Perianal Tumors Flashcards by jared Jensen

What is the most common anal sac tumor

Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)
-17% perineal tumors
-2% skin tumors

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What are the breed predispositions of Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)

GSD
Spaniels
Dachshunds
Malamutes

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At what age do most dogs get Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)

9-11 years old

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T/F: Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) has a sex preference for females

False- there are no sex preferences

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Are Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) typically unilateral or bilateral

Usually unilateral

10-15% bilateral

(new paper says that 20% neoplastic anal sac detected on histo on contralateral) this is why you might consider bilateral anal sacculectomy but too early now

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What are the clinical signs of Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)

Incidental finidng up to 47%- always perform rectal exam and express the anal glands!!

mass effect perineal regions

bleeding/discharge

excessively licking the perineal region

tenesmus/abnormal shape feces

fecal/urinary obstruction

PU/PD (16-53%) secondary to paraneoplastic hypercalcemia

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Why should you always express a dog’s anal sacs when doing a physical exam

because you will miss it if it is full
size is very important in prognosis

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What is the biological behavior of Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)

aggressive tumor

metastasis at time to presention
LN (25-95%)
Distant (0-40%)

Size of tumor does not correlate with the presence of metastatic disease
20%<2cm masses have metastatic disease

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What are the first place that Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) like to metastasis to

Sublumbar lymph nodes
25-95% metastasis at the time of presentation

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T/F: the size of Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) tumor correlates with the presence of metastatic disease

False

20% <2cm masses have metastatic disease

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How do you work up a case of suspected Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) for staging

FNA anal sac mass

Complete bloodwork- if increased total Ca++ evaluate iCa++ on blood gas

Urinalysis

thoracic imaging (radiographs vs CT)

abdominal imaging (rads vs US vs CT vs MRI) - aspirate abnormal LNs

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What does Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) look like on abdominal rads

only extremely enlarged LNs seen

Bone mets

Rads are really useless for staging

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What is a good screening test for Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)

Ultrasound

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What info about Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) does CT and MRI tell you

able to identify more metastatic LNs and can better visualize the sacral LNs

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How do you treat hypercalcemia if significant

1) IV fluid
2) Diuretics
3) Bisphosphonate
4) Calcitonine

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For Apocrine Gland Anal Sac Adenocarcinoma (AGASACA), what do you do if LN extirpation

Blood type

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How do you do LN extirpation

caudal abdominal approach (umbilicus to pubis)

express bladder before rolling in OR

Know well anatomy-
ureters
internal and external iliac a. and v.
median sacral a. and v.

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what is the most common treatment for Apocrine Gland Anal Sac Adenocarcinoma (AGASACA),

Surgery

Anal sacculectomy AND LN extirpation
-Dorsal and sternal recumbency
Both surgeries in dorsal

Always do LN extirpation first

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What structures are in the iliosacral lymphocenter

1) Medial iliac LN
-Deep iliac circumflex a. and v.
2) Internal iliac LN
-Internal iliac a. and v.
3) Sacral LN
-Dorsal aspect pelvic canal next to median sacral a. and v.

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Where is the medial iliac LN

by the deep iliac circumflex a. and v.

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Where is the internal iliac LN

by the internal iliac a. and v.

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Where is the sacral LN

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by the dorsal aspect pelvic canal next to the median sacral a. and v.

When is surgery for Apocrine Gland Anal Sac Adenocarcinoma (AGASACA) not indicated

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1) Invasion to musculature

2) 360 degrees involvement of vessels (both internal and external iliac a. and v.)

3) If extensive seeding to abdominal wall after previous sx (rare)

CT can help you deciding which case is surgical

What position if an anal sacculectomy done in

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Sternal recumbency

What instruments are used for Apocrine Gland Anal Sac Adenocarcinoma (AGASACA),

electrocautery right angle forceps Gelpi or lone star retractor

What should you do post-op after anal sacculectomy for Apocrine Gland Anal Sac Adenocarcinoma (AGASACA),

usually can go home same day Liposome encapsulated bupivacaine NSAIDs Restage q3-4 months for 18months then q6 months

What should you do post-op after lapartomy and anal sacculectomy for Apocrine Gland Anal Sac Adenocarcinoma (AGASACA),

monitor for possible bleeding overnight Lipsome encapsulated bupivacaine Opioids overnight NSAIDs

After anal sacculectomy, when do you restage

Restage q3-4 months for 18months then q6 months

What are the complications of anal sacculectomy

-Infection (~10%) -Local recurrence (~20%) -Transient or permanenet fecal incontinence (rare) -Rectal perforation (19x risk of post op complications) -Rectocutaneous fistula -Hypocalcemia (extremely rare)

What are alternative routes for Apocrine Gland Anal Sac Adenocarcinoma (AGASACA), when surgery (anal succelectomy) is not an option

Radiation responsive tumor Multiple protocols available (IMRT v SBRT) Consider surgery for primary tumor and radiation for LNs when not surgical

What chemotherapy options are available for Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)

Different protocols describes (Doxorubicin, carboplatin, cisplatin, mitoxantrone, toceranib) if no surgery or metastasis to LN Carboplatin Gross dz setting - Toceranib *NO evidence that it does anything

What is the prognosis of Apocrine Gland Anal Sac Adenocarcinoma (AGASACA)

Small <3.2cm AGASACA and no mets- MST = 1237d with no chemo LN metastasis MST=293-448d Stage 3b tumors MST surgery 182d vs MST radiation 447d Distant metastasis MSMT 71-82d

T/F: AGASACA is a radiation response tumor

You are presented with a 5yo MC labrador retriever that has a 2 month history of scooting and licking his perineal region. On rectal exam you identify a 1cm mass arising from the left anal sac and no lymphadenopathy. The dog had thoracic radiographs 2 weeks ago at another clinic for coughing and they were remarkable. What are you recommendation to your client as far as next steps?

The mass is most likely an AGASAVA but i cant be sure only based on palpation. I will offer to get a FNA, finish staging the dog with abdominal imaging. Depending on the results I will offer surgery to remove the mass plus or minus the enlarged lymph nodes

The majority of perineal tumors are

perianal gland adenoma

Where does perianal gland adenoma arise from

the circumanal glands -Prepuce -Scrotum -Tail -Inguinal area

perianal gland adenomas are associated with

plasma androgen levels -Intact male dogs -spayed female dogs (evaluate adrenals - rare but testosterone can be secreted)

What breeds commonly get perianal gland adenoma

-Cockerspaniels -English bulldogs -Beagles -Fox terriers -Dachshunds -Samoyeds

perianal gland adenoma may ______ but are usually not ___

perianal gland adenoma may ulcerate but usually not invasive or fixed

Are perianal gland adenoma or perianal adenocarcinoma androgen dependent

Perianal adenocarcinomas are NOT androgen dependent however, perianal gland adenomas are

What are the characteristics of perianal adenocarcinomas

5-21% of all perianal neoplasms NOT androgen dependent locally invasive and can metastasize (15% at presentation) -Lymph nodes, also lungs, liver, bone, kidney

What breeds typically get perianal adenocarcinomas

GSD and arctic breed

T/F: FNA can differentiate perianal adenomas from carcinomas

False - some data suggest that perianal adenomas may progress to carcinomas

How does perianal adenoma differ from adenocarcinoma

Adenoma: can be single or multiple, can be ulcerated, large or diffuse, not fixed and usually asymptomatic, slower progression Adenocarcinoma: faster growth rate, fixed to underlying tissues, recur after conservarive therapy, can present with signs like dyschezia or constipation due to LN metastasis

Do perianal adenomas or adenocarcinomas have a faster growth rate

Adenocarcinoma

Do perianal adenomas or adenocarcinomas become fixed to underlying tissues

adenocarcinoma

Do perianal adenomas or adenocarcinomas typically present asymptomatic

Adenoma

Do perianal adenomas or adenocarcinomas present with signs like dyschezia or constipation due to LN metastasis

Adenocarcinoma

Do perianal adenomas or adenocarcinomas have a slower progression

Adenoma

T/F: you should FNA all perineal / perianal masses

True- you may not be able to differentiate adenoma vs adenocarcinoma but can rule out other tumor types Surgery is main treatment option but surgical dose may vary depending on tumor type

What should you do for AGASACA if LN not resectable or owner is reluctant for surgery

Radiation therapy

T/F: there is no proof of benefit of chemotherapy for regional metastatic AGASACA

True but consider it

For AGASACA, what should you do if recurrence primary/LN metastasis consider *

second surgery (increase survival time, one of the few that increase survival)

Perianal Tumors Flashcards

(53 cards)