Gastrointestinal Neoplasia in Dogs & Cats

What are the THREE categories of metastatic potential?

low risk, moderate risk, high risk

What are the TWO routes of metastasis and where they spread at?

◦ Carcinomas - lymphatic

◦ Sarcomas - hematogenous

What tumor is known as the "liquid tumor" and involves the lymphoreticular system is common/expected?

Lymphoma

What are the SIX things that makes up the Lymphoreticular system?

LNs, liver, spleen,

thymus, bone marrow, Peyers patches

What are some clinical signs of Oropharyngeal Neoplasia?

-Mass/swelling

-Bleeding

-Halitosis

-Ptyalism

-Dysphagia

-Pawing at mouth

-Shifting/loose teeth, tooth loss

-Exophthalmos

-Epistaxis/Nasal discharge/sneezing

-Incidental finding

What are some general ddx for gingivolabial diseases?

-inflammatory conditions

- Gingival Hyperplasia

- Neoplasia

What are TWO types of inflammatory conditions that you can see in the gingivolabial area?

◦ Eosinophilic granuloma

◦ Polyps

Which one of the inflammatory disease is seen in cats?

◦ Eosinophilic granuloma

What breed is predisposed to gingival hyperplasia?

boxers

What do you use for diagnosis and staging of Oropharyngeal Neoplasia?

- CBC, chem panel, UA

- Thorough oral exam

-LN palpation & cytology

T/F In your oral exam, you should sedate the patient

True

What LN are you going to do a FNA of even if they are small and normal?

mandibular LNs

T/F You can feel the Medial retropharyngeal LNs on a normal exam

False, you can only feel then if there is an issue

What are the TWO common places that oral tumors metastisize to?

• mandibular LNs

• Medial retropharyngeal LNs

How many views of thoracic rads are you doing for an oral tumor?

3

You decide to do a CT of the head of a suspected tumor in the oral cavity. Why did you decide to do this?

to see what all is involved

What are the Pros and Cons of doing a FNA and cytology for getting a tumor sample?

◦ Pros - inexpensive, fast, non-invasive

◦ Cons - poor exfoliation, concurrent necrosis & inflammation

What is the preferred method for getting a diagnosis of the with tumors?

Incisional Biopsy

What is the best diagnostic to use to evaluate extent of disease and plan for RT and surgery?

CT scan

T/F Oral radiographs overestimate the extent of disease

False, underestimate

Why are incisional biopsy ideal for a diagnosis?

you can take a large and deep sample (you need to be aware of necrosis and inflammation)

T/F Biopsy is important for future curative intent

surgeries and RT planning

True

Where do you need to biopsy from and why?

-sample from inside the oral cavity

- this is because if you go through the skin anywhere that the sample touches then has to be apart of the surgery to take out. ( this is bc cancer cells could be seeded in the tract)

Why do you do a incisional biopsy?

so you can be able to plan definitive treatments later (the mouth heals really well so if you dont leave some of it, then you dont know where to find it)

What are FIVE negative prognostic factors of oral tumors in dogs? (know these)

- Larger size

- Location

- Bone invasion

- Adequate Local Control

- Metastasis

What size of oral tumor in dogs is associated with a worse prognosis?

>4cm

What are the THREE locations of oral tumors in dogs is associated with a bag prognosis?

- Caudal

- Maxillary

- Tonsillar

What is the most economical, expeditious, and curative treatment?

Surgical Excision (Mandibulectomy, Maxillectomy, Palatectomy, Glossectomy)

What is the most important part of a treatment plan with oral tumors?

Local control

When is Radiation Therapy indicated over surgery? (3)

- extensive diseases

- if the owner is not willing to go to surgery

- cannot completely excise the tumor (post op)

What is not effective for primary tumor control but is used as an adjuvant to surgery and RT in dogs with metastasis?

Chemotherapy

Chemotherapy and Immunotherapy are used for systemic control. Why is this the case?

if there is a high risk of Metastasis or there is noted Metastasis

What is the goal of systemic treatment?

control of metastasis

she said do not memorize slide 21 to 23

okay slay

What does the surgical dose of lingual tumors dependent on?

Surgical dose dependent on tumor location and size

What are the TWO indications for radiation therapy?

◦ Alternative to surgery

◦ Incomplete resection

What are the TWO benign K9 Oral Neoplasms? (know the order- first is most common)

- Acanthomatous ameloblastoma

- Peripheral Odontogenic Fibroma

What are the FOUR malignant K9 Oral Neoplasms? (know the order- first is most common)

- Melanoma

- Squamous Cell Carcinoma

- Fibrosarcoma

- Osteosarcoma

What is a Benign tumor, that is odontogenic epithelial cell origin that invades underlying bone and does not metastasize?

Acanthomatous Ameloblastoma

Where is the most common location of Acanthomatous Ameloblastoma?

rostral mandible

What treatment of Acanthomatous Ameloblastoma is often curative?

Surgery

Acanthomatous Ameloblastoma has a ___ response rate and the median time to progression is ____ years?

High, 3

What is a benign tumor that is from the periodontal ligament origin, slow growing and firm and not ulcerated?

Does it invade the bone?

- Peripheral Ondotogenic Fibroma

- no

What is the most common location of Peripheral Ondotogenic Fibroma?

rostral maxilla

What is the treatment for Peripheral Ondotogenic Fibroma?

conservative surgical removal is often curative

What is the most common oral tumor in dogs?

Melanoma

What are TWO things that you can see on cytology and histopath that would help point you to it being Melanoma?

◦ Mixed cellular morphology - round, spindeloid, epitheliod

◦ Cytoplasmic pigment

What is the tumor behavior of oral melanoma?

-Highly malignant

- Locally aggressive

- High metastatic rate

Where are TWO of the most common places that Oral Melanoma met to?

◦ Lymph nodes

◦ Lungs

What is the local treatment of disease of oral melanom?

◦ Surgery

◦ RT

What is something that you can use to to treat systemic disease of melanoma?

Oncept Melanoma Vaccine

When do you recommend chemo for melanoma?

◦ Recommended if metastasis present ( it is a very resistant tumor)

What is the MOA of the ONCEPT melanoma vaccine?

Xenogeneic (human) recombinant tyrosinase DNA vaccine

What is unique to melanocytes; enzyme involved in melanin production?

Tyrosinase

T/F Human tyrosinase is homologous to canine tyrosinase, but different enough to break immune tolerance

True

DNA of tyrosinase is cloned into what?

bacterial plasmid with a constitutively active promote

Explain the ONCEPT melanoma vaccine? (sorry bad worded questions slide 34)

- Needless vaccine given transdermally on the medial thigh

- Within the muscle, professional

antigen presenting cells (APCs) pick up the DNA

-The APCs present the antigen to the immune system which leads to an immune response

(antibody and T cell production)

What are the FOUR indications of the ONCEPT Melanoma Vaccine?

◦ Microscopic disease setting

◦ Combination with surgery and radiation therapy

◦ Label use - stage II and III oral canine melanoma

◦ Off label - any dog with melanoma

She said protocol and price is FYI

i love her

What is the 2nd most common oral tumor in dogs and most common oral tumor in cats?

Squamous Cell Carcinoma

What is the behavior of Non-tonsillar Oral SCC?

- Locally invasive

- Relatively low risk of metastasis

Where can Non-tonsillar Oral SCC metastasize to? (3)

LN, lungs, tonsils

What is the MST of a dog that gets surgery for Non-tonsillar Oral SCC?

1.5 - 3.5+ yrs

When would RT be used for Non-tonsillar Oral SCC?

- Solitary therapy

- Post-operative adjuvant

For Non-tonsillar Oral SCC, prognosis is generally ___- with local control

GOOD

What is the behavior of Tonsillar SCC?

Locally infiltrative

Highly metastatic

Where do Tonsillar SCC metastasize to?

LN and lungs

What are the FOUR treatments for Tonsillar SCC?

◦ Surgery

◦ RT

◦ Chemo

◦ NSAIDs

T/F With surgery, recurrence is frequent

True

What is the prognosis of Tonsillar SCC?

very poor

What must you do for the best outcome with Tonsillar SCC? What is the MST?

Sx + RT + chemo + NSAID provides best outcome

- 200 days

What is the third most common oral tumor in dogs?

Fibrosarcoma (FSA)

What is the signalment that is FSA? What are the common breeds?

Large breed dogs

◦ Goldens and Labradors

What is needed for diagnosis of FSA?

Histopath

How would you describe the histological and biological grade of a FSA?

Histologically low grade, biologically high grade

What would you see on histo with FSA?

fibroma or low grade FSA

T/F FSA has very local invasive and rapid grade

Trie

What is the risk of metastasis of FSA? Where does it go to?

low

-lungs and LN

With canine oral FSA, what is needed when you are doing surgery?

WIDE resection

T/F Local recurrence common in oral FSA

True

What is the treatment of choice for canine oral FSA because it improves local control?

Surgery + radiation therapy

If you use RT alone with oral FSA, what is the MST?

7 months

What are the THREE types of benign feline oral tumors?

• Nasopharyngeal polyp

• Eosinophilic granuloma

• Epulides

What are the TWO types of malignant oral tumors in cats?

• Squamous cell carcinoma (SCC)

• Fibrosarcoma

What is the most common oral tumor in cats?

Feline Oral SCC

How would you describe Feline Oral SCC?

- Exophytic and ulcerated

-Locally invasive

- Lower metastatic risk

Where is common areas that feline oral scc invades?

Bone invasion and lysis

What is the concerns with surgery post op of feline oral SCC?

Dysphagia (up to 25% of cats may have a feeding tube or may not even eat ever)

What is the MST of cats with feline oral SCC post surgery?

200 days

What is the palliative care that can be set in place for feline oral SCC?

◦ NSAIDs and other pain meds

◦ RT

◦ Chemotherapy

What are THREE NSAIDs that can help cats that have feline oral SCC?

- Piroxicam

- Meloxicam

- Onsior

T/F RT doesnt really do alot for feline oral scc it really just helps with temporary pain relief

True

What is the MST of Palliative care provided to cats?

<6 months

What is the 2nd most common feline oral tumor?

Feline oral FSA

What is the risk of Feline oral FSA going to surgery?

o Risk of post-op dysphagia

T/F Long term survival possible with

complete excision with good local control and good recovery post op

True

Where is the most common location for lymphoma in cats?

GIT

slide 44 summary chart of all that cute stuff

okay yay

What are the ranking of the canine oral tumors from most to least invasiveness?

FSA > OSA, melanoma, SCC > acanthomatous ameloblastoma (AA) > fibroma

What are the FIVE canine oral tumors that involve bone?

- FSA

- OSA

- melanoma

- SCC

- acanthomatous ameloblastoma (AA)