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Bronchiolar and Pulmonary Neoplasia 135

• Cytology: may be nondiagnostic but often
provides diagnostic sample
VetBooks.ir eral lesions (p. 1112): results are improved Diseases and Disorders
○ Transthoracic needle aspiration of periph-
with imaging guidance and larger masses
○ Bronchoalveolar lavage (pp. 1073 and
1074)
• Biopsy
○ If primary lung cancer is suspected, lobec-
tomy can be diagnostic and therapeutic.
○ If primary lung cancer is not suspected
and cytology is nondiagnostic, biopsy
can provide information necessary for
treatment.
TREATMENT
Treatment Overview
Treatment is specific to the type of tumor, and
a definitive diagnosis is critical.
Acute General Treatment BRONCHIOLAR AND PULMONARY NEOPLASIA Lateral radiographs of metastatic osteosarcoma to
Supportive care as indicated: thoracocentesis the lungs.
if pleural effusion or pneumothorax present
and impairing respiration (p. 1164), oxygen
supplementation (p. 1146) as needed
Chronic Treatment
• For solitary lung mass, surgery is the treat-
ment of choice using partial or complete
lung lobectomies, depending on mass size
and location within the lung lobe. Biopsy
of hilar lymph nodes is also recommended
for prognostic information.
• Chemotherapy for treatment of primary lung
cancer is not well studied in dogs or cats.
Vinorelbine reaches higher concentrations
in lung tissue than plasma in people, and 2
of 7 dogs with bulky tumors responded to
treatment in one study. Platinum-based drugs
may also be considered. Chemotherapy after A B
incomplete surgical resection or in dogs or
cats with lymph node metastasis is not well BRONCHIOLAR AND PULMONARY NEOPLASIA A, Primary lung tumor found incidentally on abdominal
studied. radiographs for an unrelated problem. B, CT scan for surgical planning in the same dog.
• Pulmonary metastasis carries guarded to poor
prognosis; consultation with a veterinary
oncologist is recommended.
• Lymphoma treatment is described on pp. ○ Histologic grade: median survival for well • Early intervention is best; once a pulmonary
607 and 609. differentiated, 790 days; moderately mass is found, full staging and evaluation
differentiated, 251 days; poorly differenti- for surgery should be discussed with clients.
Recommended Monitoring ated, 5 days
• Thoracic radiographs every 2-3 months for • Cats treated with surgery for primary lung Technician Tips
the first year postoperatively. cancer • Thoracic radiographs should include all lung
• If treating bulky disease with chemotherapy, ○ Histologic grade: median survival for well fields and the entire diaphragm.
monitoring thoracic radiographs regularly differentiated, 23 months; poorly differ- • Three views (right and left lateral, ventro-
(every 6-8 weeks) is recommended. Monitor- entiated, 2.5 months dorsal) are best for evaluation.
ing CBC for cytopenia is also indicated. • Metastatic lung cancer: guarded to poor • Imaging the thorax alone rather than
Other monitoring depends on chemotherapy prognosis thorax and abdomen will allow for the best
drug used. technique.
PEARLS & CONSIDERATIONS
PROGNOSIS & OUTCOME SUGGESTED READING
Comments Polton GA, et al: Impact of primary tumour stage
• Dogs treated with surgery for primary lung • A diagnosis of pulmonary neoplasia cannot on survival in dogs with solitary lung tumors. J
cancer be made with thoracic imaging alone. Cel- Small Anim Pract 49:66-71, 2008.
○ No clinical signs at diagnosis (median lular confirmation is necessary because some
survival 545 vs. 240 days) disorders that closely mimic cancer carry a AUTHOR: Sandra M. Bechtel, DVM, DACVIM
EDITOR: Megan Grobman, DVM, MS, DACVIM
○ No metastasis to lymph nodes (median good prognosis (e.g., eosinophilic broncho-
survival 15 vs. 1-2 months) pneumopathy, parasitic granuloma).
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