What is the 4th most common site of D/C tumors
Oral tumors
Oral tumors occur more in what species and sex
Dog, Male
Oral tumor presenting complaint
middle aged -> older
visible mass: difficulty eating, oral bleeding, halitosis
Recent dental hx
Genetic predisposition to oral tumors
Boxers, GSD, Goldens, Cockers, Mini poodle, German SHP, Gordon Setter, Chows, Weimaraner
Oral tumor differential diagnosis - Dog
Melanoma. SCC. Fibrosarcoma.
OSA.
Odontogenic tumors (epulides)
Oral tumor differential diagnosis - Cat
SCC. Fibrosarcoma.
Oral tumor Work up & Staging
Cytology - ineffective Biopsy Radiographs - low yield Lnn Staging w/ FNA 3 view thoracic met check (ALL)
Oral tumor biopsies
proliferative mass - shave biopsy
Non proliferative mass - incisional
Oral Malignant melanoma
Black or melanotic melanoma
80% mets (high malignancy - lungs/lnn)
thorough staging! Biopsy
Oral Malignant melanoma biggest failure
systemic mets
Oral SCC
locally invasive, low mets.
Cats: paraneoplastic hyperCa. Sublingual site preferred
Oral Fibrosarcoma
Young, large breeds
very invasive but looks benign - don’t believe fibroma histopath.
Oral Fibrosarcoma biggest failure
recurrent disease: didn’t resect it all
Odontogenic tumor origin
periodontal ligament
3 types of odontogenic tumors
Acanthomatous ameloblastoma
Peripheral odontogenic fibroma
Feline inductive odontogenic tumor
Acanthomatous ameloblastoma
locally invasive (bone) no mets very aggressive sx required - 1 cm margins Shetland and sheep dogs, rare in cats
Peripheral odontogenic fibroma
slow, benign - no bone involvement
common in dogs
cryotherapy
Feline Inductive odontogenic tumor
young cats (8-18m) locally invasive
Treatment of oral tumors
Aggressive Sx excision - almost all have bone involvement
2cm margins for malignancies
Radiation and chemo or oral tumors
Adjunct RT - melanoma!, SCC, Acanthomatous ameloblastoma, FSA.
Chemo not commonly used
Oral positive prognostic indicators
Smaller tumor
Rostral location
Complete resection
No evidence of preop mets
Esophageal tumors
Rare.
Older animals
S. lupi - sarcomas
esophageal obstruction, stricture, 2˚ aspiration pneumonia
Differential diagnosis of esophageal tumors
SCC
Leiomyosarcoma
feline esophageal SCC tumor
females.
Middle 1/3rd, caudal to thoracic inlet
Esophageal work up and staging
Imagining - megaesophageus?
Esophagoscopy (GS)- biopsy
fecal
Esophageal tumor therapy
Surgery!
best for low grade leiomyosarcomas
RT - limited
Palliation - feeding tube
Esophageal tumor prognosis
Very poor
benign/low grade/LSA can be okay
Drug to resolve S. lupi infection
Dormectin
Gastric tumors
uncommon
males
chronic gastritis, helicobacter
Asymptomatic until blocking outflow - anorexia/hematemesis
Gastric tumor genetic predilection
Belgian shepherd, chows
Benign - beagles
Gastric Tumor dog differentials
Big 2
Adenocarcinoma (70-80%)
Leiomyosarcoma
Gastric tumor Cat differentials
Big 1
Lymphoma
Cat systemic status w/ gastric lymphoma
negative FeLV
possible concurrent LSA in small intestine
Gastric ademocarcinoma
predictable - pyloric antrum/lesser curvature
Scirrhous (leather)
High met rate (anywhere)
deeply ulcerative
Gastric work up and staging
Non specific lab
Abdominal US (decreased motility)
ENDOSCOPY - biopsy
Gastric leiomyomas
well circumscribed, submucosal mass
cardiac location - benign
Gastric tumor Treatment
Surgical excision
partial gastrectomy
gastroduodenostomy/jejunostomy (bilroth 1 or 2) - high morbidity
Gastric tumor prognosis
surgical excision, tumor type/grade, mets.
ACA Gastric tumor prognosis
poor - majority dead in 6m
LSA Gastric tumor prognosis
Doesn’t respond to chemo,
resect and chemo might not be needed
Leiomyosarcoma Gastric tumor prognosis
12-21m
Cured with aggressive surgery
Intestinal tumors
older animals, same presentation as gastric tumors
Intestinal tumor Dog
uncommon
Large intestine!
Collie, GSD, male
Intestinal tumor cat
uncommon
Small intestine!
Intestinal tumor work up/staging
similar to gastric -
Goal: rule out LSA (no sx tx)
endoscopy (understand limits)
US guided FNA/cytology
Intestinal tumor differential diagnosis dog
Big 3
LSA > ACA > Leiomyosarcoma
GIST
Intestinal Tumor differential diagnosis cat
Big 3
LSA, ACA, MCT
no order
Intestinal tumor treatment
Exploratory laparotomy - R&A
except LSA
4-8cm margins
assess mesenteric and regional lnn
LSA intestinal tumor DOG
T cell, multifocal
not good remission or survival
Neg prog. factors: Failed to achieve remission
LSA intestinal Tumor CAT
responds well to chemo
prognostic factor: response to tx
ACA intestinal tumor dog
44% met rate - stage!
female neg prognosis?
ACA intestinal tumor cat
72% mets on dx
neg prognostic: histo subtype and mets
MCT intestinal tumor dog
100% mortality in 2m.
100% met rate.
BAD
MCT intestinal tumor cat
poor - euthanize/death
*solitary MCT w/o mets have good survival
Leiomyosarcoma intestinal tumor
old data.
8m MST dogs
cat - very uncommon
Gastrointestinal Stromal Tumor (GISTs)
IHC can differentiate from leiomyosarcoma
from cells of cajal (GI pacemaker)
express c-kit
predilection for cecum
die from septic peritonitis (ruptured mass)