Nasal Cavity Tumors


Key Points

Nasal tumors are locally invasive and have a lower tendency to spread early in the course of the disease

Radiation followed by surgery seems to provide the longest survial times

Chemotherapy may be an option if radiation therapy is not an option

 

Introduction

  • Cancer of the nasal cavity accounts for 1% of all cancers in the dog.
  • About 80% of all nasal tumors in dogs are malignant.
  • Nasal cavity cancer tends to be a locally invasive disease. Late in the course of the disease, the cancer can spread to other parts of the body, with the lungs being the most common site. In one study, 0 to 12% of cases were found to have metastatic disease at the time of diagnosis; however, at the time of death, 46% of the dogs had evidence of spread of the cancer to lymph nodes and lungs.
  • The most common type of cancer that affects the nasal cavity in dogs is the carcinoma. This type of cancer includes nasal adenocarcinoma, squamous cell carcinoma and undifferentiated carcinoma and consists of 2/3’s of all types of nasal tumors.

Clinical signs

  • The average age of dogs with nasal cavity cancer is 10 years and males are slightly more affected by this tumor than females. Medium to large breeds more commonly develop nasal cavity cancer than small breeds.
  • Clinical signs of nasal cancer include bleeding from the nose, white, yellow or green nasal discharge, deformity of the face and tearing from one or both eyes.

Diagnosis

  • Although the aforementioned clinical signs can be due to intranasal cancer, other causes may include high blood pressure, fungal infection and allergies. If your pet has depigmentation of the nose and nasal discharge, fungal infection is likely to the be cause versus cancer.
  • The first tests that are run include blood work such as a complete blood count, biochemistry profile, urinalysis and clotting profile.
  • Chest radiographs (x-rays) are made to evaluate that patient for spread of the tumor to the lungs.
  • Radiographs of the nasal cavity are generally of little diagnostic value to the clinician, therefore CT scan is recommended. This diagnostic modality will give the veterinarian a very good idea as to the type of disease process present (cancer vs. fungal infection) and the extent of the disease.
  • Definitive diagnosis of a nasal tumor is based on the evaluation of a biopsy of the tumor and is typically performed at the time of a nasal CT scan. Anesthesia is required for both procedures.

Treatment options

  • No treatment is an option, however survival times following diagnosis of a malignant intranasal cancer is quite short. One study showed a median survival time of 95 days. Dogs that had bloody nasal discharge had a median survival time of 88 days versus those dogs that did not have blood in the nasal discharge had a median survival time of 224 days.
  • Surgery alone results in median survival times that are less than six months, therefore is not recommended as the sole treatment.
  • Surgery followed by orthovoltage radiation therapy resulted in a median survival time of 23 months in one study, however other studies have not been able to reproduce these results. The type of radiation therapy seems to play a role in patient survival. One study which included 42 dogs, showed that surgery and orthovoltage radiation therapy was inferior to megavoltage radiation therapy reported in other studies.
  • Radiation therapy followed by surgical removal of the contents of the nasal cavity has given the longest survival times. In Adam’s study (2005) of 53 dogs, the median survival time was 19.7 months with radiation alone and 47.7 months with 10 doses of 4.2 Gy per dose and subsequent surgery. Currently, this seems to be the best treatment for dogs that have intranasal tumors.
  • Photodynamic therapy (injection of the patient with a special light sensitizer and illumination of the site with a special light) has been reported in 4 cases and resulted in clinical remission of the cancer in the patients that had epithelial tumors, but not the dog that had a sarcoma.
  • Chemotherapy (carboplatin, adriamycin and piroxicam) has been reported in a series of 8 cases, in which 75% responded to treatment. Disease free intervals in the responding patients ranged from 150 to 510 days. This treatment may be a consideration if radiation therapy is not an option.

Complications

  • Recurrence of the tumor in most cases is expected.
  • Chronic nasal discharge and recurrent infection in the nasal cavity is a common problem following radiation and surgery of the nasal cavity, thus intermittent treatment with antibiotics may be needed.
  • Side effects of radiation include:
    • loss of hair over the bridge of the nose
    • chronic nonhealing wounds over the bridge of the nose
    • mucositis (sores in the mouth)
    • brain damage
    • blindness due to cataracts or damage to the eyes
    • oronasal fistulae – a hole that develops in the mouth that communicates with the nasal cavity

Summary of prognostic factors in dogs

  • Dogs afflicted with a nasal cavity tumor tend to have a shorter life span with
    • bloody nasal discharge
    • age greater than 10 years
    • sex: males
    • metastasis of the cancer at the time of diagnosis
    • failure of resolution of clinical signs following radiation therapy
    • please note that just because your dog may have one or more of these factors does not mean that treatment will not extend quality of life

Specifics about cats and nasal cavity tumors

  • Ninety-two percent of all nasal cavity tumors are malignant.
  • Lymphoma is the most common cancer that affects the nasal cavity in cats. In a study of 123 cats afflicted with nasal cavity cancer, the second most common cancer was carcinomas (adenocarcinoma and squamous cell carcinoma). Older cats are generally affected with a median age of 9 months in one study.
  • The most common clinical signs include nasal discharge, sneezing and vomiting. Other signs include loss of appetite, breathing difficulty and decreased activity.
  • On study showed that lymphoma may be localized to the nasal cavity (in about one third of the cases) and radiation therapy may be the treatment of choice. Cats that are infected with Feline Leukemia Virus or Feline Immunodeficiency Virus generally do not do as well and development of lymphpoma in other parts of the body are quite possible. Almost all cases are B-cell lymphoma. Nasal lymphoma tends to be more resistant to chemotherapy than other forms of lymphoma.
  • In a report of 19 cats that had stage 1 intranasal lymphoma, treatment with radiation and chemotherapy resulted in a disease free interval of 31 months and a median survival time of 31.4 months. Based on the fact that 17.6% of the cases had recurrences in distant locations, radiation therapy is not recommended as a sole treatment and chemotherapy should be also used.
  • In a series of 8 cats with nonlymphomatous intranasal tumors treated with course fraction megavoltage radiation (4 to 6 treatments) the median survival time was 382 days.

References

  1. Malinowski C. Canine and feline nasal neoplasia. Clinicial techniques in small animal practice 2006; 21:89-94.
  2. Demko JL, Cohn LA. Chronic nasal discharge in cats: 75 cases (1993- 2004). J Am Vet Med Assoc
    2007;230:1032–1037.
  3. Rassnick KM, Gldkamp CE, Erb HN, et al. Evaluation of factors associated with survival in dogs with untreated nasal carcinomas: 139 cases (1993-2003). J Am Vet Med Assoc 2006;229:401–406.
  4. Mukaratirwa S, van der Linde-Pipman JS, Gruys E. Feline nasal and paranasal sinus tumours clinicopathological study, histomorphologial description and diagnostic immunohistochemistry in 123 cases. J Fel Medicine and Surgery 2001; 3: 235–245.
  5. Mellanby RJ, Herrtage ME, Dobson JM. Long-term outcome of eight cats with nonlymphoproliferative nasal tumours treated by megavoltage radiotherapy. Journal of Feline Medicine and Surgery 2002;4:77–81.
  6. Litle L, Patel R, Gldschmidt M. Nasal and nasopharyngeal lymphoma in cats 50 cases 1989 to 2005. Vet Pathol 2007;44:885–892.
  7. Adams WM, Bjorling DE,McAnulty JF, et al, Outcome of accelerated radiotherapy alone or accelerated radiotherapy followed by exenteration of the nasal cavity. J Am Vet Med Assoc 2005;227:936–941.
  8. Geiger T, Rassnick K, Siegel S, et al. Palliation of clinical signs oin 48 dogs with nasal carcinomas threated with coarse-fraction radiation therapy. J Am Anim Hosp Assoc 2008;44:116-123.
  9. Lucroy MD, Long KR, Blaik MA et al. Photodynamic therapy for the treatment of intranasal tumors in 3 dogs and 1 cat. J Vet Intern Med 2003;17:727–729.
  10. Sfiligoi G, The’on AP, Kent MS. Response of 19 cats with nasal with nasal lymphoma to radiation therapy and chemotherapy. Vet Radiology & Ultrasound, Vol. 48, No. 4, 2007, pp 388–393.
  11. Northrup NC, Etue SM, Ruslander DM et al. Retrospective study of orthovoltage radiation therapy for nasal tumors in 42 dogs. J Vet Intern Med 2001;15:183–189.
  12. Henry CJ, Brewer WG, Tyler JW, et al. Survival in dogs with nasal adeoncarcinoma 64 cases 1981 to 1995. J Vet Intern Med 1998:12:436-439.
  13. Langova V, Mutsaers AJ, Phillips B, Straw R. Treatment of 8 Dogs with Nasal Tumours with Alternating Doses of Doxorubicin and Carboplatin in Conjunction with Oral Piroxicam. Australian Veterinary Journal 2004;82(11):676-680.

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