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Oncology > Mammary tumors > Flashcards

Mammary tumors Flashcards

1
Q

Mammary tumor incidence in the US

A
  • Lower in the US than in countries where females are still not routinely spayed
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2
Q

Signalment of canine mammary tumors: sex

A
  • Usually female

- Risk in male is 1% or less the risk of female

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3
Q

Data for incidence of mammary tumors after spay PRIOR TO FIRST ESTRUS

A
  • 0.5% the risk for development of malignant tumors of intact females
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4
Q

How much does the risk of mammary tumors rise after 1st and 2nd estrus?

A
  • Significantly

- ~8% and 26% after 1st and 2nd estrus, respectively

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5
Q

Mammary tumor risk if spayed after 2nd estrus?

A
  • At later than 2nd estrus does not reduce incidence of malignant tumors but can decrease the incidence of benign tumors
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6
Q

Mammary tumor risk if spayed at less than 2 years prior to tumor development or even at the same time as tumor development?

A
  • Can increase survival
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7
Q

Risk factors for canine mammary tumors

A
  • Being intact
  • Use of synthetic progestins increases incidence of benign tumors
  • Obesity at 9-12 months of age regardless of spay status
  • Eating home cooked meals increases risk of developing mammary tumors
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8
Q

Where do canine mammary tumors occur most likely?

A
  • 65-70% occur in glands 4 and 5 (caudal chains)
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9
Q

Presentation possibilities for canine mammary tumors?

A
  • Presence of mammary mass
  • Inflammatory tumors
  • Respiratory, neurologic signs or bone pain secondary to metastasis
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10
Q

Inflammatory mammary tumors

A
  • Plaque like thickening or multiple nodules in the skin

- Diffuse edema and inflammation

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11
Q

What dog population does 50% rule apply to for mammary tumors?

A
  • INTACT dogs

- Remember that spayed dogs with a mammary tumor are less likely to have benign tumors relative to spayed dogs

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12
Q

50% rule for mammary tumors

A

~50% of mammary tumors are malignant

~50% of malignant tumors are low grade

  • Older dogs with larger tumors are more likely to be malignant
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13
Q

Degrees of mammary tumors from worst to best

A
  • Carcinosarcoma (worst)
  • anaplastic
  • Papillary
  • Tubular carcinoma
  • Solid carcinoma (better)
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14
Q

Behavior of inflammatory carcinoma

A
  • Poorly differentiated carcinoma with extensive inflammatory cell infiltrates
  • VERY AGGRESSIVE
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15
Q

Cytology for mammary tumors

A
  • NEVER diagnostic for malignant vs benign

- Cytology can help diagnose something other than a mammary tumor

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16
Q

Diagnosis for mammary tumors - what does it require?

A
  • Histopathology
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17
Q

Staging for canine mammary tumors

A
  • Tumor (evaluate local tumor; many have multiple)
  • LN evaluation (palpation, aspiration, removal, and histopathology)
  • Chest radiographs
  • Aggressive mammary tumor can have widespread mets (liver, bone CNS)
  • Do a CBC/chemistry/UA and PE to determine where else to look
18
Q

Surgery for canine mammary tumors

A
  • BIG one
19
Q

Lumpectomy

A

Usually one gland behind and one gland behind

20
Q

Complete mastectomy

A
  • Taking the whole chain on the left or right side

- Usually not necessary in the dog

21
Q

Where do caudal mammary chains drain?

A
  • Inguinal lymph nodes
22
Q

Where do cranial mammary chains drain?

A
  • Axillary lymph node
23
Q

Chemotherapy for canine mammary tumors

A
  • Logical but hard to assess efficacy

- If tumor is metastatic or in lymphatics or high grade in nature

24
Q

If you were to use chemo for canine mammary tumors, which agent?

A
  • Doxorubicin single agennt

- Can also do doxorubicin and docetaxel, gemcitabine, or TKI

25
Q

Radiation therapy for canine mammary tumors

A
  • Logical but generally only for dogs where local control is a problem
26
Q

What are the big markers for prognosis of canine mammary tumors?

A
  • Tumor size
  • Lymph node involvement
  • Presence of distant metastasis
  • Histologic type
  • Degree of invasion
  • Intravascular or lymphatic growth
27
Q

% of feline mammary tumors that are malignant

A
  • More than 75% are malignant in cats
  • At least the third most frequent tumor in a cat
  • Any cat presenting with a mammary mass must be taken very seriously
28
Q

Signalment for feline mammary tumors

A
  • Generally female
  • In the US they are usually spayed now
  • Age tends to be 10-12 years
  • Short haired cats more common
  • Siamese cats have 2x risk of other breeds
29
Q

What likely plays a role in development of mammary tumors in cats?

A
  • Hormonal influences
  • Past history of synthetic progestins or estrogen-progestin combinations increase risk 3x (usually for cases in male cats)
  • Cats spayed at a later age or left intact have increased risk
30
Q

Presentation for feline mammary tumors

A
  • Mammary mass

- Metastatic lesions (LN, lungs, bone)

31
Q

Biologic behavior of mammary tumors in cats

A
  • 80% are adenocarcinomas
  • Highly aggressive, metastasis common
  • In one study at postmortem 76% had mestastasis to lungs and 88% to other organs
32
Q

Diagnosis of mammary tumors in cats

A
  • Requires histopathology

- ASSUME ALL ARE BAD

33
Q

Staging of feline mammary tumors - when to do in relation to removal?

A
  • Prior to removal
34
Q

Staging of feline mammary tumors

A
  • Assess tumor and ALL mammary glands
  • Assess draining lymph nodes (for cranial glands axillary LN must be assessed)
  • Chest rads (feline metastatic lesion can appear less obvious on rads than in dog; evaluate sternal node)
  • Ultrasound of abdomen if tumor is gland 3 or 4 or cat is sick
35
Q

Treatment for feline mammary tumors

A
  • GET IT RIGHT THE FIRST TIME
  • COMPLETE RADICAL MASTECTOMY
  • Occasional bilateral mastectomy
36
Q

What does complete radical mastectomy include for complete radical mastectomy?

A
  • Include at least closest LN (axillary for 1 &2; inguinal for 3&4)
  • Microscopic evidence of tumor was found in 27% of LNs draining tumor areas in cats with mammary tumors at necropsy, and only 6% were palpably enlarged
37
Q

Radiation therapy for feline mammary tumors

A
  • Not routinely used but can be used when local control is a problem
38
Q

Chemotherapy for feline mammary tumors

A
  • More likely to be helpful than in the dog
39
Q

Chemotherapy for feline mammary tumors - which drugs?

A
  • Doxorubicin**
  • Doxorubicin + cyclophosphamide
  • Mitoxantrone
  • Carboplatin
  • TKI
40
Q

Prognosis for feline mammary tumors

A
  • Average survival since detection is 10-12 months (poor in general)
41
Q

What is the most important indicator of survival in female mammary tumors?

A
  • Size of tumor at diagnosis is the most important

- Tumors less than 8 cm^3 having the best prognosis - median survival 3 years

42
Q

What is important for optimal survival of feline mammary tumors?

A
  • Aggressive surgery
  • Doxorubicin and surgery - 15 month survival
  • Chemo needs to be studied better

Oncology (9 decks)

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