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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
Prognosis for canine tongue SCC with surgery
- 8 months
26
Prognosis for canine tongue SCC with radiation alone
4 months
27
Which chemotherapy for SCC of the tongue?
- Carboplatin is best | - Toceranib + NSAID can be helpful too
28
Nail bed melanoma staging?
- Aspirate local node | - Thoracic imaging
29
Nail bed melanoma treatment
- Surgery | - Melanoma vaccine
30
Prognosis for nail bed melanoma
- Better than oral
31
Squamous cell carcinoma imaging for nail bed tumor
- Aspirate local LN
32
SCC nail bed tumor treatment
-Surgery
33
SCC nail bed tumor prognosis
- Can be cured, but some dogs develop tumors in multiple toes - Black Standard poodles, Giant Schnauzers, Russian terriers
34
Canine oral fibrosarcoma appearance?
- Flat boring mass to proliferative - Can be very boring looking - dfdx would be gingival hyperplasia
35
Signalment for oral fibrosarcoma
- a little younger than melanoma and SCC | - M > F
36
Metastasis of canine oral fibrosarcoma
- Uncommon but depends on grade and age of dog
37
What info from biopsy of a canine oral fibrosarcoma?
- 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
38
Staging for canine oral fibrosarcoma?
- Chest rads (+/- CT) | - CT/Rads (generally more bone involved than appreciated
39
Treatment for canine oral fibrosarcoma: Surgery
- Must have large margins | - 3 cm in dogs and 5 cm in cats
40
Radiation for canine oral fibrosarcoma
- MUST dose higher than 50 Gy or large fraction size (stereotactic radiation)
41
What is best approach for canine oral fibrosarcoma?
- Surgery + Radiation - Still, rarely curative - Median survival is 18 months
42
Epulides - where do they arise?
- Peridontal tissue
43
Which epulides are benign?
- Fibromatous epulis | - Ossifying epulis
44
Which epulides are malignant?
- Acanthomatous ameloblastoma | - Aggressive locally but almost never metastasize
45
Staging for acanthamotous ameloblastoma
- biopsy - Thoracic radiographs - Local radiographs and CT
46
Treatment for acanthomatous ameloblastoma
- SURGERY OR RADIATION
47
Surgery for acanthamotous ameloblastoma
- 90% controlled with small margins
48
Radiation for acanthamotous ameloblastoma
- 85% controlled | - Slight possibility of future malignancy
49
Other types of canine oral tumors
- 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
Feline oral SCC appearance
- Inflamed proliferative mass, or ulcer, or facial distortion
51
What is the most common feline oral tumor?
- SCC
52
Signalment for feline oral SCC?
- 11-12 years
53
Where can cats get oral SCC?
- Anywhere | - Tongue, maxilla, mandible, tonsil, larynx
54
Metastatic potential for feline oral SCC
- Can metastasize beyond lymph nodes, but often late
55
Treatment for feline oral SCC
- Palliative - Surgery alone - Radiation alone - Surgery and radiation
56
Prognosis for feline oral SCC: palliative
- 2 months | - Feeding tubes, buprenorphine, NSAIDs
57
Prognosis for feline oral SCC: surgery alone
- only if small and rostral | - MAY be curative
58
Prognosis for feline oral SCC: radiation alone
- 3-6 months
59
Prognosis for feline oral SCC: surgery and radiation
- a little over a year
60
Prognosis for feline oral SCC: accelerated radiation
~ 6 months
61
Accelerated radiation treatment
- 2x a day, 15 treatments in ~10 days | - +Carboplatin
62
Prognosis for feline oral SCC: TKI
- 2 months
63
Staging feline oral SCC
- Depends on treatment options | - Probably more for surgery alone
64
Oral fibrosarcoma in cats appearance
- Diffuse proliferative tissue | - 2nd most common in cats
65
Signalment of feline oral fibrosarcoma
- ~10 years
66
Biologic behavior of feline oral fibrosarcoma
- Bone involvement common | - Metastasis rare
67
Feline oral fibrosarcoma treatment options
- Surgery | - Radiation
68
Surgery for feline oral fibrosarcoma
- Rarely possible to achieve clean margins
69
Radiation for feline oral fibrosarcoma
- Curative rarely helpful | - Palliative can slow progression/shrink tumor for ~6 months
70
Miscellaneous feline oral tumors
- Melanoma - Mast cell tumors - LSA - Osteosarcoma - Acanthomatous epulis
71
Most common tonsilar tumor in dogs?
- SCC | - Then LSA and metastasis from another oral lesion (e.g. melanoma)
72
Metastatic potential for dog tonsilar SCC
- COMMON | - Can go intra-abdominal
73
Common presentation for a dog with a tonsilar SCC?
- Cervical mass (retropharygneal lymph node that went down the neck)
74
Prognosis for a dog with a tonsilar SCC?
- Surgery + radiation is about 3.5 months | - Chemo likely helpful (cisplatin or carboplatin)
75
Cat tonsilar SCC prognosis and treatment?
- CURABLE with radiation
76
SIgnalment of nasal tumors in dogs
- Slight male predilection | - Median age around 10 years
77
History for nasal tumors in dogs
- Noisy breathing, sneezing, nasal discharge, nasal bleeding - Reverse sneezing - Second hand smoke exposure is big
78
Nasal tumor physical in dogs vs cats
- 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
Biologic behavior for most nasal tumors
- Locally aggressive | - Metastasis as high as 50% at necropsy, but often not losing them to this specifically
80
Nasal tumor types
- 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
Diagnostic appraoch for nasal tumors
- Rule out other causes of nasal bleeding - Diagnosis requires histopathology - imaging PRIOR to biopsy (you will cause the appearance to change)
82
Imaging nasal tumors
- Plain films - CT - MRI
83
Biopsy for nasal tumors
- BE AGGRESSIVE
84
What is best way to biopsy nasal tumors?
- 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
Staging nasal tumors
- CBC/Chem/UA - Chest rads - LN palpation and aspiration - Image tumor (CT/MR)
86
Surgery for nasal tumors
- Survival is the same as with no therapy | - Debulking MAY be helpful with sarcomas
87
Chemotherapy for nasal tumors
Depends on the tumor - In general, Piroxicam or other NSAID works - Carboplatin and piroxicam (or other NSAID) - TKI
88
Chemotherapy for LSA nasal tumor
- standard chemo
89
Chemotherapy for carcinoma nasal tumor
- Cisplatin/Carboplatin will ameliorate signs but may not prolong survival
90
Radiation for nasal tumors
- Curative radiation therapy is the best, but side effects can be severe - Palliative therapy is possible (survive about 6 months)
91
Which nasal tumors are best for curative radiation?
1. Chondrosarcoma (best) 2. Adenocarcinoma 3. Squamous cell carcinoma 4. Undifferentiated carcinomas
92
Signalment for thyroid tumors
- Older dogs | - Boxer, golden retrievers, beagles at increased risk
93
Incidence of thyroid tumors
- Low overall but seems common in the PNW
94
Cause of thyroid tumors
- Radiation? (ingested radiation) - Hypothyroidism (tumors retain TSH receptors) - Huskies may be predisposed
95
How do thyroid tumors present?
- Present for mass in neck in a variety of sites
96
Biologic behavior of thyroid tumors
- 30-50% are benign, but we may not be detecting them | - MOST detectable tumors are malignant tumors
97
Metastatic potential of thyroid tumors
- <40% | - Risk of met is higher in dogs with tumor >5 cm in diameter or with bilateral tumors
98
Where would thyroid tumors met?
- Usually retropharyngeal LN, cranial cervical, mandibular nodes, lungs
99
Functionality of most canine thyroid carcinomas
- Non-functional mostly | - 60% of dogs are euthyroid; 30% are hypothyroid
100
Diagnosis or staging of thyroid tumors
- FNA - Imaging is important (may be better or worse than we think) - Histopath and surgical impression are important (invasiveness, vascular invasion, pleomorphism)
101
Staging for thyroid tumors
- Thoracic radiographs or CT | - Image the tumor
102
Gold standard treatment for thyroid tumors
- SURGERY | - Median survival of mobile thyroid carcinomas with COMPLETE surgical resection is 24-36+ months
103
How many thyroid tumors are removable at presentation?
- Only25-50% are removable at presentation
104
External beam radiation therapy for thyroid tumors
- Median survival 24+ - Palliative treatment has survival of 22 months - Clinically look better, but may be a bit equivocal
105
Radioactive iodine for thyroid tumors
- 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
Other treatments for thyroid carcinomas?
- Long term thyroid supplementation advised to suppress TSH secretion regardless of primary therapy used - Do this even if thyroid levels are normal
107
Conventional chemotherapy and TKI for thyroid carcinoma
- 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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