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URI2 > Neoplasia > Flashcards

Neoplasia Flashcards

1
Q

Describe the characteristics of primary renal tumours

A
  • Relatively uncommon
  • Often solitary
  • Often unilateral
  • Unilateral tumour will not cause azotaemia
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2
Q

Name the benign primary renal tumours that may occur

A
  • Adenoma
  • Fibroma
  • Haemangioma
  • Interstitial cell tumour
  • Leiomyoma
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3
Q

Name the malignant primary renal tumours that may occur

A
  • Adenocarcinoma/carcinoma
  • Lymphoma
  • Fibrosarcoma
  • Haemangiosarcoma
  • Leiomyosarcoma
  • Transitional cell carcinoma
  • Cystadenocarcinoma and nodular dermatofibrosis (GSDs)
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4
Q

Outline the characteristics of renal tumours in dogs

A
  • Adenocarcinoma most common primary tumour
  • Often unilateral
  • Middle aged and older dogs
  • Males > females
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5
Q

Outline the characterstics of renal tumours in cats

A
  • Lymphoma most common, can be primary or secondary
  • 6-7yo
  • FeLV is a risk factor, need to test
  • Renal adenocarcinoma common primary tumour
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6
Q

Describe nephroblastomas

A
  • Embryoma
  • Most commonly dogs <1year
  • May be in only one pole of an affected kidney
  • Demonstres mixed tissues histologically (muscle, cartilage etc.)
  • Surgery may be curative
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7
Q

Outline the clinical signs of renal tumours

A
  • Often vague: anorexia, depression, weight loss, lethargy
  • May have palpable abdominal mass/masses
  • Haemturia throughout urination
  • Abdominal pain or distension
  • Development of pelvic limb oedema if lymphatic drainage compromised
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8
Q

What may be found on blood biochemistry and haematology with a renal tumour?

A
  • Often unremarkable
  • Regenerative anaemia if haematuria
  • Azotaemia if bilateral
  • HyperCa as paraneoplastic (uncommon unless lymphoma)
  • Rarely may be polycythaemic
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9
Q

What may be found on urinalysis with a renal tumour?

A
  • Proteinuria
  • +/- haematuria
  • Neoplastic cells very uncommon
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10
Q

What may be found on imaging with a renal tumour?

A
  • Renomegaly may be seen on radiographs

- Ultrasonography usually better

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11
Q

List the differentials for a mass in the region of the kidney

A
  • Neoplasia
  • Cyst
  • Granuloma
  • cPSS, pyelonephritis, AKI, amyloidosis (generally not distinct masses)
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12
Q

Give a brief overview of the approach to a mass in the region of the kidney

A
  • Identify location ie. renal, adrenal, other?
  • Rule in/out differentials
  • Tissue sampling to diagnose as benign or malignant
  • If malignant, met check: palpate bones, LNs, and imaging of thorax
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13
Q

Discuss the tissue sampling of a renal mass

A
  • Aspirate, trucut or surgical biopsy
  • Not always diagnostic
  • If cavitated mass, may not get a representative sample
  • Referral may be needed
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14
Q

Outline the treatment of renal tumours

A
  • Nephrectomy +/- chemo (unless lymphoma)
  • Not always curative - carcinoma MST 8mo, sarcoma MST 5mo post removal
  • Nephroblastoma cured by removal
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15
Q

Discuss the presentation of renal lymphoma in dogs and cats

A
  • Cats: 7.5yo, may be FeLV +ve, may have systemic disease, may have CNS involvement, present with bilateral renomegaly and azotaemia +/- renal pain
  • Dogs: less common, uni or bi lateral, often no associated clinical signs
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16
Q

Outline the treatment and prognosis for renal lymphoma

A
  • Chemo: COP or CHOP, consider dose reduction depending on degree of azotaemia (renal drug excretion)
  • Negative prognostic indicators: FeLV, CNS involvement, severity of renal failure
  • Survival 5-13 months
17
Q

Outline renal tumours in budgie

A
  • Second most common tumour
  • Often <5yo
  • Uni or bilateral HL lameness/paralysis without hx of trauma
  • Reduced sensation below stifle joint, abdominal enlargement, generally unwell, weight loss
  • Tx: steroids (not surgery)
18
Q

Name the benign and malignant tumours that may occur in the ureters

A
  • Benign: leiomyoma

- Malignant: leiomyosarcoma

19
Q

Discuss the impact of bladder tumours

A
  • Not systemically ill generally

- Quality of life reduced due to inability to urinate

20
Q

Briefly describe the characteristics of transitional cell carcinomas

A
  • Majority of bladder tumours
  • Trigone
  • Usually locally invasive, may extend beyond bladder wall to organs such as vagina, uterus, prostate
  • Distant mets to local LN, lung, liver spleen in 50% of cases
21
Q

Outline bladder tumours in horses

A
  • Uncommon
  • Squamous > TCC
  • Presentation and diagnosis as for dogs
  • Laser therapy is an option for treatment
22
Q

Outline bladder tumours in ruminants

A
  • Cattle > sheep
  • High prevalence if graze infested pastures long term
  • Intoxication with praquilloside is cumulative
  • Bovine papillomaviruses associated with development of neoplasia in cattle exposed to bracken fern
  • Initially ingestion of bracken fern leads to enzootic haematuria, then bladder tumours
23
Q

What is the typical signalment for bladder tumours in dogs?

A
  • FN, mean age 10yo
  • Scotties, Beagle, JR, Collies, WHWT
  • Some have history of UTI
  • Exposure to flea powders, dips, collars, herbicides, insecticides increases risk
24
Q

What is the typical signalment for bladder tumours in cats?

A
  • No breed predispositions

- Mean age 10yo

25
Q

Describe the typical presentation of bladder and urethral tumours

A
  • May get complete obstruction of bladder outflow (urethral more dysuric)
  • Stranguria, haematuria, pollakiuria
  • Lameness (bone mets, hypertrophic oestopathy)
  • Cough/dysnoea (thoracic mets)
  • Dysuria with no clear urinary abnormalitites
26
Q

Outline the approach to urethral/bladder masses

A
  • Distinguish urethral vs bladder
  • Benign or malignant?
  • If malignant, stage it
  • Respond well to steroids
27
Q

What diagnostic methods are useful for bladder tumours and what results are indicative?

A
  • Urinalysis: +/- proteinuria, +/- haematuria, sometimes neoplastic cells (<30% of tumours exfoliate into urine), tumour antigen in urine (but false +ves common)
  • Contrast radiography: filling defects/abnormalities
  • Ultrasonography: thickened, irregular bladder wall, usually in trigone region
  • Cystoscopy: direct visualisation, may see frond-like structures
  • FNA, biopsy (endoscopic, or catheter suction biopsy)
28
Q

What is required in order to stage a bladder/urethral tumour?

A
  • Local LN check
  • Thoracic radiographs
  • Abdomnal ultrasonography
  • FNA/biopsy
29
Q

Outline the treatment options for urethral/bladder tumours

A
  • Surgery (partial cystectomy)
  • Palliative urinary diversion (good short term)
  • Stent placement (best to pre-treat with NSAIDs and post with chemo)
  • Medical management: NSAIDs, adjunctive chemo, metronomic chemo
30
Q

Discuss the use of NSAIDs in the medical management of bladder tumours

A
  • Meloxicam, piroxicam, firocoxib
  • 15-20% go into partial remission, most enter stable disease
  • TCCs can benefit from COX-2 inhibitors
31
Q

Discuss the use of adjunctive chemo in the management of bladder tumours

A
  • Carboplatin, doxorubicin, mitoxantrone added to NSAIDs
  • Result in improved remossion rates and times in some dogs
  • Carboplatin has fewer side effects, but mitoxantrone may be more advantageous
  • Can continue carboplatin to manage clinical signs
32
Q

Discuss the use of metronomic chemo in the management of bladder tumours

A
  • Chlorambucil daily may help where others fail
  • 70% of dogs had stable disease, median survival time 221 days
  • Anti-angiogenic rather than anti-proliferative
33
Q

Discuss the prognosis for bladder tumours

A
  • Depends on site and TNM grade
  • Prognosis generally poor
  • Depends also on signs at presentation (few signs = better)
  • Surgery MST 3mo
  • NSAIDs MST ~6mo
  • Combined modalities more expensive but may live longer

URI2 (9 decks)

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