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 F  Heart Rate: 120 bpm  Respiratory rate: 24 bpm  Normal thoracic auscultation  No discomfort on abdominal palpation  Normal rectal palpation

Diagnostics – Laboratory Findings CBC Urinalysis SpG: 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 Urinalysis SpG: 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

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 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, Retrieved from Contrast studies of small animals. (2015). Retrieved from 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, Knapp, D. W. (2013). Canine bladder cancer. Retrieved from Scurell, E. (2012). Transitional cell carcinoma (TCC) in a dog. Retrieved from The Finnish Veterinary Association. (n.d.). Kuvat figures. Retrieved from Thrall, D. E. (2013). Textbook of veterinary diagnostic radiology (6th ed.). : Saunders.