Difference between revisions of "Exocrine Pancreatic Neoplasia - Dogs and Cats"
| Line 6: | Line 6: | ||
* Adenomas | * Adenomas | ||
| + | It is important to make the distinction between pancreatic neoplasia and nodular hyperplasia which frequently occurs in older animals. | ||
| − | |||
==Signalment== | ==Signalment== | ||
| Line 14: | Line 14: | ||
* Airedale terriers may have a breed predisposition | * Airedale terriers may have a breed predisposition | ||
* Affected cats have a mean age of 12 years | * Affected cats have a mean age of 12 years | ||
| + | |||
==Description== | ==Description== | ||
| − | Aetiology is idiopathic. Adenomas, although they do not metastasise and are frequently small and focal they can compress the surrounding pancreas. Carcinomas are aggressive with local invasion of the stomach or duodenum and metastasis to the liver, regional lymph nodes, lungs, periotoneal surface and other abdominal organs. Other complications include blockage of the common bile duct and exocrine pancreatic insufficiency. Pancreatitis can also occur where pancreatic atrophy results in tumour necrosis and an inflammatory response. | + | Aetiology is idiopathic. Adenomas, although they do not metastasise and are frequently small and focal they can compress the surrounding pancreas. Carcinomas are aggressive with local invasion of the stomach or duodenum and metastasis to the liver, regional lymph nodes (hepatic and splenic), lungs, periotoneal surface and other abdominal organs. Other complications include blockage of the common bile duct and exocrine pancreatic insufficiency. Pancreatitis can also occur where pancreatic atrophy results in tumour necrosis and an inflammatory response. |
| + | |||
==Diagnosis== | ==Diagnosis== | ||
| Line 33: | Line 35: | ||
===Physical Examination=== | ===Physical Examination=== | ||
In cats, a mass may be palpable in the abdomen | In cats, a mass may be palpable in the abdomen | ||
| + | |||
| + | ===Haematology and Biochemistry=== | ||
| + | Potential abnormalities include: | ||
| + | * Anaemia | ||
| + | * Neutrophilia | ||
| + | * Elevated hepatic enzymes or bilirubinaemia - if there is cholestasis or biliary obstruction | ||
| + | * Hyperglycaemia - If there is concurrnet beta cell destruction | ||
| + | * Hypokalaemia | ||
| + | |||
| + | ===Plain Radiography=== | ||
| + | Abdominal radiography may reveal a mass or mottled appearance on account of local peritonitis. In addition, there may be diplacement of the descending duodenum and pylorus. Where there is peritoneal metastasis and effusion loss of serosal detail and increased radiodensity may be observed. Thoracic radiography is also advised for pulmonary metastases. | ||
| + | |||
| + | ===Ultrasonography=== | ||
| + | Provides information on the extent of the tumour and its invasiveness. A guided fine needle aspirate may be taken at this time, however, cytological examination is often unrewarding as pancreatic tumour cells do not exfoliate well. | ||
| + | |||
| + | ===Exploratory Celiotomy=== | ||
| + | Excising the whole tumour if operable or taking a sample via shave biopsy or crush ligation allows histopathological confirmation. | ||
| + | |||
| + | |||
==Treatment== | ==Treatment== | ||
| + | ===Surgery=== | ||
| + | Often at the time of diagnosis adenocarcinomas have already metastasised or local invasion has already taken place. If metastasis has no yet occurred surgical resection may be attempted with care to avoid iatrogenic trauma to the vascular supply to the proximal duodenum and obstruction of the main pancreatic duct. Total pancreatectomy is not advised. Tumours of the body or base of the pancreas are inoperable. Small pancreatic adenomas may be removed via partial pancreatectomy. | ||
| + | |||
| + | ===Chemotherapy=== | ||
| + | Not recommended. | ||
| + | |||
| + | ===Radiotherapy=== | ||
| + | Not recommended. | ||
| + | |||
==Prognosis== | ==Prognosis== | ||
| + | Poor for adenocarcinomas on account of their invasiveness and early metastasis. Survival time is less than 1 year for such tumours. | ||
| + | |||
==References== | ==References== | ||
Revision as of 15:31, 12 August 2009
 |
This article is still under construction. |
Primary pancreatic tumours are rare, however the pancreas is also a site for metastasis from particularly gastro-intestinal neoplasms. Primary tumours include:
- Carcinomas
- Adenocarcinomas
- Adenomas
It is important to make the distinction between pancreatic neoplasia and nodular hyperplasia which frequently occurs in older animals.
Signalment
Carcinomas:
- Usually female dogs with a mean age of 10 years
- Airedale terriers may have a breed predisposition
- Affected cats have a mean age of 12 years
Description
Aetiology is idiopathic. Adenomas, although they do not metastasise and are frequently small and focal they can compress the surrounding pancreas. Carcinomas are aggressive with local invasion of the stomach or duodenum and metastasis to the liver, regional lymph nodes (hepatic and splenic), lungs, periotoneal surface and other abdominal organs. Other complications include blockage of the common bile duct and exocrine pancreatic insufficiency. Pancreatitis can also occur where pancreatic atrophy results in tumour necrosis and an inflammatory response.
Diagnosis
Clinical Signs
Non-specific including:
- Lethargy
- Weight loss
- Anorexia
- Vomiting
- Diarrhoea
- Constipation
- Abdominal pain/distension
- Jaundice - if biliary obstruction
- Alopecia - as a paraneoplastic syndrome, ventral, facial and limbs in cats with adenocarcinoma
Physical Examination
In cats, a mass may be palpable in the abdomen
Haematology and Biochemistry
Potential abnormalities include:
- Anaemia
- Neutrophilia
- Elevated hepatic enzymes or bilirubinaemia - if there is cholestasis or biliary obstruction
- Hyperglycaemia - If there is concurrnet beta cell destruction
- Hypokalaemia
Plain Radiography
Abdominal radiography may reveal a mass or mottled appearance on account of local peritonitis. In addition, there may be diplacement of the descending duodenum and pylorus. Where there is peritoneal metastasis and effusion loss of serosal detail and increased radiodensity may be observed. Thoracic radiography is also advised for pulmonary metastases.
Ultrasonography
Provides information on the extent of the tumour and its invasiveness. A guided fine needle aspirate may be taken at this time, however, cytological examination is often unrewarding as pancreatic tumour cells do not exfoliate well.
Exploratory Celiotomy
Excising the whole tumour if operable or taking a sample via shave biopsy or crush ligation allows histopathological confirmation.
Treatment
Surgery
Often at the time of diagnosis adenocarcinomas have already metastasised or local invasion has already taken place. If metastasis has no yet occurred surgical resection may be attempted with care to avoid iatrogenic trauma to the vascular supply to the proximal duodenum and obstruction of the main pancreatic duct. Total pancreatectomy is not advised. Tumours of the body or base of the pancreas are inoperable. Small pancreatic adenomas may be removed via partial pancreatectomy.
Chemotherapy
Not recommended.
Radiotherapy
Not recommended.
Prognosis
Poor for adenocarcinomas on account of their invasiveness and early metastasis. Survival time is less than 1 year for such tumours.