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Y4 SA - Oncology > Solid tumours - Oral and Mammary > Flashcards

Solid tumours - Oral and Mammary Flashcards

1
Q

List the clinical signs of oral tumours

A
  • Mass / facial swelling
  • Oral bleeding
  • Dysphagia / pain
  • Halitosis
  • Epistaxis
  • Loose teeth / proliferative lesions noted at dentals (always biopsy)
  • Cervical lymphadenopathy
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2
Q

How can you assess a patient for oral tumours?

A
  • Under GA usually required
  • Biopsy (incisional wedge)
  • FNA mass
  • FNA submandibular lymph nodes
  • Assessment of local lymph nodes
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3
Q

Describe the methods involved in the staging of primary oral tumours

A
  • Many oral tumours are locally invasive
  • Visual assessment underestimates the quantity of disease
  • Radiographs insensitive
  • Advanced imaging: useful for surgical planning especially maxillectomy, required for radiation therapy (RT) planning
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4
Q

How can you assess metastasis from primary oral tumours?

A

Likelihood of distant metastases depends on tumour type
Thoracic imaging:
- XR – 2 x laterals and 1 DV of thorax - inflated
- CT has greater sensitivity
Abdominal imaging also for melanoma

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5
Q

Name the 3 most common oral tumours of dogs

A

Malignant melanoma
Squamous cell carcinoma
Fibrosarcoma

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6
Q

What is the treatment of choice for oral tumour management?

A

Surgery

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7
Q

Describe the surgical options for primary oral tumour management

A
  • Maxillectomy/mandibulectomy
  • Margin dictated by histology
  • Surgery very well tolerated in dogs
  • Cats take longer to adapt: feeding tube (up to months)
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8
Q

Describe the margins required for a squamous cell carcinoma and fibrosarcoma

A

2cm+ for SCC
3-5cm+ for FSA

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9
Q

For fibrosarcomas and squamous cell carcinomas, how can the best results be provided?

A

Surgery followed by adjuvant RT

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10
Q

What are some complications of oral surgery?

A

Dogs generally adapt very well, cat more variable
- Bleeding
- Infection
- Altered cosmetic appearance
- Difficulty prehending food / messy eating
- Salivation
- Mandibular drift
Recurrence

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11
Q

Melanomas are most commonly seen in which pateints?

A

Generally smaller dogs
Generally older dogs – mean 11.4 years
Golden Retriever, cocker spaniel, miniature poodle, ChowChow

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12
Q

Describe the characteristics or oral melanomas

A

Very locally invasive
High metastatic rate – up to 80%
Check both submandibular lymph nodes, regardless of location in mouth

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13
Q

How are oral melanomas diagnosed?

A
  • Diagnosis based upon melanin containing mesenchymal cells
  • Immunohistochemistry required
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14
Q

Describe surgery for primary melanomas

A

Surgery associated with high rates of local recurrence
- 22% after mandibulectomy
- 48% after maxillectomy
- 1 year survival 35%
Tumour size and stage significant for survival
Completeness of excision also relevant

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15
Q

Describe anti-metastatic treatment for oral melanomas

A

Survival time if distant metastasis <3 months
Chemotherapy does not meaningfully extend survival
Plasmid vaccine immunotherapy
- Use in stage II and III disease
- Targets a melano-protein – tyrosinase*
- Only minor local side effects
- Expensive

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16
Q

Is the metastatic rate of oral squamous cell carcinomas high or low?

A

Low

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17
Q

Describe treatment for oral squamous cell carcinomas

A
  • Surgery: rostral mandible best outcome
  • Radiotherapy
  • Combines
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18
Q

Describe medical therapy for oral squamous cell carcinomas

A

When other therapies aren’t possible
Metastatic disease
Neoadjuvant
Piroxicam
Piroxicam + carboplatin

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19
Q

Describe the clinical presentation of a patient with a tonsillar squamous cell carcinoma

A
  • Dysphagia, coughing
  • Enlarged cervical lymph nodes -> abcessation
  • Oral examination reveals enlargement of 1 or both tonsils
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20
Q

FNA of enlarged cervical LNs in cases of tonsillar squamous cell carcinomas would reveal?

A

FNA yields necrotic debris and sometimes tumour cells

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21
Q

Is the metastatic rate of tonsillar squamous cell carcinomas high or low?

A

High - more than 70%

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22
Q

Describe treatment of tonsillar squamous cell carcinomas

A
  • Local control of tonsillar enlargement - surgery or RT
  • Surgery or RT for lymph node metastasis
  • Carboplatin or mitoxantrone chemotherapy might be beneficial
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23
Q

Describe the prognosis of tonsillar squamous cell carcinomas

A

Prognosis - 7 mths
Patients who receive the most therapy live longest
Control of local/regional disease most important

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24
Q

Name the 3rd most common canine tumour?

A

Fibrosarcoma

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25
In which patients are fibrosarcomas most commonly seen?
Large breed dogs especially Golden Ret and Labrador Middle age dog – median age approx 7.5 years
26
Describe the characteristics of fibrosarcomas
Invasive Low / moderate metastatic risk - lung and occasionally lymph nodes
27
Describe treatment of fibrosarcomas
- Surgery single most important therapy - Multimodal therapy often best: surgery and RT - MST 18 – 26 months - RT alone: MST – 7 months
28
What are the surgical margins needed for a fibrosarcoma?
3-5cm+
29
Describe the main features of a histologically low grade, biologically high grade fibrosarcoma
- Often caudal maxilla - Aggressive, rapidly progressing oral tumour with benign histological appearance even after large biopsy (tumours reported as low grade, fibroma or even granulation tissue or epulis) - Very locally invasive: aggressive local management with surgery and RT required
30
What are epulides?
Non-metastatic lesions arising from gingiva
31
Name two common epulide types seen in small animals
Acanthomatous ameloblastoma Peripheral odontogenic fibroma
32
Describe the behaviour of an acanthomatous amleoblastoma
Aggressive local behaviour and bone invasion
33
Describe the behaviour of a peripheral odontogenic fibroma
Slow growing firm masses usually not invasive
34
What determines the prognosis of a canine oral osteosarcoma?
Site and histological grade Survival: mandibular > maxillary 14 – 18 mths vs 5 – 10 mths
35
Most dogs with maxillary osteosarcoma tumours tumours die of ... ? Most dogs with mandibular osteosarcoma tumours die of ... ?
Reoccurrence Metastasis
36
Name some uncommon oral tumours of dogs
Mast cell tumour Haemangiosarcoma Extramedullary oral plasmacytoma Oral lymphoma
37
Rank the 4 most common canine oral tumours in order of frequency
1 = malignant melanoma 2 = squamous cell carcinoma 3 = fibrosarcoma 4 = acanthomatous ameloblastoma
38
Name the most common oral tumour of cats
Feline squamous cell carcinoma
39
The risk of feline oral squamous cell carcinomas is increased by what factors?
Middle aged and older cats Risk increased by living in a smoker's household, flea collars, canned tuna
40
Describe the behaviour of feline oral squamous cell carcinomas
Locally invasive ?low metastatic rate Higher metastatic rate if caudal Present with discomfort, hyporexia
41
Where is the predilection site of feline oral squamous cell carcinomas
Base of the tongue
42
Describe the treatment options for feline oral squamous cell carcinomas
No really good effective treatment - One year survival usually 10% or less - Almost never present when surgically resectable: some mandibular tumours - Can control tumour using radiotherapy
43
How does the location of a feline oral SCC determine outcome?
Mandible better than maxilla Rostral location better Poor outcome if associated with the tongue
44
Which cats are most commonly affected by a fibrosarcoma?
Usually middle aged or older
45
Describe the behaviour of feline oral fibrosarcomas
Very locally invasive Main challenge in local control Metastatic rate unknown
46
Describe treatment of feline oral fibrosarcomas
Main treatment is surgery - Good outcomes possible with mandibulectomy - Maxilla more difficult Insufficient data for radiotherapy
47
Which oral lesion has a 'popcorn' appearance on radiography?
Multilobular osteochondrosarcoma in dogs - usually a local problem
48
Describe viral papillomatosis in dogs
Wart like lesions affecting oral soft tissues Usually resolve in 4- 8 weeks Occasionally persist in immunosuppressed animals
49
Which patients are predisposed to eosinophilic granulomas?
Husky and CKCS
50
How are eosinophilic granulomas treated in dogs vs cats?
Dog = Surgery and corticosteroids Cat = Steroids / hypoallergenic diets, RT, surgery
51
List the risk factors for mammary tumours
- Not-neutering - Obesity - Age - Breed
52
How does neutering affect the risk of mammary tumours?
Neutering prior to first oestrus – 0.5 % life time risk Neutering prior to second oestrus – 8 % risk Neutering prior to third oestrus – 26 % risk No risk reduction if neutering after the second season
53
What can occur as a consequence of early neutering which must be considered?
Urinary incontinence
54
Why is obesity a risk factor for mammary tumours?
- Obesity leads to reduced sex hormone-binding globulin -> increased oestrogen levels - Being underweight at puberty -> reduced risk
55
Why is age a risk factor for mammary tumours?
Mean age of dogs with benign tumours 7 – 9 years Mean age of dogs with malignant tumours 9 – 11 years Mean age of cats 10 – 12 years
56
Which breeds are more at risk of mammary tumours?
- Poodles, Chihuahua, dachshund, Maltese, cocker spaniel and Yorkshire Terrier - Siamese cats
57
How should you approach mammary masses?
- >70% have more than 1 tumour - Examine other glands carefully - About 50% of canine MG tumours are benign - FNA can be useful to exclude other ddx e.g. mastitis, lipoma or mast cell tumour, hyperplasia
58
Why can FNA not be used to determine mammary tumour malignancy?
Heterogeneity of mammary tumours makes FNA unreliable for determining malignancy
59
Describe using an excisional biopsy for mammary tumours
Excisional biopsy by single or segmental mastectomy reasonable for single lesions without negative prognostic indicators E.g. small, non fixed lesions
60
Mammary tumours over what size have a poor outcome?
3cm
61
Describe local and distant staging of mammary tumours
Local staging - Assessment of local lymph nodes - Consider typical drainage patterns - Not absolute so assess all nodes Distant staging - Thoracic radiographs/CT - Abdominal ultrasound: visceral metastases - Mammary tumours can metastasise to bone so carefully consider bone pain
62
What should be considered when performing surgery on intact bitches with mammary tumours?
- 55% develop a new tumour on the ipsilateral side hence consider unilateral chain mastectomy - Likely hormone field effect therefore consider bilateral resection in young intact bitches with multiple tumours
63
Describe the excisional margins for canine mammary tumour surgery
For mobile lesions – whole gland removal enough Fixed lesions – need 2 cm margins and removal of affected abdominal fascia / wall
64
Describe the post surgical prognostic factors for mammary tumours
Tumour type: - Benign versus malignant - Less tissue heterogeneity associated with a poorer outcome (complex vs simple) - Sarcoma especially osteosarcoma – poorer than carcinoma Possible prognostic factors: - Mitotic rate / Ki-67 - Grade - Hormone receptor expression: lack of expression correlates with poorer outcome
65
Describe the main features of canine inflammatory carcinomas
Tumours extremely painful Easily mistaken for mastitis Generally all gland affected FNA yields inflammatory cells and tumour cells
66
Describe treatment of canine inflammatory carcinomas
- Excision not typically feasible: recurrence very common - Prognosis generally very poor - Treatment is palliative - Medical therapy might prolong survival – few months
67
What % of feline mammary tumours are malignant?
85-95%
68
Describe the clinical presentation of feline mammary tumours
>60% have more than 1 tumour at diagnosis Hormone receptor expression frequencies are lower
69
What is a significant differential of feline mammary tumours?
Fibroepithelial hyperplasia
70
List the clinical prognostic factors of feline mammary tumours
1. Tumour size > 2 cm – MST 6 months < 2 cm – MST > 3 years 2. Lymph node metastasis - Lymphatic drainage less predictable than dog - Assess inguinal and axillary nodes bilaterally 3. Distant metastasis 4. Breed - DSH have better outcome
71
Describe surgery for feline mammary tumours
Chain mastectomy preferred to single or regional mastectomy: - Unilateral when lesions on one side - Stage bilateral when lesions bilateral
72
When is ovariohysterectomy at the time of mammary excision indicated?
Dogs - For benign mammary tumours OHE at the time of mastectomy halves the chance of a new mammary tumour (to ~ 35 %) - Benefit of OHE less clear for carcinoma - But OHE may extend survival in oestrogen receptor expressing mammary tumours and grade 2 tumours - Unlikely to be detrimental

Y4 SA - Oncology (12 decks)

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