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Transitional Cell Carcinoma

The following information is simply informational. Its intent is not to replace the advice of a veterinarian nor to assist you in making a diagnosis of your pet. Please consult with your own veterinary physician for confirmation of any diagnosis. Your pet’s life may depend on it.

OVERVIEW

TCC usually involves the neck of the bladder in the area called the trigone. Both ureters from the kidneys dump their urine into the bladder in the trigone area. It is easy to understand why a mass in this location may cause a disturbance of urine flow. Many cases of suspected prostate cancer in dogs may actually be transitional cell carcinoma (TCC) of the urethra that is metastatic to the prostate.

CLINICAL SIGNS
Pets often strain while trying to eliminate urine. They often urinate blood clots or blood stained urine (hematuria). This activity appears or mimics a urinary tract infection, which can delay the discovery of this cancer. Antibiotics often create an apparent improvement. This masks the symptoms and further delays the diagnosis of this insidious cancer.

DIAGNOSIS/INITIAL EVALUATION
Persistent hematuria should urge pursuit of the diagnosis with ultrasound, cystoscopy, fine needle aspirates for cytology or true cut biopsy of the prostate. The new tumor antigen test (V-BTA Test, Bion Diagnostic Sciences, Redmond, Wash.) may help diagnose TCC in its early stages as a screening test. Unfortunately hematuria causes false positives and since hematuria is the chief symptom in TCC, the test is limited. The urethra and prostate are also common sites for TCC to strike. Widespread seeding along the mucosal (inside) surface of the bladder makes surgery ineffective to prolong survival. Late diagnosis is typical due to owner delay and mimicry with cystitis.

We seldom recommend surgery for bladder cancer, as it is unhelpful and rarely enhances quality of life or longevity. TCC will eventually spread to the local pelvic lymph nodes and cause death due to metastatic disease, hydronephrosis, urinary obstruction, anemia and toxicity. My favorite way to treat TCC is with mitoxantrone (Blue Thunder), piroxicam and pepcid. Data shows over a 50% response rate with reduction of stranguria and hematuria in TCC for a valuable time period ranging from 4-12 months. I start the mitoxantrone at a dose of 5mg/M2 to 5.5mg/M2 i.v. every 21-30 days.

If the White Blood Cell Count was not depressed, then I increase the dose to 6mg/M2 and then 6.5 mg/M2 incrementally or until symptoms regress. Workers at Perdue University conducted a TCC study using the N-SAID, piroxicam (feldene), which is a prostaglandin antagonist of PGE-2, as a single agent at 0.3mg/kg daily PO in 34 dogs. They reported 2 complete and 4 partial responses at one and two months. Stable disease was noted in 18 dogs and 10 cases progressed showing no benefit. The median survival time for the 34 dogs was 181 days, which compared favorably to the data reported using cisplatin (Trust me, the diuresis needed for cisplatin can be very difficult to accomplish in compromised cases! We do not recommend using this drug any more for TCC cases, we will use carboplatin at a dose of 300mg/M2 every 21-30 days i.v. in dogs if there is no renal impairment.

We use a lower carboplatin dose of 165 to 200mg/M2 every 21-30 days i.v. in cats. We like to administer subcutaneous fluids with vitamin C and B complex at each treatment to assist in diuresis and well being after treatment for every patient. We monitor the kidneys with blood work and ultrasound to detect hydronephrosis. In selected cases we offer bladder drainage procedures that may be temporary or permanent.In the face of extreme blood loss due to severe hematuria, we will infuse a 1% solution of formalin mixed with one vial of the topical ear solution, synotic, which has DMSO. We will keep this solution in the bladder for 10-15 minutes and then void and flush out any clots. This procedure helped our patient, “Darcy” Danko, survive an additional two precious weeks. Stopping severe hematuria is life saving and much appreciated by the family.

CLINICAL TRIALS FOR TRANSITIONAL CELL CARCINOMA

We are not aware of any clinical trials at this time

CLINICAL TRIAL RESULTS
Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Division of Hematology and Oncology, Department of Medicine, School of Medicine, University of Missouri-Columbia, Columbia, MO 65211, USA henryc@missouri.edu

Canine TCC of the bladder is a disease for which early detection and multimodality therapy are likely to produce the most favorable results. Urine screening tests are being investigated as tools to permit earlier detection. The possibility of tumor seeding must be considered when obtaining urine for analysis and when performing surgery. Because these tumors tend to be very locally invasive at the time of diagnosis and are likely to metastasize, cures are unlikely. Currently, combination protocols using chemotherapy and the nonsteroidal anti-inflammatory agent piroxicam show the most promise in producing tumor responses. Surgery and radiation therapy are useful treatment modalities in select cases. Despite advances in treatment of canine TCC, median survival times reported for prospective clinical trials have never exceeded 1 year, regardless of the treatment modality. Development of accurate tests for early tumor detection could have a significant impact on the success of treatment of this tumor in canine patients.

LINKS FOR TRANSITIONAL CELL CARCINOMA

Cyber Biblioteca

Good Dog Magazine

Future Drugs

Perdue University

Rennie’s Page

Vetbta.com

Antech Diagnostics

ACKNOWLEDGMENTS

Many thanks and acknowledgment to Dr. Alice Villalobos, Editor-in-Cheif of the American Association of Human Animal Bond Veterinarians; Animal Oncology Consultation Service Coast Pet Clinic of Hermosa Beach, Inc. for enthusiatically granting us permission to use the above information. To read more about the wonderful work Dr. Villalobos has done in the field click here

PubMed, Published for MEDLINE, National Library of Medicine

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