Flashcards in Oncology - Bladder and AGASACA Deck (46)
Typically what type of neoplasia are bladder neoplasias?
Invasive transitional cell carcinomas
Where do TCCs like to locate in the dog? Cat?
Dog - trigone
Cats - apical and mid-body
Where do TCCs like to spread?
Urethra, prostate, nodal metastasis, and distant metastasis (they like to move cranially)
What breeds are the poster children for TCC?
Scotties - 18x
What are some risk factors for TCC?
Female, neutered, obesity, exposure to older generation flea products and lawn chemicals, and cytoxan exposure
What presenting clinical signs are associated with bladder tumors?
Hematuria, dysuria, pollakiuria, tenesmus, and potential lameness due to bony metastasis or hypertrophic osteopathy
What differentials should you consider with TCC?
Chronic cystitis, fibroepithelial polyps, granulomatous cystitis/urethritis, gossypioboma, calculi, other tumor types, and Botryoid rhabdomyosarcoma in young dogs
How is clinical staging done for TCC?
Good PE including rectal
Minimum database - azotemia
UA and culture
____% of dogs will have neoplastic cells due to TCC in the urine.
What diagnostic methods can be done for TCC?
CADET BRAF and BRAF Plus
Histopathology - biopsy (last course), cystoscopy, traumatic catheter, or prostatic wash
What does CADET BRAF look for a mutation in?
Does a negative CADET BRAF test rule out TCC?
How is traumatic catheter done?
Catheterize and empty bladder
Attach a 12 cc syringe to the catheter
Apply suction while moving the catheter
Remove catheter and centrifuge sample
You will need to sedate females
What can mask a TCC when doing traumatic catheter?
a concurrent UTI
Can FNA be done for TCC?
Yes, but only if necessary
Seeding is possible
What are the options for treatment of TCC?
Surgery, radiation therapy, medical therapy/chemotherapy, interventional therapy
What surgical considerations do you need to keep in mind for TCC?
Complete excision is not usually possible
Is it appropriate to try?
You need to have superb surgical techniques
TCC is highly exfoliative = seeding
Refer in complicated cases
What palliative options are there for surgery of TCC?
Prepubic cystostomy catheters, ureter/urethral stents, balloon dilation, and laser ablation
Why is uterocolonic anastomosis not recommended?
The colon will reabsorb the urine resulting in an uptake of ammonia and eventually death
What is one of the biggest problems associated with urethral stents?
25% have major incontinence
In the case of using urethral stents for TCC, what is death usually due to?
What complications are associated with laser ablation as palliative care for TCC?
Stranguria, hematuria, stenosis, spread, urethral perforation, bacterial cystitis
What are the goals of palliative radiation therapy for TCC?
Improve the clinical status with low risk for severe toxicity
What is the approach of palliative radiation therapy for TCC?
Once weekly for 5 weeks or once daily for 10 days
What is the outcome for palliative radiation therapy for TCC?
Can improve comfort and micturition but does not improve survival time beyond chemotherapy and NSAIDs
When is palliative radiation therapy for TCC reserved?
For cases where medical therapies fail to improve QOL
What complications are associated with definitive radiation therapy for TCC?
Low grade GI, genitourinary and skin
30% late-onset difficulty urinating/defecating
What medical therapy do we use for TCC?
COX-inhibitors and chemotherapy
What COX inhibitors can be used for TCC therapy?
Piroxicam, Deracoxib, and Firoxocib