Mammary tumors
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Transcript of Mammary tumors
MAMMARY TUMORS IN DOGS
Originate in the mammary gland
Older female dogs and cats
Being intact increases the occurrence
Associated with teats and extend along the mammary chain
INTRODUCTION
NINE YEAR OLD BITCH WITH MAMMARY TUMOR.
Note deep emaciation in bitch
PREVALENCE
In dog thrice that of breast cancer in women
Second most common tumors in dogs( after skin)
Most common tumor in bitches
Lifetime risk to develop mammary tumors • Intact bitches-25%• Males- 1%
EPIDEMIOLOGYAge of Spaying in bitches Risk of occurrence of
mammary tumours vs. intact female
Before first heat 0.5%
After just one heat cycle 8%
Post second heat cycle 26%
EPIDEMIOLOGY CONTD….
Age of dogs affected 10 to 11y for malignant tumours
Body condition Obesity at 1y
Nutritional factors Eating red meat and high fat homemade diets
Breeds at increased risk:• Poodles• Brittany spaniel• English setter• Pointer• Fox Terrier• Boston Terrier• Cocker Spaniel• Lhasa Apso
TYPES AND BEHAVIOUR OF TUMOURS
• Approximately 50% of mammary tumours in dog – malignant
Types of tumours Examples
Benign AdenomasFibroadenomasBenign mixed tumoursMesenchymal tumours
Malignant SarcomaCarcinosarcomaInflammatory carcinomaCarcinomas
PROGNOSIS
• Uniform grading system absentCriteria of classification Types Prognosis
Blood vessel wall invasion
With invasion Poor
Without invasion Only slightly better
Size Greater than 5cm dia Increased chances of lymphnode metastasis
Type Sarcoma and Carcinosarcomas
better
Inflammatory carcinoma
Poor prognosis and will have metastasised by the time of diagnosis
Deg
ree
of n
ucle
ar
diffe
renti
ation
Well differentiated 20% recurrence
Moderately differentiated
Poorly differentiated 80% recurrence
Sarcomas
Osteosarcoma
Fibrosarcoma
Osteochondrosarcoma
• Metastasis occurs to regional lymph nodes and lungs• Mixed malignant tumours have histological characteristics of
mesenchymal and epithelial malignancy
CLINICAL SIGNS
Palpable mass underneath the skin of the abdomen
A single mass or multiple masses
The majority (greater than 65%) of mammary tumors develop in the fourth and fifth mammary glands
CLINICAL SIGNS
Benign tumors are often small, well-circumscribed, and firm
• rapid growth,• poorly defined borders,• fixation to skin or underlying tissue, and • inflammation or ulceration.
Malignant tumors exhibit more aggressive behavior, such as:
INFLAMMATORY CARCINOMA
• An aggressive type of mammary tumor seen in dogs
• Often painful with swollen mammary glands.
• Swelling is often diffuse and can involve either a single mammary chain (i.e., all glands on either the left or right side) or all mammary glands
• Other signs include inappetence, weight loss, generalized weakness, and swelling of one or both hind legs
DIAGNOSIS
Appearance and location of tumour
Thorough evaluation of all mammary glands, lymph nodes
Auscultation of lungs
Lameness examination
FNA discouraged
DIFFERENTIAL DIAGNOSIS
Mast cell tumors
Soft tissue sarcomas
Epithelial inclusion cysts.
Mastitis
Dermatologic disease (i.e., atopy or other allergies).
CLINICAL STAGING
Thoracic radiographs
Complete blood count
Serum chemistry panel
Urinalysis
TREATMENT
Surgical excision is the treatment of choice
Chest X rays taken prior to surgery
Removal with wide margins
Spaying recommended along with tumour excision
Chemotherapy rarely used
SURGICAL ANATOMY OF MAMMARY GLANDS
Five pairs of mammary glands
• Axillary • Superior inguinal• Inguinal• Sublumbar• Anterior mediastinal
Lymphatic drainage by
Lymphatic communication
Blood supply:
• Perforating sternal branches of internal thoracic artery• Mammary branches of Epigastric arteries to Abdominal and inguinal glands
SURGICAL TREATMENT
Extent of surgery is not associated with improved survival
May have theoretical implications based on lymphatic drainage for invasive tumours
SURGICAL OPTIONS
• Removal of just the tumourSimple Lumpectomy
•Removal of a single gland, when tumour is in the centre of the gland, more than 1cm dia, adherence to over or underlying skin or subcutis
Mammectomy
•Removal of cranial (1st to 3rd) or caudal (3rd to 5th ) region segment of mammary chain, if consecutive glands are involved
Regional Mastectomy
•Removal of entire mammary chain if multiple masses preclude individual gland removal or regional mastectomy
Radical Mastectomy
SIMPLE LUMPECTOMY
Skin incised
Blunt dissection of tumour with rim of
normal tissue
Malignancy revealed
in histopatho
logy
Surgical margins found
unclean
A second more
aggressive surgery
indicated
MAMMECTOMY
Elliptical incision around gland with 2cm margins from the tumour
Skin, subcutis and superficial layer of abdominal wall fascia removed if
involved
MAMMECTOMY INCISION
REGIONAL MAMMECTOMY
Includes removal of the glands and their lymphatic drainage in one unit
Procedure similar to mammectomy
Elliptical incision being carried over the entire region concerned
RADICAL MASTECTOMY
Elliptical incision around the entire chain
of mammary glands to be
removed
Caudal superficial epigastric artery and vein can be easily identified, isolated, ligated
and divided.
Ligature and electrocautery used to control haemorrhage
Tension free closure is
essential to prevent
dehiscence
Not indicated to improve the survival in dogs
PANHYSTERECTOMY
Ovarohysterectomy performed along with tumour excision because:
• To prevent pyometra• Nearly 50% of mammary tumours contain receptors for oestrogens
If concurrent ovarohysterectomy is elected, done prior to tumour excision.
ADJUVANT THERAPY
Advocated if one or more negative prognostic factors present
Despite high frequency of mammary tumours in dogs, no protocol has been standardised
Tamoxifen-use precluded in dogs due to high incidence of oestrogenic side effects
Doxorubicin alone or in combination with Cyclophosphamide also used
Radiation therapy not been reported widely for treating mammary gland malignancy in dogs
THANK YOU
References:
• Textbook of Small Animal Surgery by D. Slatter Edition 3• Merck’s Veterinary Manual, Edition 9• Clinical Textbook for Veterinary Technicians by Mc Currin and
Bassert, Edition 6