Bladder Tumors by MikeJenny

VIEWS: 5 PAGES: 4

									                                                                  Bladder Tumors
                                                                         Surgery Service

                             Anatomy
                             The urinary system consists of the kidneys, the ureters, the urinary bladder, and the urethra.
                             The kidneys are the organs that filter the blood to remove wastes and maintain the electrolyte
                             balance of the body. The filtered waste becomes urine, and travels to the urinary bladder
                             through the ureters. The urine continuously collects in the bladder. The bladder is able to
                             expand due to the special properties of its lining made of transitional cells. When an animal
                             urinates the urine is voided from the body through the urethra.

Available Services
                             What is urinary tract cancer?
	
  
•      24/7 Emergency
       & Critical Care       The most common type of urinary bladder cancer is transitional cell carcinoma (TCC). This
                             is a tumor of the cells that line the urinary bladder. Other less common types of tumors of
•      Cardiology            the bladder may include leiomyosarcomas, fibrosarcomas, and other soft tissue tumors.
•      Computed              TCC can also arise in the kidney, ureters, urethra, prostate, or vagina. It can spread
       Tomography            (metastasize) to the lungs, lymph nodes, bones, or other organs. Approximately 20% of
•      Dermatology           dogs with bladder cancer have metastases at the time of diagnosis. Bladder cancer is much
       & Allergy             more common in dogs than cats. In dogs, TCC accounts for less than 1% of all reported
                             cancers. TCC can occur in any breed, but is most common in Shetland sheepdogs, Scottish
•      Internal Medicine
                             terriers, Wire-hair fox terriers, West Highland terriers, and Beagles. Middle-aged or elderly
•      Interventional        female dogs are most commonly affected. Some studies have suggested that exposure to
       Radiology             certain chemicals (pesticides) may increase the risk for a dog to develop bladder cancer.
•      MRI
•      Neurology
•      Neurosurgery          Clinical signs
•      Oncology
•      Oncologic Surgery     The symptoms of bladder cancer
                             can be similar to those seen with
•      Ophthalmology         urinary tract infections. These
•      Orthopedic Surgery    include small, frequent urination,
•      Radiology             painful urination, bloody urine, and
       & Fluoroscopy         incontinence. Symptoms will often
                             improve initially with administration
•      Soft Tissue Surgery
                             of antibiotics (as bladder infection
•      Ultrasound            is a common concurrent disease),
	
                           but then recur a short time later. If
	
                           lymph nodes in the abdomen
Locations                    become very enlarged, your
                             companion may strain to defecate.
Auburn Hills                 Spread of tumor to bones can
3412 E. Walton Blvd.         cause lameness or bone pain at
(West of Squirrel Rd.)       these sites. A veterinarian may
(248) 371-3713               feel the tumor during abdominal
                             palpation if it is large. If the tumor
Grand Rapids                 has spread to lymph nodes within
1425 Michigan St. NE         the abdomen, they may be
(East of Fuller Rd.)         palpated during a digital rectal
                                                                                           Used	
  with	
  permission,	
  Hill’s	
  Pet	
  Nutrition	
  
(616) 284-5300               examination. If the bladder tumor
                             invades into the urethra it can block
MVS Southfield               urine flow and cause straining to urinate. If severe enough this can eventually lead to kidney
29080 Inkster Rd.            damage and build up of waste products in the body. Complete inability to urinate is a
(North of 12 Mile Rd.)       medical emergency and should be addressed by a veterinarian immediately.
(248) 354-6660
                               Bladder Tumors Continued…

Diagnosis        .*"%#*/()*#0,(1%2+0,"&%(3.)14(5&%,"%6+7888(
Urinalysis: Pets with bladder cancer sometimes have cancer cells found in their urine. However, inflammation of the
urinary tract from an infection can form similar kind of cells so this test is rarely diagnostic for bladder cancer.
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However, it does check for secondary infections of the bladder (due to the tumor) and helps to evaluate the health of
the kidneys.
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Blood work is often normal in pets with bladder cancer unless kidney function is impaired. In that case, your
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veterinarian may find that your pet has evidence of kidney dysfunction. Blood work is also important because it
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helps evaluate your pet’s overall health, and may affect the best treatment option.
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Veterinary bladder tumor antigen (VBTA) test: This is a screening test run on urine to check for bladder tumors in
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dogs. One of the pit falls of this test is that dogs without bladder cancer will test positive for VBTA, especially if
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there is a bladder infection.
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Abdominal Imaging: Bladder tumors are rarely evident on normal x- rays, however spread of tumor to the bones may
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be# evident. Sometimes special dye studies (cystograms) can be done to make the tumors visible on x-rays. This
study is especially helpful if your veterinarian suspects that the tumor may be invading your pet’s urethra. Another
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way to image the abdomen is with ultrasound. Ultrasound is helpful for looking at the size of the tumor within the
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bladder and the size of lymph nodes surrounding the tumor.
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Chest Imaging: Since bladder cancers can spread to the lungs your veterinarian may take chest x-rays to check for
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metastases.
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Biopsy: To definitively diagnose TCC of the bladder, a sample of cancerous cells must be evaluated. This is usually
done with either a surgical biopsy or from cells collected through an ultrasound-guided urinary catheter. In female
dogs, cystoscopy (camera is inserted into the bladder) is useful to directly visualize and biopsy the tumor. The
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biopsy will be sent to a pathologist to examine under a microscope.

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Treatment
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Surgery: Surgical removal of the entire tumor is rarely possible. This is because the tumor usually arises where the
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ureters and urethra enter the bladder and surgery would disrupt these vital structures. Occasionally the tumor
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arises elsewhere in the bladder (especially in cats) and surgery can remove all or most of the tumor. When the
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tumor is only reduced in size at surgery this is called “debulking”. Although it may temporarily relieve symptoms for
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the pet, the tumor will regrow.
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Chemotherapy: Unfortunately, a chemotherapy protocol that works well for bladder cancers in pets has not yet been
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found. Less than 20% of pets will respond to the intravenous chemotherapy protocols currently used. An oral anti-
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inflammatory drug called piroxicam (Feldene) has also been shown to have some anti-cancer activity and may help
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some dogs and works best when combined with chemotherapy.
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Radiation Therapy: Radiation therapy can be helpful in some patients with bladder cancer. Although some studies
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suggest it works better than chemotherapy it can have serious side effects (see below).

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Potential complications
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Recurrent urinary tract infections and incontinence are common in dogs with TCC of the bladder. As bladder cancer
enlarges in size it can obstruct the flow of urine. Inability to urinate is a medical emergency. When this
                                 Bladder Tumors Continued…
complication is anticipated and a pet is otherwise healthy a procedure called a “tube cystotomy placement” can be
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considered. This involves surgically placing a tube that goes from the urinary bladder to outside the pet’s body
through which urine can be emptied. Management of these tubes requires significant nursing care at home to
regularly empty urine and prevent infections. Chemotherapy can cause bone marrow suppression leading to
anemia and increased susceptibility to infections. Both chemotherapy and piroxicam can cause gastrointestinal
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(GI) side effects such as vomiting, diarrhea, or GI ulcers. Radiation therapy can have side effects such as
narrowing the urethra (causing blockage) or incontinence.
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Aftercare
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Pets with TCC of the bladder must be monitored closely at home for bladder infections (secondary to the tumor)
or :"23#:&52*0%&#"0#%(50*&)*$#(/6:*0)#"8#<3%2*#:4""$#5*44)#BDEFG)C#&0*#70*)*(2-#."/0#1*2*0%(&0%&(#<%44#)/''*)2#7*08"06%('#&#
    inability to urinate. Pets receiving chemotherapy or radiation therapy will need regular hospital stays for
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treatment. Pets receiving chemotherapy and piroxicam need frequent rechecks of their bloodwork to evaluate
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their kidney function. Repeated abdominal imaging studies are needed to follow the progress of the tumor and
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evaluate the effect of therapies. Pets with tube cystostomy require careful nursing care at home to keep their
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bladder emptied and their surgery site clean.
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Prognosis
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The long-term prognosis for pets with bladder cancer is generally poor regardless of therapy. However, with
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treatment pets can have a better quality of life for a longer period of time. On average, dogs with TCC of the
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bladder live 4-6 months without treatment and 6-12 months with treatment.
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Reference
  )*1*0&4#8&52"0)-#%(54/$%('#<3*23*0#%2#%)#&#$"'#"0#5&2-#23*#&'*#"8#23*#&(%6&4-#<3*23*0#23%)#%)#&#8%0)2#2%6*#+!,#"0#&##
Henry CJ, McCaw DL, Turnquist SE, et al. Clinical evaluation of mitoxantrone and piroxicam in a canine model of
  0*5/00*(5*#"8#&#+!,-#<3&2#23*#:&52*0%&4#"0'&(%)6#%)-#&($#<3&2#&(2%:%"2%5)#%2#%)#)*()%2%1*#2"-#&($#%8#5"674%5&2%('#8&52"0)#&0*#
human invasive urinary bladder carcinoma. Clin Cancer Res 9:906-911, 2003.
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  +!,#3&)#("2#0*5/00*$#"0#%)#/($*0#5"(20"49#,(#)"6*#&(%6&4)#<%23#5"674%5&2%('#8&52"0)#70*)*(2-#&#/0%(&0.#&(2%)*72%5#"0#&(##
  &(2%:%"2%5#6/)2#:*#'%1*(#4"('#2*06#2"#70*1*(2#&#+!,#80"6#0*"55/00%('9##
                                       Bladder Tumors Continued…

                 and recommendations
       Assessment.*"%#*/()*#0,(1%2+0,"&%(3.)14(5&%,"%6+7888(
       Patient: __________________________________                                 Date: _________________
         !"#$%&'"'(
       Treatment
         Surgery is recommended by a surgeon at Michigan Veterinary Specialists
         !"#$%&'(")*#&#+!,-#."/0#1*2*0%(&0%&(#)3"/4$#5"44*52#&#)2*0%4*#/0%(*#)&674*#80"6#."/0#7*29#!3*#:*)2#6*23"$#2"#5"44*52#/0%(*#
         Surgery is not recommended
         %)#:.#&#2*53(%;/*#5&44*$#5.)2"5*(2*)%)-#$/0%('#<3%53#&#(**$4*#%)#%()*02*$#230"/'3#23*#:"$.#<&44#%(2"#23*#:4&$$*0#&($#/0%(*#
         Further evaluation by one of our oncologists is recommended
         %)#0*6"1*$#:.#&#).0%('*9#!3%)#2*53(%;/*#%)#1*0.#)&8*#&($#7&%(4*))#2"#."/0#7*29#=0**#5&253#/0%(*#)&674*)#"0#)&674*)#":>
         2&%(*$#80"6#23*#84""0#"0#"88%5*#*?&6%(&2%"(#2&:4*#&0*#%(1&0%&:4.#5"(2&6%(&2*$#)&674*)#&($#("2#)/%2&:4*#8"0#*1&4/&2%"(#2"#
         $*2*06%(*#%(8*52%"(9##
       The following has been prescribed
         #         No medications or special diet are necessary at this time
         @"/0#1*2*0%(&0%&(#<%44#&(&4.A*#23%)#/0%(*#)&674*#B/0%(&4.)%)C#&($#*?&6%(*#&#)6&44#&6"/(2#/($*0#&#6%50")5"7*9#,8#*%23*0#"0#
                   Diet: ______________________________________________________________
         :"23#:&52*0%&#"0#%(50*&)*$#(/6:*0)#"8#<3%2*#:4""$#5*44)#BDEFG)C#&0*#70*)*(2-#."/0#1*2*0%(&0%&(#<%44#)/''*)2#7*08"06%('#&#
                   Antibiotic:__________________________________________________________
         /0%(*#5/42/0*9#!3*#70*)*(5*#"8#<3%2*#:4""$#5*44)#6*&()#23&2#%(84&66&2%"(#%)#70*)*(2#:/2#$"*)#("2#(*5*))&0%4.#6*&(#&#+!,#
                   Nonsteroidal anti-inflammatory medication: _______________________________
         %)#70*)*(29#H%I*<%)*-#%(#&(#&(%6&4#<3")*#%66/(*#).)2*6#%)#5"670"6%)*$#"0#3&1%('#3%'34.#$%4/2*$#/0%(*-#&#+!,#6&.#:*#
                   Other medication: ____________________________________________________
         70*)*(2-#:/2#23*#/0%(&4.)%)#6&.#("2#0*1*&4#<3%2*#:4""$#5*44)#"0#:&52*0%&9#J#/0%(*#5/42/0*#%)#23*#:*)2#6*23"$#8"0#5"(8%06%('#&#
         +!,#%)#70*)*(29###
       Preparation for surgery
         #
                  Start fasting your companion at midnight before surgery; water should not be withheld
         J#/0%(*#5/42/0*#%(1"41*)#)*($%('#&#)6&44#7&02#"8#23*#5"44*52*$#/0%(*#2"#&#4&:"0&2"0.#23&2#<%44#20.#2"#'0"<#23*#:&52*0%&9#,8#("#
                  Pepcid AC 10 mg tablets: give ______ tablets with water (if needed use a syringe) at 6 AM on the day of
         :&52*0%&#'0"<-#23*(#&#+!,#%)#/(4%I*4.#2"#:*#70*)*(29#,8#:&52*0%&#'0"<-#23*(#23*#"0'&(%)6#<%44#:*#%$*(2%8%*$#&($#&(2%6%50":%&4#
                    surgery
         )/)5*72%:%4%2.#<%44#:*#7*08"06*$#:.#23*#4&:"0&2"0.9#J(2%6%50":%&4#)/)5*72%:%4%2.#2*)2%('#/)/&44.#2&I*)#K>L#$&.)#8"0##
                  Other medications: ___________________________________________________
         5"674*2%"(9##
         ##
         ,(#)"6*#&(%6&4)-#&$$%2%"(&4#2*)2%('#6&.#(**$#2"#:*#$"(*-#)/53#&)#:4""$#<"0I#"0#%6&'%('#)2/$%*)#B0&$%"'0&73)#"0#/420&>
         )"/($C-#:*5&/)*#&#:&52*0%&4#+!,#6&.#"55/0#&)#&#0*)/42#"8#"0#%(#5"6:%(&2%"(#<%23#"23*0#$%)*&)*)#B*9'9-#:4&$$*0#)2"(*)-#
         530"(%5#I%$(*.#$%)*&)*-#8*4%(*#4*/I*6%&#1%0/)C9####                        Composed by Daniel A. Degner, DVM, DACVS
                                                                                         Edited by Ned F. Kuehn, DVM, MS, DACVIM
         )*+#,-+%,(

         )*1*0&4#8&52"0)-#%(54/$%('#<3*23*0#%2#%)#&#$"'#"0#5&2-#23*#&'*#"8#23*#&(%6&4-#<3*23*0#23%)#%)#&#8%0)2#2%6*#+!,#"0#&##
         0*5/00*(5*#"8#&#+!,-#<3&2#23*#:&52*0%&4#"0'&(%)6#%)-#&($#<3&2#&(2%:%"2%5)#%2#%)#)*()%2%1*#2"-#&($#%8#5"674%5&2%('#8&52"0)#&0*#
         &))"5%&2*$#<%23#23*#+!,9####
         #
         J#)%674*#B"0#/(5"674%5&2*$#+!,C#"55/0)#70%6&0%4.#%(#)7&.*$#8*6&4*#$"')#&($#%)#("2#&))"5%&2*$#<%23#).)2*6%5#%44(*))#"0#
         5"674%5&2%('#$%)*&)*)9#,(#23%)#5&)*-#&(2%:%"2%5)#&0*#2.7%5&44.#'%1*(#8"0#M#2"#NO#$&.)9##
         #
         J#5"674%5&2*$#+!,#"55/0)#<3*(#23*0*#&0*#"(*#"0#6"0*#5"674%5&2%('#$%)*&)*)#"0#%8#23*#+!,#%)#0*5/00*(29#P*6*6:*0-#23&2#
         ."/('#5&2)#0&0*4.#3&1*#&#+!,#&($#%(#"4$*0#5&2)#+!,#%)#/)/&44.#5"674%5&2*$#:.#530"(%5#I%$(*.#$%)*&)*9#J("23*0#*?&674*#"8#
         &#5"674%5&2%('#$%)*&)*#%)#$%&:*2*)#6*44%2/)#"0#3.7*0&$0*("5"02%5%)6#BF/)3%('G)#$%)*&)*C9#,(#&(%6&4)#<%23#&#5"674%5&2*$#
         +!,-#&(2%:%"2%5)#6&.#:*#0*5"66*($*$#8"0#Q#2"#R#<**I)9#J#/0%(*#5/42/0*#<%44#4%I*4.#:*#0*5"66*($*$#7&02<&.#230"/'3#23*#
         20*&26*(2#2"#6&I*#)/0*#23*#+!,#%)#/($*0#5"(20"4-#&($#23*(#&'&%(#&82*0#23*#&(2%:%"2%5#20*&26*(2#%)#8%(%)3*$#2"#6&I*#)/0*#23*#
         +!,#%)#54*&0*$9##
         #
         J423"/'3#"23*0#20*&26*(2)#&0*#)"6*2%6*)#0*5"66*($*$#B%9*9-#50&(:*00.#S/%5*C-#("#5"(54/)%1*#*1%$*(5*#70"1*)#23*.#&0*#"8#
         :*(*8%2#2"#$"')#&($#5&2)9#T0"672#&($#&770"70%&2*#&(2%:%"2%5#20*&26*(2#:&)*$#"(#/0%(*#5/42/0*#&($#)*()%2%1%2.#%)#23*#:*)2#
         <&.#2"#*0&$%5&2*#&#:&52*0%&4#+!,9####


         9*+:+%,"&%(
         ,(#6")2#%()2&(5*)#("23%('#)7*5%8%5#5&(#:*#$"(*#2"#70*1*(2#&#+!,#80"6#"55/00%('9#@"/0#$"'#"0#5&2#)3"/4$#:*#0*>*1&4/&2*$#%8#
         54%(%5&4#)%'()#0*5/09#D%23#5"674%5&2*$#+!,-#."/0#1*2*0%(&0%&(#)3"/4$#7*0%"$%5&44.#*1&4/&2*#."/0#7*2#2"#6&I*#)/0*#23&2#23*#
         +!,#3&)#("2#0*5/00*$#"0#%)#/($*0#5"(20"49#,(#)"6*#&(%6&4)#<%23#5"674%5&2%('#8&52"0)#70*)*(2-#&#/0%(&0.#&(2%)*72%5#"0#&(##
         &(2%:%"2%5#6/)2#:*#'%1*(#4"('#2*06#2"#70*1*(2#&#+!,#80"6#0*"55/00%('9##




	
  

								
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