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TRANSITIONAL CELL
CARCINOMA
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The following information is simply
informational. It's intent is not to replace the advice of a
veterinarian nor to assist you in making a diagnosis
of your pet. Please consult with your own veterinary physician for
confirmation of any diagnosis. Your pets life may depend on
it.
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OVERVIEW:*
TCC usually involves the neck of the bladder in the area
called the trigone. Both ureters from the kidneys dump their urine
into the bladder in the trigone area. It is easy to understand why a
mass in this location may cause a disturbance of urine flow.
Many
cases of suspected prostate cancer in dogs may actually be
transitional cell carcinoma (TCC) of the urethra that is metastatic
to the prostate.
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CLINICAL
SIGNS:*
Pets often strain while trying to eliminate urine.
They often urinate blood clots or blood stained urine (hematuria).
This activity appears or mimics a urinary tract infection, which can
delay the discovery of this cancer. Antibiotics often create an
apparent improvement. This masks the symptoms and further delays the
diagnosis of this insidious cancer.
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DIAGNOSIS/INITIAL
EVALUATION:*
Persistent hematuria should urge
pursuit of the diagnosis with ultrasound, cystoscopy, fine needle
aspirates for cytology or true cut biopsy of the prostate. The new
tumor antigen test (V-BTA Test, Bion Diagnostic Sciences, Redmond,
Wash.) may help diagnose TCC in its early stages as a screening
test. Unfortunately hematuria causes false positives and since
hematuria is the chief symptom in TCC, the test is limited.
The
urethra and prostate are also common sites for TCC to strike.
Widespread seeding along the mucosal (inside) surface of the bladder
makes surgery ineffective to prolong survival. Late diagnosis is
typical due to owner delay and mimicry with cystitis.
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TREATMENT:*
We
seldom recommend surgery for bladder cancer, as it is unhelpful and
rarely enhances quality of life or longevity. TCC will eventually
spread to the local pelvic lymph nodes and cause death due to
metastatic disease, hydronephrosis, urinary obstruction, anemia and
toxicity.
My
favorite way to treat TCC is with mitoxantrone (Blue Thunder),
piroxicam and pepcid. Data shows over a 50% response rate with
reduction of stranguria and hematuria in TCC for a valuable time
period ranging from 4-12 months. I start the mitoxantrone at a dose
of 5mg/M2 to 5.5mg/M2 i.v. every 21-30 days. If the White Blood Cell
Count was not depressed, then I increase the dose to 6mg/M2 and then
6.5 mg/M2 incrementally or until symptoms regress.
Workers
at Perdue University conducted a TCC study using the N-SAID,
piroxicam (feldene), which is a prostaglandin antagonist of PGE-2,
as a single agent at 0.3mg/kg daily PO in 34 dogs. They reported 2
complete and 4 partial responses at one and two months. Stable
disease was noted in 18 dogs and 10 cases progressed showing no
benefit. The median survival time for the 34 dogs was 181 days,
which compared favorably to the data reported using cisplatin (Trust
me, the diuresis needed for cisplatin can be very difficult to
accomplish in compromised cases! We do not recommend using this drug
any more for TCC).
In
resistant cases, we will use carboplatin at a dose of 300mg/M2 every
21-30 days i.v. in dogs if there is no renal impairment. We use a
lower carboplatin dose of 165 to 200mg/M2 every 21-30 days i.v. in
cats. We like to administer subcutaneous fluids with vitamin C and B
complex at each treatment to assist in diuresis and well being after
treatment for every patient.
We
monitor the kidneys with blood work and ultrasound to detect
hydronephrosis. In selected cases we offer bladder drainage
procedures that may be temporary or
permanent.
In
the face of extreme blood loss due to severe hematuria, we will
infuse a 1% solution of formalin mixed with one vial of the topical
ear solution, synotic, which has DMSO. We will keep this solution in
the bladder for 10-15 minutes and then void and flush out any clots.
This procedure helped our patient, “Darcy” Danko, survive an
additional two precious weeks. Stopping severe hematuria is life
saving and much appreciated by the family.
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CLINICAL TRIALS FOR
TRANSITIONAL CELL CARCINOMA:
We are not aware of any clinical
trials at this time
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CLINICAL TRIAL
RESULTS:**
1.
Vet Clin North Am Small Anim Pract. 2003
May;33(3):597-613
Management of transitional cell
carcinoma
Henry CJ
Department of Veterinary Clinical Sciences,
College of Veterinary Medicine, Division of Hematology and Oncology,
Department of Medicine, School of Medicine, University of
Missouri-Columbia, Columbia, MO 65211, USA. henryc@missouri.edu
Canine TCC of the bladder is
a disease for which early detection and multimodality therapy are
likely to produce the most favorable results. Urine screening tests
are being investigated as tools to permit earlier detection. The
possibility of tumor seeding must be considered when obtaining urine
for analysis and when performing surgery. Because these tumors tend
to be very locally invasive at the time of diagnosis and are likely
to metastasize, cures are unlikely. Currently, combination protocols
using chemotherapy and the nonsteroidal anti-inflammatory agent
piroxicam show the most promise in producing tumor responses.
Surgery and radiation therapy are useful treatment modalities in
select cases. Despite advances in treatment of canine TCC, median
survival times reported for prospective clinical trials have never
exceeded 1 year, regardless of the treatment modality. Development
of accurate tests for early tumor detection could have a significant
impact on the success of treatment of this tumor in canine
patients.
Publication Types:
PMID: 12852238 [PubMed - indexed for
MEDLINE]
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