Oncology: Oral and Mammary Tumours Flashcards
What are the clinical signs of oral tumours?
- Mass/facial swelling
- Oral bleeding
- Dysphagia
- Halitosis
- Epistaxis
- Loose teeth
- Cervical lymphadenopathy
How are oral tumours diagnosed?
- Biopsy- incisional wedge
- FNA
- Assessment of local
- lymph nodes in all cases
- FNA submandibular lymph nodes
How are oral tumours staged?
Primary
* Visual assessment underestimates
* Radiographs insensitive
* Advanced imaging
Nodes- FNA submandibular
Distant metastases
* Thoracic imaging
What are the most common oral tumours in dogs?
- Malignant melanoma
- Squamous cell carcinoma
- Fibrosarcoma
- Acanthomatous ameblastoma
How are primary oral tumours managed?
Surgery treatment of choice
* Maxillectomy/mandibulectomy
* Margin dictated by histology
For fibrosarcoma and SCC follow surgery with adjuvant rescue therapy
What are oral surgery complications?
- Bleeding
- Infection
- Altered cosmetic appearance
- Difficulty prehending food/messy eating
- Salivation
- Mandibular drift
- Recurrence
How are melanomas that do not contain melanin diagnosed?
IHC is required to make a diagnosis
How is a primary oral melanoma treated?
- Surgery associated with high rates of local recurrence
- Radiation therapy reasonable option
What is used for anti-metastatic treatment of melanomas?
- Stage II and III
- Targets melano-protein- tyrosinase
- Expensive
- Minor side effects-
- Not huge effect
How are oral SCC treated?
Low metastatic rate
* Surgery- MST 19-26m
* Radiotherapy- MST 15m
* Surgery/RT- MST 34m
When can medical therapy of oral SCC be considered?
What can be used?
When other therapies aren’t possible
* Piroxicam
* Piroxicam + carboplatin
* Sustained responses- MST 18m
- How does tonsillar SCC present?
- How is it treated?
- What is the prognosis?
- Dysphagia, coughing, enlarged LNs- metastatic rate >70%
- Local control of tonsillar enlargment- surgery or RT
- MST- 7m
What cancer is this?
How is it treated?
Fibrosarcoma
* Surgery- most important- MST 1y
* Surgery and RT- MST 18-26m
What characeterstics can fibrosarcomas unusually possess?
Histologically low-grade
Biologically high-grade
What are epulides?
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
What is the MST for canine oral osteosarcomas?
Mandibular has longer survival than maxillary
Mandibular 14-18m
Maxillary 5-10m
What is the most common feline oral tumour?
How can it be treated?
Squamous cell carcinoma
* Surgery not possible on presentation most of the time but good outcome if possible < 1 year survival
* RT occasionally helpful
What is the main option for treatment of feline fibrosarcoma?
Surgery
What does this image show?
Viral papillomatosis
* Wart like lesions affecting oral soft tissues
* Usually resolve in 4-8 weeks
* Occasionally persist in immunosuppressed animals
How are the following oral lesions treated?
1. Eosinophilic granuloma- dogs
2. Eosinophilic granuloma- cats
3. Transmissible venereal tumour
- Surgery and corticosteroids
- Steroids/hypoallergenic therapy, RT/Surgery
- Spontaneous regression, vincristine
How does neutering affect the risk of mammary tumours?
- 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
Other then neutering what are risk factors for mammary tumours?
- Obestity
- Age
- Breed- poodles, chihuahua, cocker spaniel
How can mammary tumours be approached?
- 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
What surgeries can be performed for canine mammary tumours?
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
What are post surgical prognostic factors (canine mammary tumours)
Tumour type
* Benign vs malignant
* Less heterogeneity associated with poorer outcome
* Sarcoma especially oesteo- poor
What tumours is:
* easily mistaked for mastitis
* Extemely painful
Canine inflammatory carcinoma
FNA- inflammatory cells, tumour cells
Prognosis poor, treatment palliative
What type of tumours are feline mammary tumours commonly?
85-95% are malignant
What affects prognosis of feline mammary tumours?
Tumour size
* > 2cm- MST 6m
* <2 cm >3y
Lymph node metastasis
* lymphatic drainage less predictable
Distant metastasis
Breed- DSH better
What surgery is indicated in feline mammary tumours?
Chain masectomy is preferred
Surgical resection of inguinal/axillar lymph nodes for high risk tumours
Is an ovariohysterectomy indicated at the time of mammary tumour excision?
Dogs
* Benign mammary tumouts half the chance of new
* Less clear for carcionma
Cats- not been assesed
