Urothelial Carcinoma Flashcards
what are differentials for bladder masses
- neoplasia
- polypoid cystitis
- blood clot
- foreign body
signalment for urothelial carcinoma
older dogs
scottish terriers
shetland sheepdogs
westies
beagles
etiologies for urothelial carcinomas
- genetic
- environmental
- lifestyle
genetic mutation associated with UC
mutation with BRAF proteins leading to uncontrolled cell growth and cancer
environmental risk factors for developing UC
smaller breed dogs = closer to the ground during urination
more likely to get pesticide contact and irritation into urinary tract –> cancer
main 3 characteristics of UC
- lower urinary tract signs
- invasive + located at the trigone
- basic staging involves ultrasound + thoracic radiographs
clinical signs of US
lower urinary tract signs
- stranguria
- pollakiuria
- hematuria
diagnostics for UC workup
- UA w/ cytology
- abdominal US
- thoracic radiographs
- FNA + cytology of the mass
- cystoscopy + biopsy
- BRAF mutation detection assay
- diagnostic catheterization
- surgery w/ biopsy
UA + cytology results w/ UC
- proteinuria
- hematuria
abdominal US of UC
bladder mass in the trigone region
check for bladder wall invasion
reason to do thoracic radiographs in staging for UC
check for metastasis to the lungs
UC mass aspirate cytology
highly cellular
cohesive cells
fits criteria of malignancy
cystoscopy characteristics of UC
irregular mucosa
check for ureteral obstruction
BRAF mutation detection assay
mutated epithelial cells get shed in the voided urine –> can be detected on PCR of the urine
HIGHLY specific for urothelial carcinoma
basic staging for UC
- abdominal US
- thoracic radiographs
always evaluate the local regional LNs for enlargement
at what stage are most UCs diagnosed
stae T2 - invasive into the bladder wall
may see spread to the LNs
medical therapy for UC
- piroxicam
- vinblastine
- lapatinib
piroxicam
NSAID
used to combat the COX2 pathways that get expressed in carcinomas + the inflammation secondary to the tumor
used in ALL medical therapies - can be used alone or in conjunction with chemo or TK inhibitors
MST 6 months
vinblastine
IV chemotherapy
often used in combination with piroxicam
MST 8-12 months
lapatinib
tyrosine kinase inhibitor
inhibits EGFR and HER2 tyrosine kinase
used in combination with piroxicam
multimodal therapies
surgery
radiation
tumor embolization
all used in combination with NSAIDS +/- chemotherapy
MST 1-2 years
why is surgery of UCs difficult
difficult to remove due to location in the trigone
what are signs of recurrence or treatment failure
progressive LUT signs
possible urethral/ureteral obstruction
hydronephrosis
AKI
if a UC causes obstruction what kind of treatment is required
salvage therapy with NSAIDs +/- chemo
1. laser ablation
2. stenting
3. cystotomy tube
