Liver/Pancreas Cancer Flashcards
generally describe hepatic neoplasia
- feline: primary, benign most common
- canine: secondary, malignant most common
-HSA
-mast cell
-other: sarcomas/carcinomas - etiology unknown
-possibly chronic toxin exposure or viral
how do we categorize hepatic tumors?
- morphology on gross exam or imaging
-massive: solitary mass in 1 lobe (mass-like, we want this)
-nodular: multifocal in more than one lobe
-diffuse: multifocal to coalescing in all lobes - histotype
-hepatocellular: arise from hepatocytes
-bile duct: arise from cells lining the bile duct
-neuroendocrine (carcinoid): arise from local neuroendocrine cells
-sarcoma: arise from local connective tissue
why does the morphology of hepatic tumors matter?
- hints at underlying histotype:
-massive more likely hepatocellular and highly unlikely neuroendocrine - hints at biologic behavior
-nodular and diffuse hepatocellular tumors have a higher metastatic rate - informs treatment decisions:
-massive more likely surgically resectable
-diffuse by definition is unresectable
describe the relationship between morphologic subtype and histotype
- hepatocellular:
-morphology: most commonly massive - bile duct:
-morph: variable (mix of all 3) - neuroendocrine (carcinoid):
-morph: 2/3 diffuse, 1/3 nodular
-NONE ever ID as massive - sarcoma:
-morph: 1/3 massive, 2/3 nodular
describe the general clinical signs for hepatic neoplasia (6)
- none; frequently incidental
- vomiting
- hyporexia
- hepatoencephalopathy: seizures, ataxia, mentation changes, head pressing, liver failure
- signs secondary to a space occupying mass in the abdomen
- PU/PD
describe physical exam findings of hepatic cancer (4)
- palpable cranial abdominal mass: up to 75% of cases
-but not really in practice if chunky - neurologic impairment
- jaundice
- ascites
describe bloodwork from liver tumors (3)
- CBC:
-paraneoplastic thrombocytosis: in 50% of massive HCC
-mild non-regen anemia - chem:
-elevated ALT, AST, ALP, GGT, t-bili
–patterns do not predict histotype (or even neoplasia)
-evidence of liver failure in advanced cases: pseudo-function parameters, coagulopathy
describe imaging of liver tumors (3)
- AXR:
-cranial abdominal mass
- +/- mineralization of biliary tract, esp with bile duct carcinoma - ultrasound:
-morphologic subtype: can’t differentiate benign vs malignant nodules
-can’t reliably differentiate histotype based on morphology or US findings - CT
describe staging of liver tumors (3)
- abdominal imaging (US vs CT)
-other liver lobes
-regional LNs
-spleen
-mesentery/omentum
-vascular invasion
-CT preferred - thoracic imaging (rads vs CT):
-pulmonary mets rare at time of dx - CT preferred over ultrasound, esp for abdomen in med to large brd dogs
describe diagnosis of liver tumors (4)
- US guided FNA cytology:
-60% accurate
-really good to rule out round cell (lymphoma MCT)
-well-differentiated HCC can be hard to call due to similarity to normal hepatocytes - tru-cut biopsy:
-90% accurate
-mild-mod risk of hemorrhage: in <5% so check clotting profile and CBC pre-bx - laparascopy: eval and biopsy
- excisional biopsy
describe liver tumor treatment (3)
- surgery:
-liver lobectomy for massive morphologies
-left liver lobes preferred vs right - regional chemo:
-chemoembolization: rarely pursued - radiation therapy:
-common in humans but still rare in vet med
describe specific liver tumor types
- hepatocellular adenoma:
-most common feline hepatocellular tumor, but NOT most common liver tumor - hepatocellular carcinoma (HCC):
-most common canine liver tumor - bile duct adenoma
-MOST COMMON FELINE LIVER TUMOR - bile duct adenocarcinoma
- hepatoblastoma: very rare
-hepatic stem cell origin
describe hepatocellular carcinoma (HCC)
- most common canine primary liver tumor
- most commonly low grade
-slow growing, less aggressive
-cells frequently resemble normal hepatocytes - human: hep B and cirrhosis linked to HCC but not proven in dogs
- most commonly massive morphology
- metastatic rate:
-massive: 0-37%
-diffuse/nodular: 93-100%
describe treatment and prognosis of HCC
- massive HCC:
-with surgical resection (dog): long survival (>1470d)
–25% sx complication rate: hemorrhage most common, 5% intra-op mortality
–similar long survival (2.4 years) in cats
-with medical management (dog/nonresectable): 270 days; 15x more likely to die to tumor related causes than surgery group
- chemo-resistant: chemo-embolization; rare in vet med
- RT unexplored
describe bile duct tumors
- bile duct adenocarcinoma (cholangiocarcinoma)
-high metastatic rate - bile duct adenoma: biliary cystadenoma
-most common feline primary liver tumor - dogs love intrahepatic, cats are 50:50 intra vs extrahepatic
- imaging: commonly cystic
-may also appear mineralized on AXR/CT - surgery preferred:
-sx resected adenoma: good prognosis; low recurrence rate
-sx resected carcinoma: poor prog (<6 months)
describe pancreatic neoplasia/exocrine pancreatic carcinoma in general
- exocrine function:
-digestive enzymes
-bicarb for neutralizing stomach acid
-exocrine pancreatic carcinoma is most common exocrine tumor! - EPC rare, highly metastatic
-most have metastasis at time of dx
-mets to: liver, regional LNs, spleen, lungs, local extension (omentum + mesentery= carcinomatosis) - ductal or acinar cell origin
describe paraneoplastic alopecia
- acute onset
- bilaterally symmetric
- abdomen first
-then face, limbs, other areas - shiny/glistening hue to skin
- footpads may slough
- may regress with tumor resection
describe diagnosis and staging of exocrine pancreatic carcinoma
- bloodwork: nonspecific
-+/- hyperbilirubinemia (if biliary obstruction)
-advanced dz: hyperglycemia
-amylase, lipase, TLI, PLI: not reliable - diagnosis:
-AUS: +/- (mass may be very small)
-mass FNA: 73.5% diagnostic, could result in adverse event
-ascites: fluid cytology may give diagnosis
-CT
-abdominal exploratory - staging: regional LNs, liver, lungs
describe treatment and prognosis of exocrine pancreatic carcinoma
- single mass with no metastasis:
-surgery + adjuvant chemo
-biopsy liver and eval LNs intra-op - disseminated intra-abdominal disease:
-intraperitoneal chemo: carboplatin, palliative to reduce effusion and improve clinical signs - radiation not generally pursued in vet med
prognosis:
-very poor; possibly slightly better for cats with cystic carcinomas
-dogs: usually days to months
-benign lesions (which are rare) do better: cystic adenoma has a 5 year reported survival time
