Transitional Cell Carcinoma in a Dog

Sarra Borne Lord

VETE 3313: Radiology and Clinical Imaging

Harriet – History and Signalment

10 year old

Spayed female

Scottish terrier

History of hematuria, without bacteruria

Repeated treatment with antibiotics to no avail

Generally good health otherwise, good appetite

Current on vaccinations

Physical Exam

Weight: 16 pounds

BCS: 3/5

Rectal temp 101.2 F

Heart Rate: 120 bpm

Respiratory rate: 24 bpm

Normal thoracic auscultation

No discomfort on abdominal palpation

Normal rectal palpation

Diagnostics – Laboratory Findings

CBC

UrinalysisSpG: 1.017, pH: 8.5

Negative for protein, glucose, ketones and bilirubin

Blood: 3+, WBC/hpf: 0-2, RBC/hpf: >100

No casts, bacteria, crystals or mucus on sediment

Biochemistry Panel GLU (glucose) 97 60-125 mg/dL

BUN (blood urea

nitrogen)

16 7-27 mg/dL

CREA (creatinine) 0.9 0.4-1.8 mg/dL

PHOS (phosphorus) 4.3 2.1-6.3 mg/dL

ALKP (alkaline

phosphatase)

191 10-150 U/L

ALT(alanine

aminotransferase)

42 5-107 U/L

K (potassium) 5.1 4.0-5.6 mmol/L

Na (sodium) 147 141-156 mmol/L

Cl (chloride) 109 105-115 mmol/L

CHOL (cholesterol) 217 112-328 mg/dL

RBC (red blood

cells

6.59 5.50-8.50

M/uL

HCT (hematocrit) 42.5 37-55 %

HGB (hemoglobin) 15.3 12-18 g/dL

WBC (white blood

cell)

8.23 5.7-16.3 K/uL

Neutrophils 5.76 3-11K/uL

PLT (platelet) 441 175-500 K/ul

Diagnostic Imaging – Retrograde Cystography

NEGATIVE CONTRAST CYSTOGRAPHY

Bladder was catheterized, the urine drained, and 60 ml carbon dioxide is instilled into the bladder until slightly turgid.

Negative contrast cystography showed a potential mass effect in the trigone area.

Carbon dioxide is removed from bladder in preparation for a positive contrast cystogram.

This procedure generally safe but can cause air embolization. Carbon dioxide or nitrous oxide can be used if available and they negate this risk.

Photo courtesy Veterinary Imaging Associates, 2015

Diagnostic Imaging – Retrograde Cystography

POSITIVE CONTRAST CYSTOGRAPHY

Diluted positive contrast media (Renografin-60 60 ml total diluted 50:50 with sterile water) isinstilled into the bladder.

Mass effect still visible but not clearly defined.

Positive contrast allows visualization of filling defects and can be used to examine the urethra for defects.

Photo courtesy Veterinary Imaging Associates, 2015

Diagnostic Imaging – Retrograde Cystography

DOUBLE CONTRAST CYSTOGRAPHY

Contrast media removed from the bladder and air re-instilled.

These radiographs are a double contrast study

Any remaining positive contrast media that adheres to bladder wall is usually because of a lesion.

This helps to define the margins of a mass effect.Photo courtesy Veterinary Imaging Associates, 2015

Diagnostic Imaging - Ultrasound

BLADDER ULTRASONOGRAPHY

Increases visibility of the margins of the mass.

Useful for scanning remainder of abdominal organs for any additional suspicious areas or metatheses.

Harriet’s liver, spleen, kidneys, and intestines were normal.

Some of her mesenteric lymph nodes were mildly enlarged.

)

Photo courtesy Veterinary Imaging Associates, 2015

Diagnostic Imaging - Cystoscopy

Diagnosis of transitional cell carcinoma requires obtaining a sample of the mass.

An aspirate of the tumor should be avoided due to the potential of tumor seeding at the site of the puncture.

Surgical biopsy can be done but is very invasive.

Cytologic evaluation can be done by rubbing the tip of a urinary catheter against the mass to extract cells.

Cystoscopy is a better option but requires referral. Transitional cell carcinoma with white fimbriation (Finnish,

n.d.)

Photo courtesy the Finnish Veterinary Association, n.d.

Transitional Cell Carcinoma

Cancer of the urinary tract can affect any of the structures (bladder, kidneys, ureters, urethra)

The most common cancer of the dog urinary bladder is transitional cell carcinoma (TCC)

It is a malignant cancer that arises from the transitional epithelial cells that line the bladder.

Scottish terriers have an 18-20% higher risk of TCC than other breeds (Knapp, 2013)

Cytology smear transitional cell carcinoma (Scurrell, 2012)

Therapeutic Recommendations

Surgical excision

Not possible if the cancer is situated in the neck or trigone area

Radiation therapy.

Can lead to harmful complications

Medical management

Piroxicam

Chemotherapy

Mitoxantrone

Vinblastine

Metronomic chemotherapy

Chemotherapy with medical management

References

Caswell, M. (2011, June). Transitional cell carcinoma of the urinary bladder in a 14-year-old dog. The

Canadian Veterinary Journal, 52, 673-675. Retrieved from

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3095172/

Contrast studies of small animals. (2015). Retrieved from http://www.online-vets.com/contrast_4.html

Glickman, L. T., Raghavan, M., Knapp, D. W., Bonney, P. L., & Dawson, M. H. (2004). Herbicide exposure

and the risk of transitional cell carcinoma of the urinary bladder in Scottish Terriers. Journal of the

American Veterinary Medical Association, 224, 1290-1297.

Knapp, D. W. (2013). Canine bladder cancer. Retrieved from

https://www.vet.purdue.edu/pcop/files/docs/CanineUrinaryBladderCancer.pdf

Scurell, E. (2012). Transitional cell carcinoma (TCC) in a dog. Retrieved from

http://www.cytopath.co.uk/caseofmonthMarch2012.html

The Finnish Veterinary Association. (n.d.). Kuvat figures. Retrieved from http://www.sell.fi/index.php?id=513

Thrall, D. E. (2013). Textbook of veterinary diagnostic radiology (6th ed.). : Saunders.