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
Signalment for mammary gland tumors
Female > male
Mean age
Cats : 10-12yrs
Dogs: 7-13yr
Breed predisposition for mammary gland tumors in cats?
DSH and Siamese
Dog Breed predisposition for mammary glad tumors?
Pointers Brittany Spaniel English springer spaniel Labrador Retreiver Great Pyrenees Samoyed Airedale terrier Miniature and toy poodle Dashunds Keeshond
Presenting complains for mammary tumors?
Visible/ palpable mass —> can be associated with glandular tissue or nipple
Ulceration is common in cats
Most mammary tumors occur in what glands most commonly?/
60-70% mammary neoplasia occurs in mammary glands 4 or 5
T/F: Mammary glad tumors in dogs are more commonly malignant
False
50:50 benign:malignant
T/F: mammary gland tumors in cats are most commonly malignant
True
85-95% malignant
Top DDx for mammary gland tumor in dog?
Benign - adenoma
Malignant - carcinoma or sarcoma
Top DDX for mammary gland tumors in cats
CARCINOMA
- adenocarcinoma with tubular, papillary, solid, and cribriform subtypes
Sarcoma, SCC, and mucinous are less common
Clinical signs associated with inflammatory carcinoma?
Pain Anorexia Weight loss Generalized weakness PU/PD
How do inflammatory carcinomas appear?
Unique and aggressive variant
Diffusely sowed with poor demarcation between normal and abnormal tissue
Most have advanced stage dz at presentation
What are risk factors for mammary tumors in felines?
Age —> 7-14yrs
Breed/genetics —> Siamese
Hormonal exposure
—> intact queen 7x higher risk (OHE reduces risk before 6months reduces risk 91%)
—> progestin exposure increase risk 3.4x
What are risk factors for mammary tumors in canines?
Age: 7-9 mostly benign; 9+ most likely malignant
Breed: purebred and smaller breeds more common
Hormonal: OHE prior to first estrus only have 0.5% risk, prior to second 8%, prior to third 26%, after this no benefit
Bodyweight during puberty - underweight = protective
Work up for mammary gland tumors ?
MDB - unrewarding
FNA/cytology - high potential for false neg , good to rule out inflammatory carcinoma and mets to LN
—> if positive = animal positive
—> if negative = biopsy (excisional in dog, incisional in cat)
3view thoracic rads
Abdominal U/S for full staging
How do you surgically treat mammary tumors in dogs?
Single mammary tumor —> wide excision to remove tumor
- lumpectomy <0.5cm, movable, and benign
- mastectomy >1cm, fixed or movable
Multiple mammary tumors —> regional mastectomy or staged bilateral mastectomy
ALWAYS DO OHE when removing MGTs
How do you surgically treat mammary tumors in cats?
Single session bilateral radical mastectomy with excision of axillary and inguinal LN
ALWAYS do OHE
What adjunctive chemo can you give in mammary gland tumors in cats? And when would you recommend it?
Recommended for cats with tumors >3cm (LN positive or negative)
Doxorubicin with NSAID or cyclophosphamide
When is chemo recommended in dogs with mammary gland tumors?
Large tumors
Positive LN
Histology suggests aggressive tumor
Prognostic factors for feline mammary gland tumors
*** tumor size —> IMP for assessing risk for mets and need for adjunctive treatment
Lymph node
Dose of surgery: more aggressive = better outcome
Breed: DSH better outcome vs purebred and Siamese
Histological grade
Age- older worse
Prognostic factors for canine mammary gland tumors?
Tumor size
Lymph node —— significant negative factor if involved
DDX for vaginal tumors?
Benign smooth muscle - leiomyoma (hormone dependent)
Leiomyosarcoma
Top DDX for testicular tumors?
Interstitial cell tumor (functional)
Seminoma — high risk (16x) in cryptorchid testide
Sertoli cell tumor — 8.8x higher risk in cryptorchid testicle
