Urogenital Tumors Flashcards
What is the most common bladder tumor?
What would be your other DDX?
Transitional cell carcinoma
SCC
ACA
Rhabdomyosarcoma
Fibroma
Polyploid cystitis (non neoplastic)
What are etiologies of bladder neoplasia?
Topical insecticide and herbicide exposure
Environmental pollution
Obesity - overweight females 28x risk
Cyclophosphamide (acrolen)
Female
Breed
What breeds have highest predisposition to bladder neoplasias?
Scottish terrier
Westies
T/F: newer spot-on flea control products with fipronil have higher risk of TCC
False
These new products are safer and NOT associated with TCC
What are ways that you can reduce risk of bladder neoplasia in pets?
Limit exposure to lawn chemicals
Avoid older flea/tick products
Feed veggies 3x/week to high risk breeds —> has shown to reduced risk of TCC
TCC is most commonly found where ?
Trigone of the bladder
—> urine tends to sit in this part of bladder (pooling at lowest point) —> toxin build up
T/F: TCCs tend to be locally invasive
True
56% have concomitant urethral involvement
29% prostate involvement
Clinical signs commonly associated with TCC?
Hematuria
Dysuria
PU
Lameness - bone met
Workup for TCC?
PE
- palpable mass in bladder
- rectal-> thickened urethra/iliac lymph node
MDB/ UA —> traumatic catheterizaiton is preferred sampling method
Thoracic rads
Contrast cystography
Cystosonography - preferred
Cystoscopy with biopsy —> assess for resectability
What can be used as a screening tool for TCC in at risk breeds in the absence of clinical signs
BRAF mutation detection asssay
—> can detect mutation in malignant cells that are shed in the URINE
What are the surgical treatment options for invasive bladder tumors?
Partial or complete cystectomy
Laser ablation
What are the surgical treatment options for less-invasive TCC?
Cystotomy tube
Transurethral stenting
Transurethral resection —> high intra-op complication rate with no survivial benitif
Indications for a partial cystectomy?
Localized bladder neoplasia where tumor can be excised with 1-2cm margins
- generally for solitary masses at the apex of the bladder that do not have regional or systemic mets*
40-70% of bladder excised
Complications to partial cystectomy?
Bladder dehiscence
Pollakiuria
Recurrence of TCC
Surgical tumor seeding (theoretical?)
How is laser ablation therapy done for TCC and what is the outcome?
Cystotomy/urethrotomy with laser ablation of entire mucosal surface area without serosal penetration
PO piroxicam and mitoxantrone
All dogs have resolution of clinical signs (disease free interval 200days)
MST = 299days
What is the purpose of urethral stenting with TCC?
Obstructive carcinoma of the urethra —> place a urethral stent to relieve obstruction
Can cause severe incontinence in 26% of cases
What is the role of NSAIDS in treatment of TCC?
COX1 expressed in normal urinary bladder epithelium
COX2 expressed on neoplastic epithelium —> suggests this is involved in tumor cell growth —> inhibition by NSAIDS (eg prioxciam) is the mechanism of the anti-neoplastic effect
Prioxicam is AKA
Feldane
T/F: all dogs with TCC should receive NSAIDS if possible
True
What are the most effective chemotherapy protocols for TCC?
Cisplatin, methotrexate, cyclophosphamide or 5FU
ONLY palliative
What is the most common chemotherapy protocol used in clinics?
Mitoxantrone with prioxicam
What is metronomic chemotherapy used with TCC?
Chlorambucil
MST 221days
What are the treatment outcomes from shortest to longest survival time?
Trigonal surgery (2.5m) Palliative chemo (6m) < Piroxicam alone (6.5m) < palliative stenting with chemo < chemo+prioxicam = laser ablation+chemo (8m) < radiation + chemo < surgery+chemo (2yr)
T/F: feline bladder neoplasia are common and usually TCC
False
Rare but are usually TCC
