Page 1455 - Cote clinical veterinary advisor dogs and cats 4th

Pancreatic Adenocarcinoma 739

DIAGNOSIS ○ Allows identification of metastatic • A single cat with carcinomatosis of pancreatic
lesions (liver target lesions, peritoneal origin was treated with toceranib phosphate;
Diagnostic Overview
VetBooks.ir Clinical signs are vague and nonspecific. In some but these are not specific for pancreatic • Successful treatment of superficial necrolytic Diseases and Disorders
masses, lymphadenopathy) and ascites,
achieved 792-day survival.
cases, there is a palpable abdominal mass, ascites
adenocarcinoma.
dermatitis in a dog has been reported after
(associated with carcinomatosis), and/or icterus
treatment with octreotide.
(associated with extrahepatic biliary obstruc- ○ Benign lesions such as hepatic nodular • Palliation of pain with analgesics (opioids,
regeneration/hyperplasia, accessory splenic
tion). Confirmation is based on detection of tissue, and others can be identified on tramadol, gabapentin)
a pancreatic mass (usually with ultrasound or ultrasound and should not be misidenti- • Palliation of gastrointestinal signs (maropitant
at exploratory laparotomy) in an older patient fied as metastases. and ondansetron for nausea and emesis; mir-
and cytologic or histopathologic exam of tissue tazapine, capromorelin, or cyproheptadine
specimens from the mass or metastatic sites or Advanced or Confirmatory Testing for appetite stimulation)
cytologic evidence of malignant epithelial cells • Cytologic or histologic diagnosis is essential
from abdominal effusion. due to the inability to grossly differentiate Nutrition/Diet
pancreatic adenocarcinoma, chronic pancre- Nutritional support utilizing an esophagostomy
Differential Diagnosis atitis, and pancreatic nodular hyperplasia. tube (p. 1106) may be considered.
• Pancreatitis: primary pancreatitis or pancre- • Evaluation of ascites (pp. 1056 and 1343)
atitis secondary to the tumor may reveal neoplastic cells. Flow cytometry Possible Complications
• Pancreatic acute fluid collections or can help distinguish between malignant and Postoperative pancreatitis; preoperative and peri-
pseudocyst nonmalignant effusions. operative octreotide (Sandostatin) 5-10 mcg/
• Pancreatic abscess • Ultrasound-guided percutaneous fine-needle kg SQ q 8h may be protective.
• Pancreatic nodular hyperplasia aspirate for cytologic exam (varied yields;
• Other pancreatic tumors (islet cell tumor, neoplastic cells may not exfoliate and dif- PROGNOSIS & OUTCOME
adenoma, sarcoma, and lymphoma) ferentiation between neoplastic lesions and
nodular hyperplasia may be difficult) • Very poor to grave
Initial Database • Ultrasound-guided percutaneous core biopsy, • Survival time of greater than 1 year is rare.
• CBC, serum biochemical profile, and laparoscopic biopsy (p. 1128) or surgical • In one study, cats with pancreatic adenocar-
urinalysis biopsy to obtain tissue for histopathologic cinoma that underwent surgery and/or che-
○ Can be unremarkable evaluation motherapy had a median survival time of 97
○ Variable neutrophilia, anemia, hyperbili- • Pancreatic lipase immunoreactivity (PLI): has days (overall) to 165 days (with chemotherapy
rubinemia, hyperglycemia, and elevations not been evaluated for pancreatic neoplasia; or their masses removed surgically), with a
in hepatic enzymes increased levels would be expected if there range of 1 day to 17 months. Those with
○ Serum lipase activities: marked hyperli- is secondary pancreatitis. abdominal effusions at the time of diagnosis
pasemia may be a noninvasive indicator • Abdominal CT or MRI (surgical planning had a median survival of 30 days.
and biochemical marker for neoplasia of and staging [p. 1132]) • A recent report described survival times of
the pancreas; activity > 25 times normal is > 300 days in several cats that underwent
probably diagnostic for exocrine pancreatic TREATMENT surgical removal of localized exocrine
carcinoma, particularly if the serum pancreatic carcinoma.
amylase activity is minimally increased. Treatment Overview
• Abdominal radiographs: nonspecific; • Surgical excision of the tumor may be pal- PEARLS & CONSIDERATIONS
may reveal cranial abdominal mass effect, liative but is not indicated if metastasis is
compression of the duodenum, and/or loss present (majority of cases). Comments
of abdominal organ detail due to ascites. • Aggressive surgical procedures (complete pan- • Pancreatic adenocarcinoma is an aggressive
• Thoracic radiographs (three views): to evalu- createctomy or pancreaticoduodenectomy) malignancy with high potential for metastasis
ate for pulmonary metastasis and/or pleural have been described, but they carry high and generally no effective treatment, although
effusion operative morbidity and mortality without cases with solitary masses without evidence
• Abdominal ultrasound (high yield) meaningful cure rates. of metastasis are candidates for surgery.
○ In most cases, a soft-tissue mass can be • Must be differentiated from non-neoplastic
identified in the region of the pancreas. Acute General Treatment pancreatic lesions. It is important to have
It may not be possible to conclusively • Supportive therapy if there is secondary a cytologic or histologic diagnosis because
identify the mass as pancreatic in origin pancreatitis (pp. 740 and 742) chronic pancreatitis may closely resemble
on ultrasound exam. Contrast-enhanced • Surgery is indicated for solitary masses pancreatic adenocarcinoma grossly.
ultrasonography has been reported for the without evidence of metastasis, although a • Suspected metastatic lesions in the liver may
diagnosis of pancreatic neoplasia and has high early metastatic rate makes this situation be benign nodules (p. 449).
shown different enhancement patterns for uncommon.
adenocarcinoma and insulinoma. • Palliative surgery if there is intestinal or Technician Tips
○ Benign pancreatic nodular hyperplasia, a biliary obstruction Technicians can help pet owners as they
common incidental finding in cats, must consider difficult decisions related to the very
be considered when pancreatic nodules Chronic Treatment poor to grave prognosis for this disease.
are identified. There is a tendency for • No effective chemotherapy or radiation
neoplastic lesions to manifest as a single, therapy protocols have been described. SUGGESTED READING
larger lesion and for nodular hyperplasia • Gemcitabine (Gemzar) is approved for the Withrow SJ: Cancer of the gastrointestinal tract:
to manifest as multiple smaller lesions, treatment of pancreatic adenocarcinoma in exocrine pancreatic cancer. In Withrow SJ, et al,
although there can be overlap of the human patients, and although cures are rare, editors: Small animal clinical oncology, ed 5, St.
imaging findings for these entities. A gemcitabine has improved survival times for Louis, 2013, Saunders, pp 401-402.
mass > 2 cm in cats is suggestive of these patients; other chemotherapeutic agents AUTHORS: Steve Hill, DVM, MS, DACVIM; Brenda
pancreatic neoplasia rather than nodular used in humans have not been evaluated in Phillips, DVM, DACVIM
hyperplasia. veterinary patients. EDITOR: Keith P. Richter, DVM, MSEL, DACVIM

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