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| − | ==Introduction==
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| − | Gastric [[Neoplasia - Pathology|neoplasia]] is uncommon and represents less than 1% of neoplasia in small animals. Aetiology is largely idiopathic though long term ingestion of dietary carcinogens may have some responsibility. In humans, ''[[Helicobacter]] pylori'' can induce gastric carcinomas and lymphomas. Its role in gastric tumours in dogs and cats has not yet been fully established though it is known to cause [[Gastritis, Acute|gastritis]] and [[Gastric Ulceration - all species|ulceration]]. Belgian Shepherd dogs may have a genetic predisposition to gastric carcinomas. Cats with gastric lymphomas are usually [[Feline Leukemia Virus|FeLV]] positive.
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| − | '''Malignant''' tumours include:
| + | More common compared with oesophageal neoplasia but still uncommon accounting for less than 1% of all malignancies. Malignant tumours include: |
| − | | + | * [[Stomach and Abomasum Proliferative - Pathology #Adenocarcinoma|Adenocarcinoma]] - 70-80% of cancers of the somach in dogs |
| − | * [[Adenocarcinoma|Adenocarcinoma]] - 70-80% of all canine gastric neoplasms | + | * [[Stomach and Abomasum Proliferative - Pathology #Squamous cell carcinoma|Squamous Cell Carcinoma]] |
| − | * [[Squamous Cell Carcinoma|Squamous Cell Carcinoma]] | + | * [[Stomach and Abomasum Proliferative - Pathology #Lymphoma|Lymphoma]] - the most common gastric neoplasm in the cat |
| − | * [[Lymphoma|Lymphoma]] - the most common feline gastric neoplasm | |
| | * Fribrosarcoma | | * Fribrosarcoma |
| | * Plasmacytoma | | * Plasmacytoma |
| | * Leiomyosarcoma | | * Leiomyosarcoma |
| | * Mast cell | | * Mast cell |
| − | * Gastrointestinal stromal tumours (GIST tumours) - 20% of these tumours occur in the canine stomach | + | Benign tumours include: |
| | + | * Polyps |
| | + | * [[Stomach and Abomasum Proliferative - Pathology #Leiomyoma|Leiomyoma]] |
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| − | '''Benign''' tumours include:
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| − | * Polyps
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| − | * [[Leiomyoma|Leiomyoma]]
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| | ==Signalment== | | ==Signalment== |
| − | Male dogs are more commonly affected than female: e.g male:female ratio in those with carcinoma 2.5:1 | + | * Male dogs are more commonly affected than female: e.g male:female ratio in those with carcinoma 2.5:1 |
| − | The mean age of dogs with carcinomas is 8 years and cats with carcinomas are usually over 10 years. For benign tumours the mean age of affected dogs is 15 years.
| + | * Mean age of dogs with carinoma - 8 years |
| | + | * Cats with carcinoma - usually over 10 years |
| | + | * Mean age of dogs with benign tumour - 15 years |
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| − | ==Diagnosis==
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| − | ===History and Clinical Signs===
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| − | Clinical signs may be mild or non-specific early on in the disease process.
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| − | Often a history of Chronic [[Vomiting|vomiting} - blood tinged/'coffee grounds' appearance (partially digested blood, weight loss, asnorexia and maleana/occult faecal blood.
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| − | Anterior abdominal pain may or may not be present.
| + | ==Description== |
| | + | Aetiology largely idiopathic though long term ingestion of dietary carcinogens may have some responsibility. Long term administration of nitrosamines may cause carcinomas in dogs. In humans, the bacterium ''Helicobacter pylori'' can induce gastric carcinoma and lymphoma. Its role in gastric tumours in dogs and cats has not yet been fully established though it can cause gastritis and ulceration. Belgian Shepher dogs may have a genetic predisposition to gastric carcinoma. Cats with gastric lymphoma are not usually FeLV positive. |
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| − | '''Adenocarcinomas''': frequently [[Neoplasia - Pathology#The Process of Metastasis| metastasise]] to the regional [[Lymph Nodes - Anatomy & Physiology|lymph nodes]] (gastroduodenal and splenic lymph nodes), also the [[Liver - Anatomy & Physiology |liver]] and sometimes the [[Lungs - Anatomy & Physiology|lungs]]. They are also locally aggressive and can cause stomach wall perforation resulting in [[Peritonitis|peritonitis]]. Other complications include pyloric outflow obstruction and ischaemic necrosis where tumour plugs develop in the surrounding vasculature.
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| − | '''Leiomyosarcomas''': rarely metastasise. | + | ==Diagnosis== (based on typical history, clinical signs, physical exam findings, imaging/laboratory results) |
| | + | ===History and Clinical Signs=== |
| | + | * Chronic vomiting - blood tinged/'coffee grounds' appearance |
| | + | * Weight loss |
| | + | * Anorexia |
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| − | '''Lymphoma''': may be limited to the stomach, may affect lymph nodes and other abdominal organs or may be multicentric.
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| − | '''Plasmacytoma''': metastasis is frequently evident in local lymph nodes.
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| − | ===Haematology and biochemistry===
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| − | A Regenerative anaemia may be present due to gastric haemorrhage. [[:Category:Electrolytes|Electrolyte]] disturbances will be evident following vomiting and also elevated [[Urea|BUN]] and [[Creatinine|creatinine]] levels due to [[Dehydration|dehydration]].
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| − | If hepatic metastasis has occurred or if there is [[Biliary Tract Obstruction|obstruction to the common bile duct]] hepatic enzymes will also be increased.
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| − | ====Paraneoplastic Syndromes====
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| − | Hypercalcaemia may be evident if lymphoma is present. Hypoglycaemia can also be associated with leiomyomas and leiomyosarcomas and is potentially reversibe following tumour resection.
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| − | ===Positive Contrast Radiography===
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| − | The following abnormalities may be observed:
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| − | * Apparent mass extending into the gastric lumen
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| − | * Delayed gastric emptying
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| − | * Changes in motility in certain areas of the stomach
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| − | * Thickening of the gastric wall or ulceration
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| − | * Filling defects
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| − | * Loss of rugal folds
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| − | ===Ultrasonography and Biopsy===
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| − | Characteristic features of gastric neoplasia are a thickened gastric wall along with disruption of the wall layers. Enlarged lymph nodes may be observed. The rest of the abdominal organs should be checked for metastases. Ulceration appears as a localised outpouching of the luminal (inner) surface with accompanying gas bubbles which become trapped. Definitive diagnosis requires histopathology of samples. Guided fine-needle or core biopsies may be taken at this time.
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| − | ===Endoscopy and Biopsy===
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| − | This allows direct visualisation of the lesion. Several biopsies can be taken via grab biopsy, however the samples may be unrepresentative.
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| − | ===Surgical Biopsy===
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| − | Alternatively, biopsies can be taken via gastrotomy at the time of surgical treatment (see below). If a GIST is susptected a CD117 immunohistochemical stain can be used for diagnosis (in half of all dogs affected GIST tumours express CD117 (c-kit), a tyrosine kinase receptor).
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| | ==Treatment== | | ==Treatment== |
| − | ===Surgery===
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| − | Prior to any surgical intervention thoracic radiography should be performed for evidence of metastasis. Regional lymph nodes should also be examined at the start of surgery along with the rest of the abdominal cavity. For tumours that have not metastasised, resection is the treatment of choice (wide partial gastrectomy or antrectomy with gastroduodenostomy. However, frequently there are difficulties as tumours are often in an advanced stage at time of presentation.
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| − | Excision with large margins whilst maintaining the ability to successfully reconstruct the stomach without post-operative complications can be problematic. Furthermore, pylorectomy and gastroduodenostomy or gastrojejunostomy for antral tumours risk iatrogenic trauma to the local blood supply as well as to the pancreas and extrahepatic biliary system.
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| − | Neoplasia associated with the lesser curvature is generally non-resectable.
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| − | ===Chemotherapy===
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| − | For lymphoma only. There is an associated risk of gastric perforation.
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| − | ===Radiotherapy===
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| − | Unreported. Surrounding tissues including the liver and intestine show poor tolerance.
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| − | ===Other Medical Management===
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| − | Symptomatic therapy of for example vomiting may improve quality of life in the short term. Treatment options include [[Emetics and Anti-Emetic Drugs|anti-emetics]] such as metocolpramide and H2 blockers including ranitidine and cimetidine.
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| | ==Prognosis== | | ==Prognosis== |
| − | Variable:
| + | Adenocarcinoma frequently metastasises to the regional lympho nodes, also the liver and lungs. |
| − | Benign tumours are frequently cured by surgical resection and hence have a good prognosis.
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| − | Lymphoma often has a poor response to chemotherapy and survival rates are low.
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| − | Most malignant tumours are associated with recurrent or metastatic cancer. Prognosis therefore usually poor despite surgical resection. Survival time up to six months.
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| − | Extramedullary plasmacytomas can have a very good prognosis following surgery and chemotherapy.
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| − | {{Learning
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| − | |Vetstream = [https://en.wikivet.net/Gastric_Neoplasia_-_Dog_and_Cat, Gastric neoplasia]
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| − | |literature search = [http://www.cabdirect.org/search.html?q=title%3A%28%22gastric+neoplasia%22%29 Gastric neoplasia publications]
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| − | }}
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| | ==References== | | ==References== |
| − | Morris J, Dobson J (2001) '''Gastrointestinal Tract, in Small Animal Oncology''', ''Blackwell Science'', pp 127-130
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| − | Liptak J. M, Withrow S.J, (2007), '''Cancer of the Gastrointestinal Tract, in Withrow and MacEwen's Small Animal Clinical Oncology''', fourth edition. ''Saunders Elsevier'', pp 480-482
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| − | {{review}}
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| − | {{OpenPages}}
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| − | [[Category:Stomach_and_Abomasum_-_Proliferative_Pathology]]
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| − | [[Category:Neoplasia]]
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| − | [[Category:Gastric Diseases - Dog]][[Category:Gastric Diseases - Cat]]
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| − | [[Category:Expert_Review - Small Animal]]
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