Today's Veterinary Practice

JUL-AUG 2017

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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71 JULY/AUGUST 2017 ■ TVPJOURNAL.COM CLINICAL INSIGHTS Without guidelines to increase both public and professional awareness, superficial masses may be monitored for too long. Allowing a tumor to grow can turn what might have been a simple surgical removal into a much more complicated one. Surgical excision of larger masses may result in less than adequate surgical margins (narrow or incomplete), leading to recurrence and additional costly therapy (more aggressive local surgery, radiation therapy, and/or chemotherapy). Even worse, the tumor may become too big or advanced to be removed or treated at all. I see this all the time. These are often the most frustrating and heartbreaking cases. In veterinary medicine, most skin and subcutaneous tumors can be cured with surgery alone if diagnosed early when they are small. I've learned three things from Smokey and from my time as a cancer specialist: 1. Be proactive with lumps and bumps. 2. Know what a mass is before you remove it. 3. Make the first surgery the only surgery. 1. Be Proactive With Lumps and Bumps See something: If a dog or cat has a mass that is the size of a pea (1 cm) and has been there 1 month, Do something: Aspirate or biopsy, and treat appropriately! Obtaining a definitive diagnosis with cytology or biopsy early and before excision will lead to improved patient outcomes for superficial masses. When smaller, superficial tumors are detected early, surgery is likely curative, especially for benign lesions and tumors that are only locally invasive with a low probability of metastasis. If a tumor is removed with complete surgical margins, the prognosis is often good with no additional treatments needed. Although the See Something, Do Something guidelines specify a 1-cm mass, smaller masses may also be aspirated or biopsied. However, they should not be allowed to grow larger than 1 cm without investigation. Practitioners should measure and document the size of the initial mass for comparison to see growth, and educate clients about the "pea" size requirement to encourage them to have masses evaluated. 2. Know What a Mass Is Before You Remove It Diagnosis of many skin and subcutaneous masses can be achieved with fine needle aspiration (FNA) and cytology. 1 Aspiration and Cytology FNA and cytology provide a diagnosis for many dermal and subcutaneous masses, especially those that that exfoliate well. FNA is useful to distinguish neoplasia from inflammation and benign masses, including lipomas and sebaceous adenomas. Cellular morphology may also allow the determination of benign or malignant phenotype. For malignant tumors, cytology provides information that assists in formulating diagnostic and treatment plans. Advantages of cytology include minimally invasive approach, low risk, low cost, and results that are available more quickly than biopsy results. The disadvantages are that results may be nondiagnostic or equivocal because of a small number of cells in the sample, poor exfoliation of the cells, or poor sample quality. In these cases, histopathologic confirmation may be required for definitive diagnosis. 3 FNA may be accomplished using one of two techniques: aspiration or fenestration. During aspiration, the needle and syringe are attached, and vacuum is maintained. In fenestration, the needle alone is inserted into the mass percutaneously. Fenestration is done without aspiration, often yields more cellular material, and causes less hemorrhage. 3 BOX 1. See Something, Do Something. Why Wait? Aspirate.® I developed the guidelines I recommend in this article with the input of fellow specialists and VCA Animal Hospitals, Inc, as the See Something, Do Something. Why Wait? Aspirate® campaign. I hope they will increase client awareness, promote early cancer detection and diagnosis, and encourage early surgical intervention. We all must do better. We must find tumors earlier when they are small, and we must aspirate them sooner. The See Something, Do Something. Why Wait? Aspirate. program was jointly developed by Dr.Sue Ettinger and VCA Animal Hospitals, Inc. © 2017 See Something, Do Something. Why Wait? Aspirate. All rights reserved.

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