Urinary Neoplasia - Green Flashcards
True/False: Primary renal tumors are common.
False
Primary renal tumors are uncommon
Most renal tumors are ____ and ____.
Adenomas and carcinomas
Which is most common concerning renal tumors: Benign or Metastatic
Metastatic
Urinary Tract Tumors: Signalment and exception
Usually older
Except Nephroblastoma (young)
C/S associated with UT Neoplasia
Vague or no C/S seen
-decreased appetite or wt loss
Classic Triad associated with UT neoplasia
- Abdominal mass
- Wt loss
- Hematuria
- abscence does not rule out neoplasm; most commonly associated w/ TCC @ renal pelvis
What type of renal neoplasia do cats tend to get?
Renal lymphoma
What is usually seen with Paraneoplastic Syndrome (renal tumors)?
- Polycythemia
- Severe leukocytosis (leukomoid reaction)
- Hypoglycemia
- Hypertrophic osteopathy
How common is TCC paraneoplastic syndrome hypertrophic osteopathy?
Not very common
Which species are bladder tumors common?
Rare?
Common in dogs
Rare in cats
Most bladder tummors are benign or malignant?
Most are malignant
What is the most common bladder tumor in dogs?
Transitional Cell Carcinoma (TCC)
Where do most of the TCC in the bladder occur?
- Trigone (67%)
- Fundus (26%)
Describe the following concerning TCC in the bladder:
Invasiveness
Transplantation/Seeding
Metastasis
- 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)
What is the staging system used for canine bladder cancer?
TNM Clinical Staging System for Canine Bladder Cancer
What does TNM stand for (TNM clinical staging system)?
- T
- Primary Tumor
- N
- Regional lymph node (internal and external iliac lymph node)
- M
- Distant metastases
Tis (TNM staging) = ____
tumor in situ
(abnormal cells there that haven’t gone in abnormal location)
T0(TNM) = ____
No evidence of primary tumor
T1 (TNM staging) = ___
Superficial papillary tumor
T2 (TNM staging) = _____
Tumor invading bladder wall, with induration
T3 (TNM staging) = _____
Tumor invading neighboring organs
(prostate, uterus, vagina, pelvic canal)
N0(TNM staging) =
N1(TNM staging) =
N2(TNM staging) =
- N0 = No regional lymph nose involvement
- N1 = Regional lymph node is involved
- **N2 **= Regional lymph node and juxtaregional lymph nodes are involved
M0 (TNM staging) =
M1 (TNM staging) =
- **M0 **= No evidence of metastasis
- **M1 **= Distance metastasis present
Key Point: What TNM stage (in regard to T) are dogs usually in when they present?
T2 or T3
Signalment for bladder neoplasia in dogs
- Older dogs
- No sex predilection
- Scottie odds ratio 18.1
Bladder neoplasia: possible etiologic factors
- Chemicals
- Drugs
- Industrial activity
- Second hand smoke
Bladder neoplasia: history and clincal signs
- 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)
Key Point: What should always be done to a female dog presenting for dysuria?
Rectal
b/c urethral involvement is easily palpable
Why should you be concerned about doing a cycstocentesis or surgery on a bladder with possible TCC?
Risk of local transplantation/seeding during surgery or after cysto
In a patient with TCC, what is the safest method to collect urine?
**Catheter or Voided **
Bladder neoplasia: Lab findings
- 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)
Key point: When an older dog presents for recurrent UTI, what should you do?
Rule out underlying bladder neoplasia
Urine sediment for TCC is helpful but not ____.
definitive
What is one way you can obtain a cytology of the bladder?
Traumatic catheterizaiton
(cytology is usually persumptive vs definitive)
What does it mean if you get a (-) result on a Bladder Tumor Antigen Test?
(+) result?
- (-) test = probably don’t have dz due to high NPV
- (+) test = need to do other dx to confirm dz due to low PPV
Transitional cell carcinoma contrast radiography (types)
Double contrast
Pneumocystogram
Focal thickening on U/S could signify tumor.
What else can be useful for evaluating?
Evaluation for obstruction (hydronephrosis, hydroureter)
A TCC located in the trigone of the bladder can lead to obstruction which can cause _________
Hydronephrosis
Definitive DX TCC
- 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
Bladder TCC TX
-
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
If you decide to perform a partial cystectomy for local control of a bladder TCC tumor, how much of the bladder can you remove?
80%
Even if you perform surgery on you P with bladder TCC, what is most likely to still occur?
Most likely to still develop mets despite surgery
What is the predicted survival time of a P w/ bladder TCC after a partial resection? Complete resection?
Partial resection - 4m
Complete resection - 12m
**Key Points regarding bladder TCC radiation therapy **
- 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
What drug is used for the medical tx of bladder TCC?
Piroxicam
**Important facts about Piroxicam **
- Non-COX specific NSAID that has an inhibitory effect on TCC in dogs
- Not directly cytolytic - MOA is unknown
Piroxicam toxicity
Gastrointestinal ulceration (anorexia, vomiting, melena)
Median survival time with medical tx of TCC using Piroxicam
6 months
When treating TCC medically, what is Misoprostol used for?
**Counteracts detrimental effect of NSAIDs on GI blood flow **
(used for ulcer prevention or treatment)
(Prostaglandin E1 analog)
When is Piroxican more effective?
When used in combo with other drugs
(combination of chemotherapy and piroxicam)
What drug should you not combine with Piroxicam due to nephrotoxic effects?
Cisplatin
Chemotherapeutic drugs used for Tx TCC in dogs
- Cisplatin
- Carboplatin
- Combo chemo and piroxicam
- Mitoxantrone and piroxicam
TCC Palliative Tx
- 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
True/False: Urethral tumors of dogs are rare
True
Signalment associated with urethral tumors in dogs
What type are they?
- Signalment
- Older ( > 10 yrs); females > males; < 25 kg
- Most are TCC (61%) or SCC (19%)
Concerning urethral tumors in dogs, what is a KEY part of the physical exam?
Rectal
What must a urethral tumor in a dog be differentiated from?
Must be differentiated from granulomatous urethritis
(treatable w/ immounosuppressive drugs)
What is the % of metastasis to the regional lymph nodes at the time of presentation with urethral tumors?
20 - 30%
What can Piroxicam do for dogs with urethral tumors?
May decrease obstruction and improve quality of life
