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==Description==  

==Description==  

A highly malignant neoplasia that readily metastasizes to the medial iliac lymph nodes. Around 50% may lead to paraneoplastic [[Hypercalcaemia - Small Animal |hypercalcaemia]] due to parathyroid hormone-related peptide(PTH-rP) . The tumours can be between 1 and 10cm in size and 50% of them will metastasize.  

A highly malignant neoplasia that readily metastasizes to the medial iliac lymph nodes. Around 50% may lead to paraneoplastic hypercalcaemia due to parathyroid hormone-related peptide (PTH-rP). The tumours can be between 1 and 10cm in size and 50% of them will metastasize.  

==Signalment==

==Signalment==

Have only been confirmed in dogs although they may occur in cats.  Typically older bitches (greater than 10 years) are affected (90% of cases) however male dogs are occasionally affected. Predisposed [[Canine Breeds - WikiNormals|dog breeds]] include the german shepherd dog, cocker spaniel, welsh spaniel and standard dachshund.

Have only been confirmed in dogs although they may occur in cats.  Typically older bitches (greater than 10 years) are affected (90% of cases) however male dogs are occasionally affected. Predisposed [[Canine Breeds - WikiNormals|dog breeds]] include the German shepherd dog, cocker spaniel, welsh spaniel and standard dachshund.

==Diagnosis==

==Diagnosis==

Also:

Also:

Obstipation due to enlarged internal iliac lymph nodes and Pernieal swelling. Additionally signs of Hypercalcaemia including polydipsia, polyuria, anorexia and weight loss.

'''Obstipation''' due to enlarged internal iliac lymph nodes and Perineal swelling. Additionally signs of '''hypercalcaemia''' including polydipsia, polyuria, anorexia and weight loss.

===Rectal examination===

===Rectal examination===

Tumours of the anal sac can be detected by digital rectal palpation of the anal sac and assosiated structures, this must be performed with care as frequently the tumours are small and unilateral. Best carried out under general anaesthetic with manual compression of the caudal abdomen towards the rectum.

Tumours of the anal sac can be detected by digital rectal palpation of the anal sac and associated structures, this must be performed with care as frequently the tumours are small and unilateral. Best carried out under general anaesthetic with manual compression of the caudal abdomen towards the rectum.

===Laboratory Tests===

===Laboratory Tests===

Serum Biochemistry:

'''Serum Biochemistry''':

Hypercalcaemia is present in 50%-90% of dogs with anal sac adenocarcinoma. This is thought to occur due to the expression of a gene for  parathyroid hormone-related peptide by the tumour. Parathyroid hormone-related peptide has actions similar to parathyroid hormone, it acts to increase calcium levels in the blood. In severe cases of hypercalcaemia organ function can become compromised changing specific parameters on the biochemistry panel.  

Hypercalcaemia is present in 50%-90% of dogs with anal sac adenocarcinoma. This is thought to occur due to the expression of a gene for  parathyroid hormone-related peptide by the tumour. Parathyroid hormone-related peptide has actions similar to parathyroid hormone, it acts to increase calcium levels in the blood. In severe cases of hypercalcaemia organ function can become compromised changing specific parameters on the biochemistry panel.  

Urinalysis:

'''Urinalysis''':

Patients may be dehydrated with a pre-renal azotaemia due but have a relatively low [[Urine Analysis - Pathology |urine specific gravity]].

Patients may be dehydrated with a pre-renal azotaemia due but have a relatively low urine specific gravity.

===Radiography===

===Radiography===

==Thoracic Radiography==

====Thoracic Radiography====

At least two views to check for thoracic metastases.  

At least two views to check for thoracic metastases.  

==Abdominal imaging==

====Abdominal imaging====

Caudal lateral abdominal radiographs or abdominal ultrasound to assess the medial iliac lymph nodes for metastases. When enlarged they  displace the rectum ventrally.  

Caudal lateral abdominal radiographs or abdominal ultrasound to assess the medial iliac lymph nodes for metastases. When enlarged they  displace the rectum ventrally.  

===Biopsy===

===Biopsy===

Ultrasound guided needle biopsy and histopathology of the effected lymph nodes.

Ultrasound guided needle biopsy and histopathology of the effected lymph nodes.

==Treatment==

==Treatment==

===Treatment of Hypercalcaemia===

===Treatment of Hypercalcaemia===

High fluid rates of 0.9% saline to diurese calcium. Furosemide should be administered (2mg/kg intravenously) once the patient in normocalcaemic.

High fluid rates of 0.9% saline to diurese calcium. Furosemide should be administered once the patient in normocalcaemic.

==Prognosis==

==Prognosis==

Potential postoperative complications include infection, wound dehiscence, faecal incontinence and in 25% of cases, local recurrence. Hypercalcaemia reoccurs in 35-50% of cases due to metastases. Serum calcium levels should therefore be reguarly along with evidence of mass regrowth. Post-op survival ranges between 2 and 39 months with the average being 8 months

Potential postoperative complications include infection, wound dehiscence, faecal incontinence and in 25% of cases, local recurrence. Hypercalcaemia reoccurs in 35-50% of cases due to metastases. Serum calcium levels should therefore be regularly checked along with evidence of mass regrowth. Post-op survival ranges between 2 and 39 months with the average being 8 months.

==References==

==References==

Dobson, J.M. and Lascelles, B.D.X. (2003) '''BSAVA Manual of Canine and Feline Oncology (2nd Edition)''' ''BSAVA''

Dobson, J.M. and Lascelles, B.D.X. (2003) '''BSAVA Manual of Canine and Feline Oncology (2nd Edition)''' ''BSAVA''

[[Category:Recto-Anal_-_Pathology]]

[[Category:Recto-Anal_-_Pathology]]

[[Category:Neoplasia]]

[[Category:Neoplasia]]

[[Category:To_Do_-_Review]]

[[Category:Expert_Review]]

[[Category:To_Do_-_Caz]]

[[Category:To_Do_-_Caz]]