Final Exam - Tumors of the Respiratory System Flashcards
what are 3 potential risk factors for dogs developing nasal tumors?
dolichocephalic breeds (collies)
urban environment
exposure to environmental tobacco smoke
what is the most common nasal tumor in dogs? what accounts for the others?
carcinomas - accounts for 2/3 of all intranasal tumors
adenocarcinomas
squamous cell carcinoma & undifferentiated carcinoma
SARCOMAS
T/F: nasal tumors in dogs are locally very aggressive but have a low metastatic rate at the time of diagnosis
true
what is the approximate duration of clinical signs in patients prior to presentation?
2-3 months
what are the clinical signs associated with nasal tumors in dogs?
unilateral epistaxis that progresses to bilateral in later stages +/- mucopurulent discharge
facial deformity
unwillingness to open mouth
sneezing/dyspnea/stertor
exophthalmus/ocular discharge
neuro signs (rare)
T/F: if facial deformity is present, the diagnosis is almost always cancer
true
what is on your differential list for nasal tumors?
fungal/bacterial rhinitis (aspergillus)
idiopathic non-specific rhinitis (lymphoplasmacytic)
nasal parasites
bleeding disorders
hypertension
foreign body/trauma
T/F: detection of a mass is not specific for neoplasia
true
how are nasal tumors diagnosed using imaging?
CT or MRI scan
what may be seen on CT/MRI for an animal with a nasal tumor?
bone destruction, abnormal soft tissue, nasopharyngeal invasion, & patchy areas of increased density within abnormal soft tissue opacity
how are nasal tumors diagnosed definitively?
histopathology - guided rhinoscopy
why is a punch/wedge biopsy not indicated in patients with facial deformity?
radiation
how are nasal tumors staged?
thoracic rads, CT scan, & FNA of both submandibular lymph nodes & others if enlarged (retropharyngeal)
what is stage 1 of a nasal tumor using the modified adams staging?
confined to 1 nasal passage, paranasal sinus, frontal sinus, & no bone involvement beyond turbinates
what is stage 2 of a nasal tumor using the modified adams staging?
any bone involvement beyond turbinates, no evidence of orbit/subcutaneous/submucosal mass
what is stage 3 of a nasal tumor using the modified adams staging?
orbit involved, or nasopharyngeal/subcutaneous/submucosal mass
what is stage 4 of a nasal tumor using the modified adams staging?
tumor causing lysis of the cribiform plate
what are some negative prognostic factors of nasal tumors in dogs?
older than 10, epistaxis, longer duration of clinical signs, advanced local tumor stage, metastatic disease, histologic subtype, & failure to achieve resolution of clinical signs with treatment
what is the treatment of choice for nasal tumors in dogs?
radiation therapy
why is surgery not an option for a nasal tumor?
curative surgery is impossible - significant morbidity without extension of life
what is the median survival time of a nasal tumor treated with radiation therapy? 1 year survival? 2 year survival?
8 to 19,7 months
43-68% - 1 year
11-44% - 2 year
what is the total dose of radiation therapy given for nasal tumors? how many treatments are received?
42 to 54 Gy
treatment delivered in 10 to 18 fractions (3 to 4.2 Gy a fraction)
what is course fractionated radiation therapy used for palliative care for a dog with a nasal tumor?
treatment delivered weekly - improvement in clinical signs reported in 66-100% of dogs
what is the goal of course fractionated radiation therapy used for palliative care in dogs with nasal tumors?
improve the quality of life without aiming to maximize tumor sterilization
what is the median duration of improvement seen with course fractionated radiation therapy used for palliative care in dogs with nasal tumors?
130-300 days
what can be used as supportive care for palliative treatment of nasal tumors in dogs?
unilateral/bilateral carotid artery ligation, NSAIDS< antibiotics, & analgesia
what is the clinical response seen with chemotherapy in dogs with a nasal tumor?
27-75%
what is the median survival time seen with chemotherapy used as palliative care in dogs with nasal tumors?
5 months
what is the most common nasal tumor in cats? what is the 2nd most common?
lymphoma
carcinoma
what is the treatment of choice for non-lymphoproliferative neoplastic nasal tumors in cats?
radiation therapy!!
what is the definitive intent radiation therapy median survival time?
12 months
what is the coarse fractionated palliative radiation therapy median survival time?
13 months
what is the overall response rate for cats treated for nasal pharyngeal lymphoma? what enhances overall survival?
70-90%
inclusion of radiation therapy
what is the combined survival time for treatment of nasal pharyngeal lymphoma?
6-30 months
what are the risk factors for pulmonary neoplasia in dogs & cats?
urban living/2nd hand smoke
inhalation of polluted air - anthracosis
experimental exposure to plutonium
dogs trained to smoke cigarettes in the presence or absence of asbestos exposure
what is the pathology of pulmonary neoplasia?
affects the epithelium of the airways or alveolar parenchyma
what is the most common pulmonary neoplasia in dogs?
bronchoalveolar carcinomas - 85%
what is the most common pulmonary neoplasia in cats?
adenocarcinoma - 60-70% of tumors
what is the metastatic rate of pulmonary neoplasia in cats?
76%
what percentage of animals are diagnosed with pulmonary neoplasia with no clinical signs?
30%
what is the most common clinical sign of pulmonary neoplasia?
coughing
others - dyspnea, lethargy, anorexia, weight loss
what paraneoplastic syndrome is most commonly reported with primary lung tissues in the dog?
hypertrophic osteopathy
what paraneoplastic syndrome is most commonly reported with primary lung tissues in the cat?
digit metastasis (scc & adenocarcinoma) & aortic thromboembolism
what diagnostics are used for pulmonary neoplasia?
thoracic rads, ultrasound guided FNA & cytology, & CT scan
what percentage is ultrasound guided FNA & cytology diagnostic in dogs & cats with pulmonary neoplasia?
dogs - 38%-90%
cats - 80-100%
what are prognostic factors in dogs for pulmonary neoplasia?
metastatic disease, histologic type/grade, tumor stage, tumor size, location within lung lobe, & involvement of entire lung lobe
what is the median survival time for a dog with a stage 3 pulmonary tumor that has invaded into adjacent tissues?
3 months
what are prognostic factors in cats for pulmonary neoplasia?
poorly differentiated tumor on histopath - median survival time is 2.5 months
well differentiated tumor on histopathology - median survival time is 23 months
what is the treatment of choice for pulmonary neoplasia?
surgery!! when possible, a complete lobectomy should be performed with the removal of local/regional lymph node
what are 3 other options used in treating pulmonary neoplasia?
chemotherapy
tyrosine kinase inhibitors - used in metastatic or non-operable disease
radiofrequency ablation - electrode is placed within the tumor to generate heat resulting in necrosis
after removing a lung tumor, why should it be submitted to histopathology even if you have already done a cytology?
further characterization of the tumor & assessment of margins
when should chemotherapy be recommended for a patient with pulmonary neoplasia?
if the patient has poor prognostic factors - large tumor size, aggressive histopath, clinical signs, & metastatic lymph nodes
what chemo drugs can be used in a post operative setting for pulmonary neoplasia?
carboplatin, doxorubicin, & vinorelbine
what is the cause of tumors of the nasal planum in cats?
UV exposure
what is the typical clinical presentation of nasal planum tumors in cats?
erythema, ulcerated, & crusted lesions
what is the treatment of choice for tumors of the nasal planum in cats?
surgery!
what dog breed is associated with nasal planum tumors? is it UV associated?
dogs - no
what is the treatment of choice for nasal planum tumors in dogs?
surgery
why is radiation therapy not used in dogs with nasal planum tumors?
it’s not effective in dogs
T/F: multimodal approach to treatment of nasal planum tumors in dogs is likely to result in superior survival times
true
