Exam 1 - Oral & GI Tumors Flashcards
what are the 3 most common oral tumors in dogs?
- malignant melanoma
- squamous cell carcinoma
- fibrosarcoma
what dog breeds are commonly affected by oral tumors?
cocker spaniel, GSD, GSP, weimaraner, goldens, gordon setters, mini poodles, chows, & boxers
what are the most common oral tumors in cats?
- squamous cell carcinomas
- fibrosarcoma
what should you look at during your physical exam for an animal with an oral mass? why do a sedated oral exam?
look at the tonsils, palpate lymph nodes, retropulse the eyes, check nasal airflow, & auscult the lungs
these tumors are painful - get an FNA or biopsy of the mass
for animals with oral tumors, what does their labwork typically look like?
usually normal - may see increased BUN if they are swallowing blood
may see a left shift
why should you do chest radiographs prior to sedating an animal with an oral tumor?
look for mets & avoid atelectasis
why is it important to know what lymph nodes drain what structures for animals presenting with masses?
best diagnostic chance on getting a sample with definitive answers
what is needed for diagnosing & staging oral tumors in small animals?
lymph node aspirates, CT scan
CBC/Chem/UA, chest rads, skull rads, & dental rads
why is a biopsy for histopathology necessary for squamous cell carcinomas?
they are very inflammatory - an FNA won’t give a great sample
histopathology will
what is the most common treatment option for oral tumors? what are the requirements of the procedure?
surgical removal - local tumor is removed & underlying bone is very commonly removed
2 cm margins are needed & any positive lymph nodes are removed
what kind of tumor do you think this is?
malignant melanoma
this dog had mandibular osteosarcoma & got a bilateral rostral mandibulectomy - why?
OSA very commonly crosses midline
what complication is commonly seen after a partial maxillectomy? how is it avoided?
oronasal fistulas
close the hard palate to the skin & place a feeding tube after surgery to prevent chewing & damage during the healing process
what is the biggest complication seen post-op for animals with oral tumors that were surgically removed?
incisional dehiscence!!!!
what complications are commonly seen post-op for animals with oral tumors that were surgically removed?
incisional dehiscence, epistaxis, increased salivation, mandibular drift (may have to file down remaining canine teeth), malocclusion, & difficulty prehending food
malignant melanoma is a disease of dogs with ______ _______ _________
pigmented oral cavities
what breeds commonly are affected by malignant melanoma? what age?
cockers, poodles, chows, & goldens
older dogs - 10-12 years
T/F: 33% of melanoma tumors are amelanotic
true
T/F: malignant melanomas are aggressive both locally & systemically with a metastatic rate > 80%
true
what history & clinical signs are associated with patients with malignant melanoma?
owner noticed a mass
facial deformity, halitosis, blood in saliva, difficulty eating, lymphadenopathy, & exophthalmus
T/F: chemotherapy is effective for treating malignant melanoma
false - not very effective but may help to slow metastasis
why is radiation therapy good for malignant melanoma therapy?
can be used in place of therapy for gross disease - can be used after surgery for incomplete margins
melanoma is very responsive to radiation - need high doses at a low frequency (looks like a palliative protocol but 6x6 protocol is seen as curative)
T/F: there are acute & chronic side effects seen with radiation therapy for treating malignant melanoma
true - side effects will occur only in the radiation field
acute - inflammatory side effects, occur 2-3 weeks after RT, skin changes (sunburn), fatigue, decreased appetite
chronic - fibrosis/permanent, occur ~6 months post RT, fibrosis (scar tissue formation) and decreased ability to heal a wound or bone fracture
what vaccine is available for malignant melanoma?
merial vaccine (conditional approval by the FDA) can use on stage 1-2 tumors that are small & haven’t metastasized
very expensive - based on human tyrosinase vaccine/DNA plasmid vaccine
what are some poor prognostic factors for malignant melanoma in dogs?
tumors > 2cm
tumors in the back of the mouth do worse
evidence of metastasis
recurrence of tumor
T/F: malignant melanoma carries a poor prognosis in dogs even if local control is achieved
true - MST is only 5-10 months
what is the most common malignant tumor in cats & second most common malignant tumor in dogs?
oral squamous cell carcinoma
what are some risk factors for oral SCC in cats?
flea collars, high intake of canned food (especially tuna), & exposure to cigarette smoke
T/F: the more rostral the oral SCC, the lower the metastatic rate
true
what oral SCC locations have a high metastatic rate in dogs?
tonsilar & tongue SCC in dogs, > 70%
T/F: oral SCC in cats are very locally invasive
true
when does metastatic disease occur in oral SCC?
late in the disease process - largely unknown in cats
what history & clinical signs are associated with patients with oral SCC?
owner notices mass in the mouth - halitosis
weight loss, difficulty chewing, facial deformity, bloody saliva, epistaxis, & loss of teeth in the face of minimal dental disease
what is the treatment of choice for oral SCC in cats? what is required?
surgery!!! surgery may be curative if margins are achieved (2cm) techniques & complications are the same as malignant melanomas
cats don’t tolerate oral surgery well for oral SCC, so what should you do?
feeding tube placed for all cats with oral surgery!!!!!
T/F: oral SCC in cats is responsive to radiation therapy
false
when is radiation therapy indicated for a cat with oral SCC?
primary treatment - palliative to alleviate bone pain
adjunct therapy - incomplete surgical margins
many fractions of small doses, place a feeding tube, & be aware of acute & chronic side effects
what chemotherapy is used for oral SCC in cats?
NSAIDS, carboplatin, mitoxanthrone - in combination with RT
what dogs have an excellent to good prognosis for oral SCC?
dogs with small rostral tumors
what are some poor prognostic factors of oral SCC in dogs?
dogs with large or caudally located tumors
dogs with tonsillar or tongue SCC
what is the prognosis for cats with oral SCC?
poor prognosis in general - MST is 4-6 months for palliative care & may get up to 1 year with surgery/radiation
what may be the first sign seen in a dog with tonsillar SCC?
change in their bark
what dogs are commonly affected by oral fibrosarcomas?
large breeds - goldens & labs that are young to middle aged (6-7 years)
T/F: oral fibrosarcomas may appear very benign on histopathology but act very aggressively
true
what is the metastatic rate of oral fibrosarcoma?
~30%
what is the 2nd most common oral tumor in cats & 3rd most common in dogs?
oral fibrosarcoma
what history & clinical signs are associated with patients with oral FSA?
owner may notice a mass - often associated with the soft & hard palate
same other signs as other oral tumors
T/F: metastatic lesions of oral FSA are usually seen in the lungs & lymph nodes first
false - yes to met lesions in lungs but lymph nodes are rarely affected
what is the median survival time for oral FSA in dogs?
surgery alone - ~1 year
surgery + RT - ~ 18-24 months
what is the prognosis of oral FSA in cats?
unknown but likely poor because of their low tolerance for big oral surgeries
what is the overall prognosis for oral FSA in dogs & cats?
guarded
what is the therapy indicated for oral FSA?
aggressive surgery with margins of 3-5cm when possible - but even with good margins, they often reoccur - underlying bone MUST BE REMOVED
radiation therapy - adjuvant therapy for incomplete margins but has severe side effects, can be palliative for gross disease
T/F: gastric cancer in dogs & cats is very rare
true
what animals are affected by gastric cancer?
male dogs - chows & belgian shepherds
gastric carcinoma - 8 years old & leiomyosarcomas - ~15 years olf
what is the most common gastric tumor type in dogs? what is the metastatic rate?
70-80% are carcinomas
high metastatic rate of 70-80%
what is the most common gastric tumor type in cats?
lymphoma is most common with small intestinal involvement
what clinical signs are associated with gastric tumors in dogs & cats?
vomiting, hematemesis, weight loss, & anorexia
what diagnostics are needed for working up a gastric tumor case?
good physical exam with thorough abdominal palpation
CBC, chem, UA - hypoglycemia (intestinal leiomyosarcoma), increased BUN, anemia
chest rads - look for mets
contrast gastrogram
abdominal ultrasound
endoscopy for biopsy in dogs - need to do surgery for leiomyosarcomas & cats to get biopsies
what dog breed is commonly affected by gastric lymphoma?
boxers
what is the medical treatment that can be used for gastric lymphoma in boxers?
chemotherapy
how is surgery used for treating gastric tumors?
tumor is often on the lesser curvature of the stomach, need to look at the vascular supply, do surgery in debilitated patients, & if leiomyosarcoma, you can shell it out
what gastric cancer type in cats has a good prognosis?
small cell lymphoma
what is the prognosis for malignant gastric tumors?
poor - MST <6 months
large cell lymphoma, early metastasis of carcinomas, & know that gastric mast cell tumors met early!!!
what is the most common intestinal tumor in dogs? what about cats?
dogs - adenocarcinoma/lymphoma affecting older male large breed dogs
cats - mostly lymphoma, older males/siamese breeds, no retroviral association
what intestinal tumor type is most common in the colon? what about the small intestines? what about the cecum?
colon - adenocarcinoma
small intestines - lymphoma
cecum - leiomyosarcoma or GIST
what locations are adenomatous polyps commonly seen in dogs & cats?
colon of dogs
small intestines of cats
what clinical signs are associated with intestinal tumors?
weight loss, diarrhea, vomiting, anorexia, melena, anemia, & hypoglycemia
what is seen on CBC/chem/UA for an animal with an intestinal tumor?
cbc - anemia, leukocytosis
chem - hypoproteinemia, increased BUN, increased liver values, hyperglycemia, & hypoglycemia
what is required in your physical exam for diagnosing a dog with an intestinal tumor?
thorough abdominal palpation feeling for a mass
rectal exam
feel for thickened intestines
what diagnostic imaging is indicated for diagnosing & staging an intestinal tumor?
chest rads - look at lungs for mets, evaluate lymph nodes, & look for malignant effusion
abdominal rads - plain & contrast
abdominal ultrasound
endoscopy/laparoscopy/exploratory - get a biopsy
how is surgery used to treat intestinal tumors?
used to alleviate many symptoms but 30-50% do metastasize
need to remove any suspicious lymph nodes or metastatic lesions
remove 5-10cm on either side of the lesion to decrease the chances of dehiscence - MCT need largest margins!!!!
or endoscopic removal of polyps
when is chemotherapy appropriate for treating intestinal tumors? what is the protocol?
appropriate for lymphoma
small cell lymphoma - chlorambucil
large cell lymphoma - CHOP
adjuvant after surgery for MCT (VBL & pred), carboplatin/doxorubicin or 5-FU for carcinomas in dogs only, & piroxicam for rectal polyps in dogs
T/F: with leiomyosarcomas, perforation is not a negative prognostic factor
true
for non-lymphoid intestinal tumors, what is a poor prognostic factor?
metastasis at diagnosis of tumor
what is the best predictive prognostic factor for cats with lymphoid intestinal tumors?
response to treatment!!
T/F: immunophenotype of lymphoid tumors in dogs & cats doesn’t play a role in prognosis
true
what is the MST of small intestinal adenocarcinomas?
with no surgery - MST is 2 weeks
with surgery - 115 days before recurrence or mets
what is the MST of large intestinal adenocarcinoma?
with surgery, MST 20 months
what are some poor prognostic factors of intestinal tumors?
extensive lesions with many adhesions
metastasis at diagnosis
carcinamatosis
what is the prognosis/MST of a cat with solid small intestinal tumors?
15 months after surgery if they survive - immediate perioperative risk
what is the prognosis/MST of a cat with solid tumors in the large intestine?
3-6 months with surgery
what is the prognosis/MST of a cat with large cell gi lymphoma?
4-6 months with therapy
what is the prognosis/MST of a cat with small cell gi lymphoma?
18-24 months with therapy
