Exam 4 - Tumors of the Urinary System

Question 1

what is the most common type of human bladder cancer? what are the 2 distinctions of this type?

Answer 1

TCC

invasive - involves deep layers of the bladder

non-invasive - involves only the transitional epithelium

most humans will have lower levels - will go to a doctor quicker

Question 2

what is the occurrence of metastasis of dogs with urinary bladder tumors at the time of diagnosis? what is important to consider about this causing mortality?

Answer 2

relatively low at the time

16% nodal metastasis

14% distant metastasis

at time of death, 50% had distant mets

most patients met their end due to local disease - not metastatic disease

Question 3

where are canine bladder tumors most commonly located?

Answer 3

trigone region

56% have urethral involvement
29% have prostate involvement

Question 4

what is the most common bladder tumor that occurs in canines? what are some others that have been reported?

Answer 4

urothelial cell carcinoma - intermediate to high grade papillary infiltrative tumors (most all higher grades)

others - SCC, adenocarcinoma, rhabdomyosarcoma, lymphoma, & hemangiosarcoma

Question 5

what is the TNM for staging bladder cancer?

Answer 5

T - primary tumor

N - regional LN

M - distant metastasis

Question 6

what does TisNoMo mean for staging bladder cancer?

Answer 6

Tis - carcinoma in situ

No - no regional lymph node involvement

Mo - no evidence of metastasis

Question 7

what does ToN1M1 mean for staging bladder cancer?

Answer 7

To - no evidence of primary tumor

N1 - regional lymph node involvement

M1 - evidence of distant metastasis

Question 8

what does N2 mean for staging bladder cancer?

Answer 8

regional lymph node & juxtaregional lymph node involvement

Question 9

what does T2 mean for staging bladder cancer?

Answer 9

tumor is invading the bladder wall

Question 10

what does T3 mean for staging bladder cancer?

Answer 10

tumor is invading neighboring organs

Question 11

T/F: 78% of dogs have T2 tumors at diagnosis & 20% have T3 tumors at diagnosis of bladder cancer

Answer 11

true

Question 12

what breeds are at risk for bladder cancer?

Answer 12

scottish terrier - 18x the risk compared to all other breeds

shelties & beagles - 4.5x the risk

Question 13

what are some known risk factors for bladder cancer in dogs?

Answer 13

exposure to older generation flea control products

lawn chemicals

obesity

cyclophosphamide exposure - chemo/metronomic long term

sex (female > male, neutered > entire rest of population) - male dogs pee on more things so less time for carcinogens to hang out in the bladder

Question 14

what did the study on herbicide exposure & risk of transitional cell carcinomas in scottish terriers find?

Answer 14

significantly higher risk in dogs that were exposed to lawn herbicides alone or herbicides & insecticides

dogs that ate veggies at least 3x a week had a reduced risk

very weak data lol

Question 15

what are the common clinical signs seen with bladder cancer?

Answer 15

hematuria, dysuria, pollakiuria, & stranguria

Question 16

what should be done when working up a patient for bladder cancer?

Answer 16

physical exam

cbc, chem, ua - free catch or catheter

staging - thoracic rads/abdominal ultrasound

Question 17

T/F: it is okay to do cystocentesis for collecting urine in a dog with suspected bladder cancer

Answer 17

nope - avoid this

Question 18

what are some differentials you should have for bladder cancer?

Answer 18

other neoplasia

chronic cystitis/polypoid cystitis

fibroepithelial polyps

granulomatous cystitis

calculi

Question 19

how may you get histopathology for diagnosing bladder cancer in dogs?

Answer 19

cystotomy, cystoscopy, or traumatic catheterization (rare)

avoid surgical biopsy (high risk of seeding!!!)

Question 20

why do you need to do further diagnostics if you see neoplastic cells in a urine sample from a dog you believe has UCC?

Answer 20

these are indistinguishable from reactive epithelial cells associated with inflammation!!!

Question 21

what is the CADET BRAF urine test? why is it helpful?

Answer 21

DNA based diagnostic test that is able to detect the presence of the BRAF gene in malignant cells shed into the urine of tumor bearing dogs!

90-95% of dogs that have UCC have the BRAF mutation gene - the mutation is not found in the urine of healthy dogs or dogs with other non-UCC forms of bladder disease!!

Question 22

what would you run a CADET BRAF test on?

Answer 22

voided urine sample!!!

Question 23

what are the advantages of using a CADET BRAF urine test?

Answer 23

convenient, non-invasive option that is very sensitive - diagnosis in > 95% of cases with bladder & prostate cancer

afforable, $220

robust test that is highly specific

Question 24

how is cystoscopy used to diagnose bladder cancer?

Answer 24

biopsy is done via transurethral cystoscopy & cystotomy for diagnosing TCC in the bladder & urethra - may not get diagnostic samples

diagnostic sample obtained in 96% of female dogs & 65% of male dogs - females have a larger urethra, so easier for them

in poorly differentiated carcinomas, uroplakin III may be helpful in distinguishing TCC from other carcinomas (expressed in > 90% of cases)

Question 25

what are the disadvantages of using ultrasound for diagnosing bladder cancer in dogs?

Answer 25

measurements of bladder tumors are affected by the changes in operator of the ultrasound & bladder volume this is significant enough to change response criteria!!! use CT instead preferably

Question 26

what are some indications for surgical treatment of bladder cancer?

Answer 26

need to obtain a tissue diagnosis - your last resort!! removal of the mass from the bladder if not affecting the trigone!! maintaining or restoring urine flow!!!

Question 27

T/F: field carcinogenesis limits the beneficial effect of surgery in dogs with bladder cancer

Answer 27

true

Question 28

what are the major risks of surgery for a patient with bladder cancer?

Answer 28

without strict surgical oncology principles, the risk for seeding the disease in the abdominal cavity & abdominal wall is very high

Question 29

what is the median survival time for patients receiving surgery as treatment for bladder cancer?

Answer 29

57 days

Question 30

T/F: patients undergoing cystotomy with bladder cancer are significantly more likely to have abdominal wall metastasis

Answer 30

true

Question 31

what are the complications associated with urethral stenting as a treatment for bladder cancer?

Answer 31

incontinence (30% of cases) re-obstruction stent migration

Question 32

what is the median survival time for patients receiving non-surgical urethral stenting as treatment for bladder cancer?

Answer 32

78 days addition of chemo following stent placement increased MST to 250 days

Question 33

when may you use urethral stenting in a dog with bladder cancer? what is the advantage of using this approach?

Answer 33

indicated in dogs with urethral obstruction resolution of the obstruction can be achieved in approximately 98% of cases

Question 34

what is the median survival time for patients receiving non-surgical palliative ultrasound guided endoscopic diode laser ablation as treatment for bladder cancer?

Answer 34

MST 360 days - a lot of animals in this study developed resistant UTIs

Question 35

what complications are seen with palliative ultrasound guided endoscopic diode laser ablation as treatment for bladder cancer?

Answer 35

stranguria, hematuria, stenosis, spread of tumor into urethra, urethral perforation, bacterial cystitis (50%, 36% resistant UTI)

Question 36

what medical therapy may be used for treating bladder cancer in dogs?

Answer 36

single agent COX inhibitor - piroxicam & deracoxib, want a COX2 inhibitor (piroxicam may be too hard on the gi tract with chemo) chemotherapy - using it to try & slow down & stop tumor growth, not to shrink it mitoxantrone & piroxicam cisplatin carboplatin

Question 37

what clinical signs are seen in cats with bladder tumors?

Answer 37

hematuria, stranguria, pollakiuria, & concurrent UTI

Question 38

what is the median age of diagnosis of cats with bladder tumors? what was the median survival time at diagnosis?

Answer 38

15.4 years MST 261 days rarely treat them other than symptomatically because of so many comorbidities - likely slowly progressive in cats

Question 39

what is the most common primary renal tumor in dogs?

Answer 39

renal cell carcinoma - 50-60% of all primary tumors others - hemangiosarcoma, nephroblastoma, TCC, sarcoma, & lymphoma (often bilateral)

Question 40

T/F: primary tumors are more common in the kidneys than tumors that metastasize from other locations

Answer 40

false - mets are more common

Question 41

what are the characteristics of canine renal tumors in german shepherds?

Answer 41

inherited disorders - legs covered in fibrotic dermal lesions, if you see this, check their kidneys!!! dermal fibrosis & fibromas renal cyst adenocarcinoma

Question 42

why do we see renal tumors more commonly in german shepherds?

Answer 42

dominantly inherited missense mutation in a tumor suppressor gene - FLCN (folliculin) similar to birt-hogg-dube syndrome in humans

Question 43

what clinical signs are seen with canine renal tumors?

Answer 43

usually non-specific - anorexia, weight loss, polyuria, lethargy, hematuria, & back pain

Question 44

what clinical staging is indicated for renal tumors in dogs?

Answer 44

cbc, chem, ua - look for anemia or polycythemia thoracic rads - look for mets abdominal ultrasound/ct - ct preferred over ultrasound gfr via scintigraphy

Question 45

what treatment is typically indicated for canine renal tumors? what was the median survival time with this treatment?

Answer 45

nephrectomy 16 months

Question 46

what is the most common prostate tumor? what is their origin? what breeds are predisposed?

Answer 46

carcinomas most common - adenocarcinoma & TCC urothelial or ductal in origin - androgen independent (humans acinar origin & androgen dependent!) scottish terriers shetland sheepdogs

Question 47

T/F: castrated dogs may be at an increased risk of prostatic tumors & metastasis

Answer 47

true

Question 48

what are some common clinical signs associated with prostatic tumors in dogs?

Answer 48

prostatomegaly, hematuria, dysuria, stranguria, dyschezia, tenesmus, & bacteriuria severe bone pain & pathological factors prostate will feel very irregular

Question 49

what are some differentials you should consider for prostatic tumors?

Answer 49

BPH prostatic & paraprostatic cysts prostatitis other prostatic neoplasia

Question 50

how are prostate tumors characterized in dogs?

Answer 50

time of diagnosis characterized by local invasion with high propensity for regional & distant metastasis

Question 51

what staging is indicated for prostate tumors in dogs?

Answer 51

physical exam - enlarged on rectal exam, large, firm, irregular, asymmetrical, +/- painful prostate cbc, chem, ua thoracic rads abdominal ultrasound advanced imaging - ct scans

Question 52

what are your diagnostic options for prostatic masses in dogs?

Answer 52

ejaculation, traumatic catheterization, prostatic massage, prostatic wash, ultrasound guided FNA/cytology, surgical biopsy, & CADET BRAF urine test

Question 53

what are your options for local treatment of prostate tumors? why do we not recommend removal of the prostate?

Answer 53

electrosurgical transurethral resection - rapid palliation but side effects limit clinical application (short survival times) incorporation of radiation therapy!!!! piggy back them with tyrosine kinase inhibitors too many risks to the point that dogs that did survive had a much lower quality of life

Question 54

T/F: bladder cancer in humans is associated with smoking

Answer 54

true

Question 55

T/F: in intact dogs, or dogs that were castrated later in life, it can be normal to have mineralization of the prostate

Answer 55

true - not necessarily indicative of cancer in these cases