Head And Neck Tumors Flashcards
What is usually the signalment for nasal planum tumors?
Cats >dogs
Older cats with lightly pigmented skin
Common presentation of nasal planum tumors?
Often protracted (months —> years) history of crusting/erythema processing to superficial ulcers and then deep erosive lesions
What is the DDX for a cat with ulcerative lesions on their nose and ears?
Squamous cell carcinoma
LSA
Eosinophilic granuloma
Mast cell tumor
What are your top DDX for a dog with ulcerative lesions on its nose?
Squamous cell carconoma
Mast cell tumor
Sarcoma
T/F: cytology can provide diagnostic tissue samples for SCC
False
Go a wedge or punch biopsy for tissue diagnosis
- > dont do full thickness
- > dont attempt under sedation
T/F: nasal planum tumors have a low metastatic rate
True
—> goes LATE
LN staging with FNA responsible especially if LN enlarged/firm
Sentinel LN with head and neck tumor is usually prescapular
Prevention of nasal planum tumors?
Limit UV exposure, sunscreen
What are treatment options for superficial nasal planum tumors?
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
How would you treat an infiltrative nasal planum tumor?
Nasal planectomy (nosectomy)
What is the prognosis for nasal planum tumors?
Aggressive surgical therapy yields improved prognosis
Combination of intra-lesional carboplatin with orthovoltage (100% response in 6 cats at 268days follow up)
What is electrochemotherapy?
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
Common presenting complaint with ear canal tumors?
Recurrent signs of infection with visible mass effect in canal
- pruritus
- bleeding
- pain or reluctance to open mouth
Breeds predisposed to ear canal tumors ?
Cocker spaniels
Poodle
GSD
What is the DDX for ear canal tumors?
Ceruminous gland adenocarcinoma (Most common)
SCC
Undifferentiated (more aggressive)
Round cell tumors
Sarcoma
T/F: ear canal tumors in cants are more likely to be malignant than in dogs
True
Cats develop malignant dz> benign
Dogs have even split between malignant : benign
You have a ear canal mass, what will you do for diagnostics?
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
What is the treatment for ear canal tumors?
Aggressive surgery - TECA- BO (total ear canal ablation and bulla osteotomy)
If invading though canal prep, wil final locally —> need primary radiation therapy
What is the mean survival time for ear canal tumors?
4.8yrs (dogs)
12-50months (cats)
What are the 4 negative prognostic factors for ear canal tumors??
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
Signalment associated with canine sinonasal tumors?
Older dogs
Medium to large breed, bolichocephalic
Common presenting complaint with sinosnal tumors?
-3months history or unilateral epistaxis, sneezing, open mouth breathing with partial response to empirical treatments
Facial deformity in advanced stages
What are you top DDX for sinonasal tumors in dogs?
CARCINOMA (ACA, SCC, and undifferentiated)
Sarcoma (fibro-, osteo, and chondro-)
Fungal disease (aspergillosis )
What are your top DDX for sinonasal tumors in cats?
LSA, LSA, LSA !
ACA, idiopathic non-specific rhinitis
What must you rule out as causes of epistaxis ?
Hypertension (BP)
Coagulopathy (coags)
Tick dz/thrombocytopenia (CBC)
What work up will you do for a sinonasal tumor?
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
What is the palliative treatment for sinosnasal tumors
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)
How can hemorrhage be controlled in sinonasal tumors?
Percutaneous arterial embolization
Image-guided transnasal cryoablation
What is the curative intent treatment for sinonasal tumors?
Radiation therapy
- external beam
- intensity modulated
- stereotactic radiotherapy
If recurrence after RT - can cut via rhinotomy
What are the negative prognostic factor for sinonasal tumors?
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
Top DDX for sinonasal tumors in cats?
LSA
Carconoma
Sarcoma
90% of the time malignant
Treatment for LSA sinonasal tumor in cat?
RT and chemo
Vs
RT alone
—> multi- institutional study showed no difference on survival time with RT vs RT and chemo
Signalment for salivary tumors?
Older dogs (spaniels) and cats (Siamese)
More aggressive in cats
Salivary tumors most commonly affect what glands?
Mandibular/parotid salivary glands
Salivary tumors are locally invasive and tend to cause what local effects?
Firm, painless swelling at gland
Dysphagia
Halitosis
What is your top DDX for a salivary tumor?
Carcinoma
Siladenitis
Mucocele
Misdiagnosed enlarged LN
T/F: regional LN Mets are common with salivary tumors
True
But distant Mets are uncommon
What work up will you do to diagnose a salivary tumor?
FNA/cytology to differentiation
LN and lung staging
CT can help assess extent of invasion/resectability
What is the treatment for salivary tumors?
Surgery with adjuvant RT for margins (can provide good local control)
T/F: Thyroid tumors are usually more metastatic in cats than dogs
False
Dogs - 90% malignant (carcinoma)
Cats - 90% beginning (adenoma)
Are thyroid tumors in dogs usually functional or non-functional?
90% are NON-functional
What are your rule outs for a thyroid mass?
Abscess Granuloma Ectopic salivary mucocele Carotid body tumor Medial retropharygneal LN enlargement
What work up will you do in a dog with a thyroid tumor?
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
Treatment fo thyroid tumors?
Thyroidectomy
RT can be used to down-stage invasive tumors prior to surgical resection
What is the prognosis of thyroid tumors?
Mobile —> 1yr survival rate 75% and 2yr survival rate 70%
Fixed —> 1yr survival rate 25% and 2yr survival rate 10%
T/F: prognosis is very poor for animals with bilateral thyroid tumors?
False
-they can do fine IF they are respectable
Careful wil PO management —> hypocaclemia (parathyroid is gone)
MST 3+ years
What are the negative prognostic factors for thyroid tumors?
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
