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Reproduction > Small Animal - Mammary Neoplasia > Flashcards

Small Animal - Mammary Neoplasia Flashcards

1
Q

What is the incidence of mammary tumours in dogs?

A

Common in female dogs
35-50% are malignant
Rare in male dogs and likely to be malignant

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2
Q

Which dog breeds are more predisposed to mammary tumours?

A 
Poodles
Spaniels
English setters
Pointers
Maltese
Yorkshire terriers
Dachshunds
Dobermans
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3
Q

What is the incidence of mammary disease in cats?

A

Less common

90% are malignant

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4
Q

What are common sites of mammary tumour metastasis?

A 
Lymph nodes - common
Lungs - common
Liver kidney
Bone
Heart
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5
Q

What is the likely cause of mammary tumours?

A

Hormonal - 90% benign and 50% malignant canine tumours have oestrogen and progesterone receptors

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6
Q

What, apart from homonal, are other aetiological factors that affect mammary neoplasia?

A 
Gene over-expression
Gene under-expression
Adhesion molecules
VEGF
Cox-2
Other factors
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7
Q

What are the risk factors for mammary tumours?

A

Increasing age - 9.5 years on average
Dogs obese early on in life
Progestagen treatment increases risk - benign in dogs, malignant in cats
Benign mammary tumours increase risk of malignancy 3 times
Intact status or bitches after 2.5 years of age

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8
Q

What is the usual clinical presentation of mammary tumours?

A

Owner noticed a mass
Incidental finding on physical examination
Occasionally signs referable to metastases

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9
Q

Why is it important to palpate all the mammary glands?

A

Masses may be variable in size
Multiple different masses may be found
Masses amy be in one or bothchains

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10
Q

What glands are canine mammary tumours most common in?

A

Caudal glands

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11
Q

What must also be palpated when mammary tumours present?

A

Axillary lymph nodes
Inguinal lymph nodes
Rectal may reveal enlarged sublumbar lymph nodes

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12
Q

What does inflammatory carcinoma present as?

A 
Diffuse swelling rather than discrete mass
Massive oedema
Erythema
Pain in multiple glands
Rapidly progresses
Highly metastatic
Systemic illness
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13
Q

What tumour types can present as mammary tumours?

A

Benign - adenoma, fibro-adenoma, benign mesenchymal tumour, benign mixed tumour
Malignant - carcinoma (solid, tubular, papillary, anaplastic/inflammatory), sarcoma, carcinosarcoma

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14
Q

What are the differential diagnoses for mammary lumps?

A 
Mastitis
Galactostasis
Galactorrhoea
Mammary hyperplasia
Cutaneous/subcutaneous tumour
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15
Q

What animals is mastitis more common in?

A

Post-partum bitches

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16
Q

When can mastitis occasionally occur?

A

After oestrus or falso pregnancy

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17
Q

Describe mastitis

A 
Glands - firm, swollen, painful
Pyrexia
Depression
Inappetance
Puppy neglect
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18
Q

Describe mastitis treatment

A

If dehydrated - IV therapy
IV antibiotics until resolved - usually 7 days
Cephalosporins a good choice
Abscesses need to bedrained surgically

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19
Q

What is galactostasis?

A

Accumulation and stasis of milk within mammary gland in nursing bitches

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20
Q

Describe galactostasis

A

Glands - warm, firm, swollen and painful

Secretions not infected

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21
Q

Describe galactostasis treatment

A

Self resolving
Gradual weaning
Food reduction helps ease transition

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22
Q

What is galactorrhea?

A

Lactation that occurs when it is not associated with pregnancy and parturition

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23
Q

What does galactorrhea result from?

A

Increased prolactin secretion

Stimulated by falling progesterone levels in late dioestrus

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24
Q

What treatment is required for galactorrhea?

A

Usually self limiting
Doesn’t require treatment
Withholding food for 24 hours followed by fradual return helps reduce lactation

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25
Q

What is mammary hyperplasia most commonly seen in?

A

Young, entire female cats

2-4 weeks after oestrus

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26
Q

What prevents recurrence of mammary hyperplasia?

A

Neutering

27
Q

Why do we carry out haematology and biochemistry for mammary tumours?

A

Make sure geriatric patients are safe to anaesthetise

28
Q

What should radiography be used for with mammary tumours?

A

Check for metastases to lung and sublumbar LN

Chest and abdomen

29
Q

What percent of dogs are lung and LN metastases present in?

A

25-50% with malignant tumours

30
Q

What should be checked on ultrasound for enlargement with mammary tumours?

A

Liver
Spleen
Sublumbar LN
Inguinal LN

31
Q

What are fine needle aspirations useful for?

A

Differentiating benign from malignant tumours
Differentiating mastitis from infalmmatory carcinoma
Investigating enlarged lymph nodes

32
Q

When would you use a coagulogram with mammary tumours?

A

If suspecting inflammatory carcinoma

33
Q

Describe surgical biopsies in mammary tumours

A

Usually excisional

Incisional for inflammatory carcinoma or other inoperable tumours

34
Q

Which tumours should you send for pathology?

A

All tumours

Record site of each one

35
Q

What does immunohistochemistry determine?

A

Presence of hormone receptors in tumour

36
Q

What should never be used as a sole treatment for mammary tumours?

A

Medical treatment

37
Q

What may chemotherapy be used as for dogs?

A

Adjunctive after surgery

38
Q

What is the treatment of choice for all mammary tumours? Which types is it not?

A

Surgery

Except inflammatory carcinoma, those with distant metastases

39
Q

What must all tumours be submittted for?

A

Pathology

40
Q

How many pairs of mammary glands do cats and dogs have?

A

Dogs - 5

Cats - 4

41
Q

Describe mammary glands

A

Compound
Tubuloalveolar
Apocrine

42
Q

What is the vascular supply for the mammary glands?

A

Caudal superficial epigastric
Cranial superficial epigastric
Branches of internal thoracic

43
Q

Describe drainage of the mammary glands in dogs

A

4 to 5 drain to inguinal LN
1 to 2 drain to axillary LN
3 can drain in either direction
Also variable connections between 3 and 4

44
Q

Describe drainage of the mammary glands in cats

A

3 and 4 drain to inguinal LN

1 and 2 drain to axillary LN

45
Q

What margins are needed with mammary tumours?

A

2-3cm skin margins

46
Q

What should be excised if tumour is attached?

A

Underlying abdominal wall fascia

47
Q

What should be done with crainal/caudal superficial epigastric vessels?

A

Ligate as they are encountered

48
Q

What should be placed if there is extensive dead space?

A

Closed-suction drain

49
Q

What surgery should be done with dogs? Cats?

A

Dogs - complete but not radical

Cats - unilateral mastectomy is minimum advised

50
Q

What are the 5 options for mammary tumour surgery?

A 
Lumpectomy
Simple mastectomy
Regional mastectomy
Unilateral mastectomy
Bilateral mastectomy
51
Q

Describe a lumpectomy

A

Excision of a mass
Surrounding margin of grossly normal tissue
Use when mass is: small, encapsulated, non-invasive, gland periphery
May get milk or lymph leakage
Can have post-op inflammation

52
Q

Describe a simple mastectomy

A

Excision of entire gland containing tumour
2cm margins
Used when tumour is >1cm
Used when tumour is in centre of the gland or involves majority of it
Less risk of milk leakage

53
Q

Describe a regional mastectomy

A

Excision of involved and adjacent glands
2cm margins
Used for excision of multiple tumours in adjacent glands
Used if mass is ebtween two glands
Caudal two glands often excised together with inguinal lymph node
Axillary LN not excised with cranial glands unless specifically indicated

54
Q

Describe a unilateral masectomy

A

Excision of tumours in the third gland
Multiple tuours in one mammary chain
Excise all tumours on one side
Quicker and easier than spearate masectomies
Careful, tension-free closure is essential

55
Q

Describe a bilateral masectomy

A

Only when multiple masses in both chains
Excise both mammary chains and inguinal LNs
Skin clouse is difficult if performed in one surgery
Decreased risk of wound breakdown if perform two unilateral several weeks apart

56
Q

What is important with mammary tumour surgery?

A

Pre-emptive multimodal analgesia

57
Q

What are four complications with mammary tumour surgery?

A

Seroma
Wound breakdown/infection
Hindlimb oedema
Recurrence of tumour or metastatic spread

58
Q

What factors affect the prognosis of mammary tumours in dogs?

A

Tumour size - 3cm 85% recurrence
Histologic type - sarcomas>carcinomas
Grade/differentiation - 90% mortality at 2 years if poorly differentiated, 24% mortality at 2 years if well differentiated
Lymphatic or vascular invasion - poorer prognosis
Lymph node involvement - 80% recurrence in present, 20% recurrence if not present
Distant metastases - poorer prognosis
Progesterone/oestrogen receptors - better prognosis
Fixation to tissue or ulceration - poorer prognosis

59
Q

What factors affect the prognosis of mammary tumours in cats?

A

Tumour size - >3cm median survival <2cm median survival 3 years
Extent of surgery - 66% recurrence if perform local compared to radical masstectomy
Histologic grading - 42% mortality at 2 years well diffenertiated, 70% mortality at 2 years moderately differentiated, 100% mortality at 2 years poorly differentiated

60
Q

What is not prognostic with mammary tumours?

A

Tumour site
Type of surgery in dogs
Number of tumours
OHE at time of excision

61
Q

What are the survival times with various tumours in dogs?

A

Inflammatory carcinoma - 30 days
Malignant, incompletely excised - 75% mortality in less than a year
Malignant, completely excised no metastases - 1 to 2 years
Malignant, completely excised and metastasized - 5 months
Benign tumours - curative

62
Q

What is the median survival time for malignant mammary tumours in cats?

A

Less than a year

63
Q

What is mammary neoplasia almost completely preventable by?

A

Early spaying

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