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RUSVM SAM 2 > Head And Neck Tumors > Flashcards

Head And Neck Tumors Flashcards

1
Q

What is usually the signalment for nasal planum tumors?

A

Cats >dogs

Older cats with lightly pigmented skin

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2
Q

Common presentation of nasal planum tumors?

A

Often protracted (months —> years) history of crusting/erythema processing to superficial ulcers and then deep erosive lesions

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3
Q

What is the DDX for a cat with ulcerative lesions on their nose and ears?

A

Squamous cell carcinoma

LSA
Eosinophilic granuloma
Mast cell tumor

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4
Q

What are your top DDX for a dog with ulcerative lesions on its nose?

A

Squamous cell carconoma

Mast cell tumor
Sarcoma

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5
Q

T/F: cytology can provide diagnostic tissue samples for SCC

A

False

Go a wedge or punch biopsy for tissue diagnosis

  • > dont do full thickness
  • > dont attempt under sedation
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6
Q

T/F: nasal planum tumors have a low metastatic rate

A

True

—> goes LATE

LN staging with FNA responsible especially if LN enlarged/firm

Sentinel LN with head and neck tumor is usually prescapular

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7
Q

Prevention of nasal planum tumors?

A

Limit UV exposure, sunscreen

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8
Q

What are treatment options for superficial nasal planum tumors?

A

Cryoablation (if less than 1cm) =minimally invasive, cheap

Photodynamic therapy - Photosensitization IV

Hyperthermia

Intralesional therapy -> carboplatin

Topical retinoids (vit A) —> increase epithelial differentiation = only for very superficial lesions

Radiation therapy/ Strontium 9 plesoitherapy

Electrochemotherapy

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9
Q

How would you treat an infiltrative nasal planum tumor?

A

Nasal planectomy (nosectomy)

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10
Q

What is the prognosis for nasal planum tumors?

A

Aggressive surgical therapy yields improved prognosis

Combination of intra-lesional carboplatin with orthovoltage (100% response in 6 cats at 268days follow up)

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11
Q

What is electrochemotherapy?

A

Combined used of chemotherapeutic dugs in combination with high-voltage electric pulses —> reversible permeabilization of cell membranes which enables more efficient entry of drugs into cells

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12
Q

Common presenting complaint with ear canal tumors?

A

Recurrent signs of infection with visible mass effect in canal

  • pruritus
  • bleeding
  • pain or reluctance to open mouth
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13
Q

Breeds predisposed to ear canal tumors ?

A

Cocker spaniels
Poodle
GSD

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14
Q

What is the DDX for ear canal tumors?

A

Ceruminous gland adenocarcinoma (Most common)

SCC
Undifferentiated (more aggressive)

Round cell tumors
Sarcoma

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15
Q

T/F: ear canal tumors in cants are more likely to be malignant than in dogs

A

True

Cats develop malignant dz> benign
Dogs have even split between malignant : benign

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16
Q

You have a ear canal mass, what will you do for diagnostics?

A

Shave or punch biopsy

Stage LN with cytology (we dont know the sentinel but can take the mandibular)

Thoracic metastasis check

Local imaging

  • > osseous changes in bulla
  • > need CT for planning if invasion through the canal is suspected
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17
Q

What is the treatment for ear canal tumors?

A

Aggressive surgery - TECA- BO (total ear canal ablation and bulla osteotomy)

If invading though canal prep, wil final locally —> need primary radiation therapy

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18
Q

What is the mean survival time for ear canal tumors?

A

4.8yrs (dogs)

12-50months (cats)

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19
Q

What are the 4 negative prognostic factors for ear canal tumors??

A

Extension beyond the ear canal

DX of SCC or undifferentiated carcinoma (high met rate)

Neuro signs

PO histology

  • > vascular or lymphatic invasion
  • > high mitotic index
20
Q

Signalment associated with canine sinonasal tumors?

A

Older dogs

Medium to large breed, bolichocephalic

21
Q

Common presenting complaint with sinosnal tumors?

A

-3months history or unilateral epistaxis, sneezing, open mouth breathing with partial response to empirical treatments

Facial deformity in advanced stages

22
Q

What are you top DDX for sinonasal tumors in dogs?

A

CARCINOMA (ACA, SCC, and undifferentiated)

Sarcoma (fibro-, osteo, and chondro-)

Fungal disease (aspergillosis )

23
Q

What are your top DDX for sinonasal tumors in cats?

A

LSA, LSA, LSA !

ACA, idiopathic non-specific rhinitis

24
Q

What must you rule out as causes of epistaxis ?

A

Hypertension (BP)
Coagulopathy (coags)
Tick dz/thrombocytopenia (CBC)

25
Q

What work up will you do for a sinonasal tumor?

A

Radiographs - Skull and chest
—> open mouth DV oblique view
—> ipsilateral turbinate loss, bone invasion, sinus infiltration = neoplasia likely

Cross -sectional imaging preferred -CT vs MRI
—> mass doesn’t always mean neoplasia

Biopsy
—> blind “trans-nostril biopsy” using cup forceps
—> nasal flushing

Regional LM -10-24% incidence

Paraneoplasic hyperCa and erythrocytosis —RARE

26
Q

What is the palliative treatment for sinosnasal tumors

A

Do nothing

  • MST - 95 days
  • 1 to 2 yrs survival (12% and 2%)

NSAIDS - COX2 over expression in 80% nasal carcinoma in dogs (firoxicam)

Low dose RT = improve respiration; MST= 1yr

Chemo alone

  • cisplatin 5months
  • doxo, carbo, pirox 210days
  • palladia —> inhibit VEGFR (clinical benefit)
27
Q

How can hemorrhage be controlled in sinonasal tumors?

A

Percutaneous arterial embolization

Image-guided transnasal cryoablation

28
Q

What is the curative intent treatment for sinonasal tumors?

A

Radiation therapy

  • external beam
  • intensity modulated
  • stereotactic radiotherapy

If recurrence after RT - can cut via rhinotomy

29
Q

What are the negative prognostic factor for sinonasal tumors?

A

Age
Presence of epistaxis
Longer duration of clinical signs
Tumor stage - cribriform involvement

Presence of met

Histological subtype (SCC/ undifferentiated) 
Failure to achieve resolution of clinical symptoms after treatment
30
Q

Top DDX for sinonasal tumors in cats?

A

LSA
Carconoma
Sarcoma

90% of the time malignant

31
Q

Treatment for LSA sinonasal tumor in cat?

A

RT and chemo
Vs
RT alone

—> multi- institutional study showed no difference on survival time with RT vs RT and chemo

32
Q

Signalment for salivary tumors?

A

Older dogs (spaniels) and cats (Siamese)

More aggressive in cats

33
Q

Salivary tumors most commonly affect what glands?

A

Mandibular/parotid salivary glands

34
Q

Salivary tumors are locally invasive and tend to cause what local effects?

A

Firm, painless swelling at gland
Dysphagia
Halitosis

35
Q

What is your top DDX for a salivary tumor?

A

Carcinoma

Siladenitis
Mucocele
Misdiagnosed enlarged LN

36
Q

T/F: regional LN Mets are common with salivary tumors

A

True

But distant Mets are uncommon

37
Q

What work up will you do to diagnose a salivary tumor?

A

FNA/cytology to differentiation
LN and lung staging

CT can help assess extent of invasion/resectability

38
Q

What is the treatment for salivary tumors?

A

Surgery with adjuvant RT for margins (can provide good local control)

39
Q

T/F: Thyroid tumors are usually more metastatic in cats than dogs

A

False

Dogs - 90% malignant (carcinoma)
Cats - 90% beginning (adenoma)

40
Q

Are thyroid tumors in dogs usually functional or non-functional?

A

90% are NON-functional

41
Q

What are your rule outs for a thyroid mass?

A 
Abscess 
Granuloma 
Ectopic salivary mucocele 
Carotid body tumor 
Medial retropharygneal LN enlargement
42
Q

What work up will you do in a dog with a thyroid tumor?

A

Met check in regional LN (prescapular and medial retropharygneal) and lungs

33% of dogs withal have multiple distinct malignancies (often intra abdominal)

CBC, CHEM, T4, three view thoracic rads, abdominal US, mandibular LN assessment

Palpation - fixed vs non fixed

FNA cytology - can be very vascular

43
Q

Treatment fo thyroid tumors?

A

Thyroidectomy

RT can be used to down-stage invasive tumors prior to surgical resection

44
Q

What is the prognosis of thyroid tumors?

A

Mobile —> 1yr survival rate 75% and 2yr survival rate 70%

Fixed —> 1yr survival rate 25% and 2yr survival rate 10%

45
Q

T/F: prognosis is very poor for animals with bilateral thyroid tumors?

A

False

-they can do fine IF they are respectable

Careful wil PO management —> hypocaclemia (parathyroid is gone)

MST 3+ years

46
Q

What are the negative prognostic factors for thyroid tumors?

A

Size : if volume is greater than 20cm^3 or if diameter is > 5cm

Movability: invasion of adjacent tissue = poor prognostic factor for surgical resection

Bilateral thyroid carcinoma has 16x grater risk of developing metastatic dz

Non medulllary thyroid carcinoma may be more likely to develop metastatic dz

RUSVM SAM 2 (44 decks)

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