Gastric carcinoma

From Dog
Gross appearance of a gastric carcinoma from a dog. [1]
Histological appearance of a gastric signet ring carcinoma[2]

Gastric carcinoma and adenocarcinoma are a relatively uncommon neoplasms of the canine stomach characterized by vomiting and weight loss.

Gastric carcinoma is the most common neoplasm in the canine stomach and usually results in death, with 60 - 70% of gastric tumors being of the malignant form[3][4].

Metastases are commonly reported, with local invasion and hematogenous spread, involving regional gastric and intestinal lymph nodes, duodenum, mediastinum[5], heart[6] and skin[7][8].

According to the World Health Organization[9], gastric carcinoma are classified according to growth pattern:

  • Gastric tubular carcinoma
  • Gastric mucinous carcinoma
  • Gastric signet ring cell carcinoma (most common)[3]
  • Gastric undifferentiated carcinoma
  • Gastric papillary carcinoma
  • Gastric choriocarcinoma[10]
  • Gastric anaplastic carcinoma[6]

Tumor suppressor genes (especially p53[11]) play an important role in the progression of different types of neoplasia[12], and certain triggers have been shown to predispose dogs to development of this form of neoplasia, including:

Clinically affected dog are usually middle-aged and older male dogs with a history of chronic vomiting, hemoptysis, anorexia and weight loss[21]. Mucinous carcinomas may manifest as concurrent cutaneous nodules. Clinical symptoms are usually progressive, developing over weeks or months[22].

Blood tests may show serum hypoglobulinemia, a mild regenerative anemia[23] and hypergastrinemia[24].

Barium meal may reveal irregularities of the gastric mucosa, and endoscopy may reveal gastric mucosal thickening and reddening (ulcerations are rare) and stenosis or narrowing at the pyloric antrum.

Ultrasonography may show varying degrees of gastric wall thickening and loss of layering, with a visible sessile masses and regional lymphadenopathy[25].

Diagnosis usually requires histopathological analysis of biopsied material obtained during endoscopy or gastrotomy. Human epidermal growth factor receptor (HER-3) is detected in over 90% of dogs with gastric adenocarcinomas and is a useful diagnostic tool for prognosis assessment[26].

A definitive diagnosis requires immunohistochemistry using cytokeratin[27], galectin-3[28], periodic acid-Schiff and alcian blue[29].

A differential diagnosis would include gastrointestinal stromal tumor and gastric leiomyoma[30] and leiomyosarcoma[31].

Treatment usually involves aggressive surgical gastrectomy with removal of the anterior duodenum (Bilroth type I procedure) with adjuvant chemotherapy in many cases, using doxorubicin or cyclophosphamide.

Enteral dietary therapy is an essential supportive modality to ameliorate cancer cachexia and decrease complications from therapy. Various means of providing enteral nutrition have been described including percutaneous and endoscopically-placed gastrostomy tubes[32].

Unfortunately, most affected dogs die within 6 momths of diagnosis, due to either recurrent or metastatic disease, regardless of therapy[33].

References

  1. Courtesy Dr. Daniel Degner, Vet Surgery Central
  2. Carrasco V et al (2011) Canine gastric carcinoma: immunohistochemical expression of cell cycle proteins (p53, p21, and p16) and heat shock proteins (Hsp27 and Hsp70). Vet Pathol 48(1):322-329
  3. 3.0 3.1 Fonda D et al (1989) Gastric carcinoma in the dog: a clinicopathological study of 11 cases. J Small Anim Pract 30:353–360
  4. Gualtieri M et al (1999) Gastric neoplasia. Vet Clin North Am Small Anim Pract 29:415–440
  5. Wang FI et al (2002) Scirrhous gastric carcinoma with mediastinal invasion in a dog. J Vet Diagn Invest 14(1):65-68
  6. 6.0 6.1 Guglielmini C et al (2007) Metastatic pericardial tumors in a dog with equivocal pericardial cytological findings. J Am Anim Hosp Assoc 43(5):284-287
  7. Dell'Orco M et al (2005) Gastric mucinous adenocarcinoma with cutaneous metastases in a dog: diagnosis by fine-needle aspiration cytology. J Small Anim Pract 46(9):449-453
  8. Nielsen C & Anderson GM (2005) Metastasis of gastric adenocarcinoma to the abdominal wall following placement of a gastrostomy tube in a dog. Can Vet J 46(7):641-643
  9. Head K et al (2003) Histological Classification of Tumors of the Alimentary System of Domestic Animals, Armed Forces Institute of Pathology and The World Health Organization, Washington, DC, 2003
  10. Poutahidis T et al (2008) Primary gastric choriocarcinoma in a dog. J Comp Pathol 139(2-3):146-150
  11. Maehara Y et al (1999) Prognostic value of p53 protein expression for patients with gastric cancer—a multivariate analysis. Br J Cancer 79:1255–1261
  12. Cho J & Kim W (1998) Altered topographic expression of p21WAF1/CIP1/SDI1, bc12 and p53 during gastric carcinogenesis. Pathol Res Pract 194:309–317
  13. Fukushima R et al (2004) A case of canine gastrinoma. J Vet Med Sci 66(8):993-995
  14. Gal A et al (2011) An unusual clinical presentation of a dog with gastrinoma. Can Vet J 52(6):641-644
  15. Hoenerhoff M & Kiupel M (2004) Concurrent gastrinoma and somatostatinoma in a 10-year-old Portuguese water dog. J Comp Pathol 130(4):313-318
  16. Yamaguchi T et al (2000) Gastric epithelial cell proliferation and apoptosis in Helicobacter pylori-infected mice. Aliment Pharmacol Ther 14(1):68-73
  17. De Stefani E et al (2012) Processed meat consumption and risk of cancer: a multisite case-control study in Uruguay. Br J Cancer 107(9):1584-1588
  18. Gestier S et al (2012) Silent pituitary corticotroph carcinoma in a young dog. J Comp Pathol 146(4):327-331
  19. Geninet C et al (2003) Sclerosing peritoneal mesothelioma in a dog - a case report. J Vet Med A Physiol Pathol Clin Med 50(8):402-405
  20. Qvigstad G et al (2008) Gastric neuroendocrine carcinoma associated with atrophic gastritis in the norwegian lundehund. J Comp Pathol 139(4):194-201
  21. Lubbes D et al (2009) Incidence of gastric carcinoma in Dutch Tervueren shepherd dogs born between 1991 and 2002. Tijdschr Diergeneeskd 134(14-15):606-610
  22. Beck C et al (2001) The use of ultrasound in the investigation of gastric carcinoma in a dog. Aust Vet J 79(5):332-334
  23. Lecoindre P et al (2012) Gastric carcinoma associated with Menetrier's-like disease in a West Highland white terrier. J Small Anim Pract 53(12):714-718
  24. de Brito Galvao JF et al (2009) Mucinous gastric carcinoma with abdominal carcinomatosis and hypergastrinemia in a dog. J Am Anim Hosp Assoc 45(4):197-202
  25. Lamb CR & Grierson J (1999) Ultrasonographic appearance of primary gastric neoplasia in 21 dogs. J Small Anim Pract 40(5):211-215
  26. Doster AR et al (2011) CDX-2 and HER-3 expression in canine gastric and colorectal adenocarcinomas. J Comp Pathol 145(1):12-19
  27. Espinosa de los Monteros A et al (1999) Coordinate expression of cytokeratins 7 and 20 in feline and canine carcinomas. Vet Pathol 36(3):179-190
  28. Woo HJ et al (2001) Immunohistochemical detection of galectin-3 in canine gastric carcinomas. J Comp Pathol 124(2-3):216-218
  29. Janke L et al (2010) The novel carbohydrate tumor antigen C2-O-sLe x is upregulated in canine gastric carcinomas. Vet Pathol 47(3):455-461
  30. von Babo V et al (2012) Canine non-hematopoietic gastric neoplasia. Epidemiologic and diagnostic characteristics in 38 dogs with post-surgical outcome of five cases. Tierarztl Prax Ausg K Kleintiere Heimtiere 40(4):243-249
  31. Swann HM & Holt DE (2002) Canine gastric adenocarcinoma and leiomyosarcoma: a retrospective study of 21 cases (1986-1999) and literature review. J Am Anim Hosp Assoc 38(2):157-164
  32. Elliott DA et al (2000) Complications and outcomes associated with use of gastrostomy tubes for nutritional management of dogs with renal failure: 56 cases (1994–1999). J Am Vet Med Assoc 217:1337–1342
  33. Withrow SJ (2001) Esophageal & gastric cancer. In: Withrow SJ, MacEwen EG, eds. Small Animal Clinical Oncology. 3rd ed. Philadelphia: WB Saunders. pp:320–327