NAVLE: Cancer Powerlectures
1. Canine
1. HSA
1.
2.
3.
4.
5.
Splenic vs RA
Median age = 10 yrs
Breeds: GSD, Goldens
Prior to splenectomy, do met check
Pg
1. Splenectomy alone = 3 mo
2. Splenectomy & chemo = 9-12 mo
2. Canine Lymphoma
1. Usually lymphoblastic (high grade) = large lymphoid cells
2. PC
1. PLN +/- PU/PD (2ndary to hypercalcemia)
3. PE findings
1. PLN
2. Enlarged liver &/or spleen
4. Dg
1. FNA
1. > 50% large, immature lymphoid cells w/ high
nucleus/cytoplasm ratio
1. 2-3x size of RBC
5. Phenotypes
1. B cell
1. B for Better prognosis (DOGS ONLY, NOT CATS)
2. More common; 80% of multi-centric lymphoma
2. T cell
1. T for Terrible prognosis (DOGS ONLY, NOT CATS)
2. Less common
3. *Only T cell lymphomas cause hypercalcemia
1. Mediated through PTHrp
6. Labwork
1. CBC
1. Circulating lymphoma
2. Hypercalcemia (if T cell phenotype)
1. Isosthenuria (2ndary to hypercalcemia)
1. Ca interferes w/ ADH
2. Reversible nephrogenic diabetes insipidus
3. +/- ELE
2. Bone Marrow Aspirate
1. Immature WBCs
7. Imaging
1. Rads
1. Lymphadenomegaly
2. Mediastinal masses
3. +/- Interstitial lung pattern
2. AUS
NAVLE: Cancer Powerlectures
1. Hypoechoic LNs in liver & spleen
8. Stages (I-V); higher = worse prognosis
1. Single LN
2. Multiple LNs on same side of diaphragm
3. Multiple LNs on both sides of diaphragm
4. Liver and/or spleen
5. Blood, marrow, or other organ involvement
9. Treatment
1. L-CHOP chemo for 6 mo
1. L-asparaginase (Elspar)
2. Cyclophosphamide (Cytoxan)
3. Hydroxydaunorubicin (Adriamycin, doxorubicin)
4. Oncovin (vincristine)
5. Prednisone
2. Rabacfosadine (Tanovea)
10. Prognosis
1. MST
1. No tx = 2-4 wks
2. Prednisone = a few wks
3. CHOP = 1 yr
2. Negative Prognostic Indicators
1. T cell phenotype
2. Sub-stage b (= clinical)
3. Hypercalcemia (usually due to above)
4. C’steroids prior to chemo
5. Cranial Mediastinal Mass
3. Mast Cell Tumors
1. Most common skin tumor in dogs
2. Appearance
1. Virtually anything
2. Fluctuate in size w/ degranulation
3. Breeds:
1. Brachycephalic
4. Contents
1. Histamine
2. Heparin
3. Eosinophilic chemotactic factor
4. Protease
5. Degranulation effects
1. Ulcers
2. Inflammation
3. Hypotension
4. Bleeding/bruising
6. Grading - REQUIRES HISTO, NOT cytology!!!
1. Low - MI < 5 / 10 hpf
1. MST years
NAVLE: Cancer Powerlectures
2. High - MI > 5/ 10 hpf
1. MST 2-5 mo
1. Even w/ tx
7. FNA -> should do PRIOR to surgery
1. Dark staining granules in/outside cells
2. Eosinophils common
8. Buffy coat smears
1. NOT recommended in dogs; some limited use in cats ONLY
9. Tx
1. Sg
1. 2-3 cm lateral margins
2. 1 fascial plane deep
2. Chemo
1. Only for high risk tumors or unrescetable
2. Options
1. Vinblasine
2. CCNU (Lomustine)
3. Prednisone
4. Palladia (Toceranib)
1. Tyrosine kinase inhibitor, targets KIT
mutation
3. Supportive care
1. H1 blockers - diphenhydramine (Benadryl)
2. H2 blockers - famotidine, ranitidine
3. PPIs - omeprazole
4. Sucralfate
10. Negative Prognostic Indicators
1. Mucosal or mucocutaneous junction location
2. NOT the NUMBER of tumors!!!
4. Nasal Tumors
1. Majority or respiratory tumors in dogs
2. Breeds: Dolicho or mesocephalic
3. Signs may include enlarged mandibular LNs (inflammation) or
exophthalmos
4. Tumor types
1. Carcinoma
1. Adenocarcinoma > SCC; but SCC carries worse prognosis
2. Sarcoma
3. Round cell - uncommon
5. Locally aggressive
1. 98% destroy turbinates
2. 80-90% bilateral
3. 1/2 maxillary bones, 1/3rd hard palate
6. Dg
1. Rads vs CT/MRI
1. Rads are just as good at detection, but worse for staging
NAVLE: Cancer Powerlectures
7. Tx
1. If carcinoma: Piroxicam (an NSAID)
2. Treatment of choice = RADIATION
8. Pg
1. No tx = 3 mo
2. Piroxicam = 3 mo
3. Sg = 3 mo
4. Radiation = 1 yr
5. Oral Tumors
1. Oral Melanoma - most common oral in DOGS
1. Behavior
1. Malignant
2. > 50% involve bones
3. Metastasize to lungs, LNs, & tonsils
2. Dg = biopsy
3. Tx = mandibulectomy or matxillectomy
1. W/ Chemo
4. Pg
1. No tx = 2 mo
2. W/ sg = 6-12 mo
3. W/ sg & chemo = 2 yrs
2. Oral SCC - 2nd most common oral in dogs
1. Behavior
1. MORE bone involvement than OM - 70%
2. LESS metastasis than OM
2. Dg = biopsy
3. Tx = mandibulectomy or matxillectomy
1. Sg w/ RADIATION
1. NOT chemo! (Ineffective)
4. Pg
1. W/ sg = 18 mo (longer than OM)
2. W/ sg & radiation = double
6. Osteosarcoma
1. Signalment
1. Almost exclusively canine (pg better for cats)
2. Breed: Large
3. Age: 9 yrs
2. Signs
1. Progressive lameness
3. Dg
1. Orthopedic exam:
1. Pain on palpation of bone
2. “Towards the knee and away from the elbow”
2. Rads:
1. Lytic, “moth-eaten” lesion
3. Bone aspirate
NAVLE: Cancer Powerlectures
4. Ddx
1. Fungal dz:
1. Coccidiodes mycosis
2. Other cancers
1. Chondrosarcoma
2. Fibrosarcoma
5. Tx
1. Amputation
2. Chemo
1. Doxorubicin
6. Pg
1. No tx = wks
2. Amp alone = 3 mo
3. Amp + chemo = 9-12 mo
7. Negative pg indicator = high ALP
7. Pheochromocytoma
1. Adrenal tumor that may or may NOT be functional
2. Rare
3. Signs - nonspecific, can fluctuate
1. Hypertension
1. Hind limb edema
2. Abdominal distension
3. Acute Blindness
4. Epistaxis
2. Tachyarrhythmias
3. Weakness / collapse
4. Anorexia / VD / WL
5. Cough / Dyspnea
6. PU/PD OR adipsia
4. Dg
1. US
1. 65-83% of time identified
2. Rads
1. Mass in 30-56% cases
3. CT
4. ECG - arrhythmias common
5. Tx
1. Peri-operative Pre-medication (all start with P for
Pheochromocytoma)
1. control hypertension
1. Phenoxybenzamine or Prazosin = a1 antagonists
2. Start low & increase gradually
2. Control arrhythmias
1. Propanolol = B blocker
2. Do NOT use atropine!
2. Intra-op
NAVLE: Cancer Powerlectures
1. Vasodilators: Phentolamine or Sodium Nitroprusside
2. Continue Propranolol or Esmolol for arrythmias
3. Sg
1. Requires skill -> 15-38% hit vena cava
1. Sg is NOT negative prognostic indicator b/c NOT
high mortality if done CORRECTLY
4. Post-op:
1. Biggest concern = hypOtension
1. Give FLUIDS b/c pheochromocytoma desensitizes
to pressors
6. Pg
1. 50% malignant
2. 22% perioperative mortality rate
3. MST = 1-2 yrs
8. Soft Tissue Sarcomas
1. Do NOT include hemangiosarcoma or osteosarcoma
1. These are more aggressive than STS
2. Biologic Behavior
1. Locally aggressive
2. Recurrence common
3. Metastasis depends on histologic grade
1. Grades 1 & 2 = 10-20% mets
2. Grade 3: 50% mets
3. Dg
1. FNA or biopsy
4. Tx
1. Sg - aggressive, wide margins
1. Usually w/ RADIATION
2. Chemo is only for grade 3
2. Feline
1. Injection Site Sarcoma
1. Frequency = 1/10,000
2. Risk factors = Rabies & FeLV
1. ANY injection can cause! (Not just vaccines)
3. Biologic behavior
1. More invasive and recurrent than normal STS
4. Dg = 1, 2, 3 rule -> Biopsy if:
1. Grows > 1 mo
2. Diameter > 2 cm
3. Present 3 mos post-injection
5. Tx
1. Sg
1. 5 cm margins (wider than canine MST)
2. 2 facial planes deep (more than canine MST)
2. Radiation - pre OR post-op
3. Chemo - doxorubicin
NAVLE: Cancer Powerlectures
6. Pg
1. Sg alone: 1 yr
2. Sg + rads: 2 yrs
2. Lymphoma
1. Risk factors
1. FeLV
1. Induces oncogenic mutations
2. Immunosuppression
1. FIV
2. Renal transplant recipients
3. Environment
1. 2ndhand smoke
4. Breeds
1. Siamese / Oriental
2. Forms
1. Gastrointestinal - most common in cats
1. Low grade - like IBD
1. Signs
1. WL, V/D
2. Pathology
1. Intestinal thickening
3. Tx
1. Prednisone & Chlorambucil
4. Pg
1. Guarded to good
2. MST: yrs
2. High grade
1. Pathology
1. Discrete masses (in addition to thickening)
2. Tx
1. CHOP
3. Pg
1. MST = 6-8 mos
2. Mediastinal
1. Signs
1. Resp. Distress
2. Pleural effusion
2. Associated w/ FeLV
3. Nodal
1. LNs of head & neck
2. Less common
4. Hodgkin’s-like
1. LNs of head & neck
2. Tx surgically
5. Renal
1. Present w/ renal failure
NAVLE: Cancer Powerlectures
2. Bilateral (both kidneys)
3. Mets to CNS
4. Can be 2ndary to intestinal form
6. Nasal
1. PC = epistaxis, facial deformity
2. Usually localized / not systemic
3. Tx = radiation
3. Dg of feline lymphoma
1. FNA
1. If cytopenias on CBC -> bone marrow aspirate
2. FeLV & FIV
3. Met check
4. Tx of feline lymphoma
1. CHOP is best
2. Low grade: prednisone & chlorambucil
5. Pg of feline lymphoma
1. Best prognostic factor = response to therapy
1. Complete response: MST yr
2. Partial: months
3. Progressive dz: weeks
2. FeLV is WORSE prognosis
3. Forms: Mediastinal & Renal have worse pg
4. T vs B cell is NOT prognostic, UNLIKE dogs!