Neoplasia of the Chest 2023 - PDF

Neoplasia of the Chest Nick Bacon MA VetMB CertVR CertSAS DiplECVS DACVS FRCVS ACVS Founding Fellow, Surgical Oncology RCVS Specialist (Surgical Oncology) Clinical Director, AURA Veterinary Professor, Surgical Oncology, University of Surrey...

Neoplasia of the Chest Nick Bacon MA VetMB CertVR CertSAS DiplECVS DACVS FRCVS ACVS Founding Fellow, Surgical Oncology RCVS Specialist (Surgical Oncology) Clinical Director, AURA Veterinary Professor, Surgical Oncology, University of Surrey www.auravet.com @ifitwasyourdog  Conflict of interest I do not have a relevant financial interest, arrangement, or affiliation with any organization or business entity (including self-employment and sole proprietorship) that could be perceived as a conflict of interest or a source of bias in the context of this presentation.  Plan Refresh neoplastic conditions Diagnostic imaging Procedure details/requirements/risks Prognosis  Tissues affected Thymus Heart Lymph node Oesophagus Trachea Chest Wall Typical patient history Weight loss Cough Lethargy Tachypnoea Inappetence +/- increased respiratory effort Collapse Chest wall mass  Physical examination Decreased lung sounds Muf ed heart sounds Jugular venous distension Head and neck distension fl Ascites Pleural effusion Paraneoplastic signs? Mega-oesophagus Exfoliative dermatitis Hypercalcaemia  Cranial mediastinal mass Differential Diagnoses Thymoma Lymphoma Ectopic Thyroid Extension of rib mass (Branchial cyst) Diagnosis Ultrasound guided aspirate +/- Flow cytometry Ultrasound guided Tru-cut biopsy Challenge to distinguish between lymphoma and thymoma Approaches to Thorax Lateral / intercostal thoracotomy Median sternotomy (Thoracoscopic)  Instruments Oscillating or sagittal saw Finochietto Rib Retractor  Malleable retractors Pericardium Right auricular appendage Satinsky vascular clamps Thymoma 38% Labradors or Golden Retrievers 17% signs of myasthenia gravis 34% hypercalcaemia 27% had another tumour 72% underwent surgery 38% Labradors or Golden Retrievers 17% signs of myasthenia gravis 34% hypercalcaemia 27% had another tumour 72% underwent surgery Surgery 635 days No surgery 76 days 2nd tumour 282 days No 2nd tumour 568 days Thrombus extraction - Cranial Vena Cava - Thymoma Thrombus extraction - Cranial Vena Cava - Thymoma Thrombus extraction - Cranial Vena Cava - Thymoma  Thymoma in cats Cats median survival 1825 days 1yr and 3yr survival 89% and 74%  Pericardial effusion Presentation Clinical Signs Physical Examination ECG Thoracic Radiographs Differential Diagnoses Idiopathic hemorrhagic effusion Neoplastic hemorrhagic effusion Cardiac Ultrasound Staging Surgery - Pericardectomy and excision of R auricle Haemangiosarcoma  Te on stents fl HSA Heart base mass - thyroid  Chest wall tumours Osteosarcoma Prognosis after surgery 3-6 mths Chondrosarcoma Prognosis after surgery Fibrosarcoma  Al e - low grade chondrosarcoma rib 5 fi  Al e - low grade chondrosarcoma rib 5 fi  34 OSA DFI 225d (chemo) vs 60d (no chemo)  25 OSA 19/23 chemo Median survival 290d 12% recurrence, 75% metastasis 13 OSA Median survival 119d 0% recurrence, 38% metastasis Chest wall resection Chest wall resection Deep Pectoral muscle Type V muscle Lateral thoracic a pedicle Rotate cranially and dorsally Segmental branches of internal thoracic rotate across midline Courtesy Dr Farese, University of Florida Courtesy Dr Farese, University of Florida Courtesy Dr Farese, University of Florida  Chest wall resection Cut skin Resect muscle and bone More dissection of muscle to help cover defect Close skin Chest drain Typically home in 2-5 days What we’ve covered Disease types Good imaging Appropriate instruments Surgical approaches Prognosis