Urinary Tract Neoplasia

Question 1

Overview

Answer 1

Bladder tumors (most common)
- TCC
 . Trigone usually affected (dogs>cats)
 . Usually unresectable
 . Best treatment usually chemo/piroxicam
Prostate tumors (less common)
- Similar clinical signs
- Poor prognosis
Kidney tumors (rare)
- Lymphoma more common *treat systemically*
- Other kidney tumors may be resectable

Question 2

UTI: Sequela or primary problem?

Answer 2

Damaged mucosa
Immunosuppressive chemotherapy
Urine culture
- Resistant and recurrent UTIs

Question 3

T/F: Contrast is a commonly used method in diagnosis of bladder tumors

Answer 3

False; impractical

Question 4

T/F: Abd US is a commonly used method in diagnosis of bladder tumors

Answer 4

True!

Question 5

Obtaining a tissue biopsy

Answer 5

Obtaining a tissue biopsy is difficult
Urinary catheter biopsy
- “traumatic” catheter biopsy
Cystoscopy
Exploratory laparotomy
Laparoscopy?
Trans-abdominal Tru-cut biopsy?

Question 6

T/F: Urine BTA tests are a commonly useful diagnostic tool

Answer 6

False; rarely useful, many false positives

Question 7

Bladder tumors

Answer 7

TCC -most common bladder tumor
Other types:
- Primary: Other carcinomas, sarcomas
- Secondary: Prostate adenocarcinoma invading into bladder
- Metastatic: uncommon e.g. abdominal carcinoma
- Systemic cancer: e.g. lymphoma

Question 8

Distant mets are __ (more/less) likely with bladder tumors

Answer 8

Distant mets less likely
Staging still important
- Metastasis often affects LNs at diagnosis
. 25% regional LN mets
. <25% distant mets (lungs, less likely liver)
- 50-75% mets at death

Question 9

Why are animals with bladder tumors most often euthanized

Answer 9

Local disease (80%)

Question 10

Most common breeds Dx with bladder neoplasia

Answer 10

Scotties, Westies, Shelties, Beagles

Question 11

T/F: Canine TCC is rarely resectable

Answer 11

True!
Canine TCC is rarely resectable
Dogs
- Trigonal, usually NOT surgical
- Anatomy (inflow/outflow) leads to obstruction
- Local invasion/extension
- Metastatic potential

Question 12

T/F: Chemotherapy is not standard care for canine TCC

Answer 12

False!
Chemotherapy is standard care for K9 TCC
Combo chemo?
-Palliative vs. remission
-~8m+ MST
- Mitoxantrone/piroxicam
Piroxicam (NSAID only), MST 6m
Shrinkage with ANY therapy = 0-35%

Question 13

Supportive care

Answer 13

Analgesics for cystitis
- Piroxicam +/-others
Secondary urinary tract infections
Incontinence, etc.

Question 14

T/F: Urethral obstruction is a common sequela of bladder neoplasia

Answer 14

True!
Emergency relief of obstruction
- catheterization
Re-stage?
- Azotemia?
- Metastasis?

Question 15

Palliative Tx of outflow obstruction

Answer 15

Tube cystostomy
Urethral stent
Radiation therapy
Debulking?
Laser therapy?
Experimental?

Question 16

Prognosis

Answer 16

Negative prognostic factors

• Younger age
• Prostatic involvement
• Advanced TNM stage
• Urethral involvement?

Question 17

Feline TCC

Answer 17

50% apical/50% trigone
- ~20% metsat dx
Chemotherapy anecdotal
MST <9m 
- Various treatments

Question 18

Signs of prostatic tumors

Answer 18

• Lower urinary tract signs
• Constipation
• Systemic illness
  . Metastasis
  . Obstruction

Question 19

Prostatic tumors (usually carcinoma)

Answer 19

Etiology
- Uncommon
- Neutered males
- Middle to larger breeds 
 . Pathology
- Adenocarcinoma
- Other carcinomas (e.g. TCC), sarcomas

Question 20

T/F: prostatic tumors are seldom metastatic

Answer 20

False!

Mets to LN, lungs, bone

Question 21

Medical Tx of prostatic tumors

Answer 21

Chemotherapy
Piroxicam/NSAIDs
Radiation therapy Resection (prostatectomy) 
Prognosis is poor
- MST 3-7m