Veterinary Medicine - February 2009 - (Page 81) 4A. A lateral caudal abdominal radiograph of a dog with anal sac adenocarcinoma and metastatic iliac lymphadenopathy. The enlarged iliac lymph nodes can be seen and are causing ventral deviation and partial obstruction of the colon. (The pellet was an incidental finding.) Surgical resection of the iliac lymph nodes was attempted but aborted because of a high risk of hemorrhage. The primary anal sac tumor was resected. Palliative radiation therapy (three weekly doses of 8 Gy) to the iliac lymph nodes resulted in resolution of clinical signs. in a study of 15 dogs that were all treated in the same manner with surgery, radiation, and mitoxantrone chemotherapy.7 None of the tumors in the dogs in this study had spread beyond the iliac lymph nodes, which may have contributed to the lengthy survival time.7 Because of the prognostic signi cance of tumor size at diagnosis and the presence of metastatic disease, the most favorable prognosis can be expected with early detection and aggressive treatment. Although hypercalcemia has been associated with a decreased survival time in some studies, it has not been a consistent nding.4,7,11 The presence of hypercalcemia should not warrant a more conservative approach, given that favorable responses and prolonged survival times with appropriate treatment have been reported.7,11 4B. A lateral caudal abdominal radiograph taken of the same dog as in Figure 4A three months after palliative radiation therapy, showing a partial reduction in the size of the iliac lymph nodes and less compression of the colon as it enters the pelvic canal. (The staples were placed during surgery to aid in radiation planning.) obstruction of the colon or rectum by the primary tumor or enlarged metastatic lymph nodes. In many cases, the tumor is an incidental nding on routine physical examination. Hypercalcemia is present in up to half of cases and may contribute to the presenting clinical signs; it typically resolves with surgical removal of the tumor. Routine staging includes a complete blood count, a serum chemistry pro le, a urinalysis, thoracic radiography, and abdominal ultrasonography. A multimodal treatment approach is recommended, with surgery and radiation therapy providing local control. The ideal chemotherapy protocol for preventing or delaying recurrence or the development of metastatic disease is still unde ned. Early detection and treatment are imperative to achieving the most favorable outcome. REFERENCES 1. Turek MM, Withrow SJ. Tumors of the gastrointestinal tract. H. Perianal tumors. In: Small animal clinical oncology. 4th ed. St. Louis, Mo: Saunders Elsevier, 2007;503-510. 2. Goldschmidt MH, Shofer FS. Anal sac gland tumors. In: Skin tumors of the dog and cat. 1st ed. Oxford, UK: Pergamon Press, 1992;103-108. 3. Ross JT, Scavelli TD, Matthiesen DT, et al. Adenocarcinoma of the apocrine glands of the anal sac in dogs: a review of 32 cases. J Am Anim Hosp Assoc 1991;27:349-355. 4. Bennett PF, DeNicola DB, Bonney P, et al. Canine anal sac adenocarcinomas: clinical presentation and response to therapy. J Vet Intern Med 2002;16(1):100-104. 5. Emms SG. Anal sac tumours of the dog and their response to cytoreductive surgery and chemotherapy. Aust Vet J 2005;83(6):340-343. 6. Polton GA, Brearly MJ. Clinical stage, therapy, and prognosis in canine anal sac gland carcinoma. J Vet Intern Med 2007;21(2):274-280. 7. Turek MM, Forrest LJ, Adams WM, et al. Postoperative radiotherapy and mitoxantrone for anal sac adenocarcinoma in the dog: 15 cases (1991–2001). Vet Comp Oncol 2003;1(2):94-104. 8. Williams LE, Gliatto JM, Dodge RK, et al. Carcinoma of the apocrine glands of the anal sac in dogs: 113 cases (1985-1995). J Am Vet Med Assoc 2003;223(6):825-831. 9. Polton GA, Mowat V, Lee HC, et al. Breed, gender and neutering status of British dogs with anal sac gland carcinoma. Vet Comp Oncol 2006;4(3):125-131. 10. Elliott J, Dobson JM, Dunn JK, et al. Hypercalcaemia in the dog: a study of 40 cases. J Small Anim Pract 1991;32:564-571. 11. Hobson HP, Brown MR, Rogers KS. Surgery of metastatic anal sac adenocarcinoma in ve dogs. Vet Surg 2006;35(3):267-270. 12. Jeffery N, Phillips SM, Brearly MJ. Surgical management of metastasis from anal sac apocrine gland adenocarcinoma of dogs. J Small Anim Pract 2000;41:390. 13. Anderson CR, McNiel EA, Gillette EL, et al. Late complications of pelvic irradiation in 16 dogs. Vet Radiol Ultrasound 2002;43(2):187-192. SUMMARY Anal sac adenocarcinoma is a locally invasive tumor with a high rate of metastasis to the local lymph nodes. Clinical signs may be associated with partial Owner fact sheet: Radiation therapy in dogs Find this client handout by searching “Vetstream” from any page on dvm360.com. VETERINARY MEDICINE February 2009 81 http://www.vetstreamcanis.com/ACI/February09/VMD3/FactSheet112.asp
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