Chapter 23 - Tumors of the Respiratory System Flashcards
In which spp is cancer of the nasal planum more common?
Most common type of nasal planum cancer overall?
Cats - common
Dogs - uncommon
SCC
Development of SCC of the nasal planum has been associated with what 2 factors?
UV light exposure and lack of protective pigment; mainly cats in the case of nasal planum SCC
Papillomavirus infection; more common in non-UV induced carcinomas
How are SCC categorized according to their degree of invasiveness?
In situ
Superficial (<2mm deep)
Infiltrative
Nasal planum SCC behavior?
Locally invasive
Rarely metastasizes to the LN in advanced dz and even more rare for it to spread to the lungs
What treatment modality is effective for nasal planum SCC in cats, but not in dogs?
RT
Tx of choice for cats and dogs with invasive nasal planum SCC?
Most common complication in cats?
MST?
Nasal planectomy
Stricture of nasal orifice
Cats MST >22 months; 80% dx free at 1-yr
Dogs MST 1.4- 4.2 yrs
What % of dogs with nasal SCC that undergo nasal planectomy with bilateral labial mucocutaneous rotational flap experience complications?
Most common complications (2)?
What % required revision surgery?
Pulmonary metastatic rate?
73% overall complication rate
50% dehiscence
20% narrowing of nasal orifice
35% revision surgery
18% pulmonary mets at ~1 yr post diagnosis
How common is develpoment of additional SCC lesions after local tx?
Common because of UV changes that cannot be reversed; 33% in one study
Prognosis for nasal planum SCC?
Good as long as local control is achieved
ORR, recurrence rate, and ST in cats with in situ nasal planum SCC in situ when treated with Strontium?
ORR 100%
RR 0%
ST > 3000d
ORR, PR, CR, recurrence rate, PFI, and OST in cats with superficial nasal planum SCC when treated with Strontium?
What % developed new lesions at a different location?
ORR 98% (CR 88%, PR 10%)
RR 20% at median time of 308d only in cats with T1+, but no in situ
ST > 3000d; better for those with a CR vs PR
New lesions 33%
ORR, CR, PR in cats with all degrees of invasive nasal planum SCC when treated with strontium?
ORR 100% (CR 87%, PR 13% )
RR 13% - only in the 2 cats that had a PR which also had T2 dz at 81 and 141d
RT and +/- IL chemotherapy can achieve local control in cats with nasal planum SCC in what %?
60%
ECT with bleomycin in cats with superficial SCC results in a complete response in what %? Duration of response?
82%
2m to >3yrs
Most common canine nasosinal tumors?
2/3 carcinomas (TCC 19%, SCC 12%)
1/3 sarcomas (FSA, chondrosarcoma, OSA, undifferentiated)
Overall metastatic rate of nasosinal tumors at the time of diagnosis and death? Which nasal tumor is most likely to spread?
10 to 25% at diagnosis
40-50% at death
LN most commonly
Carcinoma most commonly associated with mets vs sarcoma
What percentage of nasosinal carcinomas over-express COX-2 in dogs (range)?
70-95%
VEGF, EGFR, PDGFRa, and PDGFRB expression in nasal carcinomas in dogs?
Which one has been shown to be phosphorylated and potentially activated?
VEGFR 85-90% - mostly cytoplasmic-membranous
EGFR 50%
PDGFRa 70% - cytoplasmic
PDGFRb 40% - cytoplasmic
EGFR hyperphosphorylated in 63%
Most common clinical signs in dogs with nasosinal tumors?
Others?
What clinical signs could make you be more concerned about neoplasia vs non-neoplasia?
Unilateral epistaxis and/or mucopurulent discharge of 2 to 3 months duration
Other: facial deformity, sneezing, unwillingness to open mouth, dyspnea or stertorous breathing, exophthalmos, ocular discharge (due to mechanical obstruction of nasolacrimal duct)
Facial deformity, stridor -> cancer
Systemic clinical signs -> non-neoplastic (bleeding disorders, hypertension, tick-borne dz, bacterial infection)
What clinical sign in dogs with nasosinal dz is significantly noted to be more common with neoplasia, foreign bodies, and nasal mycosis?
What about with cancer specifically?
Pure or mixed hemorrhagic discharge
Stridor, facial deformity (can happen with fungal and angiomatous proliferation too)
What can be performed in cases of uncontrolled hemorrhage after nasal samples are obtained?
Ipsilateral carotid artery ligation
What staging system for dogs with nasosinal neoplasia have been associated with prognostic significance when RT is used?
Adams
Modified Adams
Describe the modified Adams staging system
Stage I - confined to one nasal passage, paranasal sinus, or frontal sinus, with NO bone involvement beyond turbinates
Stage II - ANY bone involvement beyond turbinates, BUT NO evidence of orbit/subcutaneous/submucosal mass
Stage III - involvement of orbit and/or nasopharyngeal, subcutaneous, or submucosal mass
Stage IV - cribriform plate lysis
How has the modified Adams’ staging system been associated with prognosis in dogs with nasosinal tumors that are treated with RT?
Dogs with stage IV dz based on CT images have shorter DFI and ST when treated with definitive RT
What is the MST and DFI of dogs with stage I vs stage 2 dz when treated with definitive RT?
Stage I - MST 2 yrs, DFS 6.5m
Stage IV - MST 7m, DFS 4m
Which staging system is the least clinically relevant in dogs or cats with nasosinal tumors?
WHO staging system
What paraneoplastic syndromes have been rarely associated with nasal tumors in dogs (2)?
Erythrocytosis
Hypercalcemia
What is the overall MST of dogs with untreated nasal carcinomas?
3m (95d)
What is the MST in dogs with untreated nasal carcinoma that have epistaxis vs in dogs w/o?
Epistaxis - 3m (88d)
Without - 7.5m (224d)
What is the MST in dogs with nasal tumors treated with surgery alone?
What is the problem with this tx modality?
MST 3 to 6 months
Does not significantly improve ST compared to no treatment and is associated with high morbidity
What is the MST of dogs with nasal tumors when tx with definitive RT alone?
1-yr and 2-yr survival rates?
What % of carcinomas experience tumor volume reduction compared to sarcomas?
7 to 20 months
1-yr survival rate 40-70%
2-yr survival rate 10-45%
Carcinomas - 70%
Sarcomas - 20%
What is the MST of dogs with nasal tumors tx with a combination of 1) surgery followed by RT and 2) RT followed by sx?
What is the problem with these combination?
7 to 13m - sx followed by RT; does not improve ST vs RT alone
47m - RT followed by sx; improved ST but increased incidence of late effects including rhinitis, fistula, osteomyelitis (high morbidity)
What RT boost technique were recently published in dogs with nasal tumors when treated with IMRT with the goal of administering a higher dose and decreasing side effects and what was the outcome?
Boost technique: GTV receives a higher dose while maintaining same CTV
Ocular changes were negligible
33% developed VRTOG grade 3 mucositis
Late AE not evaluated
Median PFI and ST not reached
What is the MST in dogs with nasal tumors when treated with palliative RT?
What % of dogs have improvement of clinical signs?
Median duration of response?
MST 5 to 10months
65-100% improvement of CS
Duration of response: 4 to 10m
What are some identified positive (2) and negative (5) prognostic factors in dogs with nasal tumors when tx with palliative RT?
Positive for complete resolution of CS:
- Adams stage I dz
- CS present for >90d
Negative PF:
- CS present for <90 days prior to dx associated with higher risk of relapse
- Adams stage IV dz - MST ~4.8m
- Age of <10yrs
- Non-dolichocephalic breeds
- Dyspnea
What are some acute SE from definitive RT and how long do they take to resolve?
Oral mucositis, KCS, blepharitis, rhinitis, skin desquamation
Within 2-8 weeks after tx
What are some late SE from definitive RT?
When do they usually develop?
Cataracts, corneal keratitis, corneal atrophy, KCS, uveitis, retinal hemorrhage and degeneration, neuronal tissue SE (brain necrosis causing neuro changes or seizures, optic nerve degeneration), skin fibrosis.
Months to years after therapy; irreversible
What arethe most common and clinically relevant late effects in dogs with nasal tumors treated with RT?
Ocular changes - usually occur 6 to 9 months after RT
KCS, cataract formation, blindness
What radiation tx modality has resulted in bilateral ocular sparing in dogs tx for nasal tumors? Any change in ST?
IMRT; same ST but less SE
Is there a difference in survival time between dogs with carcinoma and nasal sarcomas when treated with RT?
Not really, usually the same and many papers don’t demonstrate a survival difference
What is the overall MST and PFS in dogs with nasal tumors when treated with SRT (3 papers)?
MST specifically for carcinoma, sarcoma, and OSA?
Overall MST 8.5- 19.5m
PFS 1yr
Carcinoma - 10.4m
Sarcoma - 10.7m
OSA - 3.1m
What is the overall response or clinical response rate in dogs with nasal tumors when treated with SRT?
95-100%
What % of dogs with nasal tumors treated with SRT develop acute and late side effects?
What % of dogs are euthanized due to late AE?
Acute 23-32%
Late 17-40%; highest with SRS single fraction
7% mortality rate
What is the 1 and 2 yr SR in dogs with nasal tumors treated with SRT?
1 yr - 70%
2 yr 40%
In dogs with nasal tumors treated with SRS, what has been associated with increased acute AE?
GTV > 50cm3
When gemcitabine is used as a radiosensitizer in dogs and cats with nasosinal carcinoma that are treated with RT, what % requires dose reductions?
Cats 50%
Dogs 80%
Neutropenia or local acute tissue damage
Advantage of IMRT for nasal tumors?
- Allows for an dose to tumor while sparing normal tissues
- Reduced RT morbidity
- Decreased dose delivered to eyes and late effects
- Highly conformal compared to others
- Could result in improved tumor control
What % of dogs with nasal tumors that are re-irradiated respond to therapy?
MST after 2nd RT course?
70-88%
MST 6m
Responde duration 80d
What is the ORR and MST in dogs with nasal tumors treated with cisplatin alone?
ORR 30% (1 CR)
MST 5 months
ORR, MST, and resolution of clinical signs in dogs with advanced nasal tumors when treated with doxorubicin, carboplatin, and piroxicam based on CT images?
75% ORR (4 CR, 2PR, 2 SD)
MST 7m
All experienced resolution of clinical signs
When all treatments fail to control epistaxis, unilateral or bilateral carotid artery ligation can result in palliation of CS for ___ months or longer without damage to the brain.
3 months
What prognostic factors have been identified in dogs with nasal tumors (6)?
Negative: >10yrs epistaxis duration of clinical signs (<90d) stage/stage IV dz metastasis histologic type (anaplastic CA, undifferentiated CA, SCC) failure to achieve resolution of CS
What is the overall MST in dogs with nasal sarcomas when treated with RT?
MST for OSA, CSA, FSA?
Does RT protocol impact survival?
Overall 15m (444d) OSA 21m (624d) CSA 15m (463d) FSA 13m (379d) Undifferentiated 11m (344d)
Curative intent RT > palliative (21m vs 10m)
Daily fractionation > M, W, F (21m vs 12m)
Nasosinal tumors in cats are malignant in ___% of cases.General behavior?
> 90%
Locally agressive and low metastatic rate
What are the 1st and 2nd most common nasal tumor in cats?
#1 lymphoma #2 carcinoma
When comparing histopathology and cytology samples from cats with nasosinal masses, what is the % of agreement between them?
Exception to this?
90% agreement
Lymphoma; can be hard to differentiate from lymphoid inflammation
What is the MST of cats with non-lymphomatous nasal tumors when treated with RT?
~12m
What % of cats with nasal tumors have regional lymphadenopathy and metastasis to LN?
17% lymphadenopathy
0% mets
In cats with nasal lymphoma, ___% are classified as immunoblastic.
___% are B-cell, ___% are T-cell, and ___% are mixed.
91% immunoblastic
40-70% B-cell
20-47% T-cell1
2% mix
What % of cats with nasal lymphoma have systemic involvement at the time of death and therefore can fail local therapy?
13-16%
Overall MST in cats with nasal lymphoma when treated with multiple therapy modalities?
6m
MST and ORR of cats with nasal lymphoma when treated with chemo, RT alone vs RT + chemo?
Chemo alone - ORR 70-93%, MST 4 to 4.5m
RT alone - ORR 93%, MST 15m
RT + chemo - ORR 82%, MST 6m to 2.6yrs
Positive (2) and negative (4) prognostic indicators in cats with nasal lymphoma?
Positive:
- Achievement of CR - MST 1.5-2 yrs
- RT dose >32 Gy - MST 2.5yr vs 6m
Negative:
- Anemia
- BW of <4 kg
- RT dose <32 Gy
- Cribriform plate lysis
MST of cats with nasal lymphoma vs carcinoma w/o therapy?
LSA - 1m or <
CA - 100d
What patients are at risk for development of benign osteocartilaginous tumors?
What are these composed of and where do they arise from?
Young px with active osteochondral ossification sites
Tumors that grow from the cartilaginous rings and are composed of cancellous bone capped by cartilage; they grow at the same speed as the rest of the skeleton
May reflect a malfunction of osteogenesis rather than true cancer and are benign
Young px also at risk of oncocytoma development
Young patientsare at risk for developing what two benign tumors of the trachea and larynx?
Trachea - osteocartilaginous tumors
Larynx - oncocytomas
Most common tracheal tumor in dogs and cats?
Dogs - osteochondroma
Cats - lymphoma and carcinoma (SCC, ACA)
What are oncocytes?
Epithelial cellscharacterized by an excessive number of mitochondria, resulting in an abundant acidophilic and granular cytoplasm.
Can be benign or malignant
What are rhabdomyomas?
Benign tumor of skeletal muscle
Can be large, minimally invasive, and do not metastasize
How can rhabdomyomas be differentiated from oncocytomas?
Transmission electron microscopy and IHC
Appear the same with light microscopy
What breed of dogs may be predisposed to developing laryngeal and tracheal tumors?
Arctic breeds; 27% were Alaskan malamutes or Siberian Huskies in one study
Up to what % of the tracheal length and # of rings can be removed successfully? has been removed with successful closure?
50% of length experimentally
3-4 rings
In a study of 27 cats with a variety of laryngeal and tracheal lesions, what was the MST and what % of cats was alive at 1 year?
5 days
7%
Most common malignant laryngeal tumor in dogs and cats?
Dogs - carcinoma
Cats - lymphoma
Which laryngeal or tracheal tumor can commonly present with mineralization?
Canine osteochondroma
Median DFI of feline B-cell tracheal lymphoma case report when treated with surgical excision and chemotherapy?
20m
Most common primary lung tumor in dogs and cats? Humans?
Dogs - bronchoalveolar carcinoma 85%
Cats - adenocarcinoma 60-70%
Humans - small cell carcinoma 25% and non-small cell 85%
Pulmonary tumors most commonly originate from epithelium from which 2 locations?
Airway - near hilus/large airways
Alveolar parenchyma - near periphery
Experimentally, lung cancer has been linked to what in dogs?
Smoking
What is the local and distant metastatic rate in dogs with pulmonary carcinoma?
Local - 70%
Distant - 25%
What are the two most aggressive types of pulmonary carcinomas in dogs and what is their metastatic rate?
Anaplastic carcinoma >90%
SCC >50%
What is the metastatic rate in cats with pulmonary carcinoma?
What % of cats develop LN, intrathoracic, and distant metastasis?
What % of cats with digital carcinoma have metastasis from a primary pulmonary carcinoma?
Overall 75%
LN 30%
Intrathoracic 30%
Extrathoracic 15%
88%
What % of primary lung tumors in dogs are diagnosed incidentally on asymptomatic px?
30%
What isthe most common clinical signin dogs with primary lung tumors?
1 coughing; 50-90%
What PNS can be seen in dogs with pulmonary carcinoma and what % of dogs have it?
Hypertrophic osteopathy - 4%
Radiographic signs: periosteal new bone formation; lameness can improve w/x for tumor removal
Pulmonary neoplasia is the most common cause of HO
What is the most common clinical sign un cats with primary pulmonary carcinoma?
1 dyspnea; 25-65%
What % of cats presenting fordigital carcinoma have a primary lung carcinoma?
Most common clinical sign in these cases?
How can you confirm pulmonary metastasis on a digital lesion?
88%
Lameness; they DONT usually present for respiratory signs
IHC with TTF-1 and the presence of ciliated epithelial cells (thyroid transcription factor 1)
MST of cats with lung-digit syndrome? MST with digit amputation alone?
1 month
67d
Amputation not recommended as it can occur in other digits
What % of cats with pulmonary carcinoma have pleural effusion and pulmonary thrombosis?
30% - pleural effusion
12% - pulmonary thrombosis
Up to what % of dogs with pulmonary carcinoma have a single lung lobe affected vs multiple lobes?
55% single lung lobe
13-40% multiple lung lobes
Clinical signs in dogs with pulmonary carcinoma do not appear until the tumor reaches what size?
3cm
What % of cats with pulmonary carcinoma have bilateral dz in the lungs?
40%
Mineralization of the tumor can be seen in what % of dogs with pulmonary carcinoma undergoing a CT?
15%
uncommon in cats
What is the accuracy of CT and thoracic xrays for determination of tracheobronchial lymph node abnormalities in dogs with pulmonary carcinoma?
CT 90%
X-rays 60%
What % of dogs with solitary tumors on xrays have evidence of metastatic nodules on CT?
What % of metastatic lung nodules on CT are also noted on x-rays?
CT isable to detect pulmonary nodules down to approximately ___ in sizevs thoracic radiographs, which requiresa size of ___ for detection.
36%
9%
CT - 1mm
Xrays - 7 to 9mm
FNA cytology results yield a diagnosis in what % of dogs and cats with pulmonary carcinoma?
Dogs - 40 to 90%
Cats - 80 to 100%
What markers can be useful when trying to differentiate a poorly differentiated carcinoma of lung origin vs metastasis in dogs (3)?
TTF-1: absent in 35% of PCA, expressed in both PCA and TCA
Napsin-A: involved in surfactant production; expressed in 90% of PCA, 60% of TCA, and 60% of renal CA
Surfactant protein A (SP-A): MOST sensitive; expressed in 97% of PCA, in normal pulmonary epithelial cells and alveolar macs, but absent from ALL non-pulmonary tissue
Other common markers: cytokeratin, vimentin, CD 18
What % of cats with lung carcinoma have evidence of metastatic nodules on CT?
30-50%
What are the surgical approaches for lung lobectomies?
What approach is required for removal of lesions in multiple lobes?
What approach is associated with higher morbidity?
Lateral (intercostal) thoracotomy and median sternotomy
Median sternotomy needed for multiple
Median sternotomy - more likely to have increased fluid production from chest tube, hypoxia, prolonged hospital stay
In dogs and cats treated with pneumonectomy, what % survived to hospital discharge?
Dogs - 94%
Cats - 86%
Respiratory function was immediately acceptable post-op
Hilar LN biopsy is easier to perform with what surgical apprach?
Lateral thoracotomy
Standard of care chemotherapy drug used in the adjuvant or palliative setting in humans?
Cisplatin-based protocols
What chemotherapy drugs have been used with limited success in dogs with pulmonary carcinoma?
Doxorubicin, mitoxantrone, vindesine, cisplatin, vinorelbine
What chemotherapy drug, when given IV, is known to accumulate in the lungs at 300 times the concentration found in plasma?
Vinorelbine
Vinorelbine ORR and median time to progression in dogs with pulmonary carcinoma??
9-19-28%
TTP 2m
Response in 2 dogs with PCA tx with vindesine vs with vindesine + cisplatin>
Vindesine - minimal responses
Vindesine + cisplatin - >50% reduction in size in 2 dogs
ORR for carbo and gemcitabine in dogs with PCA?
0%
13% for other carcinomas
What is the TTP and MST in dogs with advanced pulmonary carcinoma when treated with sx vs metronomic chemotherapy with CTX, thalidomide and piroxicam vs no therapy?
Metronomic chemotherapy:
TTP 5.7m
MST 4.6m
Surgery:
TTP 3m
MST 3m
No therapy:
TTP 20d
MST 2m
Significantly longer TTP and MST with MC vs sx and MTD groups
In a phase I label of solid tumors and palladia, 1 dog had stable dz for > than ___ weeks.
10 weeks
What chemo drugs/other things have been used intracavitary for malignant pleural effusions in dogs with carcinomatosis, sarcomatosis, and mesothelioma? MST vs untreated dogs?
Cisplatin, carboplatin, mitoxantrone, talc
MST 11m vs 25d
Prognostic factors in dogs with pulmonary carcinoma (8)?
CS at diagnosis Tumor size >100cm3 TNM stage (>T1N0M0) LN involvement Involvement of entire lung lobe Gross dz post-operatively Histologic type Histologic grade
Prognostic factors in cats with pulmonary carcinoma (8)?
Clinical signs at diagnosis TNM stage (>T1N0M0) LN enlargement Pulmonary metastasis Histologic type Histologic grade Degree of differentiation Pleural effusion
MST in dogs treated with sx w/clinical signs at dx vs w/o?
w/o 18m
w/cs 8m
Also shorter DFI
MST in dogs treated with sx that are free of macroscopic dz vs in those with macroscopic dz or a higher stage?
11m w/o gross dz
1m w/gross dz
MST in dogs with T1, T2, T3, N0, and N1 pulmonary carcinoma when tx with surgery?
T1 (solitary) - 26m T2 (multiple) - 7m T3 (invasive into adjacent tissue) - 3m N0 - 15m N1 - 1 to 4m
MST in dogs with pulmonary ACA vs SCC vs papillary adenocarcinoma when treated with sx?
Papillary - 18.5m
ACA - 19m
SCC - 8m
All other tumor types 2.4m
MST of well, moderately, and poorly differentiated PCA in dogs tx with sx?
Well - 26m (grade I)
Moderately - 8.3 (grade II)
Poorly - 5d (grade III)
What are the most common laboratory abnormalities in dogs withCPLG (2)?
Basophilia and leukocytosis
What are the most common chest xray findingsin dogs withCPLG (3)?
Lung lobe consolidation
Large pulmonary granulomas
Tracheobronchial LN enlargement
How is a definitive diagnosis obtained in px with CPLG?
Biopsy; FNA/cytology unrewarding
What are some histopathologic characteristics of CPLG?
Angiocentric and angiodestructive infiltration of the pulmonary parenchyma by large lymphoreticular and plasmacytoid cells, in addition to normal-appearing lymphocytes, eosinophils, and plasma cellsThe infiltrate is typically centered around small to medium arteries and veins
Of 5 dogs with CPLG treated with a COP-based protocol, what was the outcome?
60% had a CR, rest progressed
CR dogs alive at 7, 12, and 32 months
PD dogs had either worsening of CS or progressed to lymphoid leukemia within 2 months
Breeds predisposed to develop pulmonary histiocytic sarcoma?
Pembrook Welsh Corgis, Min Schnauzers
What % of dogs with localized HS have the pulmonary form?
31%
What is the overall PFI and MST of dogs with pulmonary HS?
PFS 7m
MST 4.5-8m
What is the PFS and MST of dogs with pulmonary HS treated with CCNU chemo alone?
PFS 3m
MST 4m
What is the PFS and MST of dog with pulmonary HS treated with surgery and CCNU?
PFS 9m
MST 12.5m
What prognostic factors in dogs with pulmonary HS negatively affect PFI and MST?
Clinical signs - PFS only
Intrathoracic mets - PFS & MST
Lack of sx
ORR of dogs with pulmonary HS to chemotherapy?
44%
Palladia clinical benefit in dogs with nasal carcinoma?
71%
What is the MST in dogs with intermediate to high grade nasal LSA when treated with RT and chemo vs chemo alone? Overall? Most common immunophenotype?
Overall 12.5m
RT + chemo - 15m
chemo alone - 5m
B-cell
MST between groups not statistically significant
MST in dogs with low grade nasal LSA when treated with RT and chemo?
2.3yrs
MST of dogs with nasal MCT when treated with RT and chemotherapy?
1 to 4.5m
What is the MST in dogs with pulmonary Ca with no therapy?
<1m - 2m
MST in cats with pulmonary carcinoma when treated with sx?
4-5m
MST of cats with PCA treated with sx with or w/o clinical signs?
W/o 19m
W/cs 4d
Especially dyspnea*
MST of cats with PCA w/o vs w/pleural effusion?
W/o 16m
With 2d
MST of cats with PCA with vs w/o LN enlargement?
LN enlargement 2m
W/o 17m
MST of cats with PCA with pulmonary metastasis vs w/o?
Mets 3m
No mets 11
MST of cats with PCA with T1N0M0 vs any other stage?
T1N0M0 6m
Any other 3d
MST of cats with ACA vs cystic ACA vs minimally invasive ACA?
ACA - 3m
Cystic ACA - 4m
Minimally invasive ACA - not reached
Metastatic rate of pulmonary HS in dogs?
46% intrathoracic
16% pulmonary
Other locations: LN, kidneys, liver, CNS
What % of cats with primary lung tumor tx with surgery die from metastatic dz?
86%
MST of cats with well, moderately, and poorly differentiated PCA?
Well- 68d
Moderately- 3d
Poorly- 6d