Head and Neck Tumors

Question 1

What is the most common tumor of the nasal planum in animals exposed to UV rays?
A) Mast cell tumor
B) Squamous cell carcinoma
C) Sarcoma
D) Lymphosarcoma

Answer 1

B
Ddx:
Cats= LSA, MCT, eosinophilic granuloma
Dogs= MCT, sarcoma

Question 2

T/F: In situ SCC is the pre-cancerous form, the basement membrane has been preserved.

Answer 2

True

Question 3

T/F: Cytology is the most inexpensive and effective way to diagnose SCC on the nasal planum.

Answer 3

False- not likely to be effective!

must do an incisional biopsy= wedge or punch

Question 4

A SCC lesion is said to be superficial if less than __ mm deep.

Answer 4

2 mm

Question 5

You suspect the progressive lesion on an outside only cat’s nasal platum is SCC. Which of the following is the best way to diagnose this?
A) Fine needle aspirate while the pet is awake
B) Wedge or punch biopsy under general anesthesia
C) Wedge or punch biopsy under sedation
D) None of the above

Answer 5

B- will bleed!

Question 6

T/F: SCC of the nasal planum are highly metastatic.

Answer 6

false- highly invasive, low metastasis

Question 7

Cryoablation is minimally invasive, cheap, and widely available. This form of treatment works best for the ___ form of SCC.

Answer 7

superficial!! doesn’t allow for margin assessment= not sure if the whole tumor was removed

Question 8

If the SCC lesion is greater than __cm (meaning it is infiltrative) then surgical removal is the treatment of choice.

Answer 8

1
surgery= nasal planectomy aka nosectomy
aggressive surgical removal= improves the prognosis!! can survive for almost 2 years after surgery

Question 9

What is the most common tumor of the ear canal?
A) SCC
B) Plasmocytomas
C) Sarcomas
D) Ceruminous gland adenocarcinoma

Answer 9

D

Question 10

T/F: Dogs more often have malignant ear canal tumors that are a mixture of inflammatory, benign, and malignant lesions.

Answer 10

False- this is true of cats; dogs have a 50:50 split

Question 11

FNA is usually unrewarding/not recommended for all of the following tumors except:
A) Salivary  
B) Ear canal 
C) Sinonasal 
D) Nasal planum

Answer 11

A- do this! avoid doing a biopsy of the salivary gland

can also FNA thyroid tumors but be careful d/t vascularity!!

Question 12

T/F: Ear canal tumors are similar to nasal planum tumors in that they are locally invasive but do not commonly metastasize.

Answer 12

true

Question 13

What diagnostic modality is required if invasion of the tumor through the ear canal is suspected?

Answer 13

CT

suspect invasion if: cannot move the ear canal, they have jaw pain or swelling

Question 14

Which of the following surgeries has the best prognosis for ear canal tumors?
A) Lateral canal resection
B) TECA
C) TECA + BO
D) Radiation therapy

Answer 14

C!

if lesions on the pinna remove those as well

Question 15

Which of the following is not associated as being a negative prognostic factor for ear canal tumors?
A) Extension beyond the ear canal
B) SCC/undifferentiated carcinoma
C) Neurological signs
D) Ceruminous gland adenocarcinoma
E) invasion into the lymphatics

Answer 15

D

Question 16

Which of the following is false regarding canine sinonasal tumors?
A) More common in older dogs
B) More common in dogs exposed to smoke and kerosene heaters
C) More common in mesocephalic breeds
D) more common in med-lg breeds
E) Associated with history of unilateral epistaxis

Answer 16

C- dolicocephalic

Question 17

Which tumors have been proven to be caused by environmental factors such as smoke or kerosene exposure?
A) Thyroid carcinomas
B) Sinonasal tumors
C) Ear canal tumors
D) All of the above

Answer 17

B

Question 18

T/F: Carcinomas are the most common cause of sinonasal tumors in dogs and cats.

Answer 18

False- they are in dogs, cats= LSA!!

Question 19

Name the radiographic view preferred for evaluating sinonasal tumors

Answer 19

Open mouth DV oblique

Question 20

Preferred method of evaluating sinonasal tumors?

Answer 20

CT

Question 21

T/F: FNA of sinonasal tumors is preferred to biopsy

Answer 21

False- do a biopsy, make sure to measure to medial canthus so you don’t enter the brain…want to make them bleed= means you got a good enough sample

Question 22

What is the treatment of choice for sinonasal tumors in dogs?
A) NSAIDs 
B) Rhinotomy
C) Radiation
D) Chemotherapy

Answer 22

C
chemo= palliative…can try palladia which inhibits some growth factors
NSAIDs= decrease angiogenesis

Question 23

T/F: Dogs are often euthanized due to epistaxis associated with the tumor.

Answer 23

true- want to treat this!
can cryoablate, or embolize terminal brr of maxillary artery; can also do uni/bilateral carotid ligation - works better in dogs, only unilateral can be done in cats

Question 24

What type of radiation therapy is used for sinonasal tumors?
A) External beam- course fractionated
B) External beam- high, one time dose
C) Radiation therapy is not indicated
D) None of the above

Answer 24

A- begin with smaller doses and increase

prognosis with doing nothing= 3 month survival; with radiation= at least 1 year survival

Question 25

T/F: IMRT(computer aided) and SRT(3D) result in the same outcome as 2D fractionated but allow for fewer treatments and result in fewer side effects.

Answer 25

true- allow for more targeted therapy, not as much damage to surrounding tissue

Question 26

``` What is the TOC for sinonasal tumors in cats? A) Rhinotomy B) Chemotherapy C) Radiation D) Radiation/chemo ```

Answer 26

C/D (radiation!) not sure if chemo makes a diff must differentiate LSA form lymphoplasmocytic rhinitis= need a good biopsy

Question 27

Which is false regarding salivary tumors? A) More aggressive in cats B) Predilection in spaniels and siamese cats C) Most commonly effects zygomatic and sublingual glands D) Most commonly carcinomas E) FNA preferred to bisopy

Answer 27

C mandibular and parotid other facts, locally invasive- not metastatic, firm, painless swelling at gland

Question 28

T/F: Surgery is commonly curative for salivary tumors.

Answer 28

false- need adjuvant RT (not sure if chemo helps)

Question 29

Can you list 4 dog breeds that are predisposed to thyroid tumors?

Answer 29

Goldens, Beagles, Boxers, Huskies

Question 30

T/F: Siamese/himalayan cats are at increased risk for thyroid tumors.

Answer 30

false- decreased

Question 31

T/F: Most thyroid tumors are unilateral.

Answer 31

true

Question 32

Which of the following is true regarding thyroid tumors in cats and dogs? A) Dogs get mostly malignant, functional tumors; cats are the opposite B) Cats mainly get malignant, functional tumors; dogs are the opposite C) Dogs and cats tend to get benign, non-functional tumors D) Dogs tend to have malignant, non-functional tumors; cats are opposite

Answer 32

D Dogs= thyroid carcinomas!! Cats= thyroid adenomas

Question 33

``` What part of the body should be at the top of your list to ultrasound for another tumor if you find a thyroid carcinoma in a dog? A) Lungs B) Abdomen C) Urogenital tract D) None of the above ```

Answer 33

B! they often have concurrent abdominal tumors although it hasn't been proven to be linked to the thyroid carcinomas

Question 34

T/F: Metastasis of thyroid carcinomas is rare in the dog.

Answer 34

false- common but they can still live long even with mets

Question 35

T/F: FNA of the thyroid gland is contraindicated d/t the vascularity.

Answer 35

false- just be careful> US guided, needle OFF technique

Question 36

T/F: If you can slip your fingers around the thyroid mass and move it this is a better prognosis for surgical removal.

Answer 36

true

Question 37

T/F: The MST for a tumor that is moveable and surgically removed is similar to that if the tumor is fixed.

Answer 37

false- longer MST in moveable tumor cases; most survive up to two years, fixed tumors= usually only survive less than or up to 1 year > can use RT to down-stage invasive tumors before surgical removal

Question 38

T/F: Use of radiation delays the progression of malignant thyroid tumors for up to 3 years in many dogs.

Answer 38

true! better prognosis compared to not doing RT ...biggest issue is that if the dog is clinically sick RT can take time to shrink the tumor (8-22m) ...increased MST using fractionated vs hypofractionated

Question 39

If you have to remove both thyroid glands what is often required to be supplemented?

Answer 39

Calcium! b/c parathyroids are also gone....give calcitriol// also T4 since thyroid is gone

Question 40

T/F: I131 therapy has been shown to work well in treating non-resectable thyroid tumors in dogs.

Answer 40

false- can die from unpredictable myelosuppression!

Question 41

Which is false regarding negative prognostic factors with thyroid tumors? A) Lack of mobility is probably the most important negative prognostic factor B) Increased risk of developing metastasis related to no evidence of tumor growth progressing C) Bilateral vs unilateral, bilateral has 16X greater risk for metastasizing D) Poor prognosis if >5 cm in diameter

Answer 41

B- decreased risk of metastasis if no evidence of tumor progression