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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Mammary tumors are the third most common neoplasia in cats, following lymphoid and skin cancers. The incidence of mammary tumors in cats is reduced by 91 percent in cats spayed prior to six months of age and by 86 percent in cats spayed prior to one year, according to one study. Siamese cats and Japanese breeds seem to have increased risk, and obesity also appears to be a factor in tumor development. Malignant tumors make up 80 to 96 percent of mammary tumors in cats, almost all adenocarcinomas. Male cats may also develop mammary adenocarcinoma, albeit rarely, and the clinical course is similar to female cats. As in dogs, tumor size is an important prognostic factor, although for tumors less than three centimeters the individual size is less predictive. According to one study, cats with tumors less than three cm had an average survival time of 21 months, and cats with tumors greater than three cm had an average survival of 12 months. About 10 percent of cat mammary tumors have estrogen receptors, so spaying at the time of surgery has little effect on recurrence or survival time. Metastasis tends to be to the lungs and lymph nodes, and rarely to bone. Diagnosis and treatment is similar to the dog. There is a better prognosis with bilateral radical surgery (removing the both mammary chains) than with more conservative surgery. Doxorubicin has shown some promise in treatment.
Most mammary tumors in rats are benign fibroadenomas, which are also the most common tumor in the rat. Less than 10 percent are adenocarcinomas. They occur in male and female rats. The tumors can be large and occur anywhere on the trunk. There is a good prognosis with surgery. Spayed rats have a decreased risk of developing mammary tumors.
Although metastasis is widely accepted to be the result of the tumor cells migration, there is a hypothesis saying that some metastases are the result of inflammatory processes by abnormal immune cells. The existence of metastatic cancers in the absence of primary tumors also suggests that metastasis is not always caused by malignant cells that leave primary tumors.
The relative risk of breast cancer based on a median follow-up of 8 years, in a case control study of US registered nurses, is 3.7.
Treatment and survival is determined, to a great extent, by whether or not a cancer remains localized or spreads to other locations in the body. If the cancer metastasizes to other tissues or organs it usually dramatically increases a patient's likelihood of death. Some cancers—such as some forms of leukemia, a cancer of the blood, or malignancies in the brain—can kill without spreading at all.
Once a cancer has metastasized it may still be treated with radiosurgery, chemotherapy, radiation therapy, biological therapy, hormone therapy, surgery, or a combination of these interventions ("multimodal therapy"). The choice of treatment depends on a large number of factors, including the type of primary cancer, the size and location of the metastases, the patient's age and general health, and the types of treatments used previously. In patients diagnosed with CUP it is often still possible to treat the disease even when the primary tumor cannot be located.
Current treatments are rarely able to cure metastatic cancer though some tumors, such as testicular cancer and thyroid cancer, are usually curable.
Palliative care, care aimed at improving the quality of life of people with major illness, has been recommended as part of management programs for metastasis.
There are different opinions on the best treatment of DCIS. Surgical removal, with or without additional radiation therapy or tamoxifen, is the recommended treatment for DCIS by the National Cancer Institute. Surgery may be either a breast-conserving lumpectomy or a mastectomy (complete or partial removal of the affected breast). If a lumpectomy is used it is often combined with radiation therapy. Tamoxifen may be used as hormonal therapy if the cells show estrogen receptor positivity. Chemotherapy is not needed for DCIS since the disease is noninvasive.
While surgery reduces the risk of subsequent cancer, many people never develop cancer even without treatment and there associated side effects. There is no evidence comparing surgery with watchful waiting and some feel watchful waiting may be a reasonable option in certain cases.
Use of radiation therapy after lumpectomy provides equivalent survival rates to mastectomy, although there is a slightly higher risk of recurrent disease in the same breast in the form of further DCIS or invasive breast cancer. Systematic reviews (including a Cochrane review) indicate that the addition of radiation therapy to lumpectomy reduces recurrence of DCIS or later onset of invasive breast cancer in comparison with breast-conserving surgery alone, without affecting mortality. The Cochrane review did not find any evidence that the radiation therapy had any long-term toxic effects. While the authors caution that longer follow-up will be required before a definitive conclusion can be reached regarding long-term toxicity, they point out that ongoing technical improvements should further restrict radiation exposure in healthy tissues. They do recommend that comprehensive information on potential side effects is given to women who receive this treatment. The addition of radiation therapy to lumpectomy appears to reduce the risk of local recurrence to approximately 12%, of which approximately half will be DCIS and half will be invasive breast cancer; the risk of recurrence is 1% for women undergoing mastectomy.
MASC is currently treated as a low-grade (i.e. Grade 1) carcinoma with an overall favorable prognosis. These cases are treated by complete surgical excision. However, the tumor does have the potential to recur locally and/or spread beyond surgically dissectible margins as well as metastasize to regional lymph nodes and distant tissues, particularly in tumors with histological features indicating a high cell growth rate potential. One study found lymph node metastasis in 5 of 34 MASC patients at initial surgery for the disease; these cases, when evidencing no further spread of disease, may be treated with radiation therapy. The treatment of cases with disease spreading beyond regional lymph nodes has been variable, ranging from simple excision to radical resections accompanied by adjuvant radiotherapy and/or chemotherapy, depending on the location of disease. Mean disease-free survival for MASC patients has been reported to be 92 months in one study.
The tyrosine kinase activity of NTRK3 as well as the ETV6-NTRK3 protein is inhibited by certain tyrosine kinase inhibitory drugs such as Entrectinib and LOXO-101; this offers a potential medical intervention method using these drugs to treat aggressive MASC disease. Indeed, one patient with extensive head and neck MASC disease obtained an 89% fall in tumor size when treated with entrectinib. This suppression lasted only 7 months due to the tumor's acquirement of a mutation in the "ETV6-NTRK3" gene. The newly mutated gene encoded an entrectinib-reisistant "ETV6-NTRK3" protein. Treatment of aggressive forms of MASC with NTRK3-inhibiting tyrosine kinase inhibiting drugs, perhaps with switching to another type of tyrosine kinase inhibitor drug if the tumor acquires resistance to the initial drug, is under study.STARTRK-2
The primary method for treatment is surgical, not medical. Radiation and chemotherapy are not needed for benign lesions and are not effective for malignant lesions.
Benign granular cell tumors have a recurrence rate of 2% to 8% when resection margins are deemed clear of tumor infiltration. When the resection margins of a benign granular cell tumor are positive for tumor infiltration the recurrence rate is increased to 20%. Malignant lesions are aggressive and difficult to eradicate with surgery and have a recurrence rate of 32%.
Treatment may include the following:
- Surgery with or without radiation
- Radiotherapy
Fast neutron therapy has been used successfully to treat salivary gland tumors, and has shown to be significantly more effective than photons in studies treating unresectable salivary gland tumors.
- Chemotherapy
Most of these tumors are treated with surgical removal. It is non recurrent.
ADH, if found on a surgical (excisional) biopsy of a mammographic abnormality, does not require any further treatment, only mammographic follow-up.
If ADH is found on a core (needle) biopsy (a procedure which generally does not excise a suspicious mammographic abnormality), a surgical biopsy, i.e. a breast lumpectomy, to completely excise the abnormality and exclude breast cancer is the typical recommendation.
Dr. Sidney Farber, founder of Dana-Farber Cancer Institute, and his colleagues achieved the first remissions in Wilms tumor in the 1950s. By employing the antibiotic actinomycin D in addition to surgery and radiation therapy, they boosted cure rates from 40 to 89 percent.
The Stehlin Foundation currently offers DSRCT patients the opportunity to send samples of their tumors free of charge for testing. Research scientists are growing the samples on nude mice and testing various chemical agents to find which are most effective against the individual's tumor.
Patients with advanced DSRCT may qualify to participate in clinical trials that are researching new drugs to treat the disease.
The prognosis for DSRCT remains poor. Prognosis depends upon the stage of the cancer. Because the disease can be misdiagnosed or remain undetected, tumors frequently grow large within the abdomen and metastasize or seed to other parts of the body.
There is no known organ or area of origin. DSRCT can metastasize through lymph nodes or the blood stream. Sites of metastasis include the spleen, diaphragm, liver, large and small intestine, lungs, central nervous system, bones, uterus, bladder, genitals, abdominal cavity, and the brain.
A multi-modality approach of high-dose chemotherapy, aggressive surgical resection, radiation, and stem cell rescue improves survival for some patients. Reports have indicated that patients will initially respond to first line chemotherapy and treatment but that relapse is common.
Some patients in remission or with inoperable tumor seem to benefit from long term low dose chemotherapy, turning DSRCT into a chronic disease.
Most treatments involve some combination of surgery and chemotherapy. Treatment with cisplatin, etoposide, and bleomycin has been described.
Before modern chemotherapy, this type of neoplasm was highly lethal, but the prognosis has significantly improved since.
When endodermal sinus tumors are treated promptly with surgery and chemotherapy, fatal outcomes are exceedingly rare.
Ovarian tumors, or ovarian neoplasms, are tumors arising from the ovary. They can be benign or malignant (ovarian cancer).
The treatment of choice for both benign and malignant SFT is complete "en bloc" surgical resection.
Prognosis in benign SFTs is excellent. About 8% will recur after first resection, with the recurrence usually cured after additional surgery.
The prognosis in malignant SFTs is much more guarded. Approximately 63% of patients will have a recurrence of their tumor, of which more than half will succumb to disease progression within 2 years. Adjuvant chemotherapy and/or radiotherapy in malignant SFT remains controversial.
Overall, the mainstay of the treatment for salivary gland tumor is surgical resection. Needle biopsy is highly recommended prior to surgery to confirm the diagnosis. More detailed surgical technique and the support for additional adjuvant radiotherapy depends on whether the tumor is malignant or benign.
Surgical treatment of parotid gland tumors is sometimes difficult, partly because of the anatomical relationship of the facial nerve and the parotid lodge, but also through the increased potential for postoperative relapse. Thus, detection of early stages of a tumor of the parotid gland is extremely important in terms of prognosis after surgery.
Generally, benign tumors of the parotid gland are treated with superficial(Patey's operation) or total parotidectomy with the latter being the more commonly practiced due to high incidence of recurrence. The facial nerve should be preserved whenever possible. The benign tumors of the submandibular gland is treated by simple excision with preservation of mandibular branch of the trigeminal nerve, the hypoglossal nerve, and the lingual nerve. Other benign tumors of minor salivary glands are treated similarly.
Malignant salivary tumors usually require wide local resection of the primary tumor. However, if complete resection cannot be achieved, adjuvant radiotherapy should be added to improve local control. This surgical treatment has many sequellae such as cranial nerve damage, Frey's syndrome, cosmetic problems, etc.
Usually about 44% of the patients have a complete histologic removal of the tumor and this refers to the most significant survival rate.
Surgery may be difficult due to the location of these tumors. Surgery alone often leads to recurrence. Chemotherapy is very effective for TVTs. The prognosis for complete remission with chemotherapy is excellent. The most common chemotherapy agents used are vincristine, vinblastine, and doxorubicin. Radiotherapy may be required if chemotherapy does not work.
Laboratory cats have been used in research for a wide range of diseases including stroke and diabetes to AIDS. Less than 1% of research on animal illnesses have been dedicated to cats.
Despite opposition from organizations such as those advocating animal rights, controversial animal testing is still used in cancer research centers. These research practices are continually being conducted on the basis that its benefits to humans outweigh the costs to humans, despite the unfair costs to innocent non-human animals. In some US states, animal testing laboratories get some of their feline test subjects from animal shelters.
According to Kim Sterling, associate teaching professor of oncology at the University of Missouri College of Veterinary Medicine, the use of small animals in predicting human health care procedures is of significant benefit to humans because they are affected in similar, but not exactly the same, ways by the same diseases. This is the same analogy used in reference to cats and their unwilling role in advancing human cancer treatment research.
It is research like this that has led to a potential link between cat parasites and brain cancer in humans. Cats carry the parasite toxoplasma gondii. According to research ecologist Kevin Lafferty, of the University of California, Santa Barbara, this parasite is known to “behave in ways that could stimulate cells towards cancerous states”.
Therefore, research on cats with this parasite can help to better understand the risks of brain cancer for humans in contact with such cats.
Cats have also been used to further studies in the field of Cancer stem cell research. Small animals, like cats, experience faster rates of cancer development. As a result, they are good preclinical models for understanding processes like immortalization and its role in promoting cancerous tumors. The absence of immortalization means a cell can no longer undergo malignant transformation. Since these transformations are the basis for cancerous cell reproduction, this research can prove useful for future cancer treatments and understanding how to stop the spread of cancer in the body.
However, feline cancer research is not limited to what laboratory cats can do for other animals, there is also research being done by humans to see what can be done to improve treatment options for feline cancer. Advances, though slower than that in other animals, are being made in the field of feline cancer. This includes advances in chemotherapy research, immunization protocols and radiation therapy. In addition, there are clinical trials offering trial research treatment options for cats with cancer.
One of such treatments is the cat's claw. Although they share the same name, the cat’s claw (also known as "Uncaria tomentosa" or uña de gato) refers not to the animal cat but to a native plant of the Amazon Rainforest in Peru, South America. Cat's claw is still under research for its immunotherapic, antiproliferative abilities in suppressing cancer proliferation in humans; however, it has been deemed suitable for cat cancer treatment.
Nonetheless, feline cancer research into this, as well as other treatment options, remains an ongoing process.
The prevention of feline cancer mainly depends on the cat's diet and lifestyle, as well as an ability to detect early signs and symptoms of cancer prior to advancement to a further stage. If cancer is detected at an earlier stage, it has a higher chance of being treated, therefore lessening the chances of fatality. Taking domesticated cats for regular checkups to the veterinarian can help spot signs and symptoms of cancer early on and help maintain a healthy lifestyle. Further, due to advancements in research, prevention of certain types of feline illnesses remains possible. A widely known preventative of feline leukemia virus is the vaccine which was created in 1969. Subsequently, an immunofloures-cent antibody (IFA) test for the detection of FeLV in the blood of infected cats was formulated. The IFA test was mainly used to experiment the chances of felines being exposed to cancer. The results showed that 33% of cats who were exposed to FeLV related diseases were at a higher risk for acquiring it, while the cats that were left unexposed were left unaffected. FeLV is either spread through contagion or infection and once infected it is possible for cats to stay that way for the rest of their lives.
Interaction with other Cats
Interaction with other cats with strains or diseases related to FeLV can be a great risk factor for cats attaining FeLV themselves. Therefore, a main factor in prevention is keeping the affected cats in quarantine from the unaffected cats. Stray cats, or indoor/outdoor cats have been shown to be at a greater risk for acquiring FeLV, since they have a greater chance of interacting with other cats. Domesticated cats that are kept indoors are the least vulnerable to susceptible diseases.
Vaccines
Vaccines help the immune system fight off disease causing organisms, which is another key to prevention. However, vaccines can also cause tumors if not given properly. Vaccines should be given in the right rear leg to ease tumor removal process. Vaccines given in the neck or in between the shoulder blades are most likely to cause tumors and are difficult to remove, which can be fatal to cats. Reducing the number of vaccinations given to a cat may also decrease the risk for it developing a tumor.
Spaying and Neutering
Spaying and neutering holds many advantages to cats, including lowering the risk for developing cancer. Neutering male cats makes them less subjected to testicular cancer, FeLV, and FIV. Spaying female cats lowers the risk for mammary cancer, ovarian, or uterine cancer, as it prevents them from going into heat. Female cats should be spayed before their first heat, as each cycle of heat creates a greater risk for mammary cancer. Spaying a female cat requires the removal of the ovaries and uterus, which would eliminate their chances of developing cancer in these areas.
Exposure to Sun
The risk of skin cancer increases when a cat is exposed to direct sunlight for prolonged periods. White cats, or cats with white faces and ears, should not be allowed out on sunny days. Between the hours of 10:00 am to 4:00 pm, it is recommended to keep domesticated cats indoors, as the sun is at its highest peak between these times. Sun block is also available for cats, which can help prevent skin irritation, and a veterinarian should be contacted to find out which brands are appropriate and to use on cats.
Exposure to Secondhand Smoke
Cats living in a smoker’s household are three times more likely to develop lymphoma. Compared to living in a smoke-free environment, cats exposed to secondhand smoke also have a greater chance of developing squamous cell carcinoma or mouth cancer. Cancer is also developed mostly due to the cat's grooming habits. As cats lick themselves while they groom, they increase chances of taking in the toxic, cancer-causing carcinogens that gather on their fur, which are then exposed to their mucus membranes.
Lifestyle
Providing a cat with the healthiest lifestyle possible is the key to prevention. Decreasing the amount of toxins, including household cleaning products, providing fresh and whole foods, clean and purified water, and reducing the amount of indoor pollution can help cats live a longer and healthier life. To lessen susceptibility to diseases, domesticated cats should be kept inside the household for most of their lives to reduce the risk of interacting with other stray cats that could be infected with diseases.
The mainstay of treatment is surgical excision. Two adjuvant therapeutic strategies are Stereotactic surgery (SRS) and fractionated convention radiotherapy (FCRT). Both are highly effective means of treatment.
The majority of patients can be expected to be cured of their disease and become long-term survivors of central neurocytoma. As with any other type of tumor, there is a chance for recurrence. The chance of recurrence is approximately 20%. Some factors that predict tumor recurrence and death due to progressive states of disease are high proliferative indices, early disease recurrence, and disseminated disease with or without the spread of disease through the cerebral spinal fluid. Long-term follow up examinations are essential for the evaluation of the outcomes that each treatment brings about. It is also essential to identify possible recurrence of CN. It is recommended that a cranial MRI is performed between every 6–12 months.
Pleomorphic adenoma is a common benign salivary gland neoplasm characterised by neoplastic proliferation of parenchymatous glandular cells along with myoepithelial components, having a malignant potentiality. It is the most common type of salivary gland tumor and the most common tumor of the parotid gland. It derives its name from the architectural Pleomorphism (variable appearance) seen by light microscopy. It is also known as "Mixed tumor, salivary gland type", which describes its pleomorphic appearance as opposed to its dual origin from epithelial and myoepithelial elements.