Nasal Planum in Dogs/Cats & Laryngal/Tracheal Tumors & Thymomas
1.) Most common nasal planum tumor in dogs and cats
2.) If you see a tracheal lesion on radiographs, you should do this as your next step in the treatment plan (especially if the client is up for it).
3.) The most common primary lung tumor histology in BOTH dog and cat.
1.) What is Squamous Cell Carcinoma (SCC)
2.) What is Refer to an oncologist ASAP (preferrably at a multi-speciality hospital where multiple specialists can all scratch their head togethers to figure out what to do lol)
3.) What is Carcinoma
1.) Dogs and Cats with nasal tumors can frequently present with this condition.
2.) Reason a dog or cat may get behavioral changes or neuro signs from a nasal tumor.
3.) This is one of the few tumor types we have untreated prognosis as an actual publication.
4.) Somebody actually looked at prognosis of untreated nasal tumors and measured it and found that when dogs have epistaxis as part of their disease, the survival is _____, which makes sense sadly; without epistaxis, it's longer, about 7 months median survival time. And the prognosis in cats for nasal lymphoma when it is a stage one or isolated disease, can be excellent. They can do really, really well, and I personally believe that _______ therapy is the absolute cornerstone of that outcome. I have never had that good of an outcome with chemotherapy-alone.
1.) What is Epistaxis
2.) What is Cribiform plate degradation -> Brain involvement
3.) What is: Nasal tumors
4.) What is: shorter, radiation
1.) Most common organ target for secondary tumor development or metastasis
2.) Most common neoplasia in the lungs with a solitary lesion in dogs/cats
3.) there are sarcomas that arise primarily in the lung. They tend to be aggressive in their behavior Extremely rarely, you could see a lymphoma arising in the lung, and it, if it does, it's more likely a diffuse syndrome and less likely to be solid lumps. And of course lymphoma can show up in the chest as uh big lymph nodes in the absence of any other disease
Lung lobe torsions frequently will have some fluid with them. Uh, and maybe have a dog that is, is sicker.
1.) What is Lungs
1.) What is Bronchoalveolar carcinoma
1.) Reason CT scan would be recommended in a case where there is a presumptive primary lung tumor
2.) Lung tumors and urinary tumors have this in common.
1.) What is CT is the appropriate imaging to screen lymph nodes (You will only see the worst tracheobronchial enlargement on an X-ray. You won't see 2 centimeters versus 1 centimeter, but you will see giant lymph nodes)
2.) Risk of tumor cell seeding into the body wall if you go poking at the organ
1.) This is a common characteristic of cats with nasal planum tumors (commonly squamous cell carcinoma).
2.) This is important to consider when treating nasal planum tumors in dogs/cats and it impacts the prognosis as well.
1.) What is: White-faced, light pigmented cats that have a lot of sun exposure.
2.) What is: Treat when the tumors are small, minimally invasive (Over time, they will become really invasive/aggressive if left untreated)
1.) This tumor presents in dogs/cats as: Epistaxis (unilateral or bilateral), lots of Sneezing, and Behavioral changes/Neuro signs (from cribriform plate/brain involvement), Facial swelling in the muzzle or sinuses, and typically has a chronic presentation.
2.) Nasal tumors can be very painful, especially if bone is involved. Thus, dogs may be head shy and avoid you so you can't touch their head. You should consider this drug for managing bone pain.
3.) True or False. Be cautious with steroid use in cats that you suspect lymphoma in.
1.) What is Nasal tumor
2.) What is Bisphosphonates
3.) What is True
1.) You see a dog with "walking on eggshells", his legs look thick, and radiographs suggest hypertrophic osteopathy. This is your next diagnostic step and the reason for that choice.
2.) You should screen the _____ first if you find Hypertrophic Osteopathy in a dog.
3.) This is an important differential to rule out when you see lungs with multifocal lesions and you're concerned about neoplasia.
4.) Pulmonary neoplasia is often found by accident because you're taking a chest x-ray for some other reason and happen to find it. Neoplasia is commonly seen in the ______ lung fields on radiographs.
1.) What is Thoracic radiographs to check for a primary pulmonary lesion. HO can be secondary to intrathoracic neoplasia (primary or secondary).
2.) What is: thorax
3.)What is Fungal disease
4.) What is: caudal
1.) Interestingly, if you don't do anything for a pulmonary ________ in dogs, they may survive for actually a decently long time, like months to a year. I have actually seen a dog with early metastatic disease survive a year. When you say the median survival time with surgery is somewhere around a year, or your dog may survive up to a year without anything. When the client says, well, then why would I do surgery, you say that there is a possibility that with surgery, you get much, much more time. It's not a guarantee, but it's a possibility; whereas, without surgery, it's more of a guarantee that time will be limited in a relatively definable way. Again, no right or wrong answers, just depends on client's priorities and resources.
2.) There is a small ___ involved when you FNA a pulmonary tumor. You can still do an FNA, but it just depends on if you and the client are both willing to assume the risk to tumor ______.
1.) What is: adenocarcinoma
2.) What is: risk, seeding
1.) Nasal planum tumors in dogs/cats can have a proliferative or _______ appearance (which is what you'll see more commonly; a red crater appearance on the planum on the inside of the nasal passage).
2.) Although metastasis is rare, with nasal planum tumors, the lymph nodes and lungs are still a concern, so we're going to check those when staging the disease. We can perform nosectomies on dogs/cats, but we really want to avoid this if possible by treating when the tumors are ____, non-invasive. Dogs can be more tricky than cats since they're more likely to reoccur in dogs and impact their quality of life, leading to a ______ survival time (1 year-ish).
3.) True or False. Pleural effusion can be a negative prognostic factor in thymomas, but removing the primary tumor tends to make the pleural effusion go away (thought not always)
1.) What is: erosive
2.) What is: small, shorter
3.) What is True
1.) True or False. Nasal tumors can initially be us managing chronic nasal symptoms in cats for months or longer before we diagnose a tumor. We tend to get there a little bit faster in dogs, but again, it's not uncommon that these guys have symptoms for quite a while before we get to the diagnosis.
2.) A dog or cat presents with epistaxis. Before jumping to cancer, you should also rule out these 2 differentials (not including inflammatory/infectious diseases) before jumping to cancer.
1.) What is True
2.) What is: Coagulopathy, Foreign body (could have a stick shoved up their nose for awhile)
1.) Reason you might radiograph the thorax if you see digital lesion(s) on a cat or check the toes if you see lung lesions on radiograph.
2.) Owners that elect to treat the _____ ______ (resulting in Hypertrophic Osteopathy) may see that reactivity partially go away in their dog.
1.) What is Feline Lung-Digit Syndrome
2.) What is Primary tumor
1.) Difference in treatment approach for dog versus cat with primary lung tumor
2.) If you have identified any metastatic disease in a cat with a primary lung tumor, treatment is not worth pursuing. Their prognosis is _______.
3.) This surgery is primarily used to treat primary lung tumors, and dogs and cats can recover well from this
1.) What is:
- Dog: Individualized approach. Based on histology, not cutting seems to do well for dogs for ~ 1 year, just depends.
- Cat: Strongly recommend post-op chemotherapy (if you're going to all the trouble of removing a questionable lung tumor, then following up with chemotherapy should make sense)
2.) What is: Guarded
3.) What is: Lateral thoracotomy
1.) This is the most common paraneoplastic syndrome for thymomas in cats.
2.) True or False. Nasal planum tumors (dog and cat) are progressive, so it's important to treat sooner rather than later (when they become infiltrative/aggressive).
3.) This is the preferred treatment approach for thymomas. This is the main complication with that.
4.) For thymomas, _______ is actually a decent alternative in dogs to surgical excision, but if surgery is successful and they survive to discharge, there is a pretty good 3 year survival rate (in 42% of dogs and 72% in cats)
1.) What is Exfoliative dermatitis
2.) What is True
3.) What is: Surgical excision; high complication rate where 20-30% don't make it out of the hospital (death)
4.) What is: radiation
1.) This type of cancer is most common in dogs with nasal tumors
2.) This type of cancer is most common in cats with nasal tumors
3.) You suspect a nasal tumor in a dog or cat. There are many differentials that may be indistinguishable from each other. This is the next diagnostic you should pursue to get a diagnosis.
4.) Are radiographs or CT going to be more helpful in helping you arrive at a diagnosis for a dog/cat with nasal tumor?
1.) What is: Carcinoma (like adenocarcinoma, squamous cell carcinoma)
2.) What is: Lymphoma!
3.) What is Biopsy
4.) What is: CT are going to provide more anatomical information. Radiographs aren't super helpful because they're only going to tell you about unilateral disease and provide less information anatomically.
Cats with pulmonary carcinoma can develop digit lesions in addittion to some cats can develop mets from a lung carcinoma that are like subQ or IM. They kind of get these firm lumpy bumpies all over. That presentation is a really, really, really ___ prognosis. People have tried to treat these with chemo and supportively and palliatively, and they do not do well. They do not respond well to treatment. Unfortunately this is a systemic, aggressive, bad cancer, and there's not a ton that we can do about it so just be aware of it.
What is Bad
This is the risk of performing a blind lung aspirate in a patient with diseased lung that you should warn the owner about BEFORE you attempt.
Pneumothorax! If you cause a pneumothorax, the patient will need a chest tube and will be hanging with you in the hospital for a few days
1.) There is characteristic signature on flow cytometry for thymomas in ___ but NOT CATS. Dogs tend to have a lymphocyte component whereas cats tend to have an _______ component.
2.) True or False. Circulating lymphocytosis can occur with lymphoma or thymoma in dogs.
3.) 2 most classic paraneoplastic syndromes seen with thymoma dogs.
4.) Reason we would consider abdominal imaging in a thymoma case
1.) What is: Dogs, epithelial
2.) What is: True
3.) What is: Megaesophagus, Myasthenia gravis
4.) What is: Unrelated concurrent malignancies in up to 30% of dogs (multiple tumors that were not the same cancer, so don't assume all tumors are the same)
1.) As a general practitioner, if you are so bold, you can do a _____ biopsy on a dog that you suspect a nasal tumor on want to diagnose. You want to measure from the tip of the nose to no father than the ______ ______ of the eye so that you don't hit the brain. It'll be scary, and the tumor will feel crunchy, but you'll get your sample and be prepared for the tumor to ______! If you're lucky, the dog could also just sneeze a piece of tissue out that you could submit for biopsy.
2.) True or False. If you're going to treat a nasal lymphoma (or any lymphoma) with radiation, then you need to stage the rest of the body.
3.) This is the preferred treatment for nasal tumors in dogs.
1.) What is: blind, medial canthus, bleed
2.) What is True
3.) What is Radiation
1.) You'll see this condition when you see a dog “walking on eggshells” – shifting leg lameness, generalized pain, reduced appetite. It can look like irregular periosteal bone proliferation of long bones. This can be secondary to intrathoracic neoplasia.
2.) This is a unique site of metastasis (the digits) from primary pulmonary carcinoma in cats with a poor prognosis (like median survival time ~30 days even if try you chemotherapy)
1.) What is Hypertrophic Osteopathy
2.) What is Feline Lung-Digit Syndrome
Surgery for primary lung tumors in cats has very limited publications, but they suggest ____ MSTs and metastasis moderate to ____. Dr. G's clinical experience has a better outcome than published reports.
What is: short, high