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Sem 6: SAM 2 > Head and Neck Tumors > Flashcards

Head and Neck Tumors Flashcards

1
Q

What dog breed is predisposed to ceruminous gland adenocarcinoma?

A

Cocker spaniels

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2
Q

Cocker spaniels are predisposed to _____________ (list cancer type)

A

ceruminous gland adenocarcinoma

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3
Q

What cancers is use of Palladia effective for?

A
  • MCT (blocks tyrosine kinase like CKIT)
  • Carcinomas expressing VEGFR2
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4
Q

What is the #1 differential for dogs and cats with nasal planum tumors?

A

SCC

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5
Q

What is the presenting signalment in a dog or cat with a nasal planum tumor?

A
  • Crusting/erythema progressing to superficial ulcers
  • History of failed empirical treatments with Abx’s
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6
Q

What diagnostics should be performed on a dog or cat with a suspect nasal planum tumor?

A
  • Wedge or Punch biopsy under GA , don’t go full thickness through the nose, Biopsy the center of the lesion
  • Cytology NOT effective
  • Can sample LN but often not the regional LN

(low met rate, goes late, but not wrong to do rads to check)

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7
Q

What is the most important factor when deciding your treatment protocol for a patient with a nasal planum tumor?

A

Depth of invasion

  • If superficial lesion < 1cm, do Cryoablation
  • If deep lesion, do Nasal Planectomy
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8
Q

Treatment options for a nasal planum tumor in dogs/cats?

A
  • Cryoablation if superficial lesion < 1cm
  • Nasal planectomy
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9
Q

What is the MST for patients undergoing nasal planectomy to remove SCC from the nasal planum?

A

~20 months (1.5 yrs)

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10
Q

What is electrochemotherapy and what has it been used to treat in animals?

A
  • Chemo drugs in combo with high voltage electric pulses
  • Increases permeability of cells to allow more chemo to enter
  • Has been experimented with superficial SCC in cats in different stages
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11
Q

What is true about the behavior of ear tumors in dogs vs cats?

A
  • Cats more likely malignant ear tumors
  • Dogs 50:50 between malignant and benign
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12
Q

What is the #1 differential for a malignant ear tumor in dogs and cats?

A

Ceruminous gland adenocarcinoma

(Other Ddx: SCC, undifferentiated carcinoma, plasmacytoma)

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13
Q

What diagnostic work up and staging should be performed on a dog or cat with an ear tumor?

A
  • Shave or punch biopsy under sedation or GA
  • CT to reveal osseous changes in bulla
  • LN cytology
  • Low metastasis rate, but not wrong to do rads
  • Cytology NOT effective , usually bloody and friable, too deep in ear to reach with a needle
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14
Q

What treatment is reccommended for a patient with a malignant ear tumor?

A

TECA-BO (Total ear canal ablation w/ bulla osteotomy)

DONT DO LATERAL CANAL RESECTION - high recurrence late

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15
Q

List the negative prognostic indicators associated with ear tumors

A
  • Extension beyond ear canal
  • Diagnosis of SCC or undifferentiated carcinoma
  • Presence of neuro signs
  • Post op histo indicating high mitotic index or vascular/lymphatic invasion

Hemorrhage is NOT a prognostic indicator

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16
Q

What is the prognosis for cats and dogs treated with TECA-BO for an ear tumor?

A

Dogs: 4-8 years
Cats: 1-4 yrs (variable bc cats gets more malignant ear tumors)

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17
Q

Sinonasal tumors are common in what dog breeds?

A

Doliocephalic long nose breeds

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18
Q

What is the common presenting signalment in dogs with a sinonasal tumor?

A
  • Month long history of UNILATERAL epistaxis
  • Facial deformity in advanced cases
  • Long nose dog breeds
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19
Q

What is the most common sinonasal tumor in dogs and cats?

A

Dogs: #1 adenocarcinoma, #2 SCC

Cats: LYMPHOMA LYMPHOMA LYMPHOMA

20
Q

What diagnostic work up and staging should be performed on a dog or cat with unilateral epistaxis?

A
  • Do BP, coags, tick panel to R/O non-neoplastic causes of epistaxis
  • Trans nasal Biopsy (if no blood, not a good sample!)
  • Rads of chest and skull (Open mouth DV view) , look for turbinate lysis
  • CT/MRI > rads but $$$
  • Regional LN cytology (10-25% incidence)
21
Q

What is the MST in a patient with a sinonasal tumor if no treatment is done?

A

3 months, even worse if epistaxis present

22
Q

What is available for palliative treatment of sinonasal tumors in dogs?

A
  • NSAIDS in dogs (carcinomas over express COX-2)
  • Low dose RT
  • Chemo (but Goldie Coldmann, sinonasal tumors usually LARGE)
  • Palladia (inhibits VEGFR expressed by carcinomas)
23
Q

What curative treatment options are available for dogs with a sinonasal tumor?

A
  1. Intensity Modulated Radiation therapy
  2. Steriotactic Radiotherapy (large doses over a shorter duration, only hits tumor cells)
  3. External Beam Course Fractionated Radiation therapy (zaps huge area including normal tissue)
24
Q

____% of the cortex must be destroyed to see evidence of turbinate lysis on radiographs, which is why CT/MRI is better at detection

A

40

25
Q

External Beam (Course Fractionated) Radiation therapy is used for which of the following?

A. Ear tumors
B. Nasal planum tumors
C. Sinonasal tumors
D. Oral tumors

A

C. Sinonasal tumors

26
Q

What is the MST of sinonasal tumors using curative intent treatment options like External Beam (Course Fractionated) Radiation therapy?

A

~ 1 year

27
Q

What are the side effects of using External Beam (Course Fractionated) Radiation therapy for sinonasal tumors?

A
  • Damages surrounding local tissue, not just the tumor
  • Leads to the worst sunburn ever
  • Can cause cataracts if used around the eye
28
Q

Why is Intensity Modulated Radiation therapy or Steriotactic Radiotherapy preferred over External Beam (Course Fractionated) Radiation therapy when treating a sinonasal tumor?

A

Intensity Modulated Radiation therapy and Steriotactic Radiotherapy have less side effects, less GA time, only targets tumor cells, spares viable surrounding tissue

(MST is the same, 1 year, for all 3)

29
Q

List the negative prognostic indicators associated with sinonasal tumors (7)

A
  1. Age of patient (> 10 yrs is worse)
  2. Presence of epistaxis
  3. Long duration of CS
  4. Tumor stage (cribiform plate involvement = BAD)
  5. Presence of metastasis
  6. Histo subtype (SCC/ undifferentiated carcinoma = BAD)
  7. Failure to achieve resolution of clinical symptoms after tx
30
Q

What curative treatment options are available for cats with a sinonasal tumor?

A

RT + Chemo!! (#1 differential is lymphoma in cats) (MST ~ 2.5 years)

Radiation Options
1. Intensity Modulated Radiation therapy
2. Steriotactic Radiotherapy (large doses over a shorter duration, only hits tumor cells)
3. External Beam Course Fractionated Radiation therapy (zaps huge area including normal tissue)

31
Q

What non-neoplastic cause must be ruled out before diagnosing a neoplastic sinonasal tumor in cats?

A

Must R/O Chronic lymphocytic rhinitis

(frustrating case to diagnose)

32
Q

True of False: A dog with cribiform plate lysis is a good candidate for curative intent image guided radiation therapy

A

FALSE

Cribiform plate involvement is a negative prognostic indicator …. discuss euthanasia :(

Drops MST from 2 years to 7 months

33
Q

What is the MST of sinonasal lymphoma in a cat treated with RT and chemo?

A

~2.5 years

34
Q

What dog breeds are predisposed to salivary tumors?

A

Older spaniels, toy and standard poodles

35
Q

What cat breeds are predisposed to salivary tumors?

A

Siamese (inbred af)

36
Q

Salivary tumors most commonly affect the __________ salivary gland

A

Mandibular salivary gland

37
Q

What is the common presenting signalment in dogs and cats with salivary gland tumors?

A
  • Usually presents without CS
  • FIRM, painless swelling at the gland
  • Dysphagia, halitosis
38
Q

True or False: Regional LN mets are more common than distant mets in patients with salivary tumors

A

TRUE

(Sample the LN’s for staging!)

39
Q

A patient has a firm, painless swelling of the salivary gland. What is the Ddx for neoplastic tumors?

A
  1. CARCINOMAS (84%) (Salivary gland adenocarcinoma)

(Sialadenitis, mucocele, or misdiagnosed LN that is enlarged is possible but less likely)

40
Q

A patient has a firm, painless swelling of the salivary gland. What is the work up and treatment plan?

A
  • FNA cytology > Biopsy
  • LN cytology (Regional mets common)
  • Thoracic rads for lung staging
  • CT to assess extent of invasion/resectability
  • Surgery and adjunct RT for curative intent treatment

(surgery alone rarely curative)

41
Q

Is FNA or Biopsy preferred when dealing with salivary gland tumors?

A

FNA > Biopsy

  • Bc usually carcinomas which exfoliate well on FNA cytology
  • Don’t want to seed cancer using biopsy, could compromise surgical removal
41
Q

What dog breeds are predisposed to thyroid tumors?

A

Older Goldens, Beagles, Boxers, Huskies

42
Q

What is the common presenting signalment in dogs with thyroid tumors?

A
  • Visible/Palpable cervical mass
  • Resp signs
  • Common to see LARGE tumors at time of diagnosis
43
Q

What is the common presenting signalment in cats with thyroid tumors?

A

Signs of Hyperthyroidism! (Functional benign tumor secreting excess T4 unlike dogs)

  • Visible/Palpable cervical mass
  • Resp signs
  • Common to see LARGE tumors at time of diagnosis
44
Q

How do thyroid tumors in cats vs dogs differ?

A

Dogs: 90:10 RULE (90% are NON-functional malignant carcinomas)

Cats: 10:90 RULE (90% are functional BENIGN adenomas)

45
Q

What is the unique phenomenon that occurs with thyroid tumors in dogs?

A

33% of dogs with thyroid tumors have multiple distant malignancies, often intraABD

DO AN ABD ULTRASOUND PLZ

(additional adrenal tumors could be found)

Sem 6: SAM 2 (34 decks)

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