Neoplasia of Urinary Tract Flashcards
What are the 3 (well there’s four according to mark) golden rules of a cancer case?
- Establish the diagnosis (type and grade of tumour)
- Establish the extent/stage of the disease
- Investigate any complications
- ASK THE OWNER WHAT THEY WOULD DO!!! Can just be academic
How likely is the kidnye to be a site of metastasis?
Relatively common site
How likely are primary renal tumurs?
Uncommon
What is the appearance of primary renal tumours?
Solitary and unilateral
What is the appearance of renal metastatic tumours?
Multiple and bizarre
What are the 5 primary renal tumours?
- Adenoma
- Fibroma
- Haemangioma
- Interstitial cell tumour
- Leiomyoma
What are the 6 malignant renal tumours?
- Adenocarcinoma/carcinoma
- Lymphoma
- Fibrosarcoma
- Haemangiosarcoma
- Leiomyosarcoma
- TCC
Which renal malignant tumour affects the GSD?
•(CYSTOADENCARNIMOA and nodular dermatofibrosis)
What renal tumour do dogs most commonly get?
Adenocarcinoma - unilateral
What is the typical dog which gets a renal tumour?
More commonly seen in middle-aged and older dogs
Males>females
What is the most frequent renal tumour in cats?
Lymphoma
What is the typical cat which gets a renal tumour?
ØMost frequently seen in cats 6-7 years of age
ØFeLV is a risk factor
Other than lymphoma, what other renal tumours do cats get commonly?
Renal adenocarcinoma
What is a nephroblastoma?
Who is commonly affected?
Where is it commonly present?
What is seen histologically?
•Is an embryoma (embryonal tumour)
–Almost like a teratoma as they can have bits in them
- Occurs most frequently in young dogs often <1 year
- May be present in only one pole of an affected kidney
- Histological is many demonstrate primitive epithelial and mesenchymal tissue such as muscle, cartilage and bone and various stages of differentiation
What are the vague clinical signs of a renal tumour? (5)
–Anorexia
–Depression
–Weight loss
–Lethargy
–(just generally “not very well” )
What are the more specific clinical signs of a renal tumour? (4)
–Palpable abdominal mass/masses
–Haematuria throughout urination
–Abdominal pain or distension
–Development of pelvic limb oedema if lymphatic drainage is compromised
What can we see diagnostically for renal tumours? (4)
- Bloods often unremarkable
- May show a regenerative anaemia if significant haematuria is present
- If there is severe bilateral involvement may see azotaemia
- Hypercalcaemia can occasionally be seen as a paraneoplastic syndrome
What can happen on rare occassions what can happen to renal tumours?
•Rare cases are polycythaemic, can have bone metastases or hypertrophic osteopathy
What can be seen diagnositcally on urinalysis for a renal tumour?
- Proteinuria is a common finding
- +- haematuria (may see protein or blood)
- Neoplastic cells very uncommon
–Exfoliate cells may not be common due to the route of he urine
What can be seen with imaging of renal tumors?
•Renal tumours that demonstrate renomegaly may be apparent on plain survey radiographs
–But often not obvious
- Renal ultrasonography usually superior
- Could consider advanced imaging such as CT or MRI
What do you need to find out if there is a mass in the region of a kidney?
1.Is it a renal mass? Adrenal? Other?
●
- Is it neoplastic? Cystic? Granuloma? cPSS (congenital porto systemic shunt), pyelonephritis, acute kidney injury, amyloidosis?
- If neoplastic, is it benign or malignant?
–Tissue sample (see later)
–Finding this out is important!!!
- If malignant, metastasis check
–Palpation (bones, lymph nodes) and imaging (thorax)
How do we decide between a sample by aspirate, tru cut or surgical?
–Is it something you can do yourself?
–How much does it cost?
–What are the risks?
–What is the likely diagnostic yield?
–Is it going to change what the owner will do?
How do we treat renal tumour?
•Unless it’s lymphoma, remove the whole affected kidney = nephrectomy +/- adjunctive chemotherapy
What is the prognosis of a carcinoma and sarcoma if the kidney is removed?
–Carcinoma: median survival time 8 months (but some long survivors)
–Sarcomas: median survival time 5 months