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Oral tumors Flashcards

1
Q

Oral tumors are the ___ most common cancer in dogs

What percentage of all canine cancer?

What percentage of all feline cancer?

A

4th

6-7% of all canine cancer; 3% of all feline

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2
Q

Oropharyngeal tumors ___x more common in dogs than cats; __x more common in male dogs

A
  1. 6
  2. 4
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3
Q

2 oral tumors more common in male dogs?

A

Malignant melanoma, Tonsilar SCC, peripheral odontogenic fibroma more common in male dogs

Axial OSA in female dogs

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4
Q

List 9 breeds at risk for oropharyngeal cancer?

A

Cocker spaniel

GSD

German Shorthair Pointer

Weimaraner

Golden retriever

Gordon setter

Mini poodle

Chow Chow

Boxer

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5
Q

List 4 most common oral malignancies?

A

Malignant Melanoma

SCC

Fibrosarcoma

Acanthomatous Ameloblastoma

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6
Q

List 2 most common oral malignancies in cats?

A

SCC

Fibrosarcoma

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7
Q

List 2 canine oral tumors associated with best prognosis?

List 4 features associated with good prognosis?

Local recurrence %

A

Acanthomatous ameloblastoma, OSCC

Complete resection, rostral location, smaller diameter, earlier stage

Local recurrence 30%, function of tumor size (1: 3: 8x as likely to recur for T 1: 2: 3)

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8
Q

List 2 canine oral tumors assciated with worse prognosis?

What feature is associated with survival?

A

fibrosarcoma, melanoma

Size associated with survival (3yr PFS 55% T1, 32% T2, 20% T3)

Fibrosarcoma typically poor prognosis and high rate of recurrence post-op; requires add’l tx – chemo / radiation

Melanoma typically well controlled locally but metastatic disease req additional therapy

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9
Q

History and clinical signs associated with canine oral tumors?

A

mass in mouth, facial swelling, exophthalmos

  • cervical LN enlargement (SCC)
  • salivation, ,epistaxis, halitosis, bloody oral discharge
  • dysphagia, weight loss, loose teeth
  • rare hypercalcemia, hyperglycemia
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10
Q

Canine malignant melanoma

Breed predilection? Cats?

Sex predilection? Age?

Amelanotic cases?

IHC marker?

Metastasis?

A

only common oral tumor with small breed predilection (Cocker, mini schnauzer, Anatolian sheepdog, Gordon setter, chow, golden retriever),

rare in cats

* possible male predilection, older dogs (11.4 yrs)

* 1/3 of cases are amelanotic

* IHC with Melan A, PNL2, TRP1, TRPS - 100% specific and 94% sensitive

* Highly malignant (LN’s or lungs up to 80%; lungs 13-67%)

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11
Q

4 prognostic indicators for canine oropharyngeal tumors?

Recurrence rate with surgery for mandible and maxilla?

-No tx? Sx alone? T1 vs. T2-3?

With RT control?

A

Prognostic indicators: WHO stage, nuclear atypia, mitotic index, location (lip/tongue less metastatic

* with surgery – recurrence 22% (mandibular) to 48% (maxilla)

  • no tx: MST 64 d
  • sx alone MST 150-318d (5-10 mo); <35% survival @ 1 yr
  • T1 MST 511d; T2-3 or any node à 164d

* with RT: 83-100% control; 70% CR

  • Median local recurrence 139 d; recurrence 15-26%
  • Poor RT risk factors: non-rostral, bone lysis, macroscopic dz
  • death from metastatic disease
  • feline melanoma 60% response; MST 146
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12
Q

SCC

__ most common in cats, __ in dogs

3 Risk factors?

A

* 1st most common in cats, 2nd in dogs

* Risk factors – 4x flea collars, canned food (tuna), 2-fold increased risk cigarette smoke

  • p53 mutations may be related to smoke-related risk

* invasive to bone, particularly in cats

  • increased expression PTHrP promotes bone invasion, resorption, paran eoplastic hypercalcemia has been reported
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13
Q

Feline oral SCC

Metastasis?

MST?

Prognosis for mandibular tumors

A
  • Rarely metastatic (may be under-estimated in cats d/t generally poor control of primary disease)
  • MST’s in the range of 1-3 months with <10% 1yr survival, regardless of tx (sx, RT, chemo)
  • Improved prognosis for mandibular tumors (911 for rostral T, 217 with hemimandib, 192 if >50% mandible removed
  • Tx with radiosensitizers reported but not significant improvements
  • Strontium therapy may be effective for small tumors
  • Chemo ineffective, but one study showed improvement with NSAIDs
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14
Q

Canine oral SCC

Metastatic rate? Tongue or tonsillar?

Prognosis with surgery for maxilla? mandible?

Definitive RT?

5 different histologies subtypes: conventional, papillary, basaloid, adenosquamous, spindle cell

Pappillary - young 9 month old and rostral oral cavity

A

local tumor control most challenging, mandibular better

  • 20% metastatic (primarily if tongue or tonsillar – 73%)
  • w Sx – maxillary 10-19mo; 57% 1-yr survival

– mandibular 29-26mo; 91% 1-yr survival

  • w definitive RT – 31% recurrence

– MST RT alone à 15-16mo; + Sx à 34mo

  • young age is favorable prognosis (1080 vs 315 if <>9yo)
  • chemo if bulky, metastatic, or incomplete resection, or owner choice
  • piroxicam 2/17 (17%) response – MST responders 180d
  • Piroxicam + cisplatin (a) 56% response; MST responders 272 vs 116 non-responders (b) 57% response; 534d f/u
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15
Q

Osteosarcoma

Axial represents what % of all OSA?

Prognosis better for axial or appendicular?

MST with mandibulectomy? maxillectomy?

Most common cause of death?

Favorable prognostic factors?

A

25%

* appx 50% of axial cases are oral - mandibular (27%); maxilla (16-22%)

* prognosis better than for axial (lower rate of metastasis)

* Mandibulectomy alone MST 14-18mo; maxillectomy MST 5-10 months

* Local recurrence most common cause of death, particularly in dogs with maxillary tumors

* Complete surgical excision with margins à 1503 days DFI vs 128 with incomplete margins

* Favorable prognostic factors include: complete excision, mandibular location, small body weight

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16
Q

Oral FSA

___ most common in cats, ___ in dogs (esp large breeds)

Breeds?

Sex predilection?

Mean age?

High-low?

Metastasis?

A

2nd most common in cats, 3rd in dogs (esp large breeds)

golden retrievers and labs

possible male predilection

middle-age dogs (7.3 – 8.6 yr)

high-low common (histologically low, biologically high grade)

* always treat oral fibroma or fibrosarcoma aggressively

* 30% metastatic to lungs or regional LN

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17
Q

Canine oral FSA

Prognosis?

What is more problematic, local control or metastasis?

Metastasis to LN? Lungs?

Local recurrence mandible? Maxilla?

1-year survival? Mandible? Maxilla?

Sx + RT? Local recurrence?

A

Dogs – prognosis guarded

  • local control more problematic than metastasis
  • mets: LN 19-22%; lungs 27%
  • local recurrence (dog) post-op 59% mandib; 40% max
  • canine 1-yr survival 50% with mandib; MST 11 mand – 12 mo maxillary
  • best outcomes with Sx + RT (local recurrence reduced to 32%; MST 18-26mo)
  • Sx+RT - smaller tumors – better outcome T1 45mo MST; T2 31 mo; T3 7mo
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18
Q

Feline oral FSA

MST with mandibulectomy?

A

mandibulectomy (5 cats) à MST 859 d (2.3 yr)

Better outcome than dogs

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19
Q

Peripheral Odontogenic Fibroma

Common in __? Rare in __?

Age for dogs and cats?

Predilection?

Behaivour?

A

* Used to be called fibromatous/ossifying epulis

* common in dogs, rare in cats

* middle age dogs (8-9yo), young cats (<3yo)

* possible male predilection

* slow growing/benign

Predilection for rostral maxilla to third premolar teeth

* firm, covered in intact epithelium

* maxillary – rostral to 3rd premolar

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20
Q

Acanthomatous Ameloblastoma

Behaivour?

Breeds?

Age?

Previously called?

A

* Locally aggressive, non-metastatic

* Maxillary or mandibular (rostral mandible most)

* Sheltie, Old English Sheepdog

* 7-10 year old

* previously called acanthomatous epulis/adamantinoma

21
Q

Diagnostics for oral tumors

A

Diagnostics: biopsy!!

  • tRads (melanoma, tonsillar / caudal oral SCC)
  • LN cytology in all oral tumors (40% metastatic melanoma palpate N; 49% N melanoma ln’s palpate enlarged)
  • regional nodes: mandiblar, parotid, medial retropharyngeal
  • only mandibulars are palpable, and only 30-50% of metastatic nodes are mandibular
  • regional rads (but bone lysis not radiologically evident until 40% destroyed)
  • CT/MRI for sx planning, tumor extent
  • commonly inflamed / infected / necrotic, so get a big sample, but avoid normal tissue that cannot be resected
22
Q

Treatment for oral tumors

What tumor do you not need bone resection?

Margins?

Post-op risks?

A

Surgery

* except peripheral odontogenic fibromas, resect bone

* 2cm margins for malignant tumors, more in feline SCC

* blood loss, hypotension risks during sx

* post op risks: dehiscence, epistaxis, ásalivation, mandib. drift (à affected side), mal-occlusion, prehension difficulty

* feeding tubes required in cats with any mandibulectomy, rarely needed in dogs

* regional lymphadenectomy benefit is unknown

* cryosurgery for lesions <2cm that are fixed and minimally invasive to bone

* aggressive lesions w/cryosurgery risk fracture or oronasal fistula if aggressively frozen

23
Q

Radiation therapy for oral tumors

Radiaiton responsive tumors?

Radiaiton unresponsive tumors?

A

Radiation Therapy

* Very effective – best for T1 (<2cm), T2 (2-4cm)

* Can be primary or adjunct therapy

* radiation responsive: melanoma, canine OSCC, acanthomatous ameloblastoma

* radiation unresponsive: canine fibrosarc, feline OSCC

* radiation sensitizers – feline gemzar, etanidazole (gemzar not recommended d/t hematologic and local toxicity); canine – platinum drugs

* Melanoma à responds best to course fraction: > 8Gy responds much better than <4Gy

* Acute effects common, self limiting

* Hyperthermia has been used as adjunct to radiation, but offers no benefit alone over cryosurgery or surgery

24
Q

Chemotherapy is indicated for what oral tumors?

A

Tonsillar SCC in dogs and cats, oral melanoma in dogs

* Feline OSCC expresses cox-2 but studies haven’t documented benefit from NSAIDS/piroxicam

  • liposome encapsulated cisplatin not effective
  • some potential with RT combined with mitoxantrone

* Canine OSCC shows some response to piroxicam; piroxicam also increases response to platinum drugs

* Oral Malig Melanoma – immunotherapy

25
Q

Salivary gland tumors

Reported in young or older patients? Breed and sex in dogs? Cats?

Type of cancer?

Affect which salivary gland?

Behaivour? Metastasis? Distant Mets?

Clinical signs?

Differentials?

A

Mainly reported in older patients (10-12), no sex or breed predilection in dogs; Siamese, male more common in cats

Most are adenocarcinomas but wide variety (osteo, MCT, sebaceous ca, oncocytoma, malig. fibrous histiocytoma)

Minor or major salivary gland origin

30% of 245 salivary tumors submitted were malignant

Benign tumors are rare but mostly affect the mandibular gland (is this because this is more commonly palpated?)

Locally invasive, metastatic to regional LNs (dog 17%, cat 39%), distant mets are rare and slow (8% dogs, 16% cats)

Canine benign lipomatous infiltration can happen and is surgically curative

Patients present with halitosis, dysphagia, exophthalmos, unilateral swelling of neck / base of ear/ lip, tongue

Differentials include mucocele, abscess, infarct, sialadenitis, LSA, reactive lymphadeopathy

26
Q

Treatment for salivary gland tumor?

Main post-op complication?

Best post-op treatment?

A

Aggressive surgical removal, but can be extensive; even so “extirpation of regional neck” à good outcome

Main post-op impairment is inability to blink

Post-op RT à good local control

No reports of chemotherapy outcomes for this tumor type

27
Q

Prognosis for salivary gland tumors

What is prognostic?

Prognosis?

A

Grade not prognostic, but stage prognostic

Prognosis unkown, but presumably complete excision or partial + RT à good long term control; survival ~550d

Poorer in cats than dogs; much poorer if metastatic - One report 6 dogs with mets à MST 74 days

28
Q

Esophageal cancer

How common and cause?

4 common tumor types?

3 benign tumors?

Paraesophageal tumor invasion?

Predilection in cats?

Behaivour?

Clinical signs?

A

Rare in dog and cat, and no known cause; Carcinomas affect older animals but no gender or breed predilection

SCC, leiomyosarcoma, fibrosarcoma, osteosarcoma à Spirocerca lupi association in Africa, Israel, SE USA

Benign tumors – leiomyoma, adenomatous polyp, plasmacytoma

Paraoesophageal tumor invasion – heart base, thyroid, thymic

Cat SCC have female predilection, locate middle 3rd of the esophagus

Locally invasive, regional LN’s, direct extension, distant mets via bloodstream

Signs include weight loss, dysphagia, regurgitation, aspiration pneumonia

hypertrophic osteopathy, thoracic spondylitis, microcytic hypochromic anemia, neutrophilia with s. lupi

29
Q

Diagnosis of esophageal tumors

Rads commonly show?

A

Rads show esophageal dilation, gas, or mass

Positive contrast esophagogram, fluoro, esophagoscapy show dilation, stricture, or mass (frequently ulcerated)

CT or MRI to localize

Multiple biopsies because necrosis and inflammation common; low risk of perforation

Leiomyomas are freely movable and submucosal – difficult to bx

Surgical biopsy can be beneficial

S. lupi ova can be detected in the feces

30
Q

Therapy for esophageal tumors

A

Difficult because generally advanced stage

Surgery difficult except for low-grade leiomyosarcomas, benign tumors

If distal tumor, gastric advancement thru diaphragm possible but high complication rate (reflux esophagitis)

Chemotherapy rarely attempted

RT of limited value d/t important surrounding tissues

Palliation via e-tubes or g-tubes

31
Q

Prognosis for esophageal tumors

A

Very poor except for leiomyoma, low-grade leiomyosarcoma, lymphoma

32
Q

Exocrine pancreatic cancer

What cell type?

Metastasis?

Paraneoplastic syndrome in cats?

Rarely associated with what other condition?

A

Almost all cancers of the pancreas are epithelial and most are adenocarcinoma of ductular or acinar origin

Vast majority have already metastasized regionally or distantly at the time diagnosis

Nodular hyperplasia and benign pseudocysts are also diagnosed

Hx and Cx are vague and nonspecific and may be accompanied by pancreatitis

Patients may present for symptoms of metastatic disease

Paraneoplastic alopecia in cats

Rarely associated with diabetes

33
Q

Exocrine pancreatic cancer

Elevation in what lab values can be noted?

How do you diagnose? Organs to check for mets?

What is suggestive in cats?

Most diagnosis is made by what?

A

Elevations of serum amylase and lipase are inconsistent

Occasional (extreme cases) signs of pancreatic insufficiency

In dog, masses are not palpable but there may be ascites; in cats, a palpable mass may be present

Ultrasound to localize primary tumor and assess liver and spleen for mets

A large >2cm apparently single mass is suggestive of pancreatic cancer vs nodular hyperplasia in cats

Most diagnoses are made by ExLap

34
Q

Exocrine pancreatic cancer

Treatment?

Palliative?

A

Most tumors are locally extensive / invasive / metastatic

Complete pancreatectomy or pancreoduodenectomy (Whipple’s procedure) has been described but mortality is high

GI bypass can be palliative (for GI obstruction)

Radiation and chemo are of limited value in humans and animals

35
Q

Exocrine pancreatic cancer prognosis?

A

Very poor

36
Q

Gatric cancer

% of all cancer

Long term use of what can induce?

Gatric carcinoma has high incidence in 3 breeds?

Carcinoma distribtuion in male and female? Age?

Leiomyomas?

LSA?

Clinical signs?

A

More common than esophageal cancer but still rare (<1% all cancer)

Long-term use of nitrosamines in dogs may induce

High incidence of gastric carcinoma in Belgian shepherd, Norwegian lundehunds, Dutch Tervueren shepheds

Carcinomas: Male > Female 2.5:1, middle age (8yr)

Leiomyomas: very old (15 yrs)

Lymphoma: male >female

Feline gastric cancer: chronic gastritis, Helicobacter, common descent are implicated

Most common sign is progressive vomiting w/ blood or coffee grounds, for weeks to months

37
Q

Gastric Cancer

Most common type?

6 other types that can be seen?

What % of GIST have metastasized at time of diagnosis?

4 common locations for adenocarcinomas to metastasize?

Most common tumor in the cat?

How common are feline adenocarcinomas?

A

Adenocarcinoma 70-80%, presents as flat and nondistensible mass (linitis plastica = leather bottle)

Others: Leiomyosarcoma, lymphoma, MCT, extramedullary plasmacytoma, fibrosarcoma, GIST (20% GIST in stomach)

In humans and 50% of dogs, GIST expresses CD 117 (c-kit)

1/3 of GIST have met’d at the time of diagnosis

70-80% adenocarcinomas met to LN’s, then liver, lung, unusual (3) to testes

Tumor antigen C2-O-sLE(x) is unregulated and may play a role in temastasis

Benign tumors: leiomyoma, hypertrophy, hamartoma, adenoma

Lymphoma is the most common gastric tumor in cat, most are FeLV-negative

Feline adenocarcinomas are rare

38
Q

Hypoglycemia is a paraneoplastic syndrome associated with tumors?

A

leiomyoma/leiomyosarcoma (reversible)

39
Q

Type of anemia seen with exocrine pancreatic cancer?

A

Microcytic, hypochromic anemia

40
Q

Gastric ACA is common in what location of the stomach?

Leiomyoma is common at what location in stomach?

A

Adenocarcinoma @ lesser curvature and antrum

Leiomyoma @ cardia, grow into lumen as a well-circumscribed mass

41
Q

GIST should be stained for what marker?

A

CD117

42
Q

Common treatment for gastric masses?

A

Surgery except for LSA

43
Q

What is treatment for gastric cancer?

A

Wide surgical resection

Bilroth I = gastroduodenostomy; Bilroth II = gastrojujenostomy

44
Q

Treatment for gastric leiomyoma?

A

Leiomyomas are discrete masses in the cardia region that shell out – NOT premalignant

45
Q

Role of RT or chemotherapy for gastric cancer?

A

RT rarely utilized

No effective chemotherapy for adenocarcinoma

Lymphoma may be excised if localized but does not generally respond well to conventional therapy; exceptions being cats

46
Q
A
47
Q

Prognosis for gastric cancer in months?

Negative prognostic indic ator?

A

Poor – most <6mo

Perioperative mortality 24%, MST 33days; perioperative weight loss negative prognostic indicator

17 dogs with gastric ac, MST 2 months; rare cases… 3 yrs

MST leiomyosarcoma if made it thru perioperative period = 1 yr

Gastric extramedullary plasmyctyomas have excellent prognosis

Gastric MCT usually metastatic at presentation; <10% of patients survive 6mo

48
Q
A

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