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Small Animal Medicine II > Melanoma & Anal Sac Adenocarcinoma > Flashcards

Melanoma & Anal Sac Adenocarcinoma Flashcards

1
Q

What is the most common oral tumor in dogs? What do they most commonly affect? How do they act?

A

melanoma

gingiva, tongue, hard palate

very aggressive, rapidly grows, invasive with high metastatic potential (unless low grade)

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2
Q

What unique oral melanoma has lower metastatic potential?

A

lip/mucocutaneous junction

  • treated the same way
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3
Q

Other than oral, what are 2 other forms of melanoma in dogs?

A
  1. DIGITAL - high metastatic potential, meed systemic therapy after digital amputation
  2. CUTANEOUS - low metastatic potential (higher potential in those with high mitotic count, nuclear atypia, poor pigmentation, and high Ki67 staining)
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4
Q

What is the typical presentation of oral melanoma?

A
  • difficulty eating - decreased appetite, dropping food from one side of the mouth
  • oral bleeding - blood in water bowl
  • excessive drooling
  • halitosis
  • mass found on oral exam
  • facial deformity
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5
Q

What 2 diagnostics are used for oral melanomas?

A
  1. FNA - often poorly differentiated with minimal melanin granules
  2. biopsy - incisional for larger masses, excisional for smaller ones; allows for grading but most will be highly malignant
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6
Q

What is indicative of a low grade melanoma on histopath?

A
  • low mitotic count (<3)
  • low nuclear atypia
  • high pigmentation
  • low Ki67 staining

may be cured with surgery

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7
Q

What 4 diagnostics are used for staging oral melanoma?

A
  1. CBC/chem/UA - possible neutrophilia
  2. FNA of ipsilateral mandibular LN
  3. thoracic rads - often no visible metastasis at diagnosis due to micrometastatic disease
  4. CT - determines invasiveness, can look at thorax for micrometastasis
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8
Q

What surgery is recommended for oral melanoma?

A

partial mandiculectomy/maxillectomy

  • may still not achieve complete resection
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9
Q

When are definitive and palliative radiation recommended for oral melanoma?

A

DEFINITIVE - post-surgery for dirty margins, gross disease, higher dose per fraction

PALLIATIVE - pain and hemorrhage

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10
Q

What protocols for radiation therapy are avoided for melanoma?

A

finely fractionated —> nature of melanoma growth

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11
Q

What unique treatment is available for oral melanoma? How does it work?

A

Oncept vaccine containing plasmid of DNA encoding for human tyrosinase (involved in melanin synthesis)

  • muscle cells take up plasmid and synthesize human tyrosinase
  • antibodies made against tyrosinase attach melanoma cells
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12
Q

When is the melanoma vaccine most effectively used? What 2 things is it not helpful for? What side effects are seen?

A

in conjunction with local therapy (surgery or radiation

  1. preventing local tumor regrowth
  2. gross disease

NONE

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13
Q

What chemotherapy is recommended for melanoma?

A

carboplatin —> in conjunction with local therapy

  • poor response with gross disease
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14
Q

What is the prognosis of oral melanoma like?

A

poor —> rapid regrowth common if not completely resected, rapid metastasis compared to other neoplasms

  • local therapy = 3-6 months
  • local therapy + melanoma vaccine = 12 months
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15
Q

How does oral melanoma compare in cats?

A
  • uncommon
  • consider same testing, treatment, and prognosis
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16
Q

What does anal sac adenocarcinoma arise from? How does it act?

A

apocrine glands within anal sac —> AGASACA

high metastatic potential to sublumbar or sacral LNs (often does not spread much further)

17
Q

What is the most common presentation in patients with AGASACA?

A
  • mass/swelling in the perineal area
  • constipation, tenesmus, hematochezia
  • scooting
  • palpable sublumbar or sacral LNs
  • PU/PD
18
Q

What is the most common definitive diagnostic used for AGASACA? What else is performed if this comes back inconclusive?

A

FNA of anal sac —-> neuroendocrine epithelial cells

biopsy —> incisional for large masses and excisional for small masses

19
Q

What are 4 possible changes seen on CBC/chem/UA in cases of AGASACA?

A
  1. hypercalcemia (worse prognosis!)
  2. hyposthenuria
  3. azotemia - pre-renal, renal
  4. neutrophilia
20
Q

What 2 diagnostics are used for staging AGASACA?

A
  1. abdominal radiographs and U/S - asses sublumbar LNs, ventral deviation of colon, bladder obstruction
  2. thoracic rads - occasional pulmonary metastasis
21
Q

What surgeries are recommended for AGASACA? What 2 complications are associated?

A

anal sac and enlarged sublumbar LNs removal —> even done with metastasis with this neoplasia since it often never spreads beyond the LNs + multiple surgeries can be done due to slow growth

  1. fecal incontinence
  2. high rates of infection
22
Q

What 2 types of radiation therapy is recommended for AGASACA?

A
  1. DEFINITIVE - post-srugery to anal sac and sublumbar LN areas
  2. PALLIATIVE - sublumbar area if no surgery was performed
23
Q

What systemic therapy combo is recommended for AGASACA? When are they given? Sole therapy?

A

Palladia + chemotherapy (carboplatin, mitoxantrone

post-surgery due to high metastatic potential

Palladia - reduces gross disease, prolonged stabilization of tumors

24
Q

What commonly reverses hypercalcemia seen with AGASACA? What 4 treatments are recommended if this does not happen?

A

removal of tumor and affected LNs (more cancer volume = higher Ca)

  1. monthly Zoledronate - inhibits osteoclasts
  2. Prednisone
  3. Furosemide
  4. Calcitonin
25
Q

What is prognosis of AGASACA like?

A
  • surgery +/- systemic therapy = 9 months for larger tumors and 18 months for smaller tumors
  • surgery, radiation, chemo = 32 months

(hypercalcemia reduces survival time!)

26
Q

How does AGASACA compare in cats?

A
  • uncommon
  • same testing, treatment, and prognosis as with canine AGASACA

Small Animal Medicine II (57 decks)

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