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ONCOLOGY MED & SURG > Urogenital & Mammary Tumors > Flashcards

Urogenital & Mammary Tumors Flashcards

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1
Q

What is the most common urothelial tumor of dogs

A

transitional cell carcinoma (TCC)

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2
Q

malignant proliferation of the transitional epithelium

may affect renal pelvis, ureters, bladder, prostatic urethra, or distal urethra

A

transitional cell carcinoma (TCC)

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3
Q

transitional cell carcinomas can affect what anatomical structures

A

Renal Pelvis
Ureters
Bladder
Prostatic Urethra
Distal Urethra

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4
Q

What is the biologic behavior of transitional cell carcinomas

A

1) Locally aggressive at the primary site (urinary tract) with long invasive roots

2) Moderate risk for metastasis to regional lymph node, liver, spleen, lung and bone

3) Field carcinogenesis (field effect): microscopic cells with carcinogenic alterations that are distant to the primary tumor and within the same organ

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5
Q

What causes transitional cell carcinomas

A

1) Old topical flea and tick dip
2) Lawn herbicides
3) Obesity
4) Breed: esp scottish terrier

likely multifactorial

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6
Q

What breeds have an increased risk of transitional cell carcinomas **

A

1) Scottish terrier (18x risk)
2) Shetland sheepland (4x)
3) Beagle (4x)
4) Wirehaired fox terriers (3x)
5) West Highland white terrier (3x)

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7
Q

What is the most common location of transitional cell carcinomas

A

Trigone of the bladder

29% of males have prostatic involvement
56% of dogs have urethral involvement

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8
Q

What are the clinical signs of transitional cell carcinomas

A

Lower Urinary Tract signs
1) Dysuria
2) Hematura
3) Pollakiuria

these signs may be present for weeks to months

May resolve temporarily with antibiotic therapy

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9
Q

What might be some exam findings in dogs with transitional cell carcinomas

A

Rectal: thickening of urethra and enlarged iliac lymph nodes

Abdominal palpation: palpable mass or distended bladder

40% of dogs have normal physical exam

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10
Q

What are the different grades of TCC in dogs

A

Tis: pre-neoplastic lesion

T1: tumor invades into transitional epith and connective tissue

T2: tumor invade into muscle belly

T3: tumor invades through body wall

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11
Q

What is the grade breakdown of dogs presenting with TCC

A

80% T2 meaning its invaded into the muscle layer

20% T3 meaning its invaded into the neighboring organs

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12
Q

Where can TCC metasize to?

A

intermediate metastatic potential
1) Lymphatic spread
2) Hematogenous spread

to the spleen, liver, lungs, bone (lumbar vertebrae, pelvis), and skin

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13
Q

Why is bladder cancer a clinical challenge

A

Not common (2% of malignant tumors in dogs)
Lower urinary tract infections are much more common
Clinical signs of bladder cancer mimic clinical signs of LUT infection
Treatment with antibiotics may help mitigate signs initially (due to secondary infections)
some dogs may have delayed diagnosis due to multiple rounds of antibiotics and client hesitancy to proceed with more expensive / invasive diagnostics

this can lead to delay in diagnosis, resulting in many dogs being diagnosed at advanced stage disease (tumor invasive into bladder wall, metastasis)

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14
Q

How can we work towards early detection of TCC

A

1) encourage early work-up if clinical signs recur (after 1st round antibiotics or NSAIDs)

2) Recognize breeds: Scottish terriers, Shetland sheepdog, Beagle, Wirehaired fox terrier, West Highland white terrier

3) Consider CADET BRAF testing early

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15
Q

Neoplastic cells are presnet in the urine sediment of _______ % of dogs with TCC

A

30%
can be difficult for pathologist to differentiate malignant from reactive

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16
Q

What is the risk of cystocentesis with TCC

A

low risk (<0.009% risk, unknown risk)
discuss risks with client prior to proceeding
consider if other options for diagnosis not feasible

considered a <4% risk

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17
Q

For TCC, what would you see on rads

A

bone metastasis to LS/pelvic region (difficult to detect mass effect within bladder)

Positive contrast cystography

Excretory urogram

3 view thoracic radiographs to evaluate for sternal lymphadenopathy and pulmonary metastasis

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18
Q

What is a great first wave screening diagnostic

A

ultrasound - sensitive for detection and localization of bladder masses

evaluate for intra-abdominal metastasis

allows evaluation of the prostate

*pelvic urethra is hard to image (surrounded by bone)

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19
Q

CT imaging of TSS in dogs

A

improved detection of metastasis

possibly less inter-observer variability

*difficult to evaluate the pelvic urethra *

requires anesthesia which is more expensive for clients

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20
Q

Cystoscopy for TSS in dogs

A

*excellent for imaging the pelvic urethra *

evaluate for other lesions (field carcinogenesis) not detectable on US or CT in cases with solitary lesions at apex

assessment for cases with urethral involvement only

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21
Q

What is excellent for imaging for pelvic urethra

A

Cystoscopy

also good for cases with urethral involvement only

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22
Q

How do you obtain a definitive TSS diagnosis

A

1) Histopathology- cystoscopy or cystotomy

2) Cytology - cytospin, traumatic catherization, percutaneous FNA via ultrasound guidance

3) CADET BRAF urine testing

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23
Q

What is the risk of cystotomy for TSS diagnosis in dogs

A

1) Seeding
2) Invasive
3) Anesthesia
4) Expense

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24
Q

How can you do cytology for diagnosis of TSS

A

1) Cytospin- 30% will be diagnostic, inflammatory cells may confound ability to make diagnosis

2) Traumatic catherization- inflammatory cells may confound diagnosis, invasive, risk of trauma, heavy sedation

3) Percutaneous FNA via ultrasound guidance - risk of cutaneous seeding (low risk)

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25
CADET BRAF and Vet Bladder Antigen urine testing should be paired with
imaging and ideally histo/cyto
26
What is the vet bladder tumor antigen test
Urine dipstick that measures glycoprotein complex false positive results common - glucosuria, proteinuria, hematuria, and pyuria old test
27
What is the major downside to the Vet Bladder Tumor Antigen Test
false positive results common - glucosuria, proteinuria, hematuria, and pyuria which many of these dogs have these infection (LUTS)
28
What is BRAF
proto-oncogene that plays a role in the MAP-kinase cellular signaling pathway mutated and upregulated in TSS
29
BRAF mutation is detected in urine of ____% of confirmed canine TSS
85%
30
What urine collection method is preferred for BRAF testing
free catch
31
How does BRAF work
free catch sample uses special form of PCR- digital droplet PCR (ddPCR) this improves detection level of rare forms of mutated DNA amongst the pool of wildtype (normal) DNA in the sample can detect down to <0.03% of mutated alleles
32
What is the BRAF-plus test
the 15% of false negative BRAF tests can be done again to assess for a different mutation and detect an additional 10% of cases
33
If you get a positive BRAF test you should still follow up with a
abdominal ultrasound to look for evidence of a bladder mass
34
What are the advantages of BRAF
1) Convenient: free-catch, non-invasive, collected at home or in clinic 2) Sensitive 3) Robust: not affected by the presence of blood, protein, sugars, bacteria in urine 4) Rapid: results generally available in just 5-7 business days
35
What are TSS treatment options
Most intesive: Intensity Modulated Radiation Therapy (IMRT) + chemotherapy (vinblastine or mitoxantrone) + NSAIDs Conservative: chemotherapy +NSAIDs +/- palliative radiation Most conservative: NSAIDs +/- palliative radiation Surgery: localized tumors at apex, dulking tumors at trigone, cystotomy tube, transurethral resection, urinary diversion Laser ablation
35
What should you be cautious about when doing BRAF testing
false positives and negatives may result - recommend confirming presence of urothelial tumor using imaging (+/- cytology/histopathology) prior to treatment when positive BRAF results occur -Do not base chemotherapy decision on euthanasia decision on b-raf positive alone **
36
What chemotherapy agents are used in TSS
(vinblastine or mitoxantrone) + NSAIDs
37
What is the prognosis of TSS
NSAIDs alone: MST 6-8 months NSAIDs w chemotherapy: MST 9-11 months NSAIDs w chemotherapy and IMRT: MST 15-24 months
38
What are the prognostic factors of TSS
lymph node and/or distant metastasis (poorer) urethral disease - poorer treatment pursued clinical signs management
39
For TSS, why is using NSAiDs beneficial
1) Reduce inflammation and pain 2) COX-2 inhibition cancer effect
40
T/F: Positive BRAF test is sufficient to diagnose TSS
False- it is a screening test and this alone should not be used to make treatment decisions
41
What is the clinical presentation of most mammary tumors
Middle aged to older Dogs: poodles, yorkies, springer spaniels, german shepherd, pointer, Dobe Cats: Siamese Late spayed or intact females > males
42
How do hormone influence the risk of mammary tumor development in Dogs **
Risk if OHE before 1st heat = 0.05% heat Risk if OHE after 1st heat = 8% Risk if OHE anytime after 2nd heat = 26%
43
How do hormones influence the risk of mammary tumor development in cats*
91% reduced risk if OHE before 6 months 86% reduced risk if OHE is between 7-12 months of age 11% reduced risk if OHE is between 13-24 months of age
44
In dogs, what percent of mammary tumors are benign vs malignant ****
50% benign -Adenoma -Fibroadenoma -Benign mixed tumor -Duct papilloma 50% malignant -Carcinoma -Sarcoma -Carcinosarcoma
45
In cats, what percent of mammary tumors are benign vs malignant ****
10-15% benign -Hyperplasia -Adenoma -Fibroadenoma 85-90% malignant -Majority carcinoma -Sarcoma and carcinosarcoma rare
46
In cats, 85-90% of mammary tumors are malignant, what type is this typically *
majority carcinoma
47
What should you do for first wave diagnostic when you suspect a mammary mass
Cytology of the mammary mass -Rule out abscess, cyst, or other tumor type (mast cell tumor, soft tissue sarcoma, etc) Difficult to differentiate adenocarcinoma vs adenoma on cytology due to small sample size. However, this is more straightforward in cats given the higher risk of malignant mammary masses
48
What is a downside of doing cytology of mammary masses
Difficult to differentiate adenocarcinoma vs adenoma on cytology due to small sample size. However, this is more straightforward in cats given the higher risk of malignant mammary masses For dogs: educate client that cytology is not enough to distinguish adenoma vs adenocarcinoma but cytology can rule out abscess, cysts, other tumors
49
What should you do diagnostically to work up a mammary mass
1) CBC/ CHEM/ UA 2) Regional lymph node aspirate / cytology: lymph node metastasis imparts poorer prognosis /more advanced disease 3) Three view thoracic rads: look for pulmonary metastasis, intra-thoracic lymphadenopathy 4) Abdominal ultrasound +/- cytology - look for liver/ spleen mets, intra-abdominal lymphadenopathy 5) Histopathology: required to confirm malignancy, evaluate margins, determine tumor grade and histotype
50
How do you treat dogs with mammary masses ****
Lumpectomy or mammectomy is sufficient -if the caudal gland is affected, then dissect out inguinal lymph node and submit separately If Grade 1 (low) or Grade 2 (intermediate) mammary carcinoma with complete margins then prognosis is excellent and no further treatment other than diligent monitoring IF Grade 3 (high) or metastatic lymph node then recommend adjuvant chemotherapy (Doxorubicin based or 5-fluorouracil/cyclophosphamide) MST= 12-18 months
51
What should you do for dogs with mammary masses that are grade 3 (high) or metastatic lymph node *
then recommend adjuvant chemotherapy (Doxorubicin based or 5-fluorouracil/cyclophosphamide) MST= 12-18 months
52
What is the prognosis for mammary carcinoma in a dog that was removed with complete margins and came back to be Grade 1 (low) or Grade 2 (intermediate) **
If Grade 1 (low) or Grade 2 (intermediate) mammary carcinoma with complete margins then prognosis is excellent and no further treatment other than diligent monitoring
53
What factors make mammary tumors a poorer prognosis in dogs *
1) Larger tumor 2) Metastasis 3) Lymph/Vascular invasion 4) High grade (Grade 3)
54
How do you surgically treat cat with mammary tumors ****
Chain Mammectomy -Bilateral (right and left) recommended due to cross connection of lymphatic vessels some surgeons will stage the approach
55
What is the prognosis of mammary tumors in cats
Early detection of small tumors <2cm diameter and aggressive surgery (chain mammectomy) canresult in long term survival Large tumors, metastatic disease, lymph/vascular invasion, high grade lend to a poorer prognosis Benefit of chemotherapy is not well studied, but may help in theory Various studies range from MST 450-1998 days with surgery and doxorubicin based chemotherapy
56
Does spaying at time of mammary tumor removal in dogs help
newer studies show that spay at MGT = 50% decrease in new (benign) MGT's improved outcome in intermediate grade (Grade 2) carcinomas
57
What is inflammatory mammary carcinoma associated with
recent estrus
58
inflammatory mammary carcinoma
Dermal lymphatic invasion is histopath hallmark associated with recent estrus coagulopathy (21%) 100% lymphnode metastasis in necropsy study 85% distant mets Median survival time is 7-60 days Avoid surgery Palliative therapy only -Piroxicam (MST=180 days)
59
How do you treat inflammatory mammary carcinoma
Palliative: Piroxicam (MST = 180 days) palliative RT may help alleviate discomfort AVOID SURGERY
60
What is the difference in mammary tumor treatment in dogs vs cats
Dogs: Lumpectomy or mammectomy is sufficient Cats: Bilateral chain mammectomy

ONCOLOGY MED & SURG (11 decks)

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