Oral and Intestinal Tumors Flashcards
Why are oral tumors a diagnostic challenge
Difficult for owner to see (esp cats)
commonly misdiagnosed as dental disease
may mimic inflammatory / infectious conditions
“tip of the iceberg”
What are the clinical signs of most oral tumors
1) Mass in mouth
2) Halitosis
3) Dysphagia
4) Bloody discharge
5) Loose teeth
6) Drooling (esp cats)
7) Poor grooming (esp cats)
How do you diagnostically work up oral tumors
Biopsy- incisional is best (doesnt require general anesthesia in most cases) -1 cm^3 is needed
FNA is difficult to obtain accurate diagnosis due to background of infection, inflammation
For oral tumors in dogs, where should you go for your biopsy?
A) on the cheek over the swelling
B) Intranasal
C) Lift the lip and go through the lip
D) Lift the lip and go through the maxilla
D) Lift the lip and go through the maxilla
What are important points when doing a biopsy for oral tumors
1) Incisional biopsy works best
2) Avoid going through the lip or cheek
3) Always biopsy an oral mass from the oral cavity
4) Record exactly where the lesion is
-The oral mucosa heals rapidly
-Document
-Photograph
You should always biopsy an oral mass from the
oral cavity
-avoid going through the lip or cheek
In addition to an incisional biopsy, how else should you diagnostically work up oral tumors
-Thoracic radiographs
-Lymph node aspirates (if enlarged)
-Abdominal ultrasound (geriatric pets with possible comorbidities)
T/F: skull radiographs have limited utility in working up oral tumors
True
How do you determine how bad oral tumors are
Skull CT imaging
-indirect lymphography
What is indirect lymphography
skull CT imaging whre iohexol local peritumoral injection to identify the at-risk lymph nodes
for tumors known with lymphatic metastasis
tells you what lymph nodes are at risk for draining the region with the tumor
What are the kinds of oral tumors that cats get
1) Squamous cell carcinoma (most common) - tends to be diffuse
2) Fibrosarcoma
What are the kinds of oral tumors that dogs get
1) Fibrosarcoma
2) Melanoma
3) Squamous cell carcinoma
also: osteosarcoma, mast cell tumor, plasmacytoma, tonsillar lymphoma, multilobular osteochondrosarcoma
T/F: dogs recovery quickly after aggressive maxillectomy or mandibulectomy
True
What are the potential side effects following resection of a mandibular segment
-Drifting and tilting of the mandible, can get ulceration of the canines impacting the tissue (will often self direct)
-tongue can hang to the side (can do tongue shortening)
What maxillectomy postoperative changes (<2weeks postop) should you counsel an owner preoperatively?
-Bleeding/ Epistaxis (caudal maxillary is close to carotid) - bloody sneezes or transfusion
-Permanent epiphora (lacrimal duct gets disrupted)
-Intraorbital foramen - densitization to the upper lip
-Roof of mouth needs to get covered so you dont have an oral nasal fistula
-Dehiscence
-Subcutaneous emphysema, synchronous skin motion
-Bruised appearance
-Incomplete resection
T/F: after canine maxillectomy / mandibulectomy most dogs eat the night of surgery and go home with owners the following day
True
What are complications of canine maxillectomy / mandibulectomy
Transfusion
Fistula
Malocclusion
Incomplete resection
Following canine maxillectomy / mandibulectomy what temporary lifestyle modifications are needed
Soft food for 1 month
Lowkey activity 2 weeks
No objects in mouth for 1 month
What are permanent changes following canine maxillectomy / mandibulectomy
+/- epiphora
+/- desensation to upper lip
conformation change, functional eye
normal mouth and nose use
What kind of dogs typically get oral tumors that are fibrosarcoma
large breed dogs (Golden Retrievers)
-young dogs common
What are the characteristics of canine oral fibrosarcoma *
-10 to 20% of oral cancer
-large breed dogs (golden retrievers, young dogs common)
-located on palate, maxilla, mandible
-slow to metastasize
-bone is commonly involved (if it touches bone it has to go)
Tx: complete surgical resection (radiation alternative)
fair to good prognosis (18-24 months median survival) cure is possible
will recur if incomplete resection
What do you do if a canine oral fibrosarcoma is touching bone *
If it touches bone, bone has to go
these tumors commonly involve bone
How do you treat canine oral fibrosarcoma
Complete surgical resection - maxillectomy, mandibulectomy (radiation alternative)
will recur if incomplete excision
fair to good prognosis of 18-24 month median survival
What are Hi Lo FSA
Histologically low grade, biologically high grade fibrosarcoma
Retriever breeds are overrepresented
most common on face = facical deformity, bone destruction
presents as firm mass smooth, non-ulcerated
How do Hi Lo FSAs present
most common on face = facical deformity, bone destruction
presents as firm mass smooth, non-ulcerated
may have previously diagnosed as fibroma, fibrous tissue, scar tissue, inflammation on histology (very benign on histo) but very invasive and requires larger surgical margins
retriever breeds are overrepresented
T/F: Hi Lo FSAs are highly metastatic and have high local recurrence
False- these have low metastatic rate, high local recurrent
very benign on histo but very invasive
What are the characteristics of canine oral melanoma
-30 to 40% of oral tumors
-older dogs most common
-small breeds > large
-begins in mucosa/ gingiva (anywhere in mouth or on lip margin will behave aggressively)
-Invasive to bone
-metastasis to lymph node and lung common
-2/3rds pigmented, often ulceration
What kind of dogs typically get canine oral melanoma
small breeds > large
older dogs more common
Where does canine oral melanoma typically begin
begins in mucosa/ gingiva, anywhere in mouth or on lip margin will behave aggressively
invasive to bone
where do canine oral melanomas typically metastasis to
lymph node
lung
invasive to bone
How do you treat canine oral melanoma
complete excision - maxillectomy / mandibulectomy
regional draining lymph nodes (sentinel LNs)
adjuvant:
radiation therapy if incomplete margins
radiation therapy of gross tumor with chemosensitization (365 MST)
immunotherapy/vaccines - incept, others
What is the prognosis of canine oral melanoma
poor to fair
MST 6-20 mo
survival > 1 year common if no metastasis at diagnosis
death due to metastasis if completely excised or local recurrence if margins incomplete
What kind of dogs typically have canine oral squamous cell carcinoma
larger breed dogs > smaller breed dogs
How does canine oral squamous cell carcinoma typically present
rostral mandible, tonsil tongue
red, cauliflower raised, ulcerated
larger dogs > smaller dog
What tells you that canine oral squamous cell carcinoma prognosis is better
if the mass is rostral
rostral tumors respond well to complete excisions, cure is possible, response to radiation if margins dirty, radiation alternative to excision
prognosis with tongue SCC varies with grade and location of the tumor- caudal tongue worse, high grade is worse
What tells you that the prognosis of canine oral squamous cell carcinoma is worst
1) caudally located
2) Tonsil
3) Lymph node postive or lung mets
What form of canine oral squamous cell carcinoma is very aggresive
Tonsillar form
-do bilateral tonsillectomy
-radiation therapy reported to help control disease
-<10% alive at 1 year if in the tonsils
What is the prognosis of the tongue form of canine oral squamous cell carcinoma
rostral has better prognosis
if completely excised >50% alive at 1 year
canine oral squamous cell carcinoma can be confused with
granular cell myoblastoma (which has a good prognosis)
What can you do for adjuvant therapy for canine oral squamous cell carcinoma
Piroxicam 0.3mg/kg PO daily
Cisplatin or carboplatin
Radiation therapy
What can you do for tongue form of canine oral squamous cell carcinoma
partial glossectomy
>50%-100% of movable tongue in dogs
if you do a compelte glossectomy, what do you need to do
make sure they are in an environment where they can thermoregulate
What should you do when doing partial glossectomy
short term enteral feeding tube
-maintain nutrition, hydration, hypersalivation, thermoregulation
where do acanthomatous ameloblastomas arise from
submucosa and periodontal ligament - very ingasive
BENIGN OR INVASIVE
-Fibrous epulis
-Ossifying epulis
-Acanthomatous ameloblastoma
-Fibrous epulis - BENIGN
-Ossifying epulis - BENIGN
-Acanthomatous ameloblastoma- INVASIVE but do not metastasize
How do you treat acanthomatous ameloblastomas
must remove bone
90% cure with clean margins
do not metastasize but very invasive
T/F: surgical debulking of canine oral tumors improve prognosis **
False - surgical debulking where residual gross disease remians does not improve prognossi
What will palliate bone pain in animals with non-resectable oral tumors
Radiation therapy
stereotactic radiaiton therapy for select macroscopic disease
What are the most common oral tumors of the cat
1) SCC (70%)
2) Fibrosarcoma (20%)
3) Nasopharyngeal polyps (benign)
4) Eosinohphilic granuloma (benign)
Where does feline oral squamous cell carcinoma commonly involve?
maxilla, mandible, under tongue
extensive invasion of bone common
(lymph node or lung mets uncommon) because so severe dont have time to develop metastasis
What is the prognosis of feline oral squamous cell carcinoma
poor response to surgery and radiation
<10% alive at 1 year for sublingual SCC
other sites have variable prognosis
How does feline maxillectomy/mandibulectomy differ in cats compared to dogs **
felines require more aggressive post-operative care
-G-tube
-Grooming
Where do feline oral fibrosarcomas typically occur
gingiva, lip or cheek
-firm, raised mass +/- ulcerated
occasionally metastasize
bone involvement common
fair response to surgery
oral tumors are commonly misdiagnosed as
dental disease
For incisional biopsies of oral tumors you shouldnt go through the
skin or lips
need to record exactly where the lesion is
You are performing an abdominal exploratory in a 7yo mixed breed dog having intermittent vomiting, weight loss, and a small palpable mass.
At surgery you find a focal circumferential jejunal lesion with omental adhesions, diffuse mesenteric nodules, and a liver nodule. What action do you take
Resect intestinal mass, biopsy other lesions and recover
What are the most common intestinal tumors of the small intestine and stomach
Cats
1) Lymphoma
2) Adenocarcinoma
Dogs
1) Adenocarcinoma
2) Lymphoma
What are the most common large intestine tumors
colo-rectal adenocarcima
(rectum more frequently affected than colon)
What are the most common tumors of the ileum
Leiomyosarcoma
GIST (CD117 (c-kit)
Carcinoid
What are the clinical signs of gastrointestinal tumors
-Weight loss
-Vomiting
-Melena
-Tenesmus
-abdominal mass noted on palpation or mass noted on rectal
-CBC may show anemia
-serum chemistry may show hypoproteinemia, high ALP, high BUN, electolyte disturbances
What imaging can you do for GI tumors
Abdominal rads- may identify obstructive pattern or mass effect
Abdominal ultrasound - more senstive can evaluate lymph nodes within abd cavity, guide FNA
Exploratory laparotomy
How do you treat GI tumors
solitary masses or obstructive tumors require surgery
-resection and anastomsosi, gastric resection, rectal pull through, etc
-palliation
-stenting, rerouting, bypass
-diffuse lymphoma treated with chemotherapy
What rule of thumb surgical margins should be obtrained (orad and aborad) when resecting an obstructive intestinal mass
there are anatomic constraints
stomach around antrum - 1cm
rectum - 1cm
jejunum 4-5cm
varies with the type
What are the prognostic factors of GI tumors
Positive: solitary mass, complete margins, response to chemo in cats with lymphoma, pendunculated vs annular colorectal adenocarcinoma
Negative: metastasis to lymph node, lung, peritoneum
In cats with intestinal lymphoma, is the small intestine or large intestine a better prognosis
small intestine
