Cancer of the Head and Neck Flashcards
Incidence of head and neck tumors
- Significant part of tumors of the dog and cat
Lymph nodes of the head and neck (know where they are?
- Lateral retropharyngeal
- Parotid
- Mandibular
- Medial retropharyngeal
- Superficial cervical or prescapular
History of oral tumors
- Discharge or odor, lack of appetite
- Rarely a mass
- On PE will find an oral mass
Diagnostics for oral tumors
- 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)
Melanoma appearance
- Fleshy and friable mass, often black
- MAY be amelanotic so don’t be fooled
What is the most common type of canine oral tumor?
- Melanoma (30-40%)
Signalment for canine melanoma
- Around 12 years
- Male predominance possible
- Average age 2 years
Behavior of canine oral melanoma
- HIGH probability of metastasis
Staging or oral melanoma
- 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)
Prognosis for oral melanoma with surgery
- 7-9 month survival
Prognosis for oral melanoma with radiation
- Palliative (large fractions)
- 8 months to 1 year
Chemotherapy for oral melanoma
- Carboplatin (works in about 20% of dogs)
- Metronomic chemo/NSAIDs (may help with regulation of Treg cells)
Immunotherapy for oral melanoma
- Best when primary disease is controlled
- Merial melanoma vaccine
- Cimetidine
- Metronomic chemotherapy
Squamous cell carcinoma appearance
- Ulcerated inflamed mass due to keratin
How common is SCC in dogs?
- about 20-30% in dogs
Signalment for oral SCC in dogs?
- 9-10 years (older)
Predilection site for oral SCC
- Rostral mandible
Diagnosis of oral SCC
- Cytology can be diagnostic, but biopsy better
- Not usually graded
Metastasis with canine oral SCC
- UNCOMMON, unless tonsil or tongue
- MOSTLY worried about lymph nodes
Staging for oral SCC
- Thoracic radiographs
- MR/CT/Radiographs
- May need imaging to ID LN as well
Treatment options for canine oral SCC?
- Surgery
- Radiation
When to do surgery for canine oral SCC?
- Small, superficial, rostral (mandible)
When to do radiation for canine oral SCC?
- Small, superficial, and rostral
- About 50/50% cured
- Occasionally need surgery and radiation
SCC of the tongue metastatic rate?
~50% will metastasize to LN, lung, and brain
Prognosis for canine tongue SCC with surgery
- 8 months
Prognosis for canine tongue SCC with radiation alone
4 months
Which chemotherapy for SCC of the tongue?
- Carboplatin is best
- Toceranib + NSAID can be helpful too
Nail bed melanoma staging?
- Aspirate local node
- Thoracic imaging
Nail bed melanoma treatment
- Surgery
- Melanoma vaccine
Prognosis for nail bed melanoma
- Better than oral
Squamous cell carcinoma imaging for nail bed tumor
- Aspirate local LN
SCC nail bed tumor treatment
-Surgery
SCC nail bed tumor prognosis
- Can be cured, but some dogs develop tumors in multiple toes
- Black Standard poodles, Giant Schnauzers, Russian terriers
Canine oral fibrosarcoma appearance?
- Flat boring mass to proliferative
- Can be very boring looking
- dfdx would be gingival hyperplasia
Signalment for oral fibrosarcoma
- a little younger than melanoma and SCC
- M > F
Metastasis of canine oral fibrosarcoma
- Uncommon but depends on grade and age of dog
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
Staging for canine oral fibrosarcoma?
- Chest rads (+/- CT)
- CT/Rads (generally more bone involved than appreciated
Treatment for canine oral fibrosarcoma: Surgery
- Must have large margins
- 3 cm in dogs and 5 cm in cats
Radiation for canine oral fibrosarcoma
- MUST dose higher than 50 Gy or large fraction size (stereotactic radiation)
What is best approach for canine oral fibrosarcoma?
- Surgery + Radiation
- Still, rarely curative
- Median survival is 18 months
Epulides - where do they arise?
- Peridontal tissue
Which epulides are benign?
- Fibromatous epulis
- Ossifying epulis
Which epulides are malignant?
- Acanthomatous ameloblastoma
- Aggressive locally but almost never metastasize
Staging for acanthamotous ameloblastoma
- biopsy
- Thoracic radiographs
- Local radiographs and CT
Treatment for acanthomatous ameloblastoma
- SURGERY OR RADIATION
Surgery for acanthamotous ameloblastoma
- 90% controlled with small margins
Radiation for acanthamotous ameloblastoma
- 85% controlled
- Slight possibility of future malignancy
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
Feline oral SCC appearance
- Inflamed proliferative mass, or ulcer, or facial distortion
What is the most common feline oral tumor?
- SCC
Signalment for feline oral SCC?
- 11-12 years
Where can cats get oral SCC?
- Anywhere
- Tongue, maxilla, mandible, tonsil, larynx
Metastatic potential for feline oral SCC
- Can metastasize beyond lymph nodes, but often late
Treatment for feline oral SCC
- Palliative
- Surgery alone
- Radiation alone
- Surgery and radiation
Prognosis for feline oral SCC: palliative
- 2 months
- Feeding tubes, buprenorphine, NSAIDs
Prognosis for feline oral SCC: surgery alone
- only if small and rostral
- MAY be curative
Prognosis for feline oral SCC: radiation alone
- 3-6 months
Prognosis for feline oral SCC: surgery and radiation
- a little over a year
Prognosis for feline oral SCC: accelerated radiation
~ 6 months
Accelerated radiation treatment
- 2x a day, 15 treatments in ~10 days
- +Carboplatin
Prognosis for feline oral SCC: TKI
- 2 months
Staging feline oral SCC
- Depends on treatment options
- Probably more for surgery alone
Oral fibrosarcoma in cats appearance
- Diffuse proliferative tissue
- 2nd most common in cats
Signalment of feline oral fibrosarcoma
- ~10 years
Biologic behavior of feline oral fibrosarcoma
- Bone involvement common
- Metastasis rare
Feline oral fibrosarcoma treatment options
- Surgery
- Radiation
Surgery for feline oral fibrosarcoma
- Rarely possible to achieve clean margins
Radiation for feline oral fibrosarcoma
- Curative rarely helpful
- Palliative can slow progression/shrink tumor for ~6 months
Miscellaneous feline oral tumors
- Melanoma
- Mast cell tumors
- LSA
- Osteosarcoma
- Acanthomatous epulis
Most common tonsilar tumor in dogs?
- SCC
- Then LSA and metastasis from another oral lesion (e.g. melanoma)
Metastatic potential for dog tonsilar SCC
- COMMON
- Can go intra-abdominal
Common presentation for a dog with a tonsilar SCC?
- Cervical mass (retropharygneal lymph node that went down the neck)
Prognosis for a dog with a tonsilar SCC?
- Surgery + radiation is about 3.5 months
- Chemo likely helpful (cisplatin or carboplatin)
Cat tonsilar SCC prognosis and treatment?
- CURABLE with radiation
SIgnalment of nasal tumors in dogs
- Slight male predilection
- Median age around 10 years
History for nasal tumors in dogs
- Noisy breathing, sneezing, nasal discharge, nasal bleeding
- Reverse sneezing
- Second hand smoke exposure is big
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
Biologic behavior for most nasal tumors
- Locally aggressive
- Metastasis as high as 50% at necropsy, but often not losing them to this specifically
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)
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)
Imaging nasal tumors
- Plain films
- CT
- MRI
Biopsy for nasal tumors
- BE AGGRESSIVE
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
Staging nasal tumors
- CBC/Chem/UA
- Chest rads
- LN palpation and aspiration
- Image tumor (CT/MR)
Surgery for nasal tumors
- Survival is the same as with no therapy
- Debulking MAY be helpful with sarcomas
Chemotherapy for nasal tumors
Depends on the tumor
- In general, Piroxicam or other NSAID works
- Carboplatin and piroxicam (or other NSAID)
- TKI
Chemotherapy for LSA nasal tumor
- standard chemo
Chemotherapy for carcinoma nasal tumor
- Cisplatin/Carboplatin will ameliorate signs but may not prolong survival
Radiation for nasal tumors
- Curative radiation therapy is the best, but side effects can be severe
- Palliative therapy is possible (survive about 6 months)
Which nasal tumors are best for curative radiation?
- Chondrosarcoma (best)
- Adenocarcinoma
- Squamous cell carcinoma
- Undifferentiated carcinomas
Signalment for thyroid tumors
- Older dogs
- Boxer, golden retrievers, beagles at increased risk
Incidence of thyroid tumors
- Low overall but seems common in the PNW
Cause of thyroid tumors
- Radiation? (ingested radiation)
- Hypothyroidism (tumors retain TSH receptors)
- Huskies may be predisposed
How do thyroid tumors present?
- Present for mass in neck in a variety of sites
Biologic behavior of thyroid tumors
- 30-50% are benign, but we may not be detecting them
- MOST detectable tumors are malignant tumors
Metastatic potential of thyroid tumors
- <40%
- Risk of met is higher in dogs with tumor >5 cm in diameter or with bilateral tumors
Where would thyroid tumors met?
- Usually retropharyngeal LN, cranial cervical, mandibular nodes, lungs
Functionality of most canine thyroid carcinomas
- Non-functional mostly
- 60% of dogs are euthyroid; 30% are hypothyroid
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)
Staging for thyroid tumors
- Thoracic radiographs or CT
- Image the tumor
Gold standard treatment for thyroid tumors
- SURGERY
- Median survival of mobile thyroid carcinomas with COMPLETE surgical resection is 24-36+ months
How many thyroid tumors are removable at presentation?
- Only25-50% are removable at presentation
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
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)
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
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)
