Respiratory Tract Neoplasia in SA Flashcards by Anna Burrows

How are tumours sub-classified?

By tissue of origin
Then by benign vs malignant
- remember when taking to clients – they often don’t know what they are talking about. Remember to tell them whether its cancerous or not

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For epithelial tumours:

what are some tissues of origin?
Name some benign examples
Name some malignant examples

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For mesenchymal tumours:

what are some tissues of origin?
Name some benign examples
Name some malignant examples

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Hopw can lymphoma be subclassified?

Chemo or radiation sensitive?

•Lymphoma = lymphosarcoma = malignant

–Subclassified histologically by:

cell type
grade (cellular differentiation, mitotic rate etc)
Cell distribution (diffuse/ nodular)

–Also immunophenotyping and anatomic site

B vs T – very simplistic
Multicentric, alimentary, thymic, cutaneous, extranodal

–Remember paraneoplastic problems

•Chemo and radiation sensitive

–Rarely considered a surgical disease

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What is leukaemia?

How is it classified?

•Leukaemia = any bone marrow derived haematopoetic neoplasm

–Lymphoid vs myeloid (anything NOT a lymphocyte) cell lines in origin

•Rarely see erythroleukaemias

–Acute (AML/ ALL) vs chronic leukaemia (CLL/CML)

– Chronic > acute chemosensitivity

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What is multiple myeloma?

•Multiple myeloma = plasma cells

–Secrete excess Igs of one clonal class

–Usually present due to paraneoplastic signs

–Chemosensitive

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For benign and malignant neoplasias describe:

Growth rate
Growth manner
Effects on adjacent structures
Metastasis
Effect on host

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With regards to the LRT, where can tumours arise?

Nasal planum
Nasal cavity
Tonsils, larynx, pharynx, trachea
Mediastinum
Thyroid
Thymus
Heart and great vessels (see RJ lectures)
Lung parenchyma
Pleura
Ribs

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With regards to tumours of the LRT, where does detection rely on clinical signs?

Nasal cavity
Tonsils, larynx, pharynx, trachea
Mediastinum
(Thyroid)
Thymus
Heart and great vessels (see RJ lectures)
Lung parenchyma
Pleura

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What are some clinical signs you would see with a nasal tumour?

Discharge (particularly blood (epistaxis)), snoring, nasal obstruction – so nasal sturtor, some disfigurement sometimes

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What are some clinical signs you would see with a tumour of the upper airways?

Changes in voice and sound, harshness and respiratory stridor

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What are some clinical signs you would see with a tumour of the lower airways and pulmonary?

Dyspnoea possibly (but if its in parenchyma its less likely), Off colour, chronic weight loss, lethargy due to expanding cancerous mass

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What are some clinical signs you would see with a mediastinal tumour?

Dyspnoea (it’s a space occupying lesion), changes in resp effort, cranial mediastinal area of often very dull of percussion

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What are some clinical signs you would see with a pleural tumour?

Loss of lung sounds and inspiratory or biphasic

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What are some clinical signs you would see with a cardiac tumour?

Sometimes not a lot!

Can bleed – haemothorax

May present collapsed with arrhythmias

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What can cause a tumour of the nasal planum?

White cats with solar exposure, rare in dogs
Carcinoma in situ –> superficial SqCC –> infiltrative SqCC, locally invasive, mets rare.

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What are some therapies for a nasal planum tumour?

Photodynamic therapy (PDT), planectomy (biopsy may cure!), immunomodulators (imiquimod)

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What are some pros and cons of the following for nasal caivty disease investiagion methods?

Radiography
MRI
CT
Rhinoscopy

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What kind of tumours are common of the nasal cavity in dogs?

carcinomas, rarely SqCC, lymphoma, fibrosarcomas, chondrosarcomas and osteosarcomas

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What kind of tumours are common of the nasal cavity in cats?

adenocarcinoma or lymphoma > others

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What is the investigation for tumours of the nasal cavity?

MRI/ CT and then rhinoscope and biopsy – usually CT above MRI. Rhinoscopy can be skipped as if you see lump on CT, can measure, plan where the lump is, measure where biopsy needs to get to and can often get biopsy without rhinoscopy, as this is especially difficult in cats.

What is the therapy for tumours of the nasal cavity?

radiotherapy+/-chemo +/NSAIDs
- Surgery very rarely performed as these things are often diffuse
Little apparent benefit of surgical resection
- Margins and morbidity
- Exceptions?

What is the prognosis for tumours of the nasal cavity?

Guarded prognosis (dog carcinomas approx 250 days MST with radiotherapy or NSAIDs) but can go on for a few years… variable. Not without realms of reasonability to send these dogs for treatment

Describe what can be seen on this scan of the nose?

Can see a space occupying lesion (left arrow) eroding throuhg central nasal septum, bulging into sinus and eroding into bone at the top (right)

How common are tumours of the larynx and trachea? What types are common in cats and dogs?

* RARE * Cats: laryngeal lymphoma recognised, very similar granulomatous proliferation – can see inflammatory disease, so try and biopsy if you can * Dogs: oncocytoma/rhabdomyosarcoma, tracheal cartilaginous tumours, OSA, fibrosarcoma, SCC.

How are tumours of the larynx and trachea diagnosed? How are they treated?

* Usually diagnosed on examination under anaesthesia, then biopsy if possible * Tracheal masses may be benign so can be resected, difficult surgery - refer * Need for permanent tracheostomy rare * Generally only find these when examining under GA. * Tracheal masses can be benign, if you can get a diagnosis – can be a curative aspect to these

What is the arrow pointing to?

Tracheal abnormality

What are these arrows pointing to?

Tracheal abnormality Post stenotic dilation of the trachea. Dilated here stenosis on left, dialtion on right

What can cause primary tumours of the lung in dog and cat? How common are primary ones?

* Primary lung tumours are very rare in comparison to humans (1%) * Dog\>cat, weak links with passive smoking * Metastatic disease by far the commonest –Oral melanoma, thyroid Ca, osteosarcoma, haemangiosarcoma and mammary Ca.

If you have a primary lung tumour, what are you likely to see? What kind of tumours are most common to be primary?

* Primary - cough * Solitary lung tumour * Usually older dogs * Usually carcinomas

What is the median age for primary lung cancer? What are they generally - how are they classified?

* Median age 11 years * Generally carcinomas, classified by location, often hard to tell exact origin –Can also see pulmonary lymphoma, pulmonary lymphomatoid granulomatosis, malignant histiocytosis –Rare to see mesenchymal tumours in the lung •\>50% solitary (often right caudal lobe)

How do primary lung cancers present?

* Present with non productive cough or exercise intolerance, low grade coughs, often lose weight * Hypertrophic osteopathy as rare paraneoplastic disease – get lameness due to distal limbs periosteal proliferation

What is the prognosis for a primary lung tumours?

* Depends on size, location (resectability) and spread – adjunctive chemo little use? * Best case scenario 50% alive at 1 year * Adenocarcinoma has a better prognosis than SqCC survival oDepends whether you have LN involvement and the size etc.

How do lung tumours as metastatic disease present? What is the most common metastatic disease?

* Often present as a bit of a cough, * May be incidental finding or present with cough/ tachypnoea * May be the first an owner knows about animal having cancer * Commonest = osteosarcoma, haemangiosarcoma, thyroid carcinoma, melanoma of the mucocutaneous junction – check pre-op! - Remember not all tumours met to the chest

What is therapy for metastasis?

•Solitary metastasis removal increasingly common –Need CT to get best info on how many and where, and slow radiographic doubling time –Thoracoscopic approaches increasing –Care on seeding to portal sites •May start getting locally delivered chemo –Delivery and penetration problems •Median survival time 3 months with no tx –Unclear survival if early detection on CT

What types of things can mediastinal disease be? Diagnostic imaging and diagnosis?

* May be benign or malignant tumours, cystic lesions, enlarged mediastinal lymph nodes or haematomas * Pros and cons of diagnostic imaging as for lung masses though CT very useful if surgical * May be hidden behind pleural effusion – check tracheal position * Diagnosis can be very challenging however important as clear distinction in treatment options for e.g. lymphoma vs sarcoma

How do patients with mediastinal lymphoma present? What type of cats is it most common in? What else should you check in cats?

* Commonest in young cats (predisposition for siamese?), also seen in dogs with multicentric or stage 3-5 lymphoma if so is considered a negative prognostic indicator * Tachypnoea, inspiratory hyperpnoea, dull heart sounds, pleural effusion (cytology for dx) * Non compressible anterior mediastinum –NB practice compressing normal –Usually the front part of the chest is a bit squishy with light pressure. If it doesn’t squash, might be a mass there •Check FeLV/ FIV status (~50% positive for FeLV)

What are some differential diagnoses for mediastinal lymphoma in cats? Treatment?

* DDx thymoma – consult a cytologist! As thymoma is a surgical disease! * Treatment: chemo +/- radiotherapy? * Generally remission, cure rare

How common in thymoma in dogs and cats? Where does a thymoma originate?

* RARE, commonest in older dogs, rare in cats * From thymic epithelium, often infiltrated with lymphocytes due to the fact they are thymic –Ddx thymic lymphoma – good cytologist!

How does a thymoma present?

•Present with resp distress +/- cranial caval syndrome +/- myaesthenia gravis –These things can be really big and prevent drainage from their head so their head can often be quite big but the rest of the body is okay

How can you diagnose a thymoma? What is the treatment? Prognosis?

* Thoracic radiographs to confirm a mass * Cytology +/- tru-cut +/- flow cytometry to get diagnosis –Be sure of diagnosis as possible - lymphoma is not a surgical disease –Adjunctive imaging e.g. CT may help * Surgical resection as treatment of choice – excellent prognosis if fully resectable * Poor prognosis if old, megaoesophagus, invasive •

What can cause a thyroid mass? How do you diagnose? Treatment?

* Heavy ectopic masses sink into the thorax * Dogs rarely hyperthyroid, cats usually are –Dogs diagnosed on mass signs/incidental –Cats diagnosed as unresponsive hyperthyroids * Confirmation on scintigraphy if active * Treat with 131I or surgery * If \>3cm diameter, radiotherapy may be better as poorer prognosis

What would you use to image/investiage the pleural space?

Ultrasound CT is always a good bet but expensive and not always accesible

Where can pleural tumours arise from, how common are they? What is there a major link with?

* Mesothelioma (pleural tumours) - RARE * From epithelial lining cells – pleural, abdominal, pericardial * Major link with asbestos inhalation, complex mechanism

What does a pleural tumour cause? How to image?

* Causes large volume effusions and pain ++ - unclear reason for pleural effusion in a dog. Would raise strong suspicion * Multifocal small masses, hard to image, Ultrasound and CT most useful.

How do you diagnose a mesothelioma?

* Diagnosis hard, ddx reactive mesothelial cells * Histo ideal, thorascopy best as non-invasive. * Treatment via intra-cavitary carboplatin/ cisplatin, but painful and poor px – remove as much fluid as you can * Large volume effusion cause of euthanasia * If fluid was in there for a long time, would have reactive mesothelial cells

What can be seen here? What should you not get it mixed up with?

Lump of neoplastic mesothelial cells Easy to mistake for reactive mesothelial cells (you get with chronic transudate), so don’t want to be putting it down on this. Get help from elsewhere

What is the best way to image/investigate a tumour of the ribs?

Radiography Ultrasound

What is the problem with tumours of the ribs? What are the most common tumours?

* Often only tip of the tumour… * Osteosarcomas and chondrosarcomas, but remember overlying soft tissue tumours too eg infiltrative lipomas * OSAs aggressive in this location (cf other axials) * What is visible on the outside may be only 20-30% of the total – the rest is inside and not visible!

What is the treatment and prognosis for rib tumours?

* Treatment via rib resection = thoracotomy plus post-op chemo if osteosarcoma * Prognosis depends on diagnosis – chondrosarcoma better than osteosarc