Intestinal Neoplasia UoS 2024 PDF

Intestinal neoplasia in the dog and cat Nick Bacon MA VetMB CertVR CertSAS DECVS DACVS FRCVS Clinical Director, AURA Veterinary Professor, Surgical Oncology, University of Surrey Advancing patient care through innovation, discovery and collabora...

Intestinal neoplasia in the dog and cat Nick Bacon MA VetMB CertVR CertSAS DECVS DACVS FRCVS Clinical Director, AURA Veterinary Professor, Surgical Oncology, University of Surrey Advancing patient care through innovation, discovery and collaboration @i twasyourdog fi Tumours Of The Gastrointestinal Tract Not common in the dog and cat Gastric 1% Intestinal 3% ⅔ are malignant Male predominance 2.5:1 Older dogs 70-80% of stomach cancers were adenocarcinoma 70-80% metastasis to local LNs Many Leiomyosarcomas and Leiomyosarcoma have been reclassified as Gastro Intestinal Stromal Tumours (GIST)  Gastric Tumours GISTs express CD117 (c-kit) while true leiomyomas and leiomyosarcomas do not Gastric Adenocarcinoma in dogs 70-80% metastasis to Local LNs Prognosis is very poor, survival times with treatment of 1-2 m Primary gastric tumours rare in cats More likely to get lymphoma Benign stomach lesions include: Adenomas Hypertrophic gastropathy (aka Chronic Hypertrophic Pyloric Gastropathy) in Shih-tzus and Lhasa Apsos  Intestinal Tumours More common than gastric and oesophageal tumours < 10% of all tumours in cats and dogs Most common SI tumour in cats is lymphoma (75%) Distribution of SI tumours in dogs is approx; 30% lymphoma 30% carcinoma 25% GIST/smooth muscle Dogs Older male dogs overrepresented in smooth muscle , GISTs and lymphoma Overall LI tumours more common than SI tumours  Intestinal Tumours; type Alimentary Adenocarcinoma (ACA) Cats-usually in SI, dogs usually colon/rectum GIST/Leiomyosarcoma/Leiomyoma Caecum-higher tendency of these tumours vs ACA Adenomatous Polyps Rectum of dogs, duodenum in cats Carcinoid Endocrine cell origin, not true epithelial tumours Can secrete 5HT, secretin, somatostatin, gastrin (gastrinomas)  Diagnosis History Vomiting (coffee grounds) or haematemesis Melaena, haematochezia Anorexia, weight loss Physical exam Palpable mass Abd pain/discomfort on palpation Weight loss CBC, Chemistry panel Anaemia (blood loss) Protein losing enteropathy Hypoglycaemia with GIST/Leiomyoma Diagnosis of Intestinal Obstruction Oral exam! Palpation - 70-75% Radiography Loss of detail Fluid or gaseous dilatation Contrast Ultrasonography Percutaneous needle aspirate ‘Plication’ Radiography 50% diagnostic Loss of detail Fluid or gaseous dilatation Contrast Radiography 50% diagnostic Loss of detail Fluid or gaseous dilatation Contrast Diagnostic Work-up Plain radiographs Diagnostic Work-up Static + dynamic contrast studies Dogs Maximal small intestinal diameter >1.6x the height of the body of L5 measured at the mid centrum >2x have 80% or greater chance of obstruction Graham, J. JSAP. 39: 521, 1998. Cats1 Maximal small intestinal diameter should not exceed 12 mm 12mm Morgan, JP. VRU. 22 (4): 159, 1981.1 Schwarz, LA. VRU. 44(2): 165, 2003.2  Diagnosis Special Procedures – Radiology (barium follow through) – Ultrasound – Fine needle aspirate (FNA) – fine for lymphoma but can be negative for other neoplasms – Excisional biopsy (staging laparotomy) Sample mesenteric lymph node Normal small intestine See 5 layers of alternating echogenicity Penninck, DG. VRU. 30: 272, 1989. Dilated, fluid filled small intestinal loops Ultrasonography Neoplasia Mass/ wall thickening Lack of visualisation of normal wall layering Leiomyoma Leiomyosarcoma1 Adenocarcinoma2 Lymphoma3,4 Myers, NC. VRU. 35: 391, 1994.1 Rivers, B. VRU. 38: 300, 1997.2 Penninck, D. VRU. 35: 299, 1994.3 Grooters, AM. VRU. 35: 468, 1994.4 Ultrasonography Lymphoma Circumferential symmetric hypoechoic Adenocarcinoma Symmetric or asymmetric mixed echogenicity Intussusception Increased circumference symmetric target  Symptoms Vomiting over 1-3 months Haematemesis, melaena Anorexia, weight loss Gastric Outlet Obstruction AETIOLOGY Foreign bodies Neoplasia - intra + extraluminal Peptic ulcer disease (Fungal granuloma)  Diagnostic Work-up CBC + biochemisty Plain radiographs Static + dynamic contrast studies Endoscopy and biopsy Serum gastrin levels Ulcerated adenocarcinoma - body Gastric carcinoma Gastric carcinoma - polypoid  Gastric Neoplasia Benign Benign adenomatous polyps Leiomyoma Malignant Adenocarcinoma Leiomyosarcoma LSA-cats most common FSA dogs and cats  Gastric carcinoma Mean age 8 years old, male > female Pyloric antrum raised plaques with ulcers diffuse in ltrating masses fi Gastric carcinoma Metastatic gastric LN Gastric carcinoma liver metastasis  Thoraco-abdominal (TA) stapler Gastric leiomyoma Thoraco-abdominal (TA) stapler Partial gastrectomy - lesser curvature Partial gastrectomy - lesser curvature Partial gastrectomy - lesser curvature Endoscopic guided surgery  Pylorectomy + Gastrodudenostomy Neoplasia, stricture or 360 degree hyperplasia Ligate right gastric vessels Ligate right gastroepiploic vessels Clamp, cut + oversew gastric stump Anastomose duodenum to gastric stump Pyloric Resection BILROTH 1 Gastrodudenostomy BILROTH 2 Gastrojejunostomy +/- Cholecystoduodenostomy Bilroth I Bilroth II  Prognosis Gastric carcinoma carries poor prognosis anatomical location advanced stage Gastric lymphoma in cats small cell - better prognosis  Treatment - intestinal tumours Surgical excision (including regional lymph nodes) Neoadjuvant chemotherapy Doxorubicin Cats with LI carcinomas; Sx plus Doxorubicin MST 280 days vs 55 days Carboplatin NSAIDs Piroxicam Rectal polyps Adenocarcinoma? Feline solitary lymphoma Intussusception  End to End Anastomosis Ligate mesenteric vessels Ligate arcuate vessels Angle resection 45-60O Begin at mesenteric border - 6 o'clock Antimesenteric border - 12 oclock 3mm intervals –12-16 sutures total  Arcuate and mesenteric vessels Jejunal resection 4 layers...  In ltrative lymphoma, jejunum fi Appositional Simple interrupted appositional...  Pressure leak testing of anastomosis - Rule of 10 All will leak with enough force 10cm apart doyens or ngers 10ml H20 Creates 30-40mmHg pressure 3-4 times physiologic pressure fi Intestinal leak test Intestinal leak test Lymph node biopsy Lymph node biopsy Small Intestinal Adenocarcinoma in Cats - 32 Cases Palpation 50% Radiographs 38% 9 cats biopsy + euthanise 23 cats R + I 11 lived < 2 weeks LN involvement 12 lived - mean 15 months death due to recurrence  Prognosis Canine Overall 40% one year survival for SI tumours MST of 22 months for colorectal carcinoma receiving sx vs 15 months with medical management alone Mean survival time of 12 days without treatment and 120 days with surgery for SI adenocarcinoma MST of 3 years for GIST vs 230 days for leiomyosarcomas Feline (adenocarcinoma) Metastasis at diagnosis MST 2.5–5 months No metastasis at diagnosis MST 10-15 months Duodenal polyps (long-term survival) LI tumours-MST 4.5m for adenocarcinoma !ank y" for y"r a#ention www.auravet.com