Oncology - Bladder and AGASACA Flashcards
Typically what type of neoplasia are bladder neoplasias?
Invasive transitional cell carcinomas
Where do TCCs like to locate in the dog? Cat?
Dog - trigone
Cats - apical and mid-body
Where do TCCs like to spread?
Urethra, prostate, nodal metastasis, and distant metastasis (they like to move cranially)
What breeds are the poster children for TCC?
Scotties - 18x
What are some risk factors for TCC?
Female, neutered, obesity, exposure to older generation flea products and lawn chemicals, and cytoxan exposure
What presenting clinical signs are associated with bladder tumors?
Hematuria, dysuria, pollakiuria, tenesmus, and potential lameness due to bony metastasis or hypertrophic osteopathy
What differentials should you consider with TCC?
Chronic cystitis, fibroepithelial polyps, granulomatous cystitis/urethritis, gossypioboma, calculi, other tumor types, and Botryoid rhabdomyosarcoma in young dogs
How is clinical staging done for TCC?
Good PE including rectal Minimum database - azotemia UA and culture Chest rads Abdominal ultrasound
____% of dogs will have neoplastic cells due to TCC in the urine.
30%
What diagnostic methods can be done for TCC?
UA
CADET BRAF and BRAF Plus
Histopathology - biopsy (last course), cystoscopy, traumatic catheter, or prostatic wash
What does CADET BRAF look for a mutation in?
BRAF gene
Does a negative CADET BRAF test rule out TCC?
No
How is traumatic catheter done?
Catheterize and empty bladder Attach a 12 cc syringe to the catheter Apply suction while moving the catheter Remove catheter and centrifuge sample You will need to sedate females
What can mask a TCC when doing traumatic catheter?
a concurrent UTI
Can FNA be done for TCC?
Yes, but only if necessary
Seeding is possible
What are the options for treatment of TCC?
Surgery, radiation therapy, medical therapy/chemotherapy, interventional therapy
What surgical considerations do you need to keep in mind for TCC?
Complete excision is not usually possible
Is it appropriate to try?
You need to have superb surgical techniques
TCC is highly exfoliative = seeding
Refer in complicated cases
What palliative options are there for surgery of TCC?
Prepubic cystostomy catheters, ureter/urethral stents, balloon dilation, and laser ablation
Why is uterocolonic anastomosis not recommended?
The colon will reabsorb the urine resulting in an uptake of ammonia and eventually death
What is one of the biggest problems associated with urethral stents?
25% have major incontinence
In the case of using urethral stents for TCC, what is death usually due to?
metastatic disease
What complications are associated with laser ablation as palliative care for TCC?
Stranguria, hematuria, stenosis, spread, urethral perforation, bacterial cystitis
What are the goals of palliative radiation therapy for TCC?
Improve the clinical status with low risk for severe toxicity
What is the approach of palliative radiation therapy for TCC?
Once weekly for 5 weeks or once daily for 10 days
What is the outcome for palliative radiation therapy for TCC?
Can improve comfort and micturition but does not improve survival time beyond chemotherapy and NSAIDs
When is palliative radiation therapy for TCC reserved?
For cases where medical therapies fail to improve QOL
What complications are associated with definitive radiation therapy for TCC?
Low grade GI, genitourinary and skin
in-field recurrenct
geographic mass
30% late-onset difficulty urinating/defecating
What medical therapy do we use for TCC?
COX-inhibitors and chemotherapy
What COX inhibitors can be used for TCC therapy?
Piroxicam, Deracoxib, and Firoxocib
What is the standard of care for TCC in dogs and cats?
Mitoxantrone and piroxicam
What food can decrease the risk of developing bladder cancer?
Cruciferous veggies fed 3x/week
What is the prognosis for TCC?
Signs can be controlled with a good QOL for several months or longer
Ultimately it is local disease that leads to death
How is prostatic carcinoma treated?
Similarly to TCC, but radiation seems to have more effect
What are the 3 perianal tumors that dogs can get?
Perianal adenoma. perianal adenocarcinoma, and apocrine gland anal sac adenocarcinoma
What is the most common perianal tumor that you will see in private practice?
perianal adenoma
What group of dogs is more commonly affected by perianal adenomas? Why?
Male, intact dogs because it is sex hormone dependent and increases with testosterone
NOTE: Females can still get them
How are canine perianal adenomas treated?
Castration and mass removal - 90% cured
True or False: Canine perianal adenocarcinomas are hormone dependent.
False
What is the behavior of perianal adenocarcinomas?
They grow faster, larger, and are more adherent than adenomas - 15% can be metastatic
How can AGASACA patients present?
Have no clinical signs OR tenesmus, straining to urinate, ribbon stools, scooting, licking perineal area, and mass effect
How are AGASACAs diagnosed?
Good PE with rectal
Minimum database
Staging - there are high rates of metastasis
FNA
What is the most aggressive treatment for AGASACA?
Surgical removal of the mass and abdominal lymph nodes
How can you increase survival time after surgical removal of mass and LN of AGASACA?
Add radiation therapy and chemotherapy
What chemotherapy drug can control AGASACA for about 5 months?
Palladia
What is the prognosis for AGASACA?
Okay - 1.5 years MST
What are negative prognostic factors for AGASACA?
Size: >5 cm in diameter
Hypercalcemia
No surgery
Pulmonary metastatic disease
