Bladder neck tumour treatment

Re: Bladder neck tumour treatment

John Flynn — Sun, 15 Feb 2015 21:45:33 GMT

oh dear... I think i got threads confused and tagented - apologies!

Re: Bladder neck tumour treatment

John Flynn — Sun, 15 Feb 2015 21:26:29 GMT

... and I'm in the meloxicam (or insert your favourite COX-inhibitor) camp for TCC based on its favourable safety-profile in dogs/cats. I see the logic in using piroxicam as that's what used in the studies, but I think extrapolating to an NSAID with a better supported safety margin in dogs/cats is a reasonable step unless proven otherwise or there is reasonable grounds for believing this to be inferior/useless. Personally, I've found some of these to go on for couple of years quite happily, one recently I would have attributed to the meloxicam for its success, but the owner had stopped giving it as had found that flax oil did a better job... indeed she wondered if it had been "cured" (aka misdiagnosed) like those on the website selling the flax oil for this indication... an ultrasound scan showed it to have progressed quite a lot in the preceding year, but symptomatically (haematuria had only been notifced because of the snow a year previosulyt)

Re: Bladder neck tumour treatment

John Flynn — Sun, 15 Feb 2015 21:19:16 GMT

[quote user="Andrew Mellor"]asked about using methylprednisolone rather than prednisolone for fewer drinking /peeing side effects in cancer cases and no one could give me an answer whethyer it would work because everyone always uses preds because it has always been that way.[/quote]

I've certainly used methylpred for this reason in the past, though there is no published evidence that it does lead to fewer drinking/peeing side effects (I asked the drug company once and they had nothing), it did seem to in my dog so I'm a believer until proven otherwise. I use it at the 80% of pred dose, though I don't think that this is proven to be biologically-equivalent in the dog. If money was no object (like that ever happens...) I'd personally use it first-line in preference to pred for anything (derm and IM-disease as well as just oncology) given that pee-ing in the house if biggest side effect of pred and may be less with methylpred.

some would argue that pred makes no difference in lymphoma cases getting vincristine/cyclophsphamide/doxorubicin anyway and just adds to the side effects... I personally can see no reason to prefer pred to methylpred other than price for this indication.

I used L-asparaginase once only in a dog with lymphoma masses compressing lumbosacral spinal cord that had presented rather like an acute disc - my understanding was that it could hasten the onset of remission (ie make the lumps smaller faster) but was not thought to increase the likelihood of remission being reached nor the time for which remission would last. The dog did well (from grade 3/5 spine to running around for about a year) - whether due to this, the pred, time or the chemo drugs I obviously can't say.

On generalised eptiheliotropic lymphoma, I'm far from convinced that any of these drugs (CHOP / retinoids / pred+lomustine) make a blind bit of difference and tend to manage them with t-shirts / shampoos / creams / other topicals until suffering, though give preds if pruritic.

Re: Bladder neck tumour treatment

Hannah Wynne Richards — Sun, 15 Feb 2015 13:39:34 GMT

A month ago, I went on an Improve course - the topic was oncology, and the speaker Sara Gould. She liked meloxicam.

Wynne

Re: Bladder neck tumour treatment

Andrew Mellor — Sat, 14 Feb 2015 12:16:32 GMT

[quote user="Bob Russell"]

Is there a reason to use piroxicam rather than meloxicam? So far I have not had a case that has done well with NSAI's alone but I do use meloxicam at the drop of a hat especially where owners will not consider surgery!

[/quote]

I would guess because no work has been done using meloxicam, lots of studies on transitional cell tumours and piroxicam, but similar to another thread where I asked about using methylprednisolone rather than prednisolone for fewer drinking /peeing side effects in cancer cases and no one could give me an answer whethyer it would work because everyone always uses preds because it has always been that way.

Re: Bladder neck tumour treatment

Bob Russell — Sat, 14 Feb 2015 10:36:51 GMT

Re: Bladder neck tumour treatment

Andrew Kent — Sat, 14 Feb 2015 10:31:12 GMT

There are various human versions of piroxicam available in the UK, Feldene is probably the most widely available brand.

Re: Bladder neck tumour treatment

Andrew Mellor — Sat, 14 Feb 2015 08:52:23 GMT

where do you get your piroxicam from? do you import from the States?

Re: Bladder neck tumour treatment

Tim Charlesworth — Fri, 13 Feb 2015 10:16:07 GMT

Surgeons are starting to look again at these as, although dogs who respond well to piroxicam or meloxicam can do very well for years, many dogs (50%) don't show any improvement at all ie don't respond. Surgical debulking/excision is sometimes possible (and has a 100% response rate!) and may give equivalent median survivals to cox-inhibition therapy. There are always fancier options including ureteric transposition/cystectomy etc but not commonly done in the UK. As has been said palliation can be achieved by urethral stenting +/- ureteric stenting if the uretovesicular junction is compromised (or you can move the ureter out of the way).

In short, like any other tumour, the tumour needs to be confirmed and staged. I usually opt for Piroxicam first but if no response then we look at surgical options.

Tim

Re: Bladder neck tumour treatment

Lindsey Edwards — Thu, 12 Feb 2015 21:40:47 GMT

+1 piroxicam for tcc +- metronomic chemo with consideration to relieving obstruction also

Re: Bladder neck tumour treatment

Rob Davis — Thu, 12 Feb 2015 11:13:29 GMT

[quote user="Andrew Kent"]I am sure Gerry will be along with some of the chemo options shortly[/quote]

I know Gerry's away on holiday at the moment, so unless he's sad enough to be looking at vetsurgeon on his sun-lounger, don't expect a reply immediately!

Re: Bladder neck tumour treatment

Anthony Dennison — Thu, 12 Feb 2015 09:53:16 GMT

Depending on the clinical signs, there is also laser ablation to debulk every so often.

Re: Bladder neck tumour treatment

Andrew Kent — Wed, 11 Feb 2015 22:28:39 GMT

Hi Kate,

I am sure Gerry will be along with some of the chemo options shortly but I usually use a combination of piroxicam (or meloxicam) with something cytotoxic. Increasingly I use metronomic chemotherapy as a reasonable middle-ground in cases where aggressive treatment is declined.

Depending on the owners and the dog's clinical signs there are also some interventional treatments which can have some palliative benefits - for example urethral or ureteral stenting depending on location (at the point of obstruction).

Andy

Re: Bladder neck tumour treatment

Niall Taylor — Wed, 11 Feb 2015 22:01:07 GMT

[quote user="Richard Carter"]

we have a bladder transitional cell tumour (confirmed) that we may be questioning the diagnosis as over a year later on previcox is still going fine.

[/quote]

NSAID's seem to be blisteringly effective with some types of tumours, particularly transitional-cell and squamous cell tumours. I resected a tonsillar sq.c.c. with not even vague prospect of clean margins (basically a glorified de-bulking) and it went on for years just on Metacam.

Cheers,

Niall

Re: Bladder neck tumour treatment

Richard Carter — Wed, 11 Feb 2015 18:20:23 GMT

we have a bladder transitional cell tumour (confirmed) that we may be questioning the diagnosis as over a year later on previcox is still going fine.