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Small Animal - Mammary Neoplasia Flashcards

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1
Q

What is the incidence of mammary tumours in dogs?

A

Common in female dogs
35-50% are malignant
Rare in male dogs and likely to be malignant

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2
Q

Which dog breeds are more predisposed to mammary tumours?

A 
Poodles
Spaniels
English setters
Pointers
Maltese
Yorkshire terriers
Dachshunds
Dobermans
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3
Q

What is the incidence of mammary disease in cats?

A

Less common

90% are malignant

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4
Q

What are common sites of mammary tumour metastasis?

A 
Lymph nodes - common
Lungs - common
Liver kidney
Bone
Heart
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5
Q

What is the likely cause of mammary tumours?

A

Hormonal - 90% benign and 50% malignant canine tumours have oestrogen and progesterone receptors

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6
Q

What, apart from homonal, are other aetiological factors that affect mammary neoplasia?

A 
Gene over-expression
Gene under-expression
Adhesion molecules
VEGF
Cox-2
Other factors
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7
Q

What are the risk factors for mammary tumours?

A

Increasing age - 9.5 years on average
Dogs obese early on in life
Progestagen treatment increases risk - benign in dogs, malignant in cats
Benign mammary tumours increase risk of malignancy 3 times
Intact status or bitches after 2.5 years of age

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8
Q

What is the usual clinical presentation of mammary tumours?

A

Owner noticed a mass
Incidental finding on physical examination
Occasionally signs referable to metastases

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9
Q

Why is it important to palpate all the mammary glands?

A

Masses may be variable in size
Multiple different masses may be found
Masses amy be in one or bothchains

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10
Q

What glands are canine mammary tumours most common in?

A

Caudal glands

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11
Q

What must also be palpated when mammary tumours present?

A

Axillary lymph nodes
Inguinal lymph nodes
Rectal may reveal enlarged sublumbar lymph nodes

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12
Q

What does inflammatory carcinoma present as?

A 
Diffuse swelling rather than discrete mass
Massive oedema
Erythema
Pain in multiple glands
Rapidly progresses
Highly metastatic
Systemic illness
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13
Q

What tumour types can present as mammary tumours?

A

Benign - adenoma, fibro-adenoma, benign mesenchymal tumour, benign mixed tumour
Malignant - carcinoma (solid, tubular, papillary, anaplastic/inflammatory), sarcoma, carcinosarcoma

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14
Q

What are the differential diagnoses for mammary lumps?

A 
Mastitis
Galactostasis
Galactorrhoea
Mammary hyperplasia
Cutaneous/subcutaneous tumour
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15
Q

What animals is mastitis more common in?

A

Post-partum bitches

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16
Q

When can mastitis occasionally occur?

A

After oestrus or falso pregnancy

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17
Q

Describe mastitis

A 
Glands - firm, swollen, painful
Pyrexia
Depression
Inappetance
Puppy neglect
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18
Q

Describe mastitis treatment

A

If dehydrated - IV therapy
IV antibiotics until resolved - usually 7 days
Cephalosporins a good choice
Abscesses need to bedrained surgically

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19
Q

What is galactostasis?

A

Accumulation and stasis of milk within mammary gland in nursing bitches

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20
Q

Describe galactostasis

A

Glands - warm, firm, swollen and painful

Secretions not infected

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21
Q

Describe galactostasis treatment

A

Self resolving
Gradual weaning
Food reduction helps ease transition

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22
Q

What is galactorrhea?

A

Lactation that occurs when it is not associated with pregnancy and parturition

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23
Q

What does galactorrhea result from?

A

Increased prolactin secretion

Stimulated by falling progesterone levels in late dioestrus

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24
Q

What treatment is required for galactorrhea?

A

Usually self limiting
Doesn’t require treatment
Withholding food for 24 hours followed by fradual return helps reduce lactation

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25
What is mammary hyperplasia most commonly seen in?
Young, entire female cats | 2-4 weeks after oestrus
26
What prevents recurrence of mammary hyperplasia?
Neutering
27
Why do we carry out haematology and biochemistry for mammary tumours?
Make sure geriatric patients are safe to anaesthetise
28
What should radiography be used for with mammary tumours?
Check for metastases to lung and sublumbar LN | Chest and abdomen
29
What percent of dogs are lung and LN metastases present in?
25-50% with malignant tumours
30
What should be checked on ultrasound for enlargement with mammary tumours?
Liver Spleen Sublumbar LN Inguinal LN
31
What are fine needle aspirations useful for?
Differentiating benign from malignant tumours Differentiating mastitis from infalmmatory carcinoma Investigating enlarged lymph nodes
32
When would you use a coagulogram with mammary tumours?
If suspecting inflammatory carcinoma
33
Describe surgical biopsies in mammary tumours
Usually excisional | Incisional for inflammatory carcinoma or other inoperable tumours
34
Which tumours should you send for pathology?
All tumours | Record site of each one
35
What does immunohistochemistry determine?
Presence of hormone receptors in tumour
36
What should never be used as a sole treatment for mammary tumours?
Medical treatment
37
What may chemotherapy be used as for dogs?
Adjunctive after surgery
38
What is the treatment of choice for all mammary tumours? Which types is it not?
Surgery | Except inflammatory carcinoma, those with distant metastases
39
What must all tumours be submittted for?
Pathology
40
How many pairs of mammary glands do cats and dogs have?
Dogs - 5 | Cats - 4
41
Describe mammary glands
Compound Tubuloalveolar Apocrine
42
What is the vascular supply for the mammary glands?
Caudal superficial epigastric Cranial superficial epigastric Branches of internal thoracic
43
Describe drainage of the mammary glands in dogs
4 to 5 drain to inguinal LN 1 to 2 drain to axillary LN 3 can drain in either direction Also variable connections between 3 and 4
44
Describe drainage of the mammary glands in cats
3 and 4 drain to inguinal LN | 1 and 2 drain to axillary LN
45
What margins are needed with mammary tumours?
2-3cm skin margins
46
What should be excised if tumour is attached?
Underlying abdominal wall fascia
47
What should be done with crainal/caudal superficial epigastric vessels?
Ligate as they are encountered
48
What should be placed if there is extensive dead space?
Closed-suction drain
49
What surgery should be done with dogs? Cats?
Dogs - complete but not radical | Cats - unilateral mastectomy is minimum advised
50
What are the 5 options for mammary tumour surgery?
``` Lumpectomy Simple mastectomy Regional mastectomy Unilateral mastectomy Bilateral mastectomy ```
51
Describe a lumpectomy
Excision of a mass Surrounding margin of grossly normal tissue Use when mass is: small, encapsulated, non-invasive, gland periphery May get milk or lymph leakage Can have post-op inflammation
52
Describe a simple mastectomy
Excision of entire gland containing tumour 2cm margins Used when tumour is >1cm Used when tumour is in centre of the gland or involves majority of it Less risk of milk leakage
53
Describe a regional mastectomy
Excision of involved and adjacent glands 2cm margins Used for excision of multiple tumours in adjacent glands Used if mass is ebtween two glands Caudal two glands often excised together with inguinal lymph node Axillary LN not excised with cranial glands unless specifically indicated
54
Describe a unilateral masectomy
Excision of tumours in the third gland Multiple tuours in one mammary chain Excise all tumours on one side Quicker and easier than spearate masectomies Careful, tension-free closure is essential
55
Describe a bilateral masectomy
Only when multiple masses in both chains Excise both mammary chains and inguinal LNs Skin clouse is difficult if performed in one surgery Decreased risk of wound breakdown if perform two unilateral several weeks apart
56
What is important with mammary tumour surgery?
Pre-emptive multimodal analgesia
57
What are four complications with mammary tumour surgery?
Seroma Wound breakdown/infection Hindlimb oedema Recurrence of tumour or metastatic spread
58
What factors affect the prognosis of mammary tumours in dogs?
Tumour size - 3cm 85% recurrence Histologic type - sarcomas>carcinomas Grade/differentiation - 90% mortality at 2 years if poorly differentiated, 24% mortality at 2 years if well differentiated Lymphatic or vascular invasion - poorer prognosis Lymph node involvement - 80% recurrence in present, 20% recurrence if not present Distant metastases - poorer prognosis Progesterone/oestrogen receptors - better prognosis Fixation to tissue or ulceration - poorer prognosis
59
What factors affect the prognosis of mammary tumours in cats?
Tumour size - >3cm median survival <2cm median survival 3 years Extent of surgery - 66% recurrence if perform local compared to radical masstectomy Histologic grading - 42% mortality at 2 years well diffenertiated, 70% mortality at 2 years moderately differentiated, 100% mortality at 2 years poorly differentiated
60
What is not prognostic with mammary tumours?
Tumour site Type of surgery in dogs Number of tumours OHE at time of excision
61
What are the survival times with various tumours in dogs?
Inflammatory carcinoma - 30 days Malignant, incompletely excised - 75% mortality in less than a year Malignant, completely excised no metastases - 1 to 2 years Malignant, completely excised and metastasized - 5 months Benign tumours - curative
62
What is the median survival time for malignant mammary tumours in cats?
Less than a year
63
What is mammary neoplasia almost completely preventable by?
Early spaying

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