Oncology - Oral and Nasal Flashcards
What is the most common oral tumor in the dog?
Melanoma
What oral tumors do dogs get?
Melanoma, SCC, fibrosarcoma, acanthomatous ameloblastoma
What nasal tumors do dogs get?
adenocarcinoma
What history is often associated with oral tumors in dogs?
Halitosis, blood in the water bowl, ptyalism, dysphagia, and hyporexia
When you are trying to diagnose canine oral tumors, what do you want to examine in the mouth?
Mandible, maxilla, palate, tongue, under the tongue, tonsils, and palpate under the mandible and between the rami
True or False: All oral tumors look the same.
False - they can be raised, pignmented, ulcerated, smooth, and friable
What is the first diagnostic test you want to do, aside from PE, when you have an oral neoplasia?
minimum database
You should aspirate one/both regional LN in patients with an oral mass.
both - even if they could look normal
True or False: FNA is better for diagnosing oral tumors.
False - biopsy is best
What imaging methods should you do if you are dealing with an oral tumor?
Chest x-rays to look for metastasis, +/- dental rads, and CT scan
Oral malignant melanomas are tumors of the _______.
melanocytes
Where are oral melanomas most commonly seen?
Gingiva, lips, tongue, and hard palate
True or False: Not all oral melanomas are pigmented
true - 1/3 of them are not
How do oral melanomas typically look in the mouth (not color)?
ulcerated and necrotic
What does the biological behavior of oral melanomas depend on?
size, site, and histologic parameters
Oral melanomas are ______ invasive with a high _______ potential.
Locally, metastatic
How can oral melanomas be treated?
Surgery, radiation, chemotherapy, COX 2 inhibition, and the melanoma vaccine
Does a patient have a better prognosis if it gets surgery alone or surgery with radiation therapy?
surgery with radiation therapy
Does the stage of oral melanoma affect the survival time?
Yes, the worse the stage, the shorter survival time
What are some negative prognostic factors for oral melanomas?
Incomplete surgical margins, locations, and surgery alone
Is radiation alone or radiation with surgery associated with a longer survival time in oral melanoma patients?
radiation with surgery
What is the only chemotherapy that oral melanoma is responsive to?
Carboplatin - still not very responsive
What drug can inhibit COX2 and aid in treatment of oral mealnoma?
Piroxicam
What stages of oral melanoma is the melanoma vaccination licensed for?
stage II/III with local control
True or False: The oral melanoma vaccination can be used to prevent oral melanoma.
False
What is the oral melanoma vaccination made out of?
Gene for human tyrosinase is inserted into a DNA plasmid
What does the oral melanoma vaccination do?
Stimulates the immune system to the presence of the tyrosinase and targets melanoma cells
Large/small breeds more often get canine fibrosarcoma.
Large
60-72% of fibrosarcomas have ____ involvement.
bone
How are fibrosarcomas typically treated?
Surgical treatment and radiation treatment
Which of the following have a longer survival time associated with fibrosarcomas?
a. surgery alone
b. radiation alone
c. surgery and radiation
c. surgery and radiation
What are the prognostic factors for fibrosarcoma?
Size of the tumor, complete resection, smaller diameter, and rostral location
Smaller/Larger fibrosarcomas are associated with a poorer prognosis.
larger
In cases of oronasal fistulas as a result of fibrosarcoma therapy, what are treatment options?
Surgical flap or a temporary septal button
Ideally, what is the recommended treatment for oronasal fistulas?
Ideally place a button, give tumor time to regress further, and fix permanently with a flap
Why should you use caution with fibrosarcomas?
They can be histologically low grade, but biologically high grade (very locally aggressive)
What is a canine epulis?
Benign gingival proliferations arising from the periodontal ligament
What do canine epulis appear similar to?
gingival hyperplasia
True or False: Fibromatous, ossifying, and giant cell epulis have a bimodal peak in regards to age of onset (young and old)
False - It is acanthomatous that do that
Fibromatous, ossifying, and giant cell are unimodal
Where are fibromatous, ossifying, and giant cell epulis typically located?
Maxillary and mandibular premolars
What disease process are fibromatous, ossifying, and giant cell epulis associated with?
chronic gingivitis
Where are acanthomatous epulis located?
mandibular canine
What diagnostic test should you do in cases of acanthomatous ameloblastomas?
biopsy
What do you need to make sure you include when doing surgical resection of acanthomatous ameloblastomas?
include the bony margins for better tumor control
Can RT be used for acanthomatous ameloblastomas?
yes
Canine nasal neoplasia is associated with acute/chronic nasal disease.
chronic
Canine nasal neoplasia are typically ______ invasive.
locally - they can metastasize
What type of tumors are nasal neoplasias?
Carcinomas (2/3), Sarcomas (1/3), and nasal polyps
What clinical signs are associated with canine nasal neoplasia?
Intermittent and progressive unilateral epistaxis or mucopurulent discharge, neurologic signs possible, and may response initially to abx, steroids, and NSAIDs
True or False: Dogs with epistaxis and concurrent clinical signs of systemic disease are likely to have a non-neoplastic disease
true
What do you want to do on PE on patients with nasal neoplasia?
Palpate the head and nose, check airflow, check retropulsion, look for exophthalmos, ocular discharge, and fundic examination
What differentials should there be along side with nasal neoplasia?
Fungal infections, coagulopathy, foreign body, and lymphocytic-plasmacytic rhinitis
What should you do for staging of nasal neoplasia?
Minimum database, coagulation profile, blood pressure, LN FNA, chest rads, CT/rhinoscopy, biopsy, +/- ultrasound
What should you always have set up when you are doing a CT/rhinoscopy for a nasal neoplasia?
radiation
What are the considerations for nasal biopsies?
They need anesthesia (it is painful), measure, don’t go further than the medial canthus of the eye, be prepared for bleeding
When treating nasal neoplasia, what is it important to keep in mind?
You need to control local disease and bone invasion is common
True or False: Curative surgery is common for treatment of nasal neoplasia.
False
What is the treatment of choice for canine nasal neoplasia?
Radiation - stereotactic
Why is radiation such a good treatment for canine nasal neoplasia?
It treats the entire nasal cavity - including bone
What normal tissue complications are associated with radiation therapy of nasal neoplasia?
Late - cataracts, brain necrosis, and osteonecrosis
We don’t see acute signs
Is stereotactic radiation the only option for patients with nasal neoplasia?
No - you can do palliative radiation therapy to improve quality of life
What imaging may be helpful with the use of palliative radiation therapy?
CT
What is the preferred chemotherapy for canine nasal neoplasia?
Palladia
There is another protocol but it is less effective
What are some palliative treatments for nasal neoplasia?
Carotid artery ligation, Yunnan Baiyao, and NSAIDs
What are the negative prognostic indicators for canine nasal neoplasia?
Age >10 years, epistaxis, long duration of clinical signs, advanced local tumor stage (cribriform plate), metastatic disease, histologic subtype, and failure to achieve resolution of clinical signs
