Carcinomas

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Carcinomas




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Presentations text content in Carcinomas

Slide1

Carcinomas

Wendy Blount, DVM

Slide2

Carcinomas

Squamous cell carcinoma (canine & feline)

Transitional

c

ell carcinoma (canine)

Mammary Gland Tumor (canine & feline)

Perianal tumor (canine)

Anal sac tumors (

c

anine)

Slide3

Squamous Cell Carcinoma

Feline Squamous Cell carcinoma

Second most common tumor in the cat

Oral SCC behaves differently than skin SCC

Canine Squamous Cell Carcinoma

Similar behavior as SCC in cats, but not as common

Slide4

Squamous Cell Carcinoma

Feline Cutaneous Squamous Cell Carcinoma

Most frequently on the head

Pinnae, nose, eyelids

Caused by sun exposure to light colored skin

Progression over time

Solar dermatitis

– crusts and scabs

Actinic dermatitis

- plaques

SCC in situ

– noninvasive mass

Invasive SCC

– ulcerative, invasive mass

Slide5

Squamous Cell Carcinoma

Feline Cutaneous Squamous Cell Carcinoma

Solar dermatitis

Actinic dermatitis

Slide6

Squamous Cell Carcinoma

Feline Cutaneous Squamous Cell Carcinoma

SCC n situ

SCC

Slide7

Squamous Cell Carcinoma

Feline Cutaneous Squamous Cell Carcinoma

Cytology often not helpful

Very inflammatory

Dx

- histopathology

Staging not usually necessary, as metastasis is rare

Tx

– early lesions

Surgery, cryosurgery, Strontium radiotherapy, photodynamic therapy

immunomodulatory agent imiquimod (Aldara

TM

) as a topical cream

Slide8

Squamous Cell Carcinoma

Feline Cutaneous Squamous Cell Carcinoma

Tx

– advanced lesions

Difficult to treat

Removal of the nasal planum is possible, but disfiguring

Slide9

Squamous Cell Carcinoma

Feline Cutaneous Squamous Cell Carcinoma

Partial planectomy

Pinnectomy and planectomy

Slide10

Squamous Cell Carcinoma

Feline Cutaneous Squamous Cell Carcinoma

Untreat

e

d for too long

Slide11

Squamous Cell Carcinoma

Feline Oral Squamous Cell Carcinoma

Most common oral tumor in the cat

Gingiva, tongue/sublingual, tonsil

Much more aggressive than cutaneous SCC

Maxillary tumors can mimic tooth abscess

Surgery often not possible

Radiation sensitive, but high morbidity – mandatory feeding tube

Slide12

Squamous Cell Carcinoma

Feline Oral Squamous Cell Carcinoma

Chemotherapy not effective

NSAIDs are palliative

Median survival 44 days

+

NSAIDs

9% survival at one year

Survival more than a few months even with multimodal therapy is rare

Slide13

Squamous Cell Carcinoma

Feline Lung Squamous Cell Carcinoma

Often presents as multiple nail bed tumors

Primary tumor is found on chest x-rays

Always take chest x-rays prior to amputating a possibly neoplastic nail bed in a cat

Animals with systemic neoplasia often do not do well under anesthesia

Amputation is palliative only

Slide14

Transitional Cell Carcinoma

Most common bladder tumor in the dog (90%)

Most common symptoms are hematuria and stranguria

Things that increase suspicion

Atypical transitional cells in the urine sediment

Mass in the bladder or urethra on imaging

Thickened urethra on rectal exam

Ruptured urethra on catheterization

Slide15

Transitional Cell Carcinoma

Etiology

Exposure to older topical flea treatments, dips and lawn chemicals (28x)

Possibly cyclophosphamide therapy

Neutered > sexually intact

Scottish terriers 18-20x other dog breeds

Eating vegetables 3x a week is protective

Shelties, Westies, beagles 3-5x other breeds

Slide16

Transitional Cell Carcinoma

Dx

– histopath

Surgery, cystoscopy, traumatic bladder wash

Percutaneous aspiration can seed tumor cells and should be avoided

Take care to avoid seeding during surgery

Slide17

Transitional Cell Carcinoma

Tx

At one time, radiation therapy was recommended, as TCC is highly responsive

But resulting permanent incontinence was common

If at the apex, resection can produce long disease free interval (1-2 years)

Secondary UTI is common – treat PRN

Ureteral stents can restore urine flow

Urethral stents can relieve obstruction if urethral sphincter and continence can be preserved

Prepubic cystostomy tube can relieve obstruction

Slide18

Transitional Cell Carcinoma

Tx - NSAIDs

Mainstay of treatment is medical therapy

Not curative, but remission is achieved in 15-20% and stable disease is reached in 75% of dogs

Piroxicam only – median survival 195 days

0.3 mg/kg PO SID to QOD

Deramaxx only - median survival 323 days

3 mg/kg PO SID

Previcox similar success

Median survival surgery only is 109 days

Slide19

Transitional Cell Carcinoma

Tx - Chemo

Mitoxantrone and piroxicam (see chemo section for details)

35% remission with minimal toxicity

Median survival 291 days

Single agent vinblastine (see MCT notes)

36% remission

50% stable disease

Most of these had failed other therapies

Relatively more toxicity than mitoxantrone + piroxicam

Slide20

Transitional Cell Carcinoma

Px

Euthanasia often due to obstruction, metastasis or both

50% have metastasis at the time of death

Some will invade the sublumbar lymph nodes and then the spinal cord and present as acute posterior paralysis, often with urethral obstruction

Slide21

Slide22

Canine Mammary Gland Tumor

42% of tumors in all intact female dogs

Rare in dogs less than 5 years old

duration of exposure to ovarian hormones early in life determines the overall mammary cancer risk (Dorn et al, 1968).

0.5% if OHE prior to the first heat

8 if OHE prior to the 2

nd

heat

26% if OHE after the 2

nd

heat

tumor risk increases incrementally each year and plateaus around 11–13 (Schneider, 1970)

intact females are more likely to have an anaplastic tumor type, compared to dogs spayed early or late in life, prior to MGT (Ogilvie, 2006)

Slide23

Canine Mammary Gland Tumor

The effect of neutering on the risk of mammary

tumours

in dogs--a systematic review. J Small

Anim

Pract

. June 2012;53(6):314-22. W Beauvais

1

; J M Cardwell; D C

Brodbelt

Due to the limited evidence available and the risk of bias in the published results, the evidence that neutering reduces the risk of mammary neoplasia, and the evidence that age at neutering has an effect, are judged to be weak and are not a sound basis for firm recommendations.

Slide24

Canine Mammary Gland Tumor

Review article – not a clinical study at all

Conclusions:

9/13 were judged to have a high risk of bias. The remaining four were classified as having a moderate risk of bias.

One study found an association between neutering and a reduced risk of mammary

tumours

.

Two studies found no evidence of an association.

One reported "some protective effect" of neutering on the risk of mammary

tumours

Slide25

Canine Mammary Gland Tumor

70% have more than one tumor at the time of diagnosis

Mammary gland tumors can be epithelial, myoepithelial, mesenchymal or mixed

Complex MGT

– epithelial and myoepithelial

Mixed MGT

– epithelial and mesenchymal

Slide26

Canine Mammary Gland Tumor

MGT Stages

Stage I

– less than <3cm and localized

Stage II

– 3-5 cm and localized

Stage III

- >5cm and localized

Stage IV

– any size, metastasis to lymph node

Stage V

– any size, distant metastasis

Slide27

Canine Mammary Gland Tumor

MGT Staging

CBC – check for evidence of infection

Profile – hypercalcemia

Aspirate draining lymph node

Thoracic radiographs – 3 views

Abdominal US

Slide28

Canine Mammary Gland Tumor

MGT StagingCBC – check for evidence of infectionProfile – hypercalcemiaAspirate draining lymph nodeThoracic radiographs – 3 viewsAbdominal US

Slide29

Canine Mammary Gland Tumor

Surgery

As with all masses removed, label margins so they can be read out

Describe the location of the lesion

Mark one end of one direction (e.g., cranial or caudal) with one type suture

Mark one end of the plane 90

O

to above with another type suture, if necessary

Don’t forget to describe your labeling on the submission form

Slide30

Canine Mammary Gland Tumor

Surgery – OHE?

The majority of MGT of epithelial origin express estrogen receptors, suggesting that reproductive hormones may play a role in the pathogenesis

755 days median survival - dogs spayed at or within 2 years before MGT surgery

286 days median survival – dogs not spayed at MGT surgery

301 days median survival – dogs spayed more than 2 years prior to MGT surgery

MGT are uncommon in females spayed more than 2 years prior to MGT, but if it occurs, it behaves more malignantly

Slide31

Canine Mammary Gland Tumor

Prognosis

50-60% of mammary gland tumors are benign

98% of tumors <1 cm are benign

50% of tumors >3cm are malignant

Malignant tumors develop from benign masses

Early removal is usually curative

Slide32

Canine Mammary Gland Tumor

Inflammatory Mammary Carcinoma

Acute onset of painful, extensive swelling of the mammary glands

Fine needle aspiration with a 25g needle can drip blood for days (DIC)

Rapidly progressive

Grave prognosis

Slide33

Perianal Tumors

“aka” hepatoid tumor

Most common in older intact male dogs

And females with testosterone producing adrenal tumors

Tumor site – perineum > tail, abdomen

Most often found without symptoms

Tenesmus can be caused by the lesion or submandibular lymphadenopathy (palpable rectally)

60-80% benign

Those that are malignant often behave as anal sac tumors

Slide34

Perianal Tumors

Staging prior to surgery

Abdominal rads and/or sonography to evaluate sublumbar lymph nodes

Large tumors >2cm and single tumors should be removed

If multiple small tumors or coalescing tumors, castrate first (if male)

Remove any tumors that do not resolve in 2-4 weeks

Unless males are castrated, new tumors will likely arise

Slide35

Anal Sac Carcinoma

Highly malignant

Locally invasive AND distant metastases

90% develop hypercalcemia

25-50% are hypercalcemic at diagnosis

50-94% have lymph node metastasis at the time of diagnosis

Slide36

Anal Sac Carcinoma

Presentation

Found on anal sac expression

Dyschezia, tenesmus, ribbon-like stools

Attention to the perineum, scooting

Perianal bleeding

PU-PD (hypercalcemia)

Hind limb weakness or posterior paralysis

May be bilateral – check the other side

Slide37

Anal Sac Carcinoma

Staging

Profile – hypercalcemia, azotemia

Abdominal rads and/or sonography

Sonography more sensitive than rectal palpation or rads for finding enlarged sublumbar LN

Thoracic radiographs – 3 views

Aspirate popliteal and inguinal lymph nodes

Sublumbar if large enough and you are comfortable doing this with ultrasound guidance

Slide38

Anal Sac Carcinoma

M

edian Survival – no treatment

7-9 months

masses larger than 3cm

Dogs with hypercalcemia and/or pulmonary metastasis

18-19 months

Masses smaller than 3cm

Dogs with normocalcemia and no lung mets

Slide39

Anal Sac Carcinoma

M

edian Survival

Surgery only

90% survival at 6 months (hypercalcemia often goes into remission, even if incomplete excision)

65% survival at one year

29% survival at 2 years

20% temporary fecal incontinence, some permanent

Wound infection and sepsis can occur

30% perioperative fatality when sublumbar lymph nodes are removed

Slide40

Anal Sac Carcinoma

M

edian Survival

Multi-modal therapy – surgery, radiation of nodes, doxorubicin/carboplatin

18-26 months median survival

86% survival at 6 months (less than surgery alone)

69% survival at one year (same as surgery alone)

36% survival at 2 years (more than surgery alone)

14% survival at 3 years

Median survival 22 months with radiation alone

15% rectal structure

Slide41

Slide42

Acknowledgements

Jane M. Dobson, MA, BVetMed, DVetMed, DECVIM-CA&Onc, MRCVS

Department of Veterinary Medicine, University of Cambridge, Cambridge, UK

Deborah W. Knapp, DVM, DACVIM (Oncology)

Purdue University, West Lafayette, IN, USA

Karin Ulrikke Sorenmo, DVM, DACVIM, DECVIM-CA (Oncology)

Veterinary Hospital of the University of Pennsylvania

Philadelphia, PA, USA

Slide43

Acknowledgements

Erik Teske, DVM, PhD, Dip ECVIM-CA

Clinical Sciences, Companion Animals

Utrecht University, THE NETHERLANDS

Katherine Skorupski, DVM, DACVIM (Oncology)

Assistant Professor of Clinical Medical Oncology

University of California, Davis

Greg Ogilvie, DVM, DACVIM (Oncology)

Director, Angel Care Cancer Center, California


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