ONCOLOGY SKIN TUMOURS Tumour

Basal Cell Carcinoma Solitary; skin of head and trunk

Rx (incl. drugs)
Surgical Good prognosis

Squamous Cell Carcinoma Non-pigmented; hairless regions (dog ventral abdomen, face, nailbed ; cat face, nose, ear pinae) Erosive, ulcerative lesion Tumour well differentiated; locally infiltrative; slow to metastasize Surgical removal Cryotherapy Radiation therapy Carboplatin / Cisplatin intralesionally 5 fluorouracil topically Piroxicam Fair prognosis

Mast Cell Tumour Raised, erythaematous, alopecic or ulcerated mass Usually solitary nodules (50% trunk; 40% limbs; 10 % head and neck) Locally infiltrative Metastasis regional lnn., spleen & liver

Chemotherapy Prednisolone Vinblastine / prednisolone combination Ancillary therapy (systemic signs; tumour manipulated at surgery) Diphenhydramine Cimetidine Ranitidine Cases with GIT ulceration Sucralfate Misoprostol, omeprazole, ranitidine Serotonin more than histamine in cats use cyproheptadine Visceral form Prednisolone H1 and H2 Cyproheptadine Splenectomy

Feline Mast Cell Disease Cutaneous form can look like anything; confuse with eosinophilic plaques Visceral form

Melanoma Lipoma Solitary mass, well-circumscribed Surgery Solitary, round, firm, pigmented mass Head, neck, trunk, oral cavity & nail beds Malignant or benign (most on skin benign except digits & oral cavity) Malignant rapid growth and metastasize Wide surgical resection Radiotherapy Intra-lesional platinum compounds

Haemangiosarcomas Uncommon, malignant Ventral hairless skin Perianal gland adenoma Old intact male dogs Solitary, red button-like lesion (perianal, tail base, prepuce) Can be multiple Surgical (castrate simultaneously) Good prognosis if no adenocarcinoma Surgery if strictly intradermal Radiation Carboplatin / doxorubicin Poor prognosis

SOFT TISSUE TUMOURS

Benign oma Malignant sarcoma Usually solitary

Tumour
Fibrosarcoma fibrous tissue Haemangiosarcoma blood vessel tissue Bulky, non-ulcerative, massoccupying lesion Finger-like projections through pseudocapsule Local recurrence after removal Histo: pleomorphism, tumour differentiation, vascularity, mitotic activity, necrosis

Rx (incl. drugs)
Rx depends on: Clinical staging Histopath grading Location Favourable: Size < 5cm Superficial site Low histo grade Fixation mobile Clean margins Rx: Aggressive surgery Radiotherapy pre- and post- therapy Doxorubicin, vincristine, cyclophosphamide VAC vincristine, Adriamycin, cyclophosphamide

Modified staging system for soft tissue sarcomas:

T = primary tumour T1 < 5 cm T2 > 5 cm N = lymph node N0 = not involved N1 = involved

M = metastasis M0 = no mets M1 = mets Stage i 1a = T1N0M0 1b = T2N0M0 Stage ii 2a = T1N0M0 2b = T2N0M0 Stage iii 3a = T1-2N1M0 3b = T1-2AnyNM1

(Grade 1 or 2, < 5cm) (Grade 1 or 2, > 5cm)

(Grade 3, < 5cm) (Grade 3, > 5cm)

(any size and grade, lnn. mets) (any size and grade, distant mets)

HAEMATOPOETIC TUMOURS
85% of all canine haemopoetic tumours Middle aged to older animals CLASSIFICATION: Anatomical: Multicentric (80%) - Superficial lymphadenopathy; most asymptomatic, weight loss, lethargy, anorexia, febrile episodes Mediastinal (5%) enlarged craniomediastinal lnn. or thymus or both; hypercalcaemia GIT (5-7%) weight loss, anorexia, panhypoproteinaemia, malabsorption Cutaneous form solitary or generalized Extranodal (eye, CNS, renal)

Histological grade (classification see slide 2) Immunophenotype B-cell (bad) T-cell (teriible)

CLINICAL SIGNS: Non-specific weight loss, vomiting, emaciation, ascites, dyspnea, polydipsia, polyuria, fever PU/PD nb with hypercalcaemia of malignancy Paraneoplastic anaemia, thrombocytopenia, neutropenia

DIAGNOSTICS: Lymph node biopsy Keep capsule intact architecture Classification low, intermediate or high grade Avoid certain regions Popliteal and prescapular preferred Mandibular reactive area Haematology Anaemia, thrombocytopenia, neutropenia Biochemistry High ALP, ALT Hypercalcaemic GIT, kidney, T cell, mediastinal STAGING NB! Stage 1 single node / single organ Stage 2 regional area Stage 3 Generalised lnn. Stage 4 liver/ spleen Stage 5 BM / other organs Substage a no systemic signs Substage b with systemic signs

PROGNOSIS FACTORS Location Immunophenotype (B/T) Stage Substage Grade: low grade vs high grade Response to Rx Pre-Rx with prednisolone Size of animal small vs large Sex male vs female, neutered vs entire

TREATMENT Systemic requires systemic Rx Combination Rx (doxobubicin is effective alone) Surgery or radiation rarely used Nutritional CHOP protocol (cheapest minus the doxorubicin; simplest 5x doxorubicin) C cyclophosphamide H doxorubicin O vincristine P prednisolone

CR in 60-90% Approx 20% will live >2 years

Side effects of Rx Vincristine Neurotoxicity Phlebitits / tissue necrosis Cyclophosphamide Myelosuppression Haemorrhagic cystitis Doxorubicin Cardiotoxic HS Goals of Rx: Induction: complete and durable 1 remission (>6m) Reinduction: reinduce remission when tumour recurs Rescue therapy: Induce remission when cancer fails to respond; using drugs not st present in std protocols; 1 reintroduce induction protocol (except doxorubicin); remission period and rate half the previous
st

FELINE LYMPHOMA Intestinal most prevalent Only 10-20% FeLV Often substage-b COP plus DOX Prognosis better if FeLV negative and substage a, addition of DOX

Mediastinal form: Present dyspnea, collapsed Young FeLV + T-Cell Hypercalcaemia PLASMA CELL NEOPLASIA (Multiple myeloma) Produce excessive Abs (B-cells) Hyperviscosity, hypercalcaemia, cytopaenias, cardiac disease, osteolysis Rx COP

SPLENIC TUMOURS