GI Tract Tumors Flashcards
T/F: oral tumors are most often seen in male dogs
True
What breeds of doggo are predisposed to oral tumors?
Boxers GSD Goldens Cockers Miniature poodles German short haired pointer Gordon setter Chow Weimaraner
What is the usual presentation for oral tumors?
Oral bleeding
Difficulty bleeding
Halitosis
Anorexia, weight loss, loose or displace teeth, ptyalism, facial deformity, and/or nasal discharge
DDX for oral tumors in dogs
Melanoma
SCC
Fibrosarcoma
Other malignancies like OSA
Benign variants - odontogenic tumors
DDX for oral tumors in cats
SCC
Fibrosarcoma
What is the best way to sample an oral tumor?
Incisional biopsy
-> shave biopsy preferred in proliferative = Blade 1cm piece then tamponade
T/F: Radiographs are good for determining extent of lysis in oral tumors
False
Cross-sectional imaging preferred
What is the usually sentinel LN for oral tumors ?
Mandibular, parotid, and medial retropharygneal
LN draining the tumor was NOT the regional lymph node - only 55% go to mandibular
T/F: oral melanomas are usually benign
FALSE
Highly malignant — 80% of cases
How would you stage an oral melanoma?
Abdominal US
Full body CT for surgery planning
Fibrosarcoma are most commonly seen with what signalment>?
Large breed (golden and lab) Younger (7-8yrs)
T/F: fibrosarcoma are usually benign
FALSE
Locally invasive
Histologically low grade but biologically high grade variant
—> if your biopsy comes back as fibroma DO NOT believe it
What is the difference in how oral SCC appear in cats vs dogs?
Dog- locally invasive, low rate of met
Cat- locally invasive, low met, prefers sublingual site, increased expression of PTHrp -> increased reabsorption of bone and hypercalcemia
What are risk factors for oral SCC in cats?
Flea collar usage
Smoke exposure
Excessive canned food (esp tuna)
Odontogenic tumors raised from what tissue?
Periodontal ligament and often appear similar to gingival hyperplasia
What type of odontogenic tumor is locally invasive but does not metastasize? How would it be treated?
Acanthomatous ameloblastoma
Very aggressive surgery to control
Most common site for acanthomatous ameloblastomas?
Rostral mandible
What odontogenic tumor is seen in dogs, slow growing and benign? What would be the treatment?
Peripheral odontogenic fibroma
Surgical excision ideal but can watching and wait IF bx confirmed
Cryotherapy works well if <1cm
What odontogenic tumors is unique to young cats and has raided submucosal soft masses? How would it be treated?
Feline inductive odontogenic tumor
Locally invasive = aggressive local resection
What is the gold standard treatment for oral tumors?
Aggressive surgical excision
- almost always have bone involvement
2cm margin for malignancies
1cm for acanthomatous ameloblastoma
What oral tumors are responsive to radiation therapy?
SCC
Melanoma
Acanthomatous ameloblastoma
FSA
T/F: melanoma has a good prognosis when treated with chemo?
FALSE
Not chemo responsive
What are POSITIVE prognostic indicators for oral tumors?
Smaller —> less chance or recurrence
Rostral location - tumor related death 5x more likely with tumor caudal to K9 teeth
Histologically complete resection
No evidence of perioperative Mets
T/F: esophageal tumors are rare in cats and dogs
Truth
Etiology of esophageal tumors?
Spirocera lupi -> granuloma —> convert to malignancy (sarcoma).
How do animals get infected with spirocera?
Eat coprophagous beetle
Common presenting complaint with esophageal tumors ?
Weight loss
Regurgitation
Vomiting
Dysphagia
Signs of esophageal partial obstruction/stricture (secondary aspiration pneumonia)
What is the DDX for esophageal tumors?
SCC
Leiomyosarcoma
FSA, OSA
Esophageal tumors appear how on rads?
Dilation proximal to tumors
Stricture/mass effect
What is the ideal method of imaging for esophageal tumors?
Esophagoscopy —> can get biopsy
smooth mm based tumor —> mucosa looks normal
What is the preferred treatment for esophageal tumors?
Surgery
Best chance is with low grade leiomyosarcoma
Prognosis of esophageal tumors?
Generally poor
Benign lesions and low grade leiomyosarcoma do well with tax
If mass is secondary to SLupi granuloma -> tx with doramectin to response
What breeds are generically predisposed to gastric tumors?
Belgian shepherds and chows
Beagles = benign (more commonly get leiomyoma)
T/F: most gastric tumors are asymptomatic
True
- until they become large enough to effect outflow
- > anorexia is most common
- > hematemesis
DDX for gastric tumor in dog?
ADENOCARCINOMA
Leiomyosarcoma
DDX for cats with gastric tumors?
Lymphoma
What tumor type has a preference for pyloric antrum/lesser curvature of the stomach?
Gastric adenocarcinoma
- often scirrous (firm/white on serosal surface)
T/f: gastric adenocarcinoma has a high metastatic rate
True
-74%
What work up will you do in a gastric tumor case?
Non specific lab findings
- anemia if ulcerated/bleeding
- elevated T.bili
Positive contrast gastrogram
-filling defects, decrease gastric emptying, loss of normal rural folds, mucosal thickening
Abdominal u/s
-mural thickening with loss of normal wall and diminished to absent local motility
U/S guided FNA/cytology
-peri-tumors inflammation can interfere
R/O LSA —> may not be surgical
Endoscopy —> biopsy and assess respectability
When doing endoscopy for gastric tumors, ______________ are usually well circumscribed submucosal masss in the cardia, and _________ are usually extensive, ulcerated, in the pyloris
Leiomyosarcoma; adenocarcinoma
What is the treatment recommended for gastric tumors ?
Surgical excision
—> partial gastrectomy or gastroduodenosomty/jejunostomy
—> Billroth II or complete gastrectomy are extensive with high morbidity and low survival
Enlarged peri-gastic LN removed for staging
What is the prognosis for gastric ACA?
Prognosis = poor with majority dead in 6months due to either recurrent or metastatic dz
—> in no Mets and respectable than lengthy survival is possible
What is the prognosis for gastric LSA?
Doesn’t respond as well to chemo
If solitary lesions can resect
What is the prognosis for gastric leiomyosarcoma?
MST: 12-21months
54% met rate but not a poor prognostic factor
Breed predisposition to intestinal tumors ?
Collie and GSD
Males >female
Older dogs
T/F: large intestinal tumors are more common in cats than dogs?
False
Cats: small intestinal tumors»_space;> large intestine
Dogs: large intestinal tumors»_space;> small intestine
Clinical signs associated with intestinal tumors?
Anorexia
Vomiting
Diarrhea
Work up and staging for intestinal tumors??
Endoscope doest allow jejunum and proximal ileum
US FNA/cytology -> high diagnostic accuracy
R/O LSA which is not surgical unless solitary mass or causing obstrucion
Assess LN carefully with US and do FNA
DDX for Canine intestinal tumors
LSA
ACA
leiomyosarcoma
DDX for intestinal tumors in cats?
LSA
ACA
MCT
Treatment for intestinal tumors?
Exploratory laparotomy with surgical excision
Margin procurement = 4-8cm
Mesenteric and regional LS should be assessed, resected or aspirated
Majority of LSA in dogs are of __cell origin
T-cell
What is the prognosis for LSA in dogs?
MST= 77days
Remission rate 56%
What are negative prognostic indicators for intestinal LSA in dog?
Dogs that failed to achieve a remission
Diarrhea at initial presentation
What is the prognosis for intestinal LSA in cats?/
MST = 201-280days
Reponse rate is 60-87%
Are intestinal ACA more likely to me metastatic in cats or dogs?
Cats - 72% metastatic at diagnosis (MST = 5-15months with surgery)
Dog 44% (MST = 300days)
Negative prognostic indicator for ACA in dogs?
Female
Negative prognostic factor for ACA in cats?
Histologically subtype and Mets
Tubular ACA (11months) vs undifferentated/mucinious (4months)
LN Mets (12months vs 15 months if not)
Ometal mets (4.5months vs 28months ifnot)
What is the prognosis for gastric MCT in cats vs dogs?
Cat - poor prognosis unless solitary mass without mets, can have prolonged survival
Dog - 100% met rate, bad dz with MST=16ddays
Prognosis for leiomyosarcoma in dog vs cats?
Dog MST - 8months after surgical resection
Cats - very uncommon, no survival data
What is a gastrointestinal stromal tumor?
Leiomyosarcoma with more than smooth muscle
Primarily originate form interstitial cells of Cajal = pacemaker cells of the GI tract
-express C-kit
Gastrointestinal stromal tumors have a predilection for what site?
Cecum
Prognosis for gastrointestinal stromal tumors?
MST 11.6months IF they survive post op
They usually die of septic peritonitis b/c masses rupture before diagnosis
