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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?

25
Signalment for bladder neoplasia in dogs
* Older dogs * No sex predilection * Scottie odds ratio 18.1
26
Bladder neoplasia: possible etiologic factors
* Chemicals * Drugs * Industrial activity * Second hand smoke
27
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)
28
**Key Point: What should always be done to a female dog presenting for dysuria**?
**Rectal** b/c urethral involvement is easily palpable
29
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
30
**In a patient with TCC, what is the safest method to collect urine?**
**Catheter or Voided **
31
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)
32
**Key point: When an older dog presents for recurrent UTI, what should you do?**
**Rule out underlying bladder neoplasia**
33
Urine sediment for TCC is helpful but not \_\_\_\_.
definitive
34
What is one way you can obtain a cytology of the bladder?
Traumatic catheterizaiton (cytology is usually persumptive vs definitive)
35
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
36
Transitional cell carcinoma contrast radiography (types)
Double contrast Pneumocystogram
37
Focal thickening on U/S could signify tumor. What else can be useful for evaluating?
Evaluation for obstruction (hydronephrosis, hydroureter)
38
**A TCC located in the trigone of the bladder can lead to obstruction which can cause \_\_\_\_\_\_\_\_\_**
**Hydronephrosis**
39
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
40
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**
41
**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%
42
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
43
What is the predicted survival time of a P w/ bladder TCC after a partial resection? Complete resection?
Partial resection - 4m Complete resection - 12m
44
**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
45
What drug is used for the medical tx of bladder TCC?
Piroxicam
46
**Important facts about Piroxicam **
* **Non-COX specific NSAID that has an inhibitory effect on TCC in dogs** * Not directly cytolytic - MOA is unknown
47
Piroxicam toxicity
Gastrointestinal ulceration (anorexia, vomiting, melena)
48
Median survival time with medical tx of TCC using Piroxicam
6 months
49
**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)
50
When is Piroxican more effective?
When used in combo with other drugs (combination of chemotherapy and piroxicam)
51
**What drug should you not combine with Piroxicam due to nephrotoxic effects?**
**Cisplatin**
52
Chemotherapeutic drugs used for Tx TCC in dogs
* Cisplatin * Carboplatin * Combo chemo and piroxicam * Mitoxantrone and piroxicam
53
TCC Palliative Tx
* **Surgical diversion procedure**: cystectomy w/uretero-trigonic colonic transplantation has unacceptable complications (pyelonephritis, acid base and electrolyte abnormalities) * **Permanent tube cystostom**y (chronic UTI is a complication) * owners empty bladder
54
_True/False_: Urethral tumors of dogs are rare
True
55
**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%)**
56
Concerning urethral tumors in dogs, what is a KEY part of the physical exam?
Rectal
57
What must a urethral tumor in a dog be differentiated from?
Must be differentiated from granulomatous urethritis (treatable w/ immounosuppressive drugs)
58
What is the % of metastasis to the regional lymph nodes at the time of presentation with urethral tumors?
20 - 30%
59
**What can Piroxicam do for dogs with urethral tumors?**
**May decrease obstruction and improve quality of life**

Small Animal Med. I (18 decks)

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