Feline squamous cell carcinoma: Difference between revisions
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Among the most common malignant cancers of cats, '''feline squamous cell carcinoma''' has a wide range of survival expectations and treatments. The [[neoplasm]] tends not to produce distant metastases, but is highly invasive, and, especially in the mouth cavity, can interfere with quality of life. | Among the most common malignant cancers of cats, '''feline squamous cell carcinoma''' has a wide range of survival expectations and treatments. The [[neoplasm]] tends not to produce distant metastases, but is highly invasive, and, especially in the mouth cavity, can interfere with quality of life. | ||
Early diagnosis is key. A biopsy is likely to be needed, possibly aspirational but preferably incisional | Early diagnosis is key. A biopsy is likely to be needed, possibly aspirational but preferably incisional. | ||
==Treatment== | ==Treatment== | ||
Detected very early, the tumor may be removable by surgery, but, in most cases, it is inoperable yet the surgery allows a definitive [[histopathology|histopathological]] diagnosis. | Detected very early, the tumor may be removable by surgery, but, in most cases, it is inoperable yet the surgery allows a definitive [[histopathology|histopathological]] diagnosis. | ||
===Specific tumor reduction=== | ===Specific tumor reduction=== | ||
Assuming the owner authorizes active treatment, the first steps are radiation or radiation coupled with chemotherapy, followed by additional cycles of chemotherapy and possibly additional radiation. | Assuming the owner authorizes active treatment, the first steps are radiation or radiation coupled with chemotherapy, followed by additional cycles of chemotherapy and possibly additional radiation. | ||
====Antineoplastic agents==== | |||
Bleomycin and carboplatin are the most common adjuvant and palliative [[antineoplastic agent]]s. As with any cancer chemotherapy, the challenge is managing the toxicity. Weekly [[complete blood count]]s are a standard of care. | |||
Bleomycin is given as a weekly subcutaneous injection, for up to 16 weeks. After 16 treatments, there is a high risk of [[pulmonary fibrosis]]. It is less [[myelosuppression|myelosuppressive]] than carboplatin. | |||
Carboplatin is administered intravenously every 3 to 4 weeks. Its use is [[off-label]] and the dose is still being optimized. <ref>{{citation | |||
| journal = J Vet Intern Med | |||
| year = 2008 | volume = 22 | issue = 1 | pages = 83-8 | |||
| title = (Abstract) Phase I clinical evaluation of carboplatin in tumor-bearing cats: a Veterinary Cooperative Oncology Group study. | |||
| author = Kisseberth WC, Vail DM, Yaissle J, Jeglum KA, Couto CG, Ward H, Khanna C, Obradovich JE | |||
| url = http://www.ncbi.nlm.nih.gov/pubmed/18289293}}</ref> In general, a new treatment is not started until the | |||
Combined chemotherapy has been explored in early trials, and, while theoretically promising, is not yet within the standard of care. <ref>{{citation | |||
| journal = J Vet Intern Med | |||
| year = 2009 May-Jun | volume = 23 | issue = 3 | pages = 570-7 | |||
| title = (Abstract) Tolerability of gemcitabine and carboplatin doublet therapy in cats with carcinomas. | |||
| author = Martinez-Ruzafa I, Dominguez PA, Dervisis NG, Sarbu L, Newman RG, Cadile CD, Kitchell BE | |||
| url = http://www.ncbi.nlm.nih.gov/pubmed/19298611}}</ref> | |||
====Role of NSAIDs==== | |||
Some of the tumors express [[cyclooxygenase-2]], so a selective [[NSAID]], such as [[meloxicam]], offers both pain relief and the potential to reduce the inflammation of a tumor. Unfortunately, these agents also can cause life-threatening gastrointestinal bleeding.[[Misoprostol]] has not been useful as a prophylactic drug, as its overall effects on [[prostaglandin]]s cause severe side effects. It is not yet standard practice to administer them with a prophylactic [[proton pump inhibitor]] or [[histamine H2 antagonist]]. | |||
===Experimental treatments=== | |||
There is substantial research in protocols using specialized radiotherapy, (e.g., [[plesiotherapy]]) which have substantially extended life. <ref>{{citation | |||
| title = A retrospective study of <sub>90</sub>Strontium plesiotherapy for feline squamous cell carcinoma of the nasal planum | | title = A retrospective study of <sub>90</sub>Strontium plesiotherapy for feline squamous cell carcinoma of the nasal planum | ||
| author= Mark Goodfellow ''et al.'' | | author= Mark Goodfellow ''et al.'' | ||
| journal = Journal of Feline Medicine & Surgery | | journal = Journal of Feline Medicine & Surgery | ||
| volume=8 | issue=3 | date = June 2006 |pages=169-176 | | volume=8 | issue=3 | date = June 2006 |pages=169-176 | ||
|doi= 10.1016/j.jfms.2005.12.003}}</ref> | |doi= 10.1016/j.jfms.2005.12.003}}</ref> Various studies have used electric stimulation, hyperthermia and hyperbaric oxygen as a supplement to chemotherapy or radiotherapy.<ref>{{citation | ||
Various studies have used electric stimulation, hyperthermia and hyperbaric oxygen as a supplement to chemotherapy or radiotherapy.<ref>{{citation | |||
| journal = The Veterinary Journal | | journal = The Veterinary Journal | ||
| volume=179| issue = 1 | date January 2009| pages = 117-120 | | volume=179| issue = 1 | date January 2009| pages = 117-120 | ||
| Line 26: | Line 43: | ||
The tumor itself may not be painful; the concern, especially in oral cancers, is that it interferes with eating or breathing. | The tumor itself may not be painful; the concern, especially in oral cancers, is that it interferes with eating or breathing. | ||
The cat may suffer pain after manipulation of the tumor for examinations or oral medication, or perhaps by trauma (e.g., while eating). Pain management is a challenge in cats, due to their intolerance of many [[opioid analgesic]]s. [[Gabapentin]] | The cat may suffer pain after manipulation of the tumor for examinations or oral medication, or perhaps by trauma (e.g., while eating). Pain management is a challenge in cats, due to their intolerance of many [[opioid analgesic]]s. [[Gabapentin]] can provide baseline pain relief. [[Buprenorphine]], orally, in the buccal cavity, or subcutaneously is useful for breakthrough pain. | ||
==Complications== | ==Complications== | ||
Especially in | Especially when radiation or carboplatin are in use, the patient's defenses to infection are reduced. The tumor itself can predispose to infection. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:06, 25 June 2010
Among the most common malignant cancers of cats, feline squamous cell carcinoma has a wide range of survival expectations and treatments. The neoplasm tends not to produce distant metastases, but is highly invasive, and, especially in the mouth cavity, can interfere with quality of life.
Early diagnosis is key. A biopsy is likely to be needed, possibly aspirational but preferably incisional.
Treatment
Detected very early, the tumor may be removable by surgery, but, in most cases, it is inoperable yet the surgery allows a definitive histopathological diagnosis.
Specific tumor reduction
Assuming the owner authorizes active treatment, the first steps are radiation or radiation coupled with chemotherapy, followed by additional cycles of chemotherapy and possibly additional radiation.
Antineoplastic agents
Bleomycin and carboplatin are the most common adjuvant and palliative antineoplastic agents. As with any cancer chemotherapy, the challenge is managing the toxicity. Weekly complete blood counts are a standard of care.
Bleomycin is given as a weekly subcutaneous injection, for up to 16 weeks. After 16 treatments, there is a high risk of pulmonary fibrosis. It is less myelosuppressive than carboplatin.
Carboplatin is administered intravenously every 3 to 4 weeks. Its use is off-label and the dose is still being optimized. [1] In general, a new treatment is not started until the Combined chemotherapy has been explored in early trials, and, while theoretically promising, is not yet within the standard of care. [2]
Role of NSAIDs
Some of the tumors express cyclooxygenase-2, so a selective NSAID, such as meloxicam, offers both pain relief and the potential to reduce the inflammation of a tumor. Unfortunately, these agents also can cause life-threatening gastrointestinal bleeding.Misoprostol has not been useful as a prophylactic drug, as its overall effects on prostaglandins cause severe side effects. It is not yet standard practice to administer them with a prophylactic proton pump inhibitor or histamine H2 antagonist.
Experimental treatments
There is substantial research in protocols using specialized radiotherapy, (e.g., plesiotherapy) which have substantially extended life. [3] Various studies have used electric stimulation, hyperthermia and hyperbaric oxygen as a supplement to chemotherapy or radiotherapy.[4] Photosensitization and photodynamic therapy is being explored.
Quality of life
The tumor itself may not be painful; the concern, especially in oral cancers, is that it interferes with eating or breathing.
The cat may suffer pain after manipulation of the tumor for examinations or oral medication, or perhaps by trauma (e.g., while eating). Pain management is a challenge in cats, due to their intolerance of many opioid analgesics. Gabapentin can provide baseline pain relief. Buprenorphine, orally, in the buccal cavity, or subcutaneously is useful for breakthrough pain.
Complications
Especially when radiation or carboplatin are in use, the patient's defenses to infection are reduced. The tumor itself can predispose to infection.
References
- ↑ Kisseberth WC, Vail DM, Yaissle J, Jeglum KA, Couto CG, Ward H, Khanna C, Obradovich JE (2008), "(Abstract) Phase I clinical evaluation of carboplatin in tumor-bearing cats: a Veterinary Cooperative Oncology Group study.", J Vet Intern Med 22 (1): 83-8
- ↑ Martinez-Ruzafa I, Dominguez PA, Dervisis NG, Sarbu L, Newman RG, Cadile CD, Kitchell BE (2009 May-Jun), "(Abstract) Tolerability of gemcitabine and carboplatin doublet therapy in cats with carcinomas.", J Vet Intern Med 23 (3): 570-7
- ↑ Mark Goodfellow et al. (June 2006), "A retrospective study of 90Strontium plesiotherapy for feline squamous cell carcinoma of the nasal planum", Journal of Feline Medicine & Surgery 8 (3): 169-176, DOI:10.1016/j.jfms.2005.12.003
- ↑ Enrico P. Spugnini et al., "(Abstract) Electrochemotherapy for the treatment of squamous cell carcinoma in cats: A preliminary report", The Veterinary Journal 179 (1): 117-120, DOI:10.1016/j.tvjl.2007.08.011