Melphalan in a potential anal sac adenocarcinoma

RE: Melphalan in a potential anal sac adenocarcinoma

Anthony Todd — Thu, 15 Mar 2018 22:11:02 GMT

[quote user="robloxley"]As per above, if it's already metastasised then the approach may be somewhat different, hence staging masses particularly those that are expected to behave aggressively.[/quote]

Sorry, I didn't notice it's had the mass for 3 odd years;...... all the more reason to have it out at the start"

RE: Melphalan in a potential anal sac adenocarcinoma

nick shackleton — Thu, 15 Mar 2018 21:14:32 GMT

I’d just like to add that plain film radiography it’s very sensitive for picking up metastatic spread until late on in the disease process. CT is more favourable for stage possible metastatic spread. It seems like cos is an issue in this case. But for other cases CT is probably the morality of choice

RE: Melphalan in a potential anal sac adenocarcinoma

Rob Loxley — Thu, 15 Mar 2018 20:40:37 GMT

[quote user="Anthony Todd"]

When I get a mass somewhere I hope they just whip it out and do all the "work-up and investigation" after that!!

[/quote]

As per above, if it's already metastasised then the approach may be somewhat different, hence staging masses particularly those that are expected to behave aggressively.

RE: Melphalan in a potential anal sac adenocarcinoma

Anthony Todd — Thu, 15 Mar 2018 19:09:54 GMT

[quote user="Clive Ansell"]

Initial work or investigation was declined, then the O' has declined bloods for hypercalcaemia and surgery.

No diagnosis, so +/- preds, +/-pts.

[/quote]

When I get a mass somewhere I hope they just whip it out and do all the "work-up and investigation" after that!!

RE: Melphalan in a potential anal sac adenocarcinoma

Clive Ansell — Thu, 15 Mar 2018 18:17:50 GMT

Initial work or investigation was declined, then the O' has declined bloods for hypercalcaemia and surgery.

No diagnosis, so +/- preds, +/-pts.

RE: Melphalan in a potential anal sac adenocarcinoma

Rob Loxley — Thu, 15 Mar 2018 18:10:52 GMT

[quote user="Anthony Todd"]

[quote user="SER"]Full work up was declined for various reasons.[/quote]

Why wasn't the gland, with it's 3mm mass just removed?

[/quote]

Not sure what the OP means by full workup, but I'd always xray these at time of surgery having seen them metastasise at an early stage, and the approach and outcome for a metastatic anal sac adenocarcinoma is different. Have to say those I've seen with paraneoplastic hypercalcaemia have usually presented due to PUPD associated with calcium level.

RE: Melphalan in a potential anal sac adenocarcinoma

Anthony Todd — Thu, 15 Mar 2018 17:41:08 GMT

[quote user="SER"]Full work up was declined for various reasons.[/quote]

Why wasn't the gland, with it's 3mm mass just removed?

RE: Melphalan in a potential anal sac adenocarcinoma

Lou Dawson — Thu, 15 Mar 2018 16:59:26 GMT

I have never diagnosed a benign anal sac tumour. They are always malignant. Also they have a characteristic appearance on FNA but probably too late now to make any difference to the dog.

RE: Melphalan in a potential anal sac adenocarcinoma

Rob Loxley — Thu, 15 Mar 2018 16:23:59 GMT

[quote user="SER"]I considered offering an FN but I believe it is hard to tell if they are malignant or benign adenomas? [/quote]

IME most anal sac masses are nasty (cf perianal adenomas), and you've documented lymphadenomegaly which is most likely metastatic spread. Yes it could, say, be another type of mass and separate lymphoma in the iliac LNs but that would be less likely.

I guess if they don't want bloods or surgery they don't want to go for palliative radiotherapy? There are some reports of carboplatin shrinking metastatic lymph nodes, but with such chemo the owners need to be up for the appropriate monitoring.

RE: Melphalan in a potential anal sac adenocarcinoma

Braden Collins — Thu, 15 Mar 2018 12:38:20 GMT

I think if the won't do initial blood work I would just try steroids but to be honest I don't think much would work. The chance to do something meaningful was missed by the client.