Final Exam - Tumors of the Respiratory System

Question 1

what are 3 potential risk factors for dogs developing nasal tumors?

Answer 1

dolichocephalic breeds (collies)

urban environment

exposure to environmental tobacco smoke

Question 2

what is the most common nasal tumor in dogs? what accounts for the others?

Answer 2

carcinomas - accounts for 2/3 of all intranasal tumors

adenocarcinomas
squamous cell carcinoma & undifferentiated carcinoma

SARCOMAS

Question 3

T/F: nasal tumors in dogs are locally very aggressive but have a low metastatic rate at the time of diagnosis

Answer 3

true

Question 4

what is the approximate duration of clinical signs in patients prior to presentation?

Answer 4

2-3 months

Question 5

what are the clinical signs associated with nasal tumors in dogs?

Answer 5

unilateral epistaxis that progresses to bilateral in later stages +/- mucopurulent discharge

facial deformity

unwillingness to open mouth

sneezing/dyspnea/stertor

exophthalmus/ocular discharge

neuro signs (rare)

Question 6

T/F: if facial deformity is present, the diagnosis is almost always cancer

Answer 6

true

Question 7

what is on your differential list for nasal tumors?

Answer 7

fungal/bacterial rhinitis (aspergillus)

idiopathic non-specific rhinitis (lymphoplasmacytic)

nasal parasites

bleeding disorders

hypertension

foreign body/trauma

Question 8

T/F: detection of a mass is not specific for neoplasia

Answer 8

true

Question 9

how are nasal tumors diagnosed using imaging?

Answer 9

CT or MRI scan

Question 10

what may be seen on CT/MRI for an animal with a nasal tumor?

Answer 10

bone destruction, abnormal soft tissue, nasopharyngeal invasion, & patchy areas of increased density within abnormal soft tissue opacity

Question 11

how are nasal tumors diagnosed definitively?

Answer 11

histopathology - guided rhinoscopy

Question 12

why is a punch/wedge biopsy not indicated in patients with facial deformity?

Answer 12

radiation

Question 13

how are nasal tumors staged?

Answer 13

thoracic rads, CT scan, & FNA of both submandibular lymph nodes & others if enlarged (retropharyngeal)

Question 14

what is stage 1 of a nasal tumor using the modified adams staging?

Answer 14

confined to 1 nasal passage, paranasal sinus, frontal sinus, & no bone involvement beyond turbinates

Question 15

what is stage 2 of a nasal tumor using the modified adams staging?

Answer 15

any bone involvement beyond turbinates, no evidence of orbit/subcutaneous/submucosal mass

Question 16

what is stage 3 of a nasal tumor using the modified adams staging?

Answer 16

orbit involved, or nasopharyngeal/subcutaneous/submucosal mass

Question 17

what is stage 4 of a nasal tumor using the modified adams staging?

Answer 17

tumor causing lysis of the cribiform plate

Question 18

what are some negative prognostic factors of nasal tumors in dogs?

Answer 18

older than 10, epistaxis, longer duration of clinical signs, advanced local tumor stage, metastatic disease, histologic subtype, & failure to achieve resolution of clinical signs with treatment

Question 19

what is the treatment of choice for nasal tumors in dogs?

Answer 19

radiation therapy

Question 20

why is surgery not an option for a nasal tumor?

Answer 20

curative surgery is impossible - significant morbidity without extension of life

Question 21

what is the median survival time of a nasal tumor treated with radiation therapy? 1 year survival? 2 year survival?

Answer 21

8 to 19,7 months

43-68% - 1 year
11-44% - 2 year

Question 22

what is the total dose of radiation therapy given for nasal tumors? how many treatments are received?

Answer 22

42 to 54 Gy

treatment delivered in 10 to 18 fractions (3 to 4.2 Gy a fraction)

Question 23

what is course fractionated radiation therapy used for palliative care for a dog with a nasal tumor?

Answer 23

treatment delivered weekly - improvement in clinical signs reported in 66-100% of dogs

Question 24

what is the goal of course fractionated radiation therapy used for palliative care in dogs with nasal tumors?

Answer 24

improve the quality of life without aiming to maximize tumor sterilization

Question 25

what is the median duration of improvement seen with course fractionated radiation therapy used for palliative care in dogs with nasal tumors?

Answer 25

130-300 days

Question 26

what can be used as supportive care for palliative treatment of nasal tumors in dogs?

Answer 26

unilateral/bilateral carotid artery ligation, NSAIDS< antibiotics, & analgesia

Question 27

what is the clinical response seen with chemotherapy in dogs with a nasal tumor?

Answer 27

27-75%

Question 28

what is the median survival time seen with chemotherapy used as palliative care in dogs with nasal tumors?

Answer 28

5 months

Question 29

what is the most common nasal tumor in cats? what is the 2nd most common?

Answer 29

lymphoma carcinoma

Question 30

what is the treatment of choice for non-lymphoproliferative neoplastic nasal tumors in cats?

Answer 30

radiation therapy!!

Question 31

what is the definitive intent radiation therapy median survival time?

Answer 31

12 months

Question 32

what is the coarse fractionated palliative radiation therapy median survival time?

Answer 32

13 months

Question 33

what is the overall response rate for cats treated for nasal pharyngeal lymphoma? what enhances overall survival?

Answer 33

70-90% inclusion of radiation therapy

Question 34

what is the combined survival time for treatment of nasal pharyngeal lymphoma?

Answer 34

6-30 months

Question 35

what are the risk factors for pulmonary neoplasia in dogs & cats?

Answer 35

urban living/2nd hand smoke inhalation of polluted air - anthracosis experimental exposure to plutonium dogs trained to smoke cigarettes in the presence or absence of asbestos exposure

Question 36

what is the pathology of pulmonary neoplasia?

Answer 36

affects the epithelium of the airways or alveolar parenchyma

Question 37

what is the most common pulmonary neoplasia in dogs?

Answer 37

bronchoalveolar carcinomas - 85%

Question 38

what is the most common pulmonary neoplasia in cats?

Answer 38

adenocarcinoma - 60-70% of tumors

Question 39

what is the metastatic rate of pulmonary neoplasia in cats?

Answer 39

76%

Question 40

what percentage of animals are diagnosed with pulmonary neoplasia with no clinical signs?

Answer 40

30%

Question 41

what is the most common clinical sign of pulmonary neoplasia?

Answer 41

coughing others - dyspnea, lethargy, anorexia, weight loss

Question 42

what paraneoplastic syndrome is most commonly reported with primary lung tissues in the dog?

Answer 42

hypertrophic osteopathy

Question 43

what paraneoplastic syndrome is most commonly reported with primary lung tissues in the cat?

Answer 43

digit metastasis (scc & adenocarcinoma) & aortic thromboembolism

Question 44

what diagnostics are used for pulmonary neoplasia?

Answer 44

thoracic rads, ultrasound guided FNA & cytology, & CT scan

Question 45

what percentage is ultrasound guided FNA & cytology diagnostic in dogs & cats with pulmonary neoplasia?

Answer 45

dogs - 38%-90% cats - 80-100%

Question 46

what are prognostic factors in dogs for pulmonary neoplasia?

Answer 46

metastatic disease, histologic type/grade, tumor stage, tumor size, location within lung lobe, & involvement of entire lung lobe

Question 47

what is the median survival time for a dog with a stage 3 pulmonary tumor that has invaded into adjacent tissues?

Answer 47

3 months

Question 48

what are prognostic factors in cats for pulmonary neoplasia?

Answer 48

poorly differentiated tumor on histopath - median survival time is 2.5 months well differentiated tumor on histopathology - median survival time is 23 months

Question 49

what is the treatment of choice for pulmonary neoplasia?

Answer 49

surgery!! when possible, a complete lobectomy should be performed with the removal of local/regional lymph node

Question 50

what are 3 other options used in treating pulmonary neoplasia?

Answer 50

chemotherapy tyrosine kinase inhibitors - used in metastatic or non-operable disease radiofrequency ablation - electrode is placed within the tumor to generate heat resulting in necrosis

Question 51

after removing a lung tumor, why should it be submitted to histopathology even if you have already done a cytology?

Answer 51

further characterization of the tumor & assessment of margins

Question 52

when should chemotherapy be recommended for a patient with pulmonary neoplasia?

Answer 52

if the patient has poor prognostic factors - large tumor size, aggressive histopath, clinical signs, & metastatic lymph nodes

Question 53

what chemo drugs can be used in a post operative setting for pulmonary neoplasia?

Answer 53

carboplatin, doxorubicin, & vinorelbine

Question 54

what is the cause of tumors of the nasal planum in cats?

Answer 54

UV exposure

Question 55

what is the typical clinical presentation of nasal planum tumors in cats?

Answer 55

erythema, ulcerated, & crusted lesions

Question 56

what is the treatment of choice for tumors of the nasal planum in cats?

Answer 56

surgery!

Question 57

what dog breed is associated with nasal planum tumors? is it UV associated?

Answer 57

dogs - no

Question 58

what is the treatment of choice for nasal planum tumors in dogs?

Answer 58

surgery

Question 59

why is radiation therapy not used in dogs with nasal planum tumors?

Answer 59

it's not effective in dogs

Question 60

T/F: multimodal approach to treatment of nasal planum tumors in dogs is likely to result in superior survival times

Answer 60

true