RE: small intestinal carcinoma

Gerry Polton — Thu, 14 Jun 2018 13:07:08 GMT

Hi Sarah

I don't think the data exist yet that would answer the question about difference in life expectancy with and without metronomic chemotherapy. Since the LNs were grossly normal, perhaps the best thing would be to start treatment and the re-scan (ultrasound) quarterly, certainly for the first year, while the patient is on therapy.

Yours

Gerry

RE: small intestinal carcinoma

Sarah Keir — Tue, 12 Jun 2018 16:27:27 GMT

Thank you for the information Gerry. The histologist's view is what is confusing me (and the poor formatting!):

"A. Small intestine (4 sections). Invading within the submucosa, muscularis layers and mesentery is a very poorly demarcated and highly infiltrative population of neoplastic cells. The neoplastic cells are not apparent at the surgeon-cut ends of the intestinal segment. Neoplastic cells within these aggregates are arranged in nests and irregular tubular structures, supported by moderate amounts of variably dense fibrovascular to myxomatous matrix. Individual neoplastic cells are polygonal to columnar, contain moderate amounts of eosinophilic cytoplasm and have variably distinct cell borders. Nuclei are moderately large, oval and contain dispersed chromatin with 1-4 variably sized nucleoli. Mitoses are 1-4 per high power field. Throughout the submucosa, muscularis layers and subserosal stroma and mesentery there is mild to moderate oedema and congestion with moderate numbers of neutrophils infiltrating within these layers. The intestinal mucosa is well organised. Occasional aggregates of proteinaceous material and degenerate neutrophils are present on the serosal surface. B. Small intestine (4 sections). No neoplastic cells are apparent within the tissue segment. Similar histological changes to those described within the submucosa, muscularis layers and subserosal stroma above are present within the tissue. C. Small intestine (2 sections). Clusters of neoplastic cells with the same features as those described above are present within the muscularis layers of one of the samples.

Histological Diagnosis: A&C. Carcinoma, transmural, small intestine. A-C. Enteritis and peritonitis, neutrophilic, acute, diffuse, moderate, small. Comment: As suspected, there is a neoplastic process within the small intestine, representing a highly invasive carcinoma. The neoplastic cells are widely invading within the intestinal wall of the larger sample and although no neoplastic cells are present at the surgeon-cut ends of the intestinal segments, this is unlikely to prove curative. The neoplastic cells would have high potential for metastasis from this site, most likely in the first instance to regional mesenteric lymph nodes."

So I think the summary is that margins look clean but that these neoplasia's are highly malignant (don't know what percentage) or as you say badness, that will relapse at some point. As the mesenteric lymph nodes were normal on ex lap I am not sure that ultrasound viewing them would be beneficial now? Perhaps chest xrays/CT?

With the metronomic chemo, what would you say is the mean survival vs without chemo?

Sorry for all the questions but I want to be able to give the owners as much info at this stage. The dog is currently 7 days post op and bright as a button and well so they would not of chosen any differently at this stage.

RE: small intestinal carcinoma

Gerry Polton — Mon, 11 Jun 2018 13:05:11 GMT

Dear Sarah

Is it possible to explain the histologist's view that the surgery is unlikely to be curative? I am inclined to presume that they are simply stating that cancer is bad and this kind is expected to relapse at some point. They might alternatively be suggesting that the margins were clean but so close as to be nearly dirty.

Clinical stage evaluations typically involve abdominal ultrasonography and thoracic radiography. Most of these cases metastasise to the locoregional lymph nodes if they metastasise at all. I would recommend ultrasound-guided FNA of lymph nodes if it can be done.

I have treated a small number with metronomic chemotherapy: 10-12.5mg/sqm cyclophosphamide once daily and standard dose of NSAID, usual potential side effects and attendant rules apply.

Best of luck

Gerry