Oncology: Oral and Mammary Tumours

Question 1

What are the clinical signs of oral tumours?

Answer 1

• Mass/facial swelling
• Oral bleeding
• Dysphagia
• Halitosis
• Epistaxis
• Loose teeth
• Cervical lymphadenopathy

Question 2

How are oral tumours diagnosed?

Answer 2

• Biopsy- incisional wedge
• FNA
• Assessment of local
• lymph nodes in all cases
• FNA submandibular lymph nodes

Question 3

How are oral tumours staged?

Answer 3

Primary
* Visual assessment underestimates
* Radiographs insensitive
* Advanced imaging

Nodes- FNA submandibular

Distant metastases
* Thoracic imaging

Question 4

What are the most common oral tumours in dogs?

Answer 4

• Malignant melanoma
• Squamous cell carcinoma
• Fibrosarcoma
• Acanthomatous ameblastoma

Question 5

How are primary oral tumours managed?

Answer 5

Surgery treatment of choice
* Maxillectomy/mandibulectomy
* Margin dictated by histology

For fibrosarcoma and SCC follow surgery with adjuvant rescue therapy

Question 6

What are oral surgery complications?

Answer 6

• Bleeding
• Infection
• Altered cosmetic appearance
• Difficulty prehending food/messy eating
• Salivation
• Mandibular drift
• Recurrence

Question 7

How are melanomas that do not contain melanin diagnosed?

Answer 7

IHC is required to make a diagnosis

Question 8

How is a primary oral melanoma treated?

Answer 8

• Surgery associated with high rates of local recurrence
• Radiation therapy reasonable option

Question 9

What is used for anti-metastatic treatment of melanomas?

Answer 9

• Stage II and III
• Targets melano-protein- tyrosinase
• Expensive
• Minor side effects-
• Not huge effect

Question 10

How are oral SCC treated?

Answer 10

Low metastatic rate
* Surgery- MST 19-26m
* Radiotherapy- MST 15m
* Surgery/RT- MST 34m

Question 11

When can medical therapy of oral SCC be considered?
What can be used?

Answer 11

When other therapies aren’t possible
* Piroxicam
* Piroxicam + carboplatin
* Sustained responses- MST 18m

Question 12

1. How does tonsillar SCC present?
2. How is it treated?
3. What is the prognosis?

Answer 12

1. Dysphagia, coughing, enlarged LNs- metastatic rate >70%
2. Local control of tonsillar enlargment- surgery or RT
3. MST- 7m

Question 13

What cancer is this?
How is it treated?

Answer 13

Fibrosarcoma
* Surgery- most important- MST 1y
* Surgery and RT- MST 18-26m

Question 14

What characeterstics can fibrosarcomas unusually possess?

Answer 14

Histologically low-grade
Biologically high-grade

Question 15

What are epulides?

Answer 15

Non-metastatic lesions arising from the gingiva
* Acanthomatous ameloblastoma- aggressive local behaviour and bone invasion
* Peripheral odontogenic fibroma- slow growing firm masses usually not invasive

Question 16

What is the MST for canine oral osteosarcomas?

Answer 16

Mandibular has longer survival than maxillary
Mandibular 14-18m
Maxillary 5-10m

Question 17

What is the most common feline oral tumour?
How can it be treated?

Answer 17

Squamous cell carcinoma
* Surgery not possible on presentation most of the time but good outcome if possible < 1 year survival
* RT occasionally helpful

Question 18

What is the main option for treatment of feline fibrosarcoma?

Answer 18

Surgery

Question 19

What does this image show?

Answer 19

Viral papillomatosis
* Wart like lesions affecting oral soft tissues
* Usually resolve in 4-8 weeks
* Occasionally persist in immunosuppressed animals

Question 20

How are the following oral lesions treated?
1. Eosinophilic granuloma- dogs
2. Eosinophilic granuloma- cats
3. Transmissible venereal tumour

Answer 20

1. Surgery and corticosteroids
2. Steroids/hypoallergenic therapy, RT/Surgery
3. Spontaneous regression, vincristine

Question 21

How does neutering affect the risk of mammary tumours?

Answer 21

• Neutering prior to first oestrus- low risk
• Neutering prior to second oestrus- low, increased risk
• Neutering prior to third oestrus

No risk in reduction if neutering after the second season

Question 22

Other then neutering what are risk factors for mammary tumours?

Answer 22

• Obestity
• Age
• Breed- poodles, chihuahua, cocker spaniel

Question 23

How can mammary tumours be approached?

Answer 23

• Often more then 1 tumour
• FNA can exclude other DDX- masitis, lipoma, hyperplasia
• Exicisional biopsy by single or segmental masectomy
• Local staging- assesment of local lymph nodes
  front two cranial, back two caudal, middle vary
• Distant staging- thoracic radiographs- can metastasise to bone

Question 24

What surgeries can be performed for canine mammary tumours?

Answer 24

Low risk- single masectomy
High risk/intact- consider regional

Excision margins
* Mobile lesions- whole gland removal
* Fixed- 2cm margins and removal of affected abdominal fasica

Question 25

What are post surgical prognostic factors (canine mammary tumours)

Answer 25

Tumour type
* Benign vs malignant
* Less heterogeneity associated with poorer outcome
* Sarcoma especially oesteo- poor

Question 26

What tumours is:
* easily mistaked for mastitis
* Extemely painful

Answer 26

Canine inflammatory carcinoma

FNA- inflammatory cells, tumour cells

Prognosis poor, treatment palliative

Question 27

What type of tumours are feline mammary tumours commonly?

Answer 27

85-95% are malignant

Question 28

What affects prognosis of feline mammary tumours?

Answer 28

Tumour size
* > 2cm- MST 6m
* <2 cm >3y

Lymph node metastasis
* lymphatic drainage less predictable

Distant metastasis
Breed- DSH better

Question 29

What surgery is indicated in feline mammary tumours?

Answer 29

Chain masectomy is preferred

Surgical resection of inguinal/axillar lymph nodes for high risk tumours

Question 30

Is an ovariohysterectomy indicated at the time of mammary tumour excision?

Answer 30

Dogs
* Benign mammary tumouts half the chance of new
* Less clear for carcionma

Cats- not been assesed