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Withrow > Tumours of the GI System > Flashcards

Tumours of the GI System Flashcards

1
Q

What’s the MST of dogs and cats with salivary gland carcinoma treated with Sx or Sx +/- RT +/- Chemo?

A

Dogs: 550d
Cats: 516d

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2
Q

What are some of the reported biological behaviour of canine and feline salivary gland carcinoma based on the Hammer et al 2001 paper?

A
  • cats tend to have higher clinical stage than dog
  • predilection for male Siamese?
  • Cat: LN met ~ 39%, distant met ~ 16%
  • Dog: LN met ~ 15%, distant met ~ 8%
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3
Q

What parasite can induce esophageal sarcoma in dogs?

A

Spirocerca lupi

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4
Q

What’s the more common location of parasitic esophageal sarcoma in the dog?

A

caudal esophagus

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5
Q

What’s the more common location for esophageal leiomyoma in dogs?

A

distal, by the gastroesophageal junction

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6
Q

What’s the most common esophageal tumour in the cat? where is is located?

A

SCC
middle 1/3, just caudal to the thoracic inlet

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7
Q

What are some common c/s of esophageal tumours?

A
  • regurgitation
  • weight loss
  • respiratory signs if aspirated or have lung mets
  • leiomyoma = often incidental
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8
Q

How metastatic is spirocerca induced sarcoma?

A

5/11 dogs had lung mets on necropsy

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9
Q

What’s reported treatment option for esophageal tumours?

A

Surgery – partial esophagectomy
- full thickness, 1cm margins
- marginal fine with leiomyoma or low grade leiomyosarcoma

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10
Q

What’s the prognosis of esophageal tumours?

A

Leiomyoma/ leiomyosarcoma = good
- spirocerca sarcoma = guarded to poor – one report of MST of 9m with Sx and Doxorubicin
- carcinoma = poor, likely too big for complete resection

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11
Q

How common is cancer of the exocrine pancreas?

A

extremely rare

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12
Q

What’s the most common type of tumour in exocrine pancreas?

A

Epithelial, adenocarcinoma of ductular or acinar origin
- most have wide spread metastasis by the time the tumour is noted

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13
Q

What are some c/s of exocrine pancreatic tumours?

A
  • signs of pancreatitis
  • weight loss, anorexia (marked in cats)
  • vomiting
  • diabetes mellitus (rare)
  • abdominal distension (mass, fluid)
  • icterus (common bile duct obstruction)
  • lethargy
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14
Q

Are exocrine pancreatic tumours palpable?

A

generally no in dogs, yes in cats with advanced stage

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15
Q

What’s the advantage of contrast ultrasound?

A

hypoechoiec = adenocarcinoma
hyperechoiec = insulinoma

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16
Q

What’s the advantage of contrast ultrasound?

A

hypoechoic = adenocarcinoma
hyperechoic = insulinoma

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17
Q

What’s the utility of Claudin 4 and Claudin 5 in pancreatic exocrine tumours?

A

Claudin 4 = tight junction molecule, claudin 5 = endothelium specific tight junction protein
- intense apical-lateral staining of claudin 4 = well differentiated carcinoma, lack of expression = undifferentiated
- loss of claudin 5 = well differentiated or poorly differentiated carcinoma

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18
Q

What’s the mainstay of therapy for exocrine pancreatic tumours?

A

Surgery, but most tumours are quite advanced upon diagnosis (spread to LN and liver), carcinomatosis can be common in cats
- pancreatectomy no recommended due to high morbidity/mortality
- palliative option = short-lived

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19
Q

What’s the overall prognosis of exocrine pancreatic tumour?

A

very poor
cats = MST 97days, chemo or surgery = 165 days
with ascites = 30 days

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20
Q

What’s incidence of gastric tumours in dogs and cats?

A

rare

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21
Q

What’s the most common nonhematopoietic gastric tumour in the dog?

A

Dog = carcinoma

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22
Q

What’s the most common gastric tumour in cats?

A

lymphoma, carcinoma = rare

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23
Q

Is there is sex predilection for gastric tumour in dogs?

A

Yes, male

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24
Q

What’s the most common mesenchymal gastric tumour in the dog?

A

leiomyoma/ leiomyosarcoma
GIST (gastrointestinal stromal tumour)

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25
Q

What’ the IHC staining pattern for GIST re: CD117 and CD34?

A

CD117 (+), CD 34 (+)

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26
Q

What are come clinical signs of gastric tumour?

A

vomiting (most common), decreased appetite, weight loss, peritonitis, melena

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27
Q

What’s the most common locations of canine gastric carcinoma?

A

pylorus and lesser curvature

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28
Q

What’s the most common locations of the canine mesenchymal tumours?

A

cardia and pylorus

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29
Q

How common is metastasis to regional LNs for canine gastric carcinoma?

A

@ presentation, 34%
@ necropsy, 77%
- liver and lung are less affected

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30
Q

What’s a common paraneoplastic syndrome for gastric leiomyosarcoma?

A

hypoglycemia, due excessive release of IGF-2

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31
Q

How common is gastric GIST in cats?

A

rare

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32
Q

How common is gastric involvement of feline GI lymphoma?

A

relatively uncommon

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33
Q

How does the appearance differ on imaging for gastric carcinoma vs sarcoma?

A

gastric carcinoma = broad-based
gastric sarcoma = focal/ pedunculated

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34
Q

How common is pulmonary involvement for gastric tumours on presentation?

A

rare

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35
Q

What’s the treatment for gastric tumours?

A

Surgery (partial gastrectomy) if it’s solid tumor without evidence of diffuse or metastatic disease

36
Q

What’s the role of RT or chemo in gastric tumours?

A

RT = minimal, too much sensitive organs close by
chemo = unclear, does have HER-2 expression

37
Q

What’s the prognosis of gastric carcinoma?

A

poor, difficult to achieve local control and has a mod-high metastatic rate

38
Q

What’s the MST for gastric GIST, leiomyosarcoma, leiomyoma, and undifferentiated sarcoma in dogs with surgery?

A

GIST = 37.4m
leiomyosarcoma = 8-12m
leiomyoma = cured
undifferentiated sarcoma = 2.9m

39
Q

T or F. Primary hepatic tumour is more common in the dog than metastatic hepatic tumours?

A

False, it’s <1.5% of all canine tumours
Metastasis to liver in 2.5x more frequent than primary hepatic mass

40
Q

T or F. Primary hepatic tumour is more common in the cat than metastatic hepatic tumours?

41
Q

What are the 4 basic categories of hepatobiliary tumours?

A
  1. hepatocellular
  2. bile duct
  3. neuroendocrine (carcinoid)
  4. mesenchymal
42
Q

T or F. Malignant tumour of the liver is more common in the dog?

43
Q

T or F. Malignant tumour of the liver is more common in the cat?

44
Q

What are the 3 morphological types of liver tumours?

A
  1. massive
  2. nodular
  3. diffuse
45
Q

What’s the prognosis for cats with malignant liver tumour? Does it differ with the morphological type?

A

No, it’s poor regardless of morphological type

46
Q

What does keratin 19 expression mean for hepatic tumours?

A

<5% keratin 19 expression in canine hepatic tumour = well differentiated, accounts for 79% of canine HCC and all of feline HCC.
- if has lots of keratin 19 expression = high grade, aggressive

47
Q

What type of hepatocellular tumour is more common in the cat?

A

hepatocellular adneoma

48
Q

what type of hepatocellular tumour is more common in the dog?

49
Q

What’s the morphological distribution of HCC?

A

53-83% = massive
16-25% = nodular
up to 19% = diffuse

50
Q

Which side (L vs R) of the liver lobes are more commonly involved in the dog?

A

Left side (L lateral and medial; papillary process of the caudate lobe) = > 2/3 of HCC

51
Q

Which side (L vs R) of the liver lobes are more commonly involved in the cat?

A

evenly distributed

52
Q

What are some common location for metastasis for nodular/ diffuse HCC in the dog?

A

regional LN, peritoneum, and lungs

53
Q

What’s the metastatic rate for canine massive, nodular, and diffuse HCC?

A

Massive = 0-37%
nodular and diffuse - 93-100%

54
Q

What are the 2 types of bile duct tumours?

A

bile duct carcinoma or bile duct adenoma

55
Q

Which type of bile duct tumour is more common in the cat?

A

bile duct adenoma, representing >50% of feline hepatobiliary tumour
they appear cystic – aka biliary or hepatobiliary cystadenomas

56
Q

What’s the most common malignant hepatobiliary tumour in the cat?

A

bile duct adenocarcinoma (#2 in the dog; 9-41%)

57
Q

What’s the morphological distribution of bile duct carcinoma?

A

it’s similar to HCC
massive = 37-46%
nodular = up to 54%
diffuse = 17-54%

58
Q

What are some location for bile duct carcinoma?

A
  • intrahepatic
  • extrahepatic
  • within the gall bladder
59
Q

Which location is the most common for canine bile duct carcinoma?

A

intrahepatic

60
Q

Which location is the most common for feline bile duct carcinoma?

A

equal distribution to towards more extrahepatic

61
Q

Does solid or cystic differentiation have an impact on prognosis or treatment?

62
Q

What’s the biological behaviour of bile duct carcinoma?

A

aggressive
- metastasis common in the dog, up to 88% met to the regional LN and lungs
- in cats, diffuse intraperitoneal metastasis and carcinomatosis noted in 67-80% of cases

63
Q

What are carcinoids?

A

neuroendocrine tumours

64
Q

How common are carcinoids in cats and dogs in the liver?

65
Q

What are the typical signalment of hepatic carcinoid?

A
  • young
  • nodular (1/3), diffuse (2/3)
  • aggressive
  • met to 1+ liver lobes, regional LNs, peritoneum, and lungs
66
Q

How common is primary hepatic sarcoma in dogs and cats?

67
Q

What’s the most common primary hepatic sarcoma in the cat?

A

hemangiosarcoma

68
Q

What’s the most common hepatic sarcoma in the dog?

A

leiomyosarcoma

69
Q

What’s the common morphology for hepatic sarcoma?

A

massive = 36%
nodular = 64%

70
Q

Which liver tumour causes paraneoplastic hypoglycemia?

A

hepatic adenoma

71
Q

What biochemical abnormalities are often present in feline hepatobiliary tumours?

72
Q

What’s the usefulness of ferritin serum levels?

A

Ferritin can be increased in histiocytic sarcoma and IMHA. If IMHA has been ruled out, it may be useful for differentiating HS from other causes of liver disease

73
Q

What’s the % of correct diagnosis for liver tumours on FNA? needle core biopsy?

A

60% - FNA
90% - needle core biopsy

74
Q

Can CT differentiate between nodular hyperplasia, hepatic adenomas, and HCC for dogs?

A

Yes. triphasic CT (more than 90% accurate in differentiating benign vs malignant canine hepatic tumours)

75
Q

What’s the intraoperative mortality rate and surgical complication rate for liver lobectomy?

A

4.8% mortality, 28.6% complication

76
Q

What’s the prognosis of massive HCC in dogs and cats?

77
Q

What’s the local recurrence rate of canine massive HCC treated with Sx?

A

generally 0-13%,
but 12% of complete histological excision can still recur, but outcome is much better compared to incomplete resection
- MST 1836d vs 765d (5y vs 2y)

78
Q

What’s the metastatic rate for canine massive HCC?

A

0-37%, more recent papers show death is most likely not related to the tumour

79
Q

What’s the MST for canine massive HCC treated with surgery vs conservative management?

A

MST = 1460-1836d (4-5y) with surgery,
MST = 270d (9m) with conservative management

80
Q

What are some prognostic factors for canine massive HCC?

A
  • Sx
  • side of liver involvement
  • ALT/AST activity
  • ALP:AST and ALT:AST ratio
  • completeness of excision
81
Q

What’s the outcome of none ressectable HCC in dogs treated with RT?

A

6-10Gy/fx, 1-2fx/week, total dose of 18-42Gy
- partial response (5/6)
- MST 567d (1.5y)

82
Q

Which chemotherapy has had some success in treating canine HCC?

A

Gemcitabine

83
Q

What’s the outcome of gemcitabine with canine HCC?

A

overall MST = 983d (2.7y)
- massive = 1339d (3.7y)
- nodular = 983d
- diffuse = 113d (4m)
- nonresectable = 197d (6m)

84
Q

What’s the prognosis for bile duct adenomas?

A

very good
no reported local recurrence or malignant transformation

85
Q

What’s the ST for cats and dogs with bile duct carcinoma treated with liver lobectomy?

A

poor, <6m
death due to local recurrence and metastasis

86
Q

What’s the prognosis for hepatic neuroendocrine tumour?

A

poor
- aggressive biological behaviour
- usually not amendable to surgical resection
- met to regional LNs, peritoneum, and lungs occur in 93% of dogs, and usually early on in the disease process

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