Atlas of tumours by Grupo Asís

Presentation brochure

Adrián Romairone Duarte Juan Carlos Cartagena Albertus

Atlas of tumours

Servet (División de Grupo Asís Biomedia S.L.) Centro Empresarial El Trovador, planta 8, oficina I Plaza Antonio Beltrán Martínez, 1 • 50002 Zaragoza (España) Tel.: +34 976 461 480 • Fax: +34 976 423 000 • www.grupoasis.com

Atlas of tumours Oncology in daily clinical practice Adrián Romairone Duarte Juan Carlos Cartagena Albertus

The publishing strength of Grupo AsĂs Editorial Servet, a division of Grupo AsĂs, has become one of the reference publishing companies in the veterinary sector worldwide. More than 15 years of experience in the publishing of contents about veterinary medicine guarantees the quality of its work. With a wide national and international distribution, the books in its catalogue are present in many different countries and have been translated into nine languages to date: English, French, Portuguese, German, Italian, Turkish, Japanese, Russian and Chinese. Its identifying characteristic is a large multidisciplinary team formed by doctors and graduates in Veterinary Medicine and Fine Arts, and specialised designers with a great knowledge of the sector in which they work. Every book is subject to thorough technical and linguistic reviews and analyses, which allow the creation of works with a unique design and excellent contents. Servet works with the most renowned national and international authors to include the topics most demanded by veterinary surgeons in its catalogue. In addition to its own works, Servet also prepares books for companies and the main multinational companies in the sector are among its clients.

Atlas of tumours Adrián Romairone Duarte Juan Carlos Cartagena Albertus

Atlas of tumours

Oncology in daily clinical practice

Atlas of tumours Oncology in daily clinical practice Adrián Romairone Duarte Juan Carlos Cartagena Albertus

Authors: Adrián Romairone Duarte,

Juan Carlos Cartagena Albertus.

Format: 22 x 28 cm. Number of pages: 200. Number of images: 411. Binding: hardcover.

RETAIL PRICE

70 €

This book describes a practical, simple work protocol which may be useful to most of those first-opinion veterinary practitioners who have to deal with cases of neoplasia in their practices. It combines the experience in clinical oncology of a first-opinion veterinary surgeon and the knowledge of a veterinary practitioner specialised in this field, and includes a wide variety of images of the most common tumours in small animals as well as in exotic species. Some key aspects such as how to collect and send samples to the laboratory, and basic surgical techniques in oncology are also addressed.

Presentation of the book The presence of tumours (masses) is a common cause for consultation in daily clinical practice and a source of concern of pet owners. When the tumour is visible or palpable, the diagnostic and therapeutic approach is usually quick and effective, in many cases resulting in complete resolution of the tumour, or at least minimizing the effects on the health of the pet. Systemic tumours and those that are not visible or palpable (e.g. adrenal or pituitary tumours) require prior suspicion based on medical history, clinical signs, and a systematic examination, supported by a solid knowledge of internal medicine. Identification of paraneoplastic signs can mean the difference between a neoplastic process with a very poor prognosis and one which, if diagnosed in time, allows the establishment of treatments that provide a better prognosis, avoiding unnecessary suffering on the part of the patient, and by extension, the owner. When should a tumour be suspected? ALWAYS, especially when processes are refractory to initial therapy or when symptoms persist over time. It should be noted that coughing, diarrhoea, vomiting, lameness, alopecia, anaemia and hypercalcaemia, among other clinical signs, are induced in response to some form of damage or injury. Accordingly, the absence of a response to treatment or persistence of these symptoms over time is indicative of potentially pathological processes, which can often have devastating consequences for the patient. Translation of the initial suspicion to an early diagnosis opens the door to a wide range of potential cures. The veterinary clinician is the link between the patient and the veterinary oncology specialist. These are two essential players in a race against the clock to ensure the best outcome for the patient. The general knowledge of one and the specialised expertise of the other should give rise to a synergy that is transmitted to the owner in the form of trust.

Atlas of tumours

Where does the work of the clinician end and that of the specialist being? 1. After surgical removal of a visible tumour, adjuvant treatment is required to attain a longer disease-free period than that provided by surgical intervention alone. The specialist should be able provide the best information on chemotherapy and all its potential applications. 2. When specialised treatments are considered as a last resort before opting for euthanasia, whether due to the tumour type (e.g. inflammatory carcinoma, evident metastasis) or the owner’s preferences (e.g. refusal to amputate a limb in a case of osteosarcoma or to consent to a mandibulectomy). 3. In most cases of non-visible or systemic tumours (e.g. cerebral or glandular tumours), which, due to a lack of experience (casuistry) or diagnostic resources, cannot be tackled in either the diagnostic or treatment stages. I hope that the work presented here, which is the fruit of a joint collaboration between a clinician and a specialist, will serve to consolidate this specialty within our profession, not only in academia, but also in the daily clinical practice that ensures the good health of dogs, cats and new pets. Cancer research in recent decades has unravelled the mysteries of oncogenic viruses, oncogenes, suppressor genes, protooncogene activation, and the direct action of environmental stimuli, such as ultraviolet light, and has identified myriad carcinogens that can promote or produce serious mutations that result in malignant neoplasms. While there is still much to be discovered about this widespread disease, it no longer represents the threat it once did. In the words of the oncologist Jaime Modiano: “The biggest risk factor for contracting cancer is being alive”. Therefore, we must strengthen the bond between clinicians and specialists in order to harness the vast range of options for the early diagnosis and treatment of cancer. Adrián Romairone Duarte

The authors Adri谩n Duarte Romairone Degree in Veterinary Medicine from the Faculty of Veterinary Sciences, General Pico, La Pampa, part of the National University of La Pampa (Argentina). Currently in the final stage of his PhD. Veterinary clinician since 1987. Owner of Centro de Diagn贸stico Veterinario, which specialises in diagnosing diseases in companion animals and birds of prey. Owner and editor of the website www.diagnosticoveterinario.com. His areas of interest include clinical oncology, diagnostic cytology, soft tissue surgery, oncology and traumatology, with a particular focus on osteosynthesis by internal and external fixation, and medical and surgical pathology of birds of prey.

Atlas of tumours

Juan Carlos Cartagena Albertus Degree in Veterinary Medicine, Zaragoza, 1987. Member of the Royal College of Veterinary Surgeons (RCVS), Master of Science (MSc), accredited by AVEPA in the fields of oncology and soft tissue surgery and university specialist in endoscopy and minimally invasive surgery (EAMIS). He is also a member of the European Society of Veterinary Oncology (ESVONC) and of the endoscopy, oncology and soft-tissue surgery working groups of AVEPA.

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He currently works at Night Vets Limited in Upminster, UK.

Communication services Website Online visualisation of the sample chapter. Presentation brochure in PDF format. AuthorÂ´s CV. Sample chapter compatible with iPad.

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Atlas of tumours Oncology in daily clinical practice Adriรกn Romairone Duarte Juan Carlos Cartagena Albertus

Table of contents General aspects of clinical oncology 1. Basic principles of the diagnostic approach Paraneoplastic syndromes Clinical signs of suspected cancer Abdominal enlargement Alopecia Nail disorders Cutaneous calcinosis (calcinosis cutis) Faecal alterations Vomiting Oestrogen-secreting tumours Haematuria Horner syndrome Jaundice Limb swelling

2. Sample collection and transport to the laboratory Sample collection Biopsies and punctures Biopsy material Endoscopic biopsy

Fixation and storage of the sample

3. Principles of surgical oncology Safety margins Surgical manipulation of the tumour

Cancer types by system 4. Tumours of the reproductive system in males and females Female reproductive system: mammaryÂ tumours Introduction Histological classification Prognostic factors Treatment

Male reproductive system: testicular neoplasms Introduction Tumour characteristics Diagnosis Treatment Prognosis

Male reproductive system: prostatic neoplasms Introduction Clinical signs Diagnosis Treatment

5. Skin tumours Aetiology Classification Diagnostic approach in the clinic The importance of cytology

Common skin tumours

Preplanning

Papillomas

Proper handling

Squamous cell carcinoma

Use of antibiotics

Neoplasms of the sebaceous glands

Estimation of caloric and electrolyte requirements

Adenoma of the perianal glands or hepatoid cells Lipomas Schwannoma Melanoma/melanosarcoma Histiocytoma

Epitheliotropic lymphoma

Clinical signs

Mastocytoma

In the limbs

Trichoepithelioma

In the axial skeleton

Fibrosarcoma

General clinical signs of systemic disturbance

6. Tumours of the digestive system Oral malignancies Overview Canine oral tumours Feline oral tumours

Gastric neoplasms Overview

Diagnosis Diagnostic radiology Cytological and histopathological diagnosis

9. Neoplasms in non-traditional species Common tumours in non-traditional species

Canine gastric adenocarcinoma

Renal adenocarcinoma in a parakeet

Canine gastric leiomyoma or leiomyosarcoma

Osteosarcoma in a ferret

Alimentary lymphoma

Feather cysts

Canine gastric plasmacytoma

Melanocytic tumour and squamous cell carcinoma

Intestinal neoplasms Overview Rectoanal polyps and papillary adenoma of the rectum

Uterine tumour in a rabbit Abdominal tumour (ovarian) in a squirrel Mastocytoma in a goshawk

Intestinal adenomas and adenocarcinomas

Thymoma in a Bonelliâ&#x20AC;&#x2122;s eagle

Intestinal carcinoid tumours

Bile duct carcinoma

Alimentary lymphoma

Cutaneous xanthomas

7. Neoplasms of the eye and orbit Neoplasms of the eyelids Neoplasms of the eyelids in dogs Neoplasms of the eyelids in cats

Other neoplasms Intraocular neoplasms Orbital neoplasms Mesenchymal tumours Secondary intraocular tumours

Papilloma in the external ear canal of a Russian hamster

10. Practical chemotherapy Treatments Adjuvant chemotherapy Metronomic chemotherapy Small molecule inhibitors (SMI)

Side effects of chemotherapy Neutropenia and sepsis Gastrointestinal disorders

Diagnostic investigation

Annexes

Treatment

Annex 1. Most commonly used drugs in veterinary oncology

8. Neoplasms of the limbs. Osteosarcoma Aetiology Physical factors Genetic factors

Annex 2. Weight to body surface area conversion table

References

AtlAs of tumours

oncology in daily clinical practice

General aspects of clinical oncology

Alopecia Alopecia affecting a significant area of the body surface is a typical sign indicative of potential cancer of the adrenal glands. The underlying origin of the alopecia will need to be determined, ruling out common pathologies that can cause this condition (Figs. 4 and 5).

Nail disorders These include abnormal growth and complete collapse of the nail, as well as the development of deformations. These types of alterations in the absence of trauma, coupled with signs of inflammation (deformation of the digit), pain and odour, serve as a warning of possible digital tumours such as squamous cell carcinomas and melanosarcomas (Figs.6 and 7).

Figures 4 and 5. Alopecia.

Figure 6. Loss of a nail.

Figure 7. Fallen nail.

Basic principles of the diagnostic approach

Cutaneous calcinosis (calcinosis cutis) Cutaneous calcinosis is process of dystrophic mineralization of the skin and can be associated with many processes. However, above all, its presence indicates possible increases in the levels of endogenous corticosteroids (in the absence of prolonged corticosteroid treatment) (Fig. 8). The appearance of bilateral, symmetrical cutaneous signs of unknown aetiology, consistent with cutaneous calcinosis, should be evaluated as a potential indicator of neoplastic processes affecting the adrenal glands.

Faecal alterations Changes in the characteristics of the faeces (Fig. 9) in terms of morphology, appearance and frequency, together with signs of tenesmus or lameness that do not respond to anti-inflammatory medication in non-neutered males, should be considered potential indicators of prostatomegaly, which should be included in the differential diagnosis of neoplastic processes of the prostate.

Figure 8. Cutaneous calcinosis.

Figure 9. Altered stool morphology.

Any signs of potential cancer should never be considered in isolation. They should be assessed taking into account the characteristics of the patient, including age, gender, coat, breed and body condition, where the animal lives, and the habits of the owner. These characteristics may be related to the process, which must be first diagnosed and subsequently treated. Consideration of all these variables can contribute to a greater awareness of the risk factors associated with cancer in pets.

AtlAs of tumours

oncology in daily clinical practice

General aspects of clinical oncology

NOTE FOR SPECIALISTS

Resection margins can vary depending on the tumour type. For example, in the case of grade 1 mastocytomas it is crucial to attempt a surgical cure.

In many cases, due to the anatomical location of the tumour or the ownerÂ´s wish to avoid potential scarring of their pet, the surgeon must decide between a conservative surgery and radical surgery or en bloc resection of the tumour (e.g., limb amputation in the case of a diagnosed osteosarcoma). In these cases, it is essential to establish a therapeutic alliance between the owner and the veterinarian, whereby all the necessary information is shared so that both parties jointly assume the responsibilities that may arise as the disease progresses. As veterinarians we can recommend or suggest a treatment, but we cannot oblige a client to approve it.

Principles of surgical oncology

Figures 7-15. Safety margin in removing tumours. Mastocytoma.

Incision surface Lesion size Size of excision

Incision depth

Figure 16. Safety margins (lateral and deep margins).

AtlAs of tumours

Oncology in daily clinical practice

Cancer types by system

Trichoepithelioma Benign, dermoepidermal neoplasm of the hair follicle. No sex predisposition has been described. Can be solid or cystic, solitary or multiple. Common in dogs and rare in cats. The prognosis is good and correctly performed surgery is curative (Figs. 52 and 53).

Figures 52 and 53. Cystic trichoepithelioma.

Fibrosarcoma Malignant neoplasm that develops from cutaneous or subcutaneous fibroblasts. In cats the appearance of this tumour can be associated with an oncogenic virus (feline sarcoma virus) or an exacerbated reaction of the subcutaneous tissue to an injection, with subsequent malignant transformation. These are firm, solitary or multiple cutaneous masses of variable size with an uneven surface. They manifest as protrusions from the body surface (Figs. 54 and 55).

Figure 54. Fibrosarcoma on the lateral aspect of the neck of a geriatric fox terrier.

Figure 55. Fibrosarcoma associated with feline sarcoma virus or injection site reaction.

Skin tumours

THE SPECIALIST'S PERSPECTIVE

Soft tissue sarcomas:

• The staging of soft tissue sarcomas should include chest x-rays (3 positions) and evaluation of local lymph nodes.

• While aggressive surgery is the first therapeutic option, radiotherapy, if possible, gives good results in terms of long-term disease control.

• If the appropriate surgery cannot be performed, the disease will almost certainly recur.

• Computed tomography (CT) and magnetic resonance (MR) are excellent techniques for planning surgery.

• Oral sarcomas have a very poor prognosis and require thorough planning. Cutaneous melanomas:

• These are relatively rare (5 % of all skin tumours in dogs) and usually benign. • Unlike in humans, cutaneous melanomas in dogs do not appear to be related to direct exposure to sunlight.

• Melanomas located on the nails and in mucocutaneous areas are usually highly malignant.

• While surgery is the first option, radiotherapy, if possible, is very useful complement.

• Promising survival rates have been obtained with a vaccine indicated for stage II and III oral melanomas, once local disease control has been achieved.

AtlAs of tumours

Oncology in daily clinical practice

Cancer types by system

Neoplasms of the eye and orbit Introduction Ocular tumors in dogs and cats tend to be more frequent in the tissues of the anterior segment and eyelids. The orbit can also be affected.

In dogs ocular neoplasms are usually benign, while those affecting cats are more likely to be malignant.

When dealing with an ocular neoplasm, it is important to remember that although it may be benign, it can cause problems that necessitate surgery (Figs. 1 and 2).

Eyelids neoplasms Eyelid neoplasms in dogs These are the most common ocular tumours and are usually benign. Of these Meibomian gland adenoma is the most frequent (Figs. 3-8). This neoplasm resembles a papillary growth, and normally develops outward from the eyelid margin. It appears that Shih Tzus, Standard Poodles and Cocker Spaniels are more predisposed to this type of neoplasm. These breeds are also predisposed to sebaceous adenomas of the skin.

Figure 1. Benign tumor of epithelial origin in the cornea of a dog.

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Figure 2. Resection of benign tumor of the previous image.

Neoplasms of the eye and orbit

Figure 3. Meibomian gland adenoma.

Figure 4. Ulcerated and slightly pigmented Meibomian gland adenoma.

Figure 5. Ulcerated Meibomian gland adenoma. The inner surface of the eyelid and the spread of the adenoma can be observed.

Figure 6. Meibomian gland adenoma in a dog.

Figure 7. Meibomian gland adenoma on the eyelid margin of a dog.

Figure 8. Meibomian gland adenoma on the upper eyelid of a dog.

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Cancer types by system

Figure 31. Tumour on the dorsal surface of the tibiotarsus of a peregrine falcon. Figure 32. Detail from the previous image. Marked subcutaneous pigmentation is evident.

Figure 33. Feather cyst with marked lipid pigmentation. The base of the cyst resembles a xanthoma. Figure 34. Detail from the previous image showing the marked difference between the base and the surface of the tumour. Figure 35. Dissection of removed tumour.

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Neoplasms in nontraditional species

Papilloma in the ear canal of a Russian hamster Epithelial malignancies are common in rodents. They are usually benign, except for those that develop rapidly to form disorganized tumours in the subcutaneous tissue. Papillomas, especially those that bleed, must be differentiated from ceruminous adenocarcinomas (Figs. 36 and 37). More images of malignancies in nontraditional species are shown below (Figs. 38-65).

Figure 36. Papilloma obliterating the opening of the ear canal. Figure 37. A tendency is seen the self-trauma scraped.

Figure 38. Ulcerated cutaneous adenocarcinoma in a Russian hamster.

Figure 39. Meibomian gland adenoma in a Russian hamster.

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Cancer types by system

Practical chemotherapy Introduction All animals with cancer, as well as their owners, can be helped in some way. In veterinary oncology the patientÂ´s quality of life is always the priority and this specialty is continuously advancing the management of cancer in dogs and cats. Treatment approaches change frequently. This forces us to continuously renew our knowledge and update our protocols. Advances in genetics, molecular biology, and human oncology have led to progress within this veterinary specialty. Conventional chemotherapy (CC) is increasingly accepted by pet owners and other veterinarians. The acceptance of owners and the demonstrated tolerance of animals to chemotherapy protocols have contributed to this development. When chemotherapy is proposed, it is essential to inform and communicate with the customer, in order to best tailor the treatment to the needs of the animal and the considerations of the owner.

The ownerÂ´s PersPecTIve In an interesting survey (Harland et al., 2011), 55% of pet owners chose surgery as the best treatment option for their pet, while 27% preferred a combination of surgery, chemotherapy and radiotherapy (Fig. 1). Chemotherapy/ radiation therapy alone was a much less popular option. Only 51% of participants knew of the existence of veterinarians specialising in this field, but 75% agreed to be referred to another centre. Factors related to the welfare of the pet were more important than the ownerÂ´s considerations (e.g., the cost of treatment) when deciding on a treatment.

Figure 1. Patient receiving intravenous chemotherapy with mitoxantrone.

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Presentation brochure

Adrián Romairone Duarte Juan Carlos Cartagena Albertus

Atlas of tumours

Atlas of tumours Oncology in daily clinical practice Adrián Romairone Duarte Juan Carlos Cartagena Albertus