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CFT II > Exam 1 - GI Neoplasia > Flashcards

Exam 1 - GI Neoplasia Flashcards

1
Q

what is the most common perianal tumor of the dog? second & third most common?

A

perianal adenoma - 75%, benign

anal sac adenocarcinoma - 20%

perianal adenocarcinoma - 5%

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2
Q

what are some uncommon perianal tumors in the dog?

A

mast cell tumors, SCC, & melanoma

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3
Q

why are perianal adenomas most commonly seen in intact males? what do they arise from?

A

they are testosterone dependent tumors that arise from the sebaceous cells in the perianal area

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4
Q

where are perianal ademonas commonly located?

A

superficial hairless skin around perineum

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5
Q

what is the metastasis like in perianal adenocarcinoma? where are the most likely going to met to?

A

reported in up 50% - especially after multiple recurrences

medial iliac lymph nodes

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6
Q

why did we see high rates of metastasis in anal sac adenocarcinomas in the 90s? why do we not see that high of a rate now?

A

rectal exams weren’t a normal part of a physical exam, so metastasis was reported at 60-96% (end stage disease when diagnosed)

we started doing rectal exams

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7
Q

what are some important questions do you need to ask for perianal tumors?

A

patient signalment, location of the mass, slow vs. fast growing mass, painful/ulcerated mass, tenesmus, PU/PD (is calcium playing a role - paraneoplastic syndrome in AGASACA)

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8
Q

why may you see tenesmus in an animal with a perianal tumor?

A

high risk of mets - if you have big lymph nodes, may press on the colon

impacted anal gland on top of tumor, mass blocking the tumor

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9
Q

T/F: spayed female dogs can get perianal adenomas

A

true - rare

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10
Q

are perianal adenocarcinomas common or rare? what do they arise from?

A

rare - sebaceous cells in the perianal region

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11
Q

where are perianal adenomas commonly located?

A

superficial hairless skin around perineum

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12
Q

what do anal sac adenocarcinomas arise from?

A

apocrine sweat gland cells of the anal sacs - usually single mass, rarely bilateral, very locally invasive

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13
Q

T/F: there is no breed or sex predilection for anal sac adenocarcinomas

A

true

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14
Q

what kind of mass do you think this is?

A

perianal adenocarcinoma

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15
Q

what perianal tumor type is associated with hypercalcemia of malignancy? what should stick out in the history as a result?

A

AGASACA - animal will be PU/PD

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16
Q

what is the treatment of choice for perianal adenomas?

A

castration - most tumors will regress over months

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17
Q

what is the prognosis for perianal adenomas?

A

excellent

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18
Q

when is conservative surgical excision indicated for perianal adenomas?

A

ulcerated masses & recurrent masses

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19
Q

what treatment is recommended for large, diffuse lesions of perianal adenomas?

A

allow time for regression to allow for safer surgical excision if necessary

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20
Q

what is the treatment of choice for perianal adenocarcinomas?

A

wide surgical excision & lymph node extirpation of lymph node mets

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21
Q

what staging is indicated for perianal adenocarcinomas?

A

abdomen/pelvis CT or ultrasound

chest rads

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22
Q

when is radiation or chemo used for perianal adenocarcinomas?

A

radiation - post-op setting to prevent recurrence

chemo for inoperable tumors

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23
Q

what is the prognosis for perianal adenocarcinoma?

A

fair to good, <5cm is prognostic

24
Q

what is the biologic behavior of anal sac adenocarcinoma?

A

locally invasive tumor that is typically one-sided

can be small in size with marked metastatic disease

25
Q

what is the most common site of metastasis for anal sac adenocarcinomas?

A

regional lymph nodes - sub iliac

other sites - lungs, liver, spleen, & bone

26
Q

T/F: genitourinary tumors have an increased risk for bone mets

A

true

27
Q

why do we see hypercalcemia of malignancy in AGASACA?

A

in about 25% of cases

PTHrP secreted by the tumor causing hypercalcemia - only clinically evident with bulky disease

28
Q

what are some clinical signs associated with primary AGASACA?

A

scooting, perianal discomfort, & bleeding

29
Q

what are some signs associated with lymph node metastasis in animals with AGASACA?

A

tenesmus & constipation

30
Q

what clinical signs are attributed to hypercalcemia in animals with AGASACA?

A

PU/PD, anorexia, lethargy, & muscle spasms in severe cases

31
Q

what staging is done for a primary tumor of AGASACA?

A

FNA & cytology

32
Q

what staging is done for lymph node metastasis in AGASACA?

A

advanced imaging - abdominal ultrasound or abdominal rads

33
Q

what staging is needed for distant metastasis in AGASACA?

A

chest rads or thoracic CT

34
Q

what staging is needed for an animal with hypercalcemia due to AGASACA?

A

CBC/chem/UA, ionized calcium, & hypercalcemia panel

35
Q

what are the benefits of using a CT for staging?

A

complete regional lymph node evaluation!!!!

surgical planning for primary tumor +/- lymph nodes

radiation planning

good bone detail to evaluate for bony mets

evaluate liver & spleen

36
Q

T/F: stage of disease with AGASACA dictates the treatment & prognosis

A

true

37
Q

what is the treatment indicated for a primary tumor of AGASACA?

A

wide surgical excision - always

but it is an incomplete excision always because it is an anal sac tumor

38
Q

what complications are associated with removed a primary tumor of AGASACA?

A

low risk but fecal incontinence

39
Q

what surgery is recommended for AGASACA is there is lymph node metastasis? what complications are associated with it?

A

lymph node extirpation

complications depend on extent of metastasis - hemorrhage & damage to vital structures

40
Q

what are some acute side effects associated with radiation for AGASACA?

A

moist desquamation

colitis

transient fecal incontinence

41
Q

what are some chronic side effects associated with radiation for AGASACA?

A

chronic colitis, rectal/colonic stricture, & rectal/colonic perforation

42
Q

when is radiation used for a primary tumor of AGASACA?

A

definitive therapy post-op to prevent recurrence, may be used pre-op, & palliative for advanced disease

43
Q

when is radiation used for lymph node metastasis of AGASACA?

A

definitive radiation therapy to treat draining regional lymph nodes (metastatic or prophylactic setting) or palliative for advanced disease

44
Q

why is radiation used for a hypercalcemia associated with AGASACA?

A

may improve the hypercalcemia - use steroids & bisphosphonates concurrently

45
Q

T/F: chemotherapy is generally ineffective for local tumors of AGASACA

A

true

46
Q

when is chemo used for AGASACA?

A

used to address metastatic disease in lymph nodes & distant metastasis

may help improve hypercalcemia - use steroids & bisphosphonates concurrently

47
Q

what cytotoxic chemotherapy is used for AGASACA?

A

mitoxantrone, carboplatin

recommended 1st line chemo especially in an adjuvant microscopic disease setting

48
Q

what targeted chemotherapy is used for AGASACA?

A

palladia (toceranib) - used in gross disease setting

49
Q

T/F: multi-modal therapy for AGASACA improved survival times for ALL stages

A

true

50
Q

what is the MST of AGASACA when surgery, radiation, & chemo are used?

A

> 900 days

51
Q

what characteristics represent early stage AGASACA?

A

<3.2cm & no mets

52
Q

what is the MST for early stage AGASACA using surgery alone? what was seen after?

A

1200 days

30-50% developed recurrence & mets 1-2 years later

53
Q

what is the MST for AGASACA with a large primary tumor & regional lymph node metastasis?

A

surgery - 180 days

hypofractionated RT - 450 days

54
Q

what is the prognosis of AGASACA with distant mets?

A

poor to guarded

slow growing, so better than other tumors

55
Q

______ _________ with routine rectal exams is key for prognosis of AGASACA

A

early detection

56
Q

T/F: cats get perianal adenomas, perianal adenocarcinomas, & anal sac adenocarcinomas

A

false - they don’t get perianal adenomas or perianal adenocarcinomas

57
Q

what perianal tumors do cats get?

A

anal sac adenocarcinomas - RARE

CFT II (28 decks)

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