Exam 7 L. 13 Flashcards Preview

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Flashcards in Exam 7 L. 13 Deck (11):
1

Exposure to herbicides/insecticides

May increase the risk of transitional cell carcinoma

2

Transitional cell carcinoma: clinical features

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

3

Possible TCC?

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

4

Veterinary bladder tumor antigen test (VBTA)

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) does*NOT*confirm the presence of TCC

5

Diagnosis of TCC

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

6

Staging of TCC

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

7

Therapeutic options

(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

8

Surgical excision of TCC

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

9

Piroxicam in TCC

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

10

Prognosis

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

11

Bottom line with TCC

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*