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Intestinal Adenocarcinoma (view source)
Revision as of 10:22, 18 August 2009
, 10:22, 18 August 2009no edit summary
* Contrast radiography can be useful for localising masses, revealing obstructions and filling defects and for intestinal areas more difficult to visualise via ultrasonography due to the accumulation of air.
* Contrast radiography can be useful for localising masses, revealing obstructions and filling defects and for intestinal areas more difficult to visualise via ultrasonography due to the accumulation of air.
===Thoracic Radiography===
This is highly advised though presentation with pulmonary metastasis is infrequent.
===Abdominal Ultrasonography===
Is more sensitive than radiography in localising a mass and can assess involvement with the surrounding structures. In addition guided needle aspiration or biopsy may be taken at this time. Findings may include the following:
* Intestinal wall thickening with loss of wall layering - dogs with loss of layering are over 50 times more likely to have neoplastic disease rather than enteritis
* In cats, adenocarcinomas have been described as being of mixed echogenicity and are often asymmetric
* In dogs, adenocarcinomas have been described as being usually hypoechoic and most dogs had reduced motility
===Endoscopy and Laparoscopy===
Allow visualisation of the lesion. In addition, biopsies may be taken at this time, however, small samples only can be obtained thus there can be significant variation in the interepretation of the results.
===Exploratory Laparotomy===
If it has not been possible to make a definitive diagnosis using the above techniques then surgery is required. All abdominal tissues should be assessed and full thickness biopsies should be taken. Resection of the mass and intestinal anastomosis may be performed at this time.
==Treatment==
==Treatment==
===Surgery===
Resection and anastamosis is advised as primary treatment for intestinal adenocarcinoma. Complete excision can usually achieved, however extraserosal invasion or adhesions may cause difficulties. In the small intestine, stapling and suturing by hand have been shown to be equally efficient. Local excision of colorectal adenocarcinoma has a median survival time of 22 months while the use of stool softeners alone has a median survival time of 15 months. Perioperative complications include peritonitis and sepsis. There is significant perioperative risk associated with cats with small intestine adenocarcinoma with a high mortality rate within the first two weeks following surgery. However, after these two weeks long term control may be achieved. With large intestinal adenocarcinoma survival after surgery alone has been reported as approximately 4.5 months.
===Adjuvant Chemotherapy===
Has been shown to significantly improve survival times for cats with adenocarcinoma.
==Prognosis==
==Prognosis==
If no metastasis has occurred long term survival may be achieved following excision of the tumour. The rate of metastasis of adenocarcinoma to the local lymph nodes for both dogs and cats is approximately 50%. Without surgical intervention the mean survival of dogs with small intestinal adenocarcinoma is 12 days and reports varying from 114 days to 7-10 months with surgical treatment.