Exam 7 L. 13

Question 1

Exposure to herbicides/insecticides

Answer 1

May increase the risk of transitional cell carcinoma

Question 2

Transitional cell carcinoma: clinical features

Answer 2

1) dysuria and hematuria: most common sign*
- temporarily responsive to antibiotics
2) Stranguria, pollakiuria, renal insufficiency, abdominal pain, bone pain
3) physical findings: dog may have rectal or vaginally palpable masses, lumbar pain, lymphadenomegaly, weakness

Question 3

Possible TCC?

Answer 3

1) physical exam and history
2) urinalysis, urine culture, radiographs of thorax and abdomen, bladder imaging
3) location of mass: trigone in dogs-1/2 have concurrent urethral involvement
- **NOT trigone in cats (usually in apex)
4) radiology: plain abdominal films- bone, lymph node
- TCC may metastasize to bone and cause bone pain!
5) ultrasonography is superior to excretory urography and double contrast cystography

Question 4

Veterinary bladder tumor antigen test (VBTA)

Answer 4

1) tumor markers best used for early detection
2) urinary basic fibroblast growth factor is increased in tumor progression
3) identifies dogs that do NOT have TCC*
- it is a good screening test for high risk or geriatric patients (85% sensitivity for TCC)
- BUT, if there is excessive blood, protein, glucose in the urine this decreases the specificity to 45%
4) doesNOTconfirm the presence of TCC

Question 5

Diagnosis of TCC

Answer 5

1) urine sediment diagnostic in >30% superficial TCC canine cases
2) fresh free catch urine okay
3) diagnostic biopsy
- traumatic urethral catheterization
- percutaneous fine needle aspirate (risks…)
- Cystoscopy/cystotomy

Question 6

Staging of TCC

Answer 6

TCC is not measured by the size, but by its level of invasion

1) most common presenting clinical stage is invasion into bladder wall or into other organs, but WITHOUT lymph node/distant metastasis
2) metastatic pattern include spread to lungs, regional lymph nodes, bone

Question 7

Therapeutic options

Answer 7

(Not very effective)

1) surgical
- surgical/laser debulking may improve signs and survival*
- combine with chemotherapy
2) chemotherapy
3) immunotherapy
4) intra-/postoperative radiation therapy
- poor choice
5) palliation
- bladder excision and urinary diversion
- permanent stoma and port
- urethral stent

Question 8

Surgical excision of TCC

Answer 8

1) surgical excision is rarely complete even with microscopically “clean” margins
- but, if not trigonal, it may help

Question 9

Piroxicam in TCC

Answer 9

1) role of Cox-2 in TCC is unclear
- Cox-2 is not found in normal bladder epithelium, but is increased in TCC tissue
- Cox-2 overexpression increases the invasive ability of tumor cells
2) MST of 6 months with piroxicam alone
- usually well-tolerated, canine feels better overall

Question 10

Prognosis

Answer 10

1) long-term survival and response to therapy is associated with the extent of disease at the time of diagnosis
2) factors that shorten survival*
- young dog
- prostate involvement and bladder
- local invasion into bladder wall
- high tumor grade: vascular invasion observed histologically

Question 11

Bottom line with TCC

Answer 11

1) clinical improvement see almost all therapies tried
2) clinical staging and histology are useful for prognosis
3) *surgical debulking extends survival even without additional therapy
4) piroxicam therapy is reasonably effective-6 months, deracoxib better but more adverse effects?
5) repeated urinary tract signs/UTI especially in older animals should prompt screening for TCC
6) bacterial UTI is a frequent complication