Respiratory Neoplasia UoS 2023 Bacon PDF

Neoplasia of the Respiratory System 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 o...

Neoplasia of the Respiratory System 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.  Respiratory Tract Nasal planum / Nose Trachea Lungs  Squamous Cell Carcinoma Biopsy Super cial scraping often in ammatory fl fi  Staging Aspirate draining lymph node (s) Pulmonary metastasis rare LESS aggressive than oral SCC (in the cat) AS aggressive as oral SCC (in the dog)  Treatment Super cial lesions Strontium 90 Cryosurgery Intralesional chemotherapy Photodynamic therapy fi  Treatment and Prognosis Nasal planectomy Treatment of choice Radiation therapy Poor local control results Poor cosmetic results Cat Dog  Prognosis Good long term survival Cats >> Dogs degree of invasion metastatic potential Tracheal mass Neoplasia Parasitic Granuloma Radiography / Tracheoscopy Tracheal resection and anastomosis Tracheal Resection Lungs  Typical patient Cough (52%) Dyspnoea (24%) Lethargy (18%) Weight loss (12%) Tachypnoea (5%) Inappetence 25% asymptomatic at +/- increased respiratory effort diagnosis Collapse  Signalment All breeds Usually larger breeds (60% weigh 20-30kg) Urban areas (75% in one study) Passive smoking Geriatrics Dogs average age 9-11 yrs (range 5-12) Cats average age 11-13 yrs (range 2-18)  Physical examination Chest wall mass Decreased lung sounds Muf ed heart sounds Jugular venous distension Ascites Nothing fl  Paraneoplastic signs Hypertrophic osteopathy Hypercalcaemia Pyrexia  Thoracic radiographs Three views Differential diagnoses for consolidated lung or lung mass neoplasia, FB, abscess, fungal infection, lung lobe torsion Visual resolution of 5-7mm soft tissue nodules Hilar mass 5-10mm Predominant pattern is solitary nodule, occ multicentric Pleural uid, sternal or hilar lymphadenopathy fl Canine and feline primary lung tumours Rare in dogs and cats Incidence 5.6/100,000 dogs 2.2/100,000 cats Most are malignant in both species Higher metastatic potential in cats (75%) Primary Lung Tumours Carcinomas (adenocarcinoma) SCC, malignant histiocytosis, sarcoma, (lymphoma) Well demarcated mass, caudal lobes  Classi cation By site of origin Alveolar / bronchogenic / bronchial gland / bronchoalveolar By cellular morphology Adenocarcinomas (70-85%) differentiated vs undifferentiated carcinomas Squamous cell carcinoma Sarcoma (Histiocytic, FSA, OSA) fi  Primary Lung Tumours Differentiated vs non-differentiated lymphatic and blood vessel invasion Median survival time Without LN mets 12+ months With LN mets 2 months Other poor prognostic indicators Location, grade, stage, clinical signs, completeness of excision Lung metastasises to lung L Caudal L Caudal  Solitary mass Costo-phrenic recess Primary Lung Tumours - Cats Adenocarcinomas most common Presentation Can present due to multiple painful swollen digits caused by metastatic dz Take chest radiographs!!! Can also present with a cough (rare) Px poor with metastatic disease  Lung CT Intra-pulmonary metastasis Metastasis to pulmonary LNs Approach and resectability of mass  Ultrasound-guided aspirate? Depends on size and location of mass Do not perform if suspect abscess Dif cult if not adjacent to thoracic wall Reported success rate 80-90% fi  Prognosis (dogs) Solitary lesions SCC > sarcoma (19 v 8 v 1-2 month)  Prognosis (cats) Only histologic grade predictive Poorly differentiated MS 2.5 month Moderate/well differentiated MS 23 months SCC predilection for digit metastasis mechanism of action unknown treatment unrewarding Approaches to Thorax Lateral / intercostal thoracotomy Median sternotomy Trans-diaphragmatic (Thoracoscopic) Intercostal Intercostal thoracotomy Cut skin, very few muscles panniculus, (latissimus dorsi), scalenus, serratus ventralis, intercostal mm NO BONE Approach tumours of lung, heart, mediastinum Repair muscles only Chest drain Typically home in 1-3 days Median sternotomy  Median sternotomy Cut skin, re ect pectorals STERNUM OSTEOTOMY Approach tumours of lung and mediastinum Repair sternum with suture or wire Chest drain Typically home in 3-4 days fl  Advantages Single incision for abdominal / thoracic Avoids cutting intercostal muscles Disadvantages Poorer access for inspecting lymph nodes Unfamiliar approach