FelineTumors

LYMPHOMA

1)      CBC, chemistry, urinalysis – bloodwork and urine testing are essential and represent the minimum database for most cancers.  These tests are important for a variety of reasons:

  1.  CBC (with manual differential) à  Some patients with lymphoma will have overt evidence of cancer cells in the bloodstream.  It is also important to know whether or not cell counts are abnormal, as this may indicate bone marrow involvement.  These patients may require a bone marrow aspirate to confirm this, which ultimately helps determine the treatment protocol that will be used.  In addition, prior to administration of any chemotherapeutic agent it is essential to confirm that the patient has enough white/red blood cells and platelets to receive treatment. 
  2. Chemistry panel - Evaluation of internal organ function is essential prior to starting chemotherapy.  Lymphoma commonly infiltrates the liver, and can also affect the kidneys and gastrointestinal tract.  A chemistry panel may reveal specific abnormalities that are consistent with abdominal involvement.  In addition, a variety of chemotherapeutic agents are metabolized and/or excreted by the liver or kidneys, so it is important to know if these organs are abnormal prior to giving certain drugs.
  3. Urinalysis - This is another way to confirm that the kidneys are concentrating urine appropriately.  In patients with renal insufficiency, certain chemotherapeutic agents require dose reductions.  In addition, many lymphoma patients (or cancer patients in general) have a diminished immune system, and as a result, may have evidence of a urinary tract infection.  This information is important to know prior to starting steroids and systemic chemotherapy.

2)      3-view thoracic radiographs – imaging of the chest and lungs can reveal changes consistent with lymphoma, including a mediastinal mass, mediastinal/sternal lymphadenopathy, and a bronchointerstitial pattern indicative of infiltrative diease.  This information is important to know prior to starting treatment, as patients with a mediastinal mass may need repeat thoracic radiographs to monitor remission status (ie response to therapy) and patients with infiltrative disease may need prolonged steroids during treatment.

3)      Full abdominal ultrasound (performed by board certified radiologist or veterinarian with ample ultrasound experience) - Since lymphoma commonly affects the liver, spleen, abdominal lymph nodes, and gastrointestinal tract in cats, imaging of the abdomen is recommended to get an overall baseline of the degree of abdominal involvement.  This affects prognosis in some cases, especially if other organs (such as the kidneys or pancreas) are affected. 

4)      Bone marrow aspirate – In cases with an abnormal CBC, a bone marrow aspirate is recommended to check for bone marrow involvement.  If bone marrow involvement is confirmed, then a different treatment protocol may be recommended.

 

INJECTION SITE (OR OTHER SOFT TISSUE) SARCOMA

1)      CBC, Chemistry, urinalysis – patients with an ISS may not have any bloodwork abnormalities, although these tests are important prior to surgery or radiation therapy to ensure that the patient is otherwise healthy and can tolerate anesthesia.  In addition, these tests are required prior to administration of systemic or metronomic chemotherapy (which is commonly recommended for patients with this tumor type) for the reasons listed above (see lymphoma).

2)      3-view thoracic radiographs – three views are essential for all solid tumors, as a moderate percentage of pulmonary nodules will not be detected on one or two view films.  ISSs have a low to moderate metastatic rate (10-25%), although it is important to know if metastatic disease is present prior to recommending aggressive local therapy (such as definitive radiation).

3)      Abdominal ultrasound – in some cases ISSs are located over the caudal abdomen or hind limbs, and an abdominal ultrasound is recommended to evaluate the patient for internal metastatic disease (regional lymph nodes, internal organs) prior to recommending aggressive local therapy.   

4)      Regional lymph node aspirate – knowing if regional lymph node spread is present is important prior to making treatment recommendations.  If metastatic disease to the regional lymph node is documented, then treatment recommendations will likely be altered.

 

SQUAMOUS  CELL CARCINOMA

1)      CBC, Chemistry, urinalysis – patients with a SCC may not have any bloodwork abnormalities, although these tests are important prior to recommending treatment that may require anesthesia or chemotherapy (see lymphoma above).

2)      3-view thoracic radiographs – three views are essential for all solid tumors, as a moderate percentage of pulmonary nodules will not be detected on one or two view films.  SCCs have a low metastatic rate, although it is important to know if metastatic disease is present prior to recommending aggressive local therapy (such as surgery or definitive radiation therapy).

3)      Regional lymph node aspirate – knowing if regional lymph node spread is present is important prior to making treatment recommendations.  If metastatic disease to the regional lymph node is documented, then treatment recommendations may be altered.

 

MAMMARY GLAND CARCINOMA

1)      CBC, Chemistry, urinalysis – Patients with a mammary carcinoma may not have any bloodwork abnormalities, although these tests are important prior to surgery to ensure that the patient is otherwise healthy and can tolerate anesthesia.  In addition, these tests are required prior to administration of systemic or metronomic chemotherapy (which is commonly recommended for patients with this tumor type) for the reasons listed above (see lymphoma).

2)      3-view thoracic radiographs – three views are essential for all solid tumors, as a moderate percentage of pulmonary nodules will not be detected on one or two view films.  Mammary carcinomas have a moderate to high metastatic rate, and it is important to know if distant metastatic disease is present prior to recommending aggressive local therapy.

3)      Abdominal ultrasound – over 25% of patients will have evidence of lymph node metastasis at diagnosis, and thus, evaluation of abdominal and inguinal nodes with ultrasound is indicated (+/- cytology if abnormal).  It is also important to evaluate the patient for other sites of metastatic disease prior to recommending aggressive local therapy.  

4)      Regional lymph node aspirate – knowing if regional lymph node spread is present is important prior to making treatment recommendations.  If metastatic disease to the regional lymph node is documented, then treatment recommendations will likely be altered.