Page 1356 - Clinical Small Animal Internal Medicine

1294 Section 11 Oncologic Disease

database (complete blood count, biochemistry profile, Therapy
VetBooks.ir urinalysis) and abdominal ultrasound. In cases where an The majority of EPCs are diagnosed at an advanced
aspirate is going to be obtained, a clotting profile is advis-
able as prolongation in partial thromboplastin time (PTT)
and clotting disorders have been described in cats and stage. Fifty to seventy percent of animals have metastatic
disease to regional lymph nodes and distant sites docu-
people with EPC respectively. In cases where surgery is mented at the time of diagnosis. In a study where nec-
being considered, a computed tomography (CT) or mag- ropsy findings were documented in cats with EPC,
netic resonance imaging (MRI) of the abdomen may be metastases to the liver, abdominal lymph nodes, lung,
useful in preoperative planning and identifying meta- heart, diaphragm, tracheobronchial and cranial medias-
static disease. tinal lymph nodes were found. The incidence of metasta-
Laboratory findings are generally nonspecific but can sis seemed to be unrelated to the duration of clinical
include leukocytosis, anemia, hyperglycemia, and eleva- signs. Cats with the longest history of clinical signs were
tions in liver enzymes. Dogs with pancreatic neoplasia equally likely to have metastasis noted at necropsy as
may have significant elevations in serum lipase with only cats with short histories. This suggests that the duration
minimal elevations of serum amylase, implying tumor of clinical signs prior to diagnosis is not a negative prog-
production of lipase. These findings are inconsistent, nostic indicator.
however. In a small case series of eight cats with EPC, Complete pancreatectomy or pancreaticoduodenec-
50% had neutrophilia, 33% had elevations in serum alka- tomy (Whipple procedure) has been described in
line phosphatase activity, and 57% had increased alanine humans and in dogs but carries a high perioperative
aminotransferase. Mild hyperglycemia was identified in morbidity and mortality without significant cure rates.
63% of cats. Chemotherapy and radiation therapy have shown lim-
Physical examination findings can include abdominal ited value in humans and animals and information
pain, icterus, abdominal distension, and/or ascites. In regarding the use of chemotherapy in veterinary medi-
small dogs or cats, palpation of a cranial abdominal mass cine is scarce. In humans, external beam radiation ther-
can occasionally be appreciated. apy (EBRT) alone does not provide optimal tumor
Survey abdominal radiographs may show decreased control and local failure rates are as high as 72%. These
serosal detail or a cranial abdominal mass effect. The dismal results have spawned efforts to improve outcomes
sensitivity for the detection of pancreatic tumors in dogs by the concurrent administration of drugs that act as
has been reported to be 19% for radiographs and 75% for radiation sensitizers, including 5‐fluorouracil, gemcit-
ultrasound. Abdominal radiographs were helpful in iden- abine, and, most recently, paclitaxel.
tifying abdominal disease in cats with EPC. In one study, Palliative therapy to address effusions can be attempted
abdominal radiography was able to identify abdominal with regular, periodic abdominocentesis and intracavi-
disease in all cases of pancreatic adenocarcinoma. tary chemotherapy. Protocols utilizing cisplatin and
Ultrasonography is superior to abdominal radio- carboplatin have been described and appear to provide
graphs for detecting EPC in both dogs and cats. It is a palliation for select patients. When effective, this can
useful diagnostic tool for localization of the tumor, result in temporary relief from discomfort, slow the reac-
confirmation of ascites, and documentation of lym- cumulation of the effusion, and possibly delay progres-
phadenopathy and metastasis. In cats, the ultrasound sion of the disease. Palliative responses, when seen, are
findings seen with nodular hyperplasia of the pancreas generally short‐lived.
are similar to changes seen with malignant pancreatic
neoplasms. There was a trend, however, for malignant
masses to appear as a single, larger lesion exceeding Prognosis
2 cm in at least one dimension. Hyperplastic nodules
typically did not measure more than 1 cm in diameter The prognosis of EPC is generally poor, with few ani-
and were numerous. Differentials for masses of the mals living beyond a year although a small percentage
pancreas are insulinoma, gastrinoma, adenocarcinoma, of dogs and cats have experienced long‐term survival.
adenoma, pancreatic pseudocyst, abscess, pancreatitis, In dogs, a unique variant of EPC described as hyalin-
and lymphoma. izing pancreatic adenocarcinoma appears to be bio-
When effusion is present, cytology and fluid analysis logically less aggressive. The neoplasm is generally a
may reveal a modified transudate and neoplastic cells solitary mass usually involving the right limb of the
indicating carcinomatosis. Solitary masses can be diag- pancreas. Dogs without postoperative complications
nosed with cytology. Cytologic samples obtained with or concurrent life‐threatening diseases survived
ultrasound guidance correctly diagnosed EPC in 92% longer than expected (four months, 16 months, and
of cases. >19 months).