suppress TSH secretion regardless of primary therapy used
  • Do this even if thyroid levels are normal
107
Q

Conventional chemotherapy and TKI for thyroid carcinoma

A
  • Conventional chemo no likely to work (e.g. doxorubicin, cisplatin, carboplatin, metronomic therapy)
  • TKI do seem to work (toceranib, masitinib)

Oncology (9 decks)

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