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Y4 SA - Oncology > Mast Cell Tumor and Transitional Cell Carcinoma > Flashcards

Mast Cell Tumor and Transitional Cell Carcinoma Flashcards

1
Q

Name the most commonly diagnosed skin tumour in the dog

A

Mast cell tumour

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2
Q

List some other sites that mast cell tumours form

A

Subcutaneous tissue
Conjunctiva
Oral mucosa
GIT

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3
Q

Describe the behaviour of mast cell tumours

A

Variable - some benign, some aggressive

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4
Q

Describe the predispositions for mast cell tumours

A

Unknown aetiology (?Genetic predisposition)
Any age and no sex predilection
Breed predispositions e.g. Boxer, Boston terrier.

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5
Q

Describe the clinical presentation of mast cell tumours

A
  • Cutaneous mass of variable external appearance.
  • Anywhere in the body
  • Usually solitary
  • Local effects e.g., erythema, oedema, pruritus, haemorrhage (Darier’s sign)
  • Systemic signs e.g., vomiting, melaena and rarely collapse
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6
Q

How do mast cell tumours appear microscopically

A

Intracytoplasmic granules containing histamine, heparin and proteases → degranulation

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7
Q

How are mast cell tumours diagnosed?

A
  1. FNA of the mass:
    - Usually diagnostic (92-96%)
    - Round cells
    - Characteristic purple granules
  2. Diff Quick usually fine - Occasionally need special stains e.g. toluidine blue
  3. For some poorly differentiated biopsy +/- IHC required
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8
Q

How can you stage mast cell tumours

A

Tests to assess the patient for metastatic disease
1. Haematology/ Biochemistry/Urine analysis:
- Usually unremarkable
- Rule out any other problems and suitability for subsequent therapies
2. FNA or biopsy of local LN:
- Always FNA regional LN regardless of size
- Interpretation can be difficult - chemotaxis post surgery vs metastasis
3. Abdominal ultrasound
- Assess liver, spleen, LNs
- Higher risk or caudal body
4. Thoracic radiography - Lung metastasis uncommon but to evaluate sternal LN

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9
Q

List the clinical factors that influence the prognosis of mast cell tumours

A
  • Location e.g. Nail bed, oral, muzzle, prepuce, perineum, mucocutaneous junction.
  • Breed: Sharpei (high grade) vs boxer (low grade)
  • Appearance
  • Systemic illness
  • Recurrence
  • ?Clinical staging (i.e. presence of metastatic disease)
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10
Q

What is the most important prognostic factor for mast cell tumours?

A

Histological grade from a biopsy
Can predict recurrence and metastasis

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11
Q

Describe a grade 1 tumour using the Patnaik grading system

A

Grade I / well differentiated tumours:
- Benign behaviour (<10% metastasise)
- Low recurrence rates
- Unlikely to cause death (up to 7-12%)

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12
Q

Describe a grade II tumour using the Patnaik grading system

A

Grade II/ intermediate tumours:
- Variably metastatic (5-22% metastasise)
- Cause of death in 17-56% of patients
- Nodal metastases associated with poorer prognosis in some studies but not in all

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13
Q

Describe a grade III tumour using the Patnaik grading system

A

Grade III/ poorly differentiated tumours
- Highly metastatic (>80%)
- Likely to be cause of death

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14
Q

Describe the Kiupel grading system

A

Just 2 groups; low grade and high grade
Median survival time
- Less than 4 months for high-grade MCT
- More than 2 years for low-grade MCTs

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15
Q

Describe the surgical margins needed for mast cell tumours

A

3cm margins & 1 fascial plane (ideally but many not be achievable anatomically)
1-2cm lateral margins may be adequate for grade I and II tumours

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16
Q

Describe the use of radiotherapy for mast cell tumours

A
  1. Postoperative - incompletely excised (grade I/II 1-2yr DFI 81-95% and 80% alive at 5yrs)
  2. Local nodal metastasis (DFI 40mo)
  3. Gross disease - degranulation
17
Q

Describe the use of chemotherapy for mast cell tumours

A
  • High grade and/or confirmed metastasis
  • Neoadjunctively prior to surgery e.g. cases with a larger tumour or where full excision doesn’t seem possible – will shrink the tumour
  • Cases of residual microscopic disease
18
Q

Which agents are commonly used for chemotherapy of mast cell tumours?

A
  • Vinblastine/prednisolone: vinblastine weekly for 4 weeks then fortnightly for 4 further treatments
  • Lomustine: PO q 3 weeks or alternating with vinblastine q 2 weeks
19
Q

Describe the use of tyrosine kinase inhibitors for mast cell tumours

A

Toceranib/Masitinib
- Non-cytotoxic thyrosine kinase inhibitors.
- Licensed for unresectable, metastatic or high grade MCT
- Kit mutation status can determine response to treatment (70% vs 30% RR) -> tumours with a kit mutation have a poorer prognosis
- Very expensive

20
Q

Name the two forms of feline mast cell tumours

A

Cutaneous
Visceral

21
Q

Describe cutaneous feline mast cell tumours

A
  • Second most common cutaneous tumour in the cat (20%)
  • Cutaneous raised hairless masses.
  • Easily diagnosed by cytology and rarely metastatic. Multiple tumours.
  • Surgical excision is usually curative (even marginal).
22
Q

Describe the visceral forms of feline mast cell tumours

A
  1. Splenic: Most common differential for splenic disease. Clinical signs of systemic disease.
    - Staging is recommended.
    - Splenectomy is the treatment of choice even if involvement of other organs (MST 12-19 months).
    - Unclear role of chemotherapy.
  2. Intestinal: Third most common intestinal tumour.
    - Signs of GI and systemic disease and palpable abdominal mass.
    - Metastasis are common.
    - Poor prognosis (?chemotherapy/TKI).
23
Q

In which part of the bladder do transitional cell carcinomas form?

A

Bladder trigone but urethra and prostate in males.

24
Q

Where do transitional cell carcinomas most commonly metastasise to?

A

Medial iliac lymph nodes and other organs (liver, spleen, bones etc)

25
Q

What are the breed predispositions for transitional cell carcinomas?

A

Scottish terrier
WHWT

26
Q

Describe the typical clinical presentation of a transitional cell carcinoma

A
  • Low urinary tract signs (haematuria, stranguria, pollakyuria).
  • Occasionally signs related with bone metastasis (lameness) or renal dysfunction.
  • Signs can be present for months as dog gets treated for “complicated UTIs”.
  • Signs may improve with courses of antibiotics but then come back
27
Q

How are transitional cell carcinomas diagnosed?

A
  • Histopathological diagnosis although sometimes cytology very suggestive.
  • Risk of seeding with FNA
  • Traumatic catheterization/ prostatic wash
  • Cystoscopy (mainly females)/ surgical biopsy
28
Q

How can you stage transitional cell carcinomas?

A
  • Haematology/ Biochemistry/Urine analysis (including culture)
  • Abdominal ultrasound: assess bladder wall, urethra, prostate and kidneys +/- metastasis in other organs
  • T&A radiography: lung metastasis uncommon, Bone metastasis
29
Q

What results may appear on Haematology/ Biochemistry/Urine analysis in transitional cell carcinoma cases?

A
  • May show neutrophilia, renal dysfunction, presence of UTI
  • Can rule out any other problems and suitability for subsequent therapies
30
Q

Describe surgical treatment of TCC

A
  • Surgery rarely possible due to location (MST 348 days with piroxicam)
  • External beam radiotherapy: high rate of complications
  • Brachytherapy: suitable for prostatic and urethral tumours with improved survival.
31
Q

Describe medical therapies for TCC

A
  • NSAIDs alone = MST 181 days
  • Mitoxantrone and NSAIDs = MST 291 days
  • Other chemotherapy drugs (Vinblastine, chlorambucil, carboplatin etc.)
    Palliative care:
  • Regular urine cultures and antibiotic courses as appropriate
  • Cystotomy tubes/ Urethral stents
32
Q

Describe the prognosis of TCC

A
  • Poor long term prognosis but quality of life can be maintained for several months.
  • Local disease most likely cause of death/euthanasia (MST 6-8 months).
  • Rapid deterioration due to renal failure or clinical signs associated with bone metastasis (pain) also possible.
  • Owner counselling and regular monitoring of quality of life

Y4 SA - Oncology (12 decks)

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