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Small intestine: neoplasia
Introduction
- The intestines are a rare site of neoplasia in the dog; account for 8% of all malignancies.
- Sites: mainly in the jejunum and ileum.
- Cause: most important histological types are adenocarcinoma and lymphoma.
- Signs: variable depending on type of tumor present. From chronic diarrhea and weight loss to signs of obstruction.
- Diagnosis: radiography, ultrasound, or CT scan. Cytology and/or histopathology.
- Treatment: resection of adenocarcinomas and sarcomas. Chemotherapy for lymphoma.
- Prognosis: poor for lymphoma, guarded for adenocarcinoma.
Presenting signs
- Onset of symptoms chronic and insidious.
- Depends on type of tumor.
- The clinical signs are varied and non-specific for neoplastic disease:
- Vomiting.
- Anorexia Anorexia.
- Abdominal pain.
- Weight loss.
- Melena.
- Diarrhea Diarrhea: chronic.
- Dehydration.
- Complete obstruction or perforation leading to peritonitis Peritonitis.
Acute presentation
- Complete obstruction Intestine: obstruction.
- Perforation Peritonitis.
Age predisposition
- Mean age 6-9 years.
- Possibly older for leiomyosarcoma - 12 years Leiomyoma/leiomyosarcoma.
Breed/Species predisposition
- German shepherd dog German shepherd dog may be predisposed to intestinal carcinoma.
Cost considerations
- Investigation and surgical resection of tumors may be relatively costly.
Special risks
- Chemotherapy may reduce lymphoma mass sufficiently to cause intestinal perforation.
Pathogenesis
Etiology
- None known.
Benign
- Leiomyoma.
- Adenomatous polyp.
Malignant
- Adenocarcinoma Adenoma / adenocarcinoma (second most common).
- Carcinoma Adenoma / adenocarcinoma.
- Leiomyosarcoma.
- Gastrointestinal stromal tumor (GIST) Stomach: neoplasia.
- Lymphoma Lymphoma (most common, mostly lymphoblastic).
- Mast cell tumor Skin: mastocytoma.
Pathophysiology
- Variety of presentations.
- Ulceration common with adenocarcinoma, leading to hypoproteinemia Hypoproteinemia.
- Complete obstruction or perforation leading to peritonitis Peritonitis → adenocarcinoma.
- Benign and malignant lesions are equally likely to cause severe complications.
- Rarely, some tumors, eg mast cell tumors may release biologically-active agents such as histamine → cutaneous changes or acute diarrhea.
- Diffuse or infiltrating tumors, eg lymphoma Lymphoma → disturbed motility and malabsorption → weight loss, hypoproteinemia or intermittent diarrhea.
- Metastatic disease to mesenteric lymph nodes, liver, spleen, omentum, lungs.
- Metastatic rate of GIST 7% and up to 50% for adenocarcinoma.
Timecourse
- Chronic or acute.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Dailey D D, Ehrhart E J et al (2015) DOG1 is a sensitive and specific immunohistochemical marker for diagnosis of canine gastroinestinal stromal tumors. J Vet Diagn Invest 27 (3), 268-277 PubMed.
- Willard M D (2012) Alimentary neoplasia in geriatric dogs and cats. Vet Clin Small Anim 42 (4), 693-706 PubMed.
- Gieger T (2011) Alimentary lymphoma in cats and dogs. Vet Clin Small Anim 41 (2), 419-432 PubMed.
- Dominguez P A, Dervisis N G et al (2009) Combined gemcitabine and carboplatin therapy for carcinomas in dogs. JVIM 23 (1), 130-137 PubMed.
- Kaneko N, Yamamoto Y, Wada Y et al (2009) Application of polymerase chain reaction to analysis of antigen receptor rearrangements to support endoscopic diagnosis of canine alimentary lymphoma. J Vet Med Sci 71 (5), 555-559 PubMed.
- Rassnick K M, Moore A S et al (2009) Efficacy of combination chemotherapy for treatment of gastrointestinal lymphoma in dogs. J Vet Intern Med 23 (2), 317-322 PubMed.
- Spugnini E P, Gargiulo M et al (2008) Adjuvant carboplatin for the treatment of intestinal carcinoid in a dog. In Vivo 22 (6), 759-761 PubMed.
- Frank J D, Reimer S B et al (2007) Clinical outcomes of 30 cases (1997-2004) of canine gastrointestinal lymphoma. JAAHA 43 (6), 313-321 PubMed.
- Maas C P, ter Haar G, van der Gaag I, Kirpensteijn J (2007) Reclassification of small intestinal and cecal smooth muscle tumors in 72 dogs: clinical, histologic, and immunohistochemical evaluation. Vet Surg 36 (4), 302-313 PubMed.
- Russell K N, Mehler S J et al (2007) Clinical and immunohistochemical differentiation of gastrointestinal stromal tumors from leiomyosarcomas in dogs: 42 cases (1990-2003). JAVMA 230 (9), 1329-1333 PubMed.
- Sako T, Uchida E, Okamoto M et al (2003) Immunohistochemical evaluation of a malignant intestinal carcinoid in a dog. Vet Pathol 40 (2), 212-215 PubMed.
- Paoloni M C, Penninck D G & Moore A S (2002) Ultrasonographic and clinicopathologic findings in 21 dogs with intestinal adenocarcinoma. Vet Radiology & Ultrasound 43 (6), 562-7 PubMed.
- Takahashi T, Kadosawa T, Nagase M, Matsunaga S, Mochizuki M, Nishimura R, Sasaki N (2000) Visceral mast cell tumors in dogs: 10 cases (1982-1997). JAVMA 216 (2), 222-226 PubMed.
- Crawshaw J, Berg J et al (1998) Prognosis for dogs with nonlymphomatous, small intestinal tumors treated by surgical excision. JAAHA 34 (6), 451-456 PubMed.
Other sources of information
- Vail D M, Withrow S J, Page R L (2013) Cancer of the gastrointestinal tract. In: Small Animal Clinical Oncology. Withrow S J & MacEwen E G (eds). 5th edn. Philadelphia: W B Saunders Co., pp 412-423.
- (1996) The small intestine. In: BSAVA Manual of Canine & Feline Gastroenterology. J W Simpson, E Hall & D Thomas (eds). BSAVA Cheltenham. p 153.
- (1996) Neoplasms of the gastrointestinal tract. In:Strombeck's Small Animal Gastroenterology. 3rd edn, W B Saunders, Philadelphia. p 519.
- Head K W & Else R W (1981) Neoplasia and allied conditions of the canine small intestine. Veterinary Annual 21st Edition. pp 190-207.