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Small Animal Med. I > Urinary Neoplasia - Green > Flashcards

Urinary Neoplasia - Green Flashcards

1
Q

True/False: Primary renal tumors are common.

A

False

Primary renal tumors are uncommon

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2
Q

Most renal tumors are ____ and ____.

A

Adenomas and carcinomas

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3
Q

Which is most common concerning renal tumors: Benign or Metastatic

A

Metastatic

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4
Q

Urinary Tract Tumors: Signalment and exception

A

Usually older

Except Nephroblastoma (young)

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5
Q

C/S associated with UT Neoplasia

A

Vague or no C/S seen

-decreased appetite or wt loss

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6
Q

Classic Triad associated with UT neoplasia

A
  • Abdominal mass
  • Wt loss
  • Hematuria
    • abscence does not rule out neoplasm; most commonly associated w/ TCC @ renal pelvis
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7
Q

What type of renal neoplasia do cats tend to get?

A

Renal lymphoma

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8
Q

What is usually seen with Paraneoplastic Syndrome (renal tumors)?

A
  • Polycythemia
  • Severe leukocytosis (leukomoid reaction)
  • Hypoglycemia
  • Hypertrophic osteopathy
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9
Q

How common is TCC paraneoplastic syndrome hypertrophic osteopathy?

A

Not very common

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10
Q

Which species are bladder tumors common?

Rare?

A

Common in dogs

Rare in cats

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11
Q

Most bladder tummors are benign or malignant?

A

Most are malignant

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12
Q

What is the most common bladder tumor in dogs?

A

Transitional Cell Carcinoma (TCC)

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13
Q

Where do most of the TCC in the bladder occur?

A
  • Trigone (67%)
  • Fundus (26%)
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14
Q

Describe the following concerning TCC in the bladder:

Invasiveness

Transplantation/Seeding

Metastasis

A
  • Locally invasive
    • may extend into the urethra and prostate
  • Prone to local transplatation/seeding
    • why you have to be careful when doing cystos
  • >50% metastasize (regional lymph nodes, lungs, bones)
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15
Q

What is the staging system used for canine bladder cancer?

A

TNM Clinical Staging System for Canine Bladder Cancer

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16
Q

What does TNM stand for (TNM clinical staging system)?

A
  • T
    • Primary Tumor
  • N
    • Regional lymph node (internal and external iliac lymph node)
  • M
    • Distant metastases
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17
Q

Tis (TNM staging) = ____

A

tumor in situ

(abnormal cells there that haven’t gone in abnormal location)

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18
Q

T0(TNM) = ____

A

No evidence of primary tumor

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19
Q

T1 (TNM staging) = ___

A

Superficial papillary tumor

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20
Q

T2 (TNM staging) = _____

A

Tumor invading bladder wall, with induration

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21
Q

T3 (TNM staging) = _____

A

Tumor invading neighboring organs

(prostate, uterus, vagina, pelvic canal)

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22
Q

N0(TNM staging) =

N1(TNM staging) =

N2(TNM staging) =

A
  • N0 = No regional lymph nose involvement
  • N1 = Regional lymph node is involved
  • **N2 **= Regional lymph node and juxtaregional lymph nodes are involved
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23
Q

M0 (TNM staging) =

M1 (TNM staging) =

A
  • **M0 **= No evidence of metastasis
  • **M1 **= Distance metastasis present
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24
Q

Key Point: What TNM stage (in regard to T) are dogs usually in when they present?

A

T2 or T3

25
Q

Signalment for bladder neoplasia in dogs

A
  • Older dogs
  • No sex predilection
  • Scottie odds ratio 18.1
26
Q

Bladder neoplasia: possible etiologic factors

A
  • Chemicals
  • Drugs
  • Industrial activity
  • Second hand smoke
27
Q

Bladder neoplasia: history and clincal signs

A
  • Lower urinary tract signs (sounds like stones or cat with FIC)
    • Dysuria → stranguria and pollakiuria
    • Increase frequency
    • Hematuria
    • Incontinence
  • Palpable mass? (rare to palpate mass in bladder)
28
Q

Key Point: What should always be done to a female dog presenting for dysuria?

A

Rectal

b/c urethral involvement is easily palpable

29
Q

Why should you be concerned about doing a cycstocentesis or surgery on a bladder with possible TCC?

A

Risk of local transplantation/seeding during surgery or after cysto

30
Q

In a patient with TCC, what is the safest method to collect urine?

A

**Catheter or Voided **

31
Q

Bladder neoplasia: Lab findings

A
  • Urinalysis (very active sediment; may have UTI)
    • Hematuria
    • Pyuria
    • Malignant epithelial cells in urine sediment in 30% of cases
  • Urine culture often is positive for UTI (urinalysis is usually not enough to dx)
32
Q

Key point: When an older dog presents for recurrent UTI, what should you do?

A

Rule out underlying bladder neoplasia

33
Q

Urine sediment for TCC is helpful but not ____.

A

definitive

34
Q

What is one way you can obtain a cytology of the bladder?

A

Traumatic catheterizaiton

(cytology is usually persumptive vs definitive)

35
Q

What does it mean if you get a (-) result on a Bladder Tumor Antigen Test?

(+) result?

A
  • (-) test = probably don’t have dz due to high NPV
  • (+) test = need to do other dx to confirm dz due to low PPV
36
Q

Transitional cell carcinoma contrast radiography (types)

A

Double contrast

Pneumocystogram

37
Q

Focal thickening on U/S could signify tumor.

What else can be useful for evaluating?

A

Evaluation for obstruction (hydronephrosis, hydroureter)

38
Q

A TCC located in the trigone of the bladder can lead to obstruction which can cause _________

A

Hydronephrosis

39
Q

Definitive DX TCC

A
  • Urinary catheter aspiration biopsy (w/ or w/out U/S guidance)
  • Cystoscopy-guided biopsy (requires special equipment and expertise)
    • best option but may need to go to specialty center
  • Full thickness biopsy at surgery carries risk of tumor transplantation/seeding but excision is possible
  • Partial cystectomy if tumor confined to fundus
40
Q

Bladder TCC TX

A
  • Surgery (limited utility due to location of tumor)
    • surgery if in fundus or apex ….. not if in trigone
  • Radiation Therapy
  • Photodynamic Therapy
    • doesn’t work well in later stages of tumors
  • Medical Therapy
  • Palliative Therapy
41
Q

If you decide to perform a partial cystectomy for local control of a bladder TCC tumor, how much of the bladder can you remove?

A

80%

42
Q

Even if you perform surgery on you P with bladder TCC, what is most likely to still occur?

A

Most likely to still develop mets despite surgery

43
Q

What is the predicted survival time of a P w/ bladder TCC after a partial resection? Complete resection?

A

Partial resection - 4m

Complete resection - 12m

44
Q

**Key Points regarding bladder TCC radiation therapy **

A
  • Adverse effects:
    • Damage to surrounding organs
    • Bladder fibrosis
  • Requires special facilities and expertise
  • Most still develop metastasis
  • Best results if combined with chemotherapy
  • Survival of 8-12 months
45
Q

What drug is used for the medical tx of bladder TCC?

A

Piroxicam

46
Q

**Important facts about Piroxicam **

A
  • Non-COX specific NSAID that has an inhibitory effect on TCC in dogs
  • Not directly cytolytic - MOA is unknown
47
Q

Piroxicam toxicity

A

Gastrointestinal ulceration (anorexia, vomiting, melena)

48
Q

Median survival time with medical tx of TCC using Piroxicam

A

6 months

49
Q

When treating TCC medically, what is Misoprostol used for?

A

**Counteracts detrimental effect of NSAIDs on GI blood flow **

(used for ulcer prevention or treatment)

(Prostaglandin E1 analog)

50
Q

When is Piroxican more effective?

A

When used in combo with other drugs

(combination of chemotherapy and piroxicam)

51
Q

What drug should you not combine with Piroxicam due to nephrotoxic effects?

A

Cisplatin

52
Q

Chemotherapeutic drugs used for Tx TCC in dogs

A
  • Cisplatin
  • Carboplatin
  • Combo chemo and piroxicam
    • Mitoxantrone and piroxicam
53
Q

TCC Palliative Tx

A
  • Surgical diversion procedure: cystectomy w/uretero-trigonic colonic transplantation has unacceptable complications (pyelonephritis, acid base and electrolyte abnormalities)
  • Permanent tube cystostomy (chronic UTI is a complication)
    • owners empty bladder
54
Q

True/False: Urethral tumors of dogs are rare

A

True

55
Q

Signalment associated with urethral tumors in dogs

What type are they?

A
  • Signalment
    • Older ( > 10 yrs); females > males; < 25 kg
  • Most are TCC (61%) or SCC (19%)
56
Q

Concerning urethral tumors in dogs, what is a KEY part of the physical exam?

A

Rectal

57
Q

What must a urethral tumor in a dog be differentiated from?

A

Must be differentiated from granulomatous urethritis

(treatable w/ immounosuppressive drugs)

58
Q

What is the % of metastasis to the regional lymph nodes at the time of presentation with urethral tumors?

A

20 - 30%

59
Q

What can Piroxicam do for dogs with urethral tumors?

A

May decrease obstruction and improve quality of life

Small Animal Med. I (18 decks)

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