Tumours of the GI System

Question 1

What’s the MST of dogs and cats with salivary gland carcinoma treated with Sx or Sx +/- RT +/- Chemo?

Answer 1

Dogs: 550d
Cats: 516d

Question 2

What are some of the reported biological behaviour of canine and feline salivary gland carcinoma based on the Hammer et al 2001 paper?

Answer 2

• cats tend to have higher clinical stage than dog
• predilection for male Siamese?
• Cat: LN met ~ 39%, distant met ~ 16%
• Dog: LN met ~ 15%, distant met ~ 8%

Question 3

What parasite can induce esophageal sarcoma in dogs?

Answer 3

Spirocerca lupi

Question 4

What’s the more common location of parasitic esophageal sarcoma in the dog?

Answer 4

caudal esophagus

Question 5

What’s the more common location for esophageal leiomyoma in dogs?

Answer 5

distal, by the gastroesophageal junction

Question 6

What’s the most common esophageal tumour in the cat? where is is located?

Answer 6

SCC
middle 1/3, just caudal to the thoracic inlet

Question 7

What are some common c/s of esophageal tumours?

Answer 7

• regurgitation
• weight loss
• respiratory signs if aspirated or have lung mets
• leiomyoma = often incidental

Question 8

How metastatic is spirocerca induced sarcoma?

Answer 8

5/11 dogs had lung mets on necropsy

Question 9

What’s reported treatment option for esophageal tumours?

Answer 9

Surgery – partial esophagectomy
- full thickness, 1cm margins
- marginal fine with leiomyoma or low grade leiomyosarcoma

Question 10

What’s the prognosis of esophageal tumours?

Answer 10

Leiomyoma/ leiomyosarcoma = good
- spirocerca sarcoma = guarded to poor – one report of MST of 9m with Sx and Doxorubicin
- carcinoma = poor, likely too big for complete resection

Question 11

How common is cancer of the exocrine pancreas?

Answer 11

extremely rare

Question 12

What’s the most common type of tumour in exocrine pancreas?

Answer 12

Epithelial, adenocarcinoma of ductular or acinar origin
- most have wide spread metastasis by the time the tumour is noted

Question 13

What are some c/s of exocrine pancreatic tumours?

Answer 13

• signs of pancreatitis
• weight loss, anorexia (marked in cats)
• vomiting
• diabetes mellitus (rare)
• abdominal distension (mass, fluid)
• icterus (common bile duct obstruction)
• lethargy

Question 14

Are exocrine pancreatic tumours palpable?

Answer 14

generally no in dogs, yes in cats with advanced stage

Question 15

What’s the advantage of contrast ultrasound?

Answer 15

hypoechoiec = adenocarcinoma
hyperechoiec = insulinoma

Question 16

What’s the advantage of contrast ultrasound?

Answer 16

hypoechoic = adenocarcinoma
hyperechoic = insulinoma

Question 17

What’s the utility of Claudin 4 and Claudin 5 in pancreatic exocrine tumours?

Answer 17

Claudin 4 = tight junction molecule, claudin 5 = endothelium specific tight junction protein
- intense apical-lateral staining of claudin 4 = well differentiated carcinoma, lack of expression = undifferentiated
- loss of claudin 5 = well differentiated or poorly differentiated carcinoma

Question 18

What’s the mainstay of therapy for exocrine pancreatic tumours?

Answer 18

Surgery, but most tumours are quite advanced upon diagnosis (spread to LN and liver), carcinomatosis can be common in cats
- pancreatectomy no recommended due to high morbidity/mortality
- palliative option = short-lived

Question 19

What’s the overall prognosis of exocrine pancreatic tumour?

Answer 19

very poor
cats = MST 97days, chemo or surgery = 165 days
with ascites = 30 days

Question 20

What’s incidence of gastric tumours in dogs and cats?

Answer 20

rare

Question 21

What’s the most common nonhematopoietic gastric tumour in the dog?

Answer 21

Dog = carcinoma

Question 22

What’s the most common gastric tumour in cats?

Answer 22

lymphoma, carcinoma = rare

Question 23

Is there is sex predilection for gastric tumour in dogs?

Answer 23

Yes, male

Question 24

What’s the most common mesenchymal gastric tumour in the dog?

Answer 24

leiomyoma/ leiomyosarcoma
GIST (gastrointestinal stromal tumour)

Question 25

What' the IHC staining pattern for GIST re: CD117 and CD34?

Answer 25

CD117 (+), CD 34 (+)

Question 26

What are come clinical signs of gastric tumour?

Answer 26

vomiting (most common), decreased appetite, weight loss, peritonitis, melena

Question 27

What's the most common locations of canine gastric carcinoma?

Answer 27

pylorus and lesser curvature

Question 28

What's the most common locations of the canine mesenchymal tumours?

Answer 28

cardia and pylorus

Question 29

How common is metastasis to regional LNs for canine gastric carcinoma?

Answer 29

@ presentation, 34% @ necropsy, 77% - liver and lung are less affected

Question 30

What's a common paraneoplastic syndrome for gastric leiomyosarcoma?

Answer 30

hypoglycemia, due excessive release of IGF-2

Question 31

How common is gastric GIST in cats?

Answer 31

rare

Question 32

How common is gastric involvement of feline GI lymphoma?

Answer 32

relatively uncommon

Question 33

How does the appearance differ on imaging for gastric carcinoma vs sarcoma?

Answer 33

gastric carcinoma = broad-based gastric sarcoma = focal/ pedunculated

Question 34

How common is pulmonary involvement for gastric tumours on presentation?

Answer 34

rare

Question 35

What's the treatment for gastric tumours?

Answer 35

Surgery (partial gastrectomy) if it's solid tumor without evidence of diffuse or metastatic disease

Question 36

What's the role of RT or chemo in gastric tumours?

Answer 36

RT = minimal, too much sensitive organs close by chemo = unclear, does have HER-2 expression

Question 37

What's the prognosis of gastric carcinoma?

Answer 37

poor, difficult to achieve local control and has a mod-high metastatic rate

Question 38

What's the MST for gastric GIST, leiomyosarcoma, leiomyoma, and undifferentiated sarcoma in dogs with surgery?

Answer 38

GIST = 37.4m leiomyosarcoma = 8-12m leiomyoma = cured undifferentiated sarcoma = 2.9m

Question 39

T or F. Primary hepatic tumour is more common in the dog than metastatic hepatic tumours?

Answer 39

False, it's <1.5% of all canine tumours Metastasis to liver in 2.5x more frequent than primary hepatic mass

Question 40

T or F. Primary hepatic tumour is more common in the cat than metastatic hepatic tumours?

Answer 40

True

Question 41

What are the 4 basic categories of hepatobiliary tumours?

Answer 41

1. hepatocellular 2. bile duct 3. neuroendocrine (carcinoid) 4. mesenchymal

Question 42

T or F. Malignant tumour of the liver is more common in the dog?

Answer 42

T

Question 43

T or F. Malignant tumour of the liver is more common in the cat?

Answer 43

F

Question 44

What are the 3 morphological types of liver tumours?

Answer 44

1. massive 2. nodular 3. diffuse

Question 45

What's the prognosis for cats with malignant liver tumour? Does it differ with the morphological type?

Answer 45

No, it's poor regardless of morphological type

Question 46

What does keratin 19 expression mean for hepatic tumours?

Answer 46

<5% keratin 19 expression in canine hepatic tumour = well differentiated, accounts for 79% of canine HCC and all of feline HCC. - if has lots of keratin 19 expression = high grade, aggressive

Question 47

What type of hepatocellular tumour is more common in the cat?

Answer 47

hepatocellular adneoma

Question 48

what type of hepatocellular tumour is more common in the dog?

Answer 48

HCC

Question 49

What's the morphological distribution of HCC?

Answer 49

53-83% = massive 16-25% = nodular up to 19% = diffuse

Question 50

Which side (L vs R) of the liver lobes are more commonly involved in the dog?

Answer 50

Left side (L lateral and medial; papillary process of the caudate lobe) = > 2/3 of HCC

Question 51

Which side (L vs R) of the liver lobes are more commonly involved in the cat?

Answer 51

evenly distributed

Question 52

What are some common location for metastasis for nodular/ diffuse HCC in the dog?

Answer 52

regional LN, peritoneum, and lungs

Question 53

What's the metastatic rate for canine massive, nodular, and diffuse HCC?

Answer 53

Massive = 0-37% nodular and diffuse - 93-100%

Question 54

What are the 2 types of bile duct tumours?

Answer 54

bile duct carcinoma or bile duct adenoma

Question 55

Which type of bile duct tumour is more common in the cat?

Answer 55

bile duct adenoma, representing >50% of feline hepatobiliary tumour they appear cystic -- aka biliary or hepatobiliary cystadenomas

Question 56

What's the most common malignant hepatobiliary tumour in the cat?

Answer 56

bile duct adenocarcinoma (#2 in the dog; 9-41%)

Question 57

What's the morphological distribution of bile duct carcinoma?

Answer 57

it's similar to HCC massive = 37-46% nodular = up to 54% diffuse = 17-54%

Question 58

What are some location for bile duct carcinoma?

Answer 58

- intrahepatic - extrahepatic - within the gall bladder

Question 59

Which location is the most common for canine bile duct carcinoma?

Answer 59

intrahepatic

Question 60

Which location is the most common for feline bile duct carcinoma?

Answer 60

equal distribution to towards more extrahepatic

Question 61

Does solid or cystic differentiation have an impact on prognosis or treatment?

Answer 61

no

Question 62

What's the biological behaviour of bile duct carcinoma?

Answer 62

aggressive - metastasis common in the dog, up to 88% met to the regional LN and lungs - in cats, diffuse intraperitoneal metastasis and carcinomatosis noted in 67-80% of cases

Question 63

What are carcinoids?

Answer 63

neuroendocrine tumours

Question 64

How common are carcinoids in cats and dogs in the liver?

Answer 64

rare

Question 65

What are the typical signalment of hepatic carcinoid?

Answer 65

- young - nodular (1/3), diffuse (2/3) - aggressive - met to 1+ liver lobes, regional LNs, peritoneum, and lungs

Question 66

How common is primary hepatic sarcoma in dogs and cats?

Answer 66

rare

Question 67

What's the most common primary hepatic sarcoma in the cat?

Answer 67

hemangiosarcoma

Question 68

What's the most common hepatic sarcoma in the dog?

Answer 68

leiomyosarcoma

Question 69

What's the common morphology for hepatic sarcoma?

Answer 69

massive = 36% nodular = 64%

Question 70

Which liver tumour causes paraneoplastic hypoglycemia?

Answer 70

hepatic adenoma

Question 71

What biochemical abnormalities are often present in feline hepatobiliary tumours?

Answer 71

azotemia

Question 72

What's the usefulness of ferritin serum levels?

Answer 72

Ferritin can be increased in histiocytic sarcoma and IMHA. If IMHA has been ruled out, it may be useful for differentiating HS from other causes of liver disease

Question 73

What's the % of correct diagnosis for liver tumours on FNA? needle core biopsy?

Answer 73

60% - FNA 90% - needle core biopsy

Question 74

Can CT differentiate between nodular hyperplasia, hepatic adenomas, and HCC for dogs?

Answer 74

Yes. triphasic CT (more than 90% accurate in differentiating benign vs malignant canine hepatic tumours)

Question 75

What's the intraoperative mortality rate and surgical complication rate for liver lobectomy?

Answer 75

4.8% mortality, 28.6% complication

Question 76

What's the prognosis of massive HCC in dogs and cats?

Answer 76

Good

Question 77

What's the local recurrence rate of canine massive HCC treated with Sx?

Answer 77

generally 0-13%, but 12% of complete histological excision can still recur, but outcome is much better compared to incomplete resection - MST 1836d vs 765d (5y vs 2y)

Question 78

What's the metastatic rate for canine massive HCC?

Answer 78

0-37%, more recent papers show death is most likely not related to the tumour

Question 79

What's the MST for canine massive HCC treated with surgery vs conservative management?

Answer 79

MST = 1460-1836d (4-5y) with surgery, MST = 270d (9m) with conservative management

Question 80

What are some prognostic factors for canine massive HCC?

Answer 80

- Sx - side of liver involvement - ALT/AST activity - ALP:AST and ALT:AST ratio - completeness of excision

Question 81

What's the outcome of none ressectable HCC in dogs treated with RT?

Answer 81

6-10Gy/fx, 1-2fx/week, total dose of 18-42Gy - partial response (5/6) - MST 567d (1.5y)

Question 82

Which chemotherapy has had some success in treating canine HCC?

Answer 82

Gemcitabine

Question 83

What's the outcome of gemcitabine with canine HCC?

Answer 83

overall MST = 983d (2.7y) - massive = 1339d (3.7y) - nodular = 983d - diffuse = 113d (4m) - nonresectable = 197d (6m)

Question 84

What's the prognosis for bile duct adenomas?

Answer 84

very good no reported local recurrence or malignant transformation

Question 85

What's the ST for cats and dogs with bile duct carcinoma treated with liver lobectomy?

Answer 85

poor, <6m death due to local recurrence and metastasis

Question 86

What's the prognosis for hepatic neuroendocrine tumour?

Answer 86

poor - aggressive biological behaviour - usually not amendable to surgical resection - met to regional LNs, peritoneum, and lungs occur in 93% of dogs, and usually early on in the disease process